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Therapeutics > Lecture 6 Exam 5 > Flashcards

Lecture 6 Exam 5 Flashcards

1
Q

What is PCOS

A

leading cause of anovulatory infertility

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2
Q

What percebnt of women have PCIS

A

6-10%

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3
Q

What can be caused by PCOS

A

miscarriage and endometrial cancer

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4
Q

What are the 3 hallmarks for PCOS

A

Hyperandrogenism
menstrual disturbances
overweight or obese

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5
Q

What are symptoms of hyperandrogenism

A

Hirsutism
Acne
Alopecia

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6
Q

Symptoms of menstrual disturbances

A

Amenorrhea
Oligomenorrhea
Anovulation

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7
Q

What are the 3 proposed mechanisms that are thought to cause PCOS

A
  1. Inappropriate gonadotropin secretion
  2. Insulin resistance with hyperinsulinemia
  3. Excessive androgen production
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8
Q

Mechanism of inappropriate GnRH secretion in causing PCOS

A

Increase in GNRH
Causes a surge in LH too soon
No rise in FSH
No dominant follicle
No ovulation
unopposed estrogen
luteal phase never enetered
elevated androgen levels

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9
Q

Compare regular menstrual cycle and PCOS menstrual cycle

A

Normal- Normal GnRH level
LH and FSH levels spike during cycle
One dominant follicle forms

PCOS cycle

An increase in GNRH causes high LH level
FSH levels stay normal/low
no dominant follicle forms

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10
Q

Why does PCOS cause insulin resistance

A

PCOS causes body to think that it does not have enough insulin. This causes the body to be in a state of compensatory hyperinsulinemia where it makes more insulin.

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11
Q

Hyperinsulinemia is a major contributor of ________ in PCOS

A

hyperandrogenism

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12
Q

Where is SHBG produced? What binds to SHBG?

A

LIver
Testosterone binds to SHBG

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13
Q

What happens to SHBG synthesis in the liver in patients with insulin resistance

A

In patients with insulin resistance, Liver stops SHBG synthesis, this causes us to have free testosterone in blood stream, increasing free testosterone.

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14
Q

What are the 3 criteria that diagnose PCOS (two have to be met to diagnose PCOS)

A

hyperandrogenism
PCOS
chronic anovulation

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15
Q

What are some complications that could be caused by PCOS

A

Infertility
CVS thromboembolism
Type 2 diabetes
HTN
Depression and anxiety

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16
Q

What is a non-pharmacologic and 1st line of treatment for PCOS

A

exercise and weightloss

leads to improved pregnancy rates, reduced miscarriages, reduced testosterone and hyperinsulinemia

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17
Q

What is the 1st line of pharmacologic treatment for PCOS hyperandrogenism and menstrual irregularity

A

Combined oral contraceptives

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18
Q

What is the concentration of estrogen that should be given to a PCOS patient

A

If patient is over 39 yo or obese, give lowest effective dose (20 mcg of EE)

If not then give 30

19
Q

What kind of progestins do we use for PCOS patients

A

low androgenic effect progestin

20
Q

What are some low androgenic effect porgestins that can be used for PCOS patients

A

Norgestimate (lower VTE risk), norethindrone

21
Q

What are some progestins to avoid when giving to PCOS patients

A

Avoid- Desogestrel, Cyproterone, drosperinone

22
Q

Name two anti-androgen therapies

A

Spironolactone
5-a-reductase inhibitors

23
Q

How does spironolactone help as an anti androgen therapy
side effects?

A

Blocks androgen effect at hair follicle
hyperkalcemia, teratgenic (fetal abnormality)

24
Q

How does 5-a-reductase help as an antiandrogen therapy?
Most common drug?
Side effects?

A

Prevents testosterone to DHT conversion
FInasteride
teratogenic

25
FIrst line of treatment for patients with PCOS and type 2 diabetes after failed lifestyle modifications
Metformin
26
Can we take metformin if pregnant?
no
27
Can metformin help with menstrual irregularity and endometrium protection
Metformin can help with menstrual irregularity, but endometrial protection is not established until regular menses and ovulation
28
What does metformin do in the ovary
reduces insulin rate and androgen production
29
Dose of metformin? how long to see results
500 mg--->1000 mg takes up to 6 months to see results (GI side effects decrease after 2-3 weeks)
30
Treatment of insulin resistance in PCOS order (1st and 3nd line)
1st- life style modification 2nd- metformin
31
Treatment of menstrual irregularity 1st line of treatment
COC
32
treatment of menstrual irregularity 2nd line of treatment
Cyclic progestin (medroxyprogesterone, micronized progeserone) levonorgestrel IUD Metformin
33
What percent of women regain ovulation on metformin
30-40%
34
What are the treatments of hyperandrogenism in order of preference
1) COC 2) Antiandrogen (spironolactone, finasteride) 3) topical vaniqua (eflorinthine (for facial hair only))) 4) cosmetic procedures
35
Treatment for PCOS if pregnancy is desired?
Aromatase inhibitors like Letrozole (femara)
36
name an aromatase inhibitor drug
Femara (letrozole)
37
Mechanism of femara as an aromatase inhibitor
Non steroidal competitive inhibitor of aromatase enzyme, inhibition stops the conversion of androgen to estrogen)
38
effect of aromatase inhibitors or estrogen levels
Significant reduction
39
How do aromatase inhibitors induce ovulation
lower estrogen levels increase LH and FSH secretion, this induces ovulation
40
side effects of aromatas einhibitors
low estrogen side effects like hot flashes
41
How do aromatase inhibitors work in relation to BC pills
They work opposite to each other BC pills trick pituitary gland into thinking that it is giving estrogen and progesterone, so there is no surge in LH Aromatase inhibitors tell brain there is low estrogen, increasing LH and FSH
42
Letrozole (femara) dosing what if ovulation does not occur? Max number of cycles
2.5-7.5 mg X 5 days If ovulation does not occur increase by 2.5 mg increments upto 5 cycles total
43
Treatment of anovulation in PCOS order of therapy
Letrozole Low dose gonadotropin or Ovarian drilling last is invitro fertilization
44
spironolactone dose
50-100 mg BID

Therapeutics (46 decks)

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