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PHARM 443 : Sex Ed/MSK > Lecture 8 > Flashcards

Lecture 8 Flashcards

PMS and PMDD

1
Q

What are the effects of estrogen on neurotransmitters ?

A

Positive 5HT ( receptors, more affinity)

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2
Q

What are the effects of progesterone on neurotransmitters ?

A

Positive and negative on 5HT
active metabolite (allopregnanolone) agonist binds to GABA

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3
Q

What is PMS ?

A

symptoms at the luteal phase ( 2 weeks ) before periods
Mood, physical and cognitive symptoms

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4
Q

Who can have PMS ?

A

25-35 yo

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5
Q

What is severe PMS ?

A

PMDD

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6
Q

What are the theories behind PMS ?

A

NT and hormones ( 5HT)
estrogen : progesterone
Less GABA
calcium dysregulation

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7
Q

What is the diagnostic criteria for PMS ?

A

Pt has emotional or physical symptoms before mens start for 3 prior menses. gets better in 4 days and severe to interfere with daily activities

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8
Q

S/S of PMS must appear in _____ phase ?

A

luteal phae

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9
Q

What are the emotional and physical symptoms ?

A

emotional : angry, anxiety, confusion, insomnia, poor concentration, more naps

physcial : cramps, bloating, aches, headahce, skin problems , food craving

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10
Q

What food can be limited to help with PMS ?

A

caffeine, sodium, complex carbohydrate ( prevent spike of insulin)

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11
Q

What NHP can help with PMS ?

A

Calcium ( reduce fluid retention)
Magnesium ( reduce bloating)
Vitamin b6
Vitamin E ( mood and breast tenderness)
Chasteberry fruit ( breast tenderness)
Evening primrose oil
St john wort
Gingko

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12
Q

When and how does NSAID help with PMS ?

A

reduce the physical symptoms of PMS
start 1-2 days before mens start

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13
Q

When and how does spironolatone ( diuretics) help with PMS ?

A

reduce bloationg, breast tendernes, fluid retention
take in the luteal phase - before mens

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14
Q

What is Midol ?

A

combination product ( diuretic, APAP/NSAIDs and antihistmamine)
NOT added benefit

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15
Q

What do we know of the efficacy of contraceptives ?

A

CHC –> mixed results –> continuous
Progesterone –> NO benefit

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16
Q

When would you see the benefit of SSRI or SNRI for PMS/PMDD ?

A

takes 3 mens cycles

17
Q

How long should a pt take SNRI or SSRI for PMS/PMDD ?

A

14 days before luteal and stop on day 1-3 of mens

18
Q

What are the options for severe PMS if the first line don’t work ?

A

SSRI/SNRI →intermittent or continuous, start 14 days before and stop 1-3 days of mens, takes3 menstrual cycles to see an improvement

Benzo → if antidepressants don’t work

Ovulation suppression → GnRH agonist , danzol , bilateral oophorectomy

19
Q

if pt just has severe PMS , what can they try ?

A

SSRI ( continuous or intermittent) –> ( try 2) –> ( switch continuous or intermittent) –> try SNRI

20
Q

what are the hormonal pathogenesis of endometriosis ?

A

estrogen stimulates the implants

less progesterone receptors on the endometrial tissues or implants

21
Q

What are the mechanica factors for endometriosis ?

A

endometrial flow backwards in the fallopian tubes to the peritoneal cavity

Cervical stenosis

22
Q

What is the immunological factors of endometriosis ?

A

altered T/B cells, higher levels of inflammation and growth factors int he endometrial tissue

immune system: inflammation, no clearance of the endometrial tissue from the peritoneum

23
Q

What are the other theories behind endometriosis ?

A

stem cells –> implants
embryonic development –> implants are in other parts
coelomic metaplasia –> peritoneal turns into the implants
Lymphatic and vascular metastases –> travel to other parts

24
Q

What are the s/s of endometriosis ?

A

Pain
Dyspareunia ( painful sex)
BTB
GI symptoms
Dysuria and urgency

25
Q

Does the symptoms correlate with the stages ?

A

NO !
it related to the number and places of implants during the diagnosis

26
Q

What is the indication for dienogest ?

A

progestin
manage pelvic pain from endometriosis

27
Q

What are the SE of GnRH?

A

medical menopause
loss of bone density

28
Q

When would we think of adding MHT to a pt taking busoprelin for endometriosis?

A

after 6 months

29
Q

What is elagolix ?

A

direct GnRH antagonist in resulting low LSH/FSH and then estrogen

30
Q

What is the MOA of leuprolide ? in endometriosis

A

decrease FSH, LH and then estrogen

31
Q

When would it not required to add back therapy ( estrogen+ progesterone) elagolix ?

A

GnRH antagonist –> dose <150 mg daily
but need >150 mg

32
Q

What is the thing with monitoring or counselling patients that is taking Danazol ?

A

menopausal symptoms
delays conception + teratogenic
Hirustism
Voice change ( irreversible)
BTB

Monitor for increased LFT

33
Q

What is the irreversible rate of SE for GnRH vs Danazol?

A

Danazol takes time –> androgenic
GnRH –> hypoestrogenic is quick !

34
Q

What is the trial time for endometriosis Tx ?

A

2-3 months

PHARM 443 : Sex Ed/MSK (10 decks)

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