Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CDM 4 Exam 1 > Lecture 9 - PCOS & Adrenal Disorders > Flashcards

Lecture 9 - PCOS & Adrenal Disorders Flashcards

1
Q

PCOS

A

Polycystic Ovary Syndrome

diagnosed by presence of 2 of 3 following criteria…

Hyperandrogenism
ovulatory dysfunction
polycystic ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PCOS Pathophysiology

A

Never get to Corpus Luteum stage and make the primary follicle

Abnormal LH/FSH production in anterior pituitary. Pts with PCOS have 2-3 times normal ratio LH/FSH (Making more LH)

LH prevents primary follicle

Can have infertility

LH causes a lot of excess androgen production

convert cholesterol to testosterone more efficiently = more test

have some insulin resistance, and hyperinsulinemia = more test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Menstral irregularities

A

Oligomenorrhea = < 8 periods per year or menstruation cycle with duration > 35 days

Amenorrhea = no menstration for > 3 months w/o pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PCOS Clinical presentation, any of the 2 to be diagnosed

A

Central irregularities
Hyperandrogenism
Polycystic ovaries
Insulin resistance
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Polycystic ovaries defintion

A

> 20 follicles measuring 2-9mm or an inc in ovarian volume of 10ml in either ovary with no evidence of dominant folicclesa or corpora lutea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PCOS complications

A

Reproductive consequences
Endometrial cancer
Metabolic consequences
CVD risk
Obstructive sleep apnea
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PCOS Risk factors

A

Menarche at early age
Weight
Family history of PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clomiphene MOA:

A

Selective estrogen receptor modulator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clomiphene Clinical benefit

A

Management of infertility

higher risk of multiple births compared to letrozole

rec adding metformin in pts > 28yrs old who have clomiphene resistance and visceral obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clomiphene Dosing

A

50mg PO 5 days, start 5th day of cycle

can titrate up to 100-150mg in subsequent cycles

dont do more than 6 cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clomiphene CI

A

Preg or breastfeeding

preg test before each cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clomiphene ADE

A

Vasomotor symptoms
Flushing
headache
vision changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Letrozole MOA

A

Aromatase inhibitor, reduces estrogen production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Letrozole Clinical Benefit

A

Management of infertility

1st line option

Alternative for clomiphene failures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Letrozole dosing

A

2.5-7.5mg PO QD on cycle days 3-7

can take up to 5 cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Letrozole ADE

A

Edema
hot flashes
Headache
Fatigue
nausea
dizziness
bone pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Letrozole CI

A

Preg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Letrozole DI

A

CYP3A4 and CYP2A6 substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Gonadotropins info

A

second line therapy for those who failed other treatments

MOA: ovulation induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Metformin for infertility

A

2nd line
can add to clomiphene for resistance
can be used as adjunctive therapy during IVF

Dosing: 500mg TID

helps with weight loss, improvement in menstrual cycle, hyperandrogegism symptoms, and insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PCOS treatment Algorithm

A

Obese = start Lifestyle mod 3-6 months then meds
Non obese = meds

if still no preg add metformin

if ovulation returns, try for 6 months

if ovulation not return, see expert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Contraception info PCOS

A

use very low doses of estrogen (NMT 35mcg ethinyl estradiol)

preference for middle to low androgen or anti androgen progestin

can do intermittent or continuous progestin only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PCOS Oligomenorrhea Treatment Algo

A

Obese = lifestyle mod for 3-6 months, then continue previous pathway if they want baby

Non obese = if want baby then do previous pathway, if no baby then contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Preferred Hyperandrogenism treatment

A

Spironolactone

Dose: 50-100mg BID

ADE: Hyperkalemia, HA, fatigue

Pt ed : use contraception to prevent feminization of male fetuses; months to see benefit maybe

DI: ACE/ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Finasteride for Hyperandrogenism

A

Dosing: 5-7.5mg QD
ADE: Hypersensitivity, dec libido
DI: St. Johns Wart
CI: dont use pregnancy
Pt ed: use contraception, can take months

Used for management of hirsutism/alopecia

26
Q

Eflornithine info

A

used for Hyperandrogenism

Applied to face BID

ADE: stinging, burning, rash

Pt ed: stop if preg, effects not permanent, weeks to see benefit, apply 5min after hair removal & dont wash for 4hrs after, can apply lotion/sunscreen once dry

27
Q

PCOS Hirsutism Algo

A

Obese = lifestyle changes = Contraception for 6 months then can add on meds

Non obese = contraception for 6 months, then add on meds

nonpharm: shaving, waxing, etc

28
Q

PCOS monitoring

A

Height, weight, BMI
ADE of pharm therapy
BP
Lipids
Depression/Anxiety
Quality of life
Clinical signs/symptoms of PCOS

29
Q

Which zone releases mineralcorticoids

A

Zona glomerulosa, adrenal cortex

30
Q

Which zone releases glucocorticoids

A

Zona fasciculata, adrenal cortex

31
Q

Which zone releases androgens

A

Zona reticularis, adrenal cortex

32
Q

Which zone releases stress hormones

A

Epi & Norepi

Adrenal medulla

33
Q

Adrenal Gland Excess is called…

A

Cushing syndrome
hyeraldosteronism

34
Q

Adrenal Gland excess is called…

A

Cushing syndrome
Hyperaldosteronism

35
Q

Adrenal Glass insufficiency is called…

A

Addison disease

36
Q

Addison Disease info

A

also known as primary adrenal insufficiency

severe and life threatening

cortex doesnt produce enough glucocorticoids, mineralocorticoids, dehydroepiandrosterone

37
Q

Primary vs secondary Adrenal insufficiency

A

Primary #1 cause = autoimmune, happens at adrenal gland

Secondary #1 cause = long-term glucocorticoid therapy, happens outside adrenal gland

38
Q

PAI clinical presentation

A

Hyperkalemia
Hyperpigmentation
Vitiligo

39
Q

SAI clinical presentation

A

Pale Skin
Small balls
secondary hypothyroidism
Headache, Visual symptoms
Amenorrhea, dec libido

40
Q

PAI and SAI clinical presentations that overlap

A

Tiredness, weakness
Dizziness, orthostatic hypotension
Hyponatremia, hypolycemia

41
Q

Pharm therapy PAI

A

Corticosteroids
Mineralocorticoids
potentially DHEA

42
Q

Pharm therapy SAI

A

Corticosteroids

43
Q

preferred therapy for adrenal deficiency

A

Hydrocortisone

44
Q

Glucocorticoid dosing

A

Hydrocortisone = 15-25mg/day
Cortisone acetate 20-35mg/day in 2-3 divided doses preferred

avoid late due to insomnia, give majority in morning and rest later

45
Q

Glucocorticoid pt education

A

Take w/ food minimize GI discomfort

dont self D/c, have to be tapered slowly over time

wear med ID indicating on long term steroids

46
Q

Fludrocortisone (Mineralocorticoids)

A

ADE: Edema, hypokalemia, HA, muscle weakness, inc BP, hypernatremia

DI: diuretics and AA

used adjunctive therapy PAI

47
Q

DHEA info

A

used women on appropriate therapy with low libido

ADE: acne, hirsutism

DI: SSRI, lithium, triazolmam, carbamazepine, estrogen, testosterone

Monitor: morning serum DHEA lvls before taking dose

48
Q

DHEA implement and monitoring

A

Pt ed is key
consequences of missed dose
Signs/symptoms of adrenal insufficiency and crisis
stress management
wearing medical alert bracelet

49
Q

Signs and symptoms of adrenal insufficiency or adrenal excess

A

Body weight
postural BP
energy lvls
Signs of frank glucocorticoid excess (edema, weight gain)

50
Q

ACTH Dependent (80%)

A

known as Cushing Disease (Pituitary Adenoma)

produce too much cortisol

51
Q

ACTH Dependent (20%)

A

at level of cortex

52
Q

General diagnosis of Cushing syndrome

A

too much cortisol

53
Q

non-pharm Cushing Syndrome therapy

A

Surgical intervention (1st line)
radiation therapy

54
Q

Pharm Cushing Syndrome therapy

A

Adjunctive to surgery or potential use in pts unable to get surgery

55
Q

Etomidate info

A

AE: sedation, nausea, vomiting, hypotension

IV, rarely used

56
Q

Ketoconazole info

A

v high dose

ADE: GI, elevated LFTs, gynecomastia

CI: Pts w/ hepatic disease, strong CY3A4 substrate and inhib

not preferred in men

57
Q

Metyrapone

A

ADE: Androgenic effect
CYP3A4 inducer

Not preferred In women

need special permission to use in USA

58
Q

Cabergoline

A

ADE: Nausea, Dizziness, psychiatric syndromes

not best option if already psychiatric

59
Q

Pasireotide

A

$$$$

Hepatic dose adjustment
potential DDI w/ Ketoconazole

Monitoring: Serum glucose, potassium, A1C, LFTs, UFC, thyroid function, HR, ECG

60
Q

Mifepristone

A

Abortifacient, cant use in preg women

ADE: Hypokalemia

Req renal and hepatic dosing
preg testing before take

61
Q

Mitotane

A

ADE: GI upset, nausea, vomiting, diarrhea, lethargy, somnolence, CNS

Take w/ food for GI, CYP3A4 inducer

Avoid women designing pregnancy, stay in fat for years

monitor: UFC and Urinary steroid production

62
Q

Cushing Monitoring

A

Sodium conc
Free T4 conc
Prolactin conc
Cortisol conc

improvement in signs/symptoms
SE of meds

CDM 4 Exam 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions