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Therapeutics - Exam 5 > Lectures 47/50 > Flashcards

Lectures 47/50 Flashcards

O'Keefe

1
Q

types of abnormal bleeding

A

dysmenorrhea
amenorrhea
oligomenorrhea
polymenorrhea
heavy menstrual bleeding (HMB)
metrorrhagia

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2
Q

dysmenorrhea

A

pain associated with menstruation

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3
Q

dysmenorrhea types

A

primary - normal ovulatory cycles and pelvic anatomy
secondary - underlying anatomic or physiologic cause

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4
Q

dysmenorrhea symptoms

A

dizziness
crampy pelvic pain
nasuea
vomiting
diarrhea
headache
muscle cramps

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5
Q

amenorrhea

A

absence of menstrual cycle

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6
Q

amenorrhea types

A

primary - no menses by age 15
secondary - no menses for 3 months in previously menstruating women

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7
Q

amenorrhea symptoms

A

often asymptomatic
can be accompanied by weight loss or weight gain
often a symptom of another condition (PCOS, low BMI, eating disorder, excessive exercise, medication)

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8
Q

oligomenorrhea

A

menstrual cycle interval more than 35 days
overlaps with amenorrhea (similar causes and treatment approaches)

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9
Q

polymenorrhea

A

menstrual cycle interval below 21 days

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10
Q

heavy menstrual bleeding (HMB)

A

bleeding over 80mL or lasting over 7 days

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11
Q

HMB symptoms

A

heavy blood flow with menstruation
with or without pain (dysmenorrhea)
possible fatigue and lightheadedness

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12
Q

metrorrhagia

A

irregular bleeding between cycles

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13
Q

endometriosis

A

pelvic inflammatory condition associated with growth of endometrial tissue found outside the uterus

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14
Q

endometriosis SE

A

asymptomatic to severe
most common – dysmenorrhea, infertility, and dyspareunia

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15
Q

endometriosis – less common SE

A

chronic pelvic pain
heavy bleeding
chronic fatigue
dyschezia
dysuria
painful bowel movements
abdominal bloating
flank pain

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16
Q

uterine fibroids (leiomyomas)

A

common noncancerous growth in the uterus
pelvic tumor

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17
Q

uterine fibroids symptoms

A

asymptomatic sometimes
HMB leads to anemia and fatigue
dysmenorrhea
non-cylic pain
abdominal protuberance
painful intercourse or pelvic pressure
bladder or bowel dysfunction
reproductive problems

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18
Q

premenstrual disorders

A

PMS and PMDD

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19
Q

premenstrual syndrome (PMS) symptoms

A

must have at least one symptom (either affective or somatic) for three menstrual cycles

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20
Q

premenstrual dysphoric disorder (PMDD) symptoms

A

must have at least five total symptoms with at least one in two different criteria of the DSM-5 for 2 consecutive months

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21
Q

List 1 for PMDD

A

affective lability
irritability, anger, or interpersonal conflicts
depressed mood, feeling of hopelessness, or self-deprecating thoughts
anxiety, tension, or feelings of being keyed up/on edge

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22
Q

List 2 for PMDD

A

decreased interest in usual activities
difficulty in concentration
lethargy, easily fatigued, or lack of energy
change in appetite, overeating, or specific food cravings
hypersomnia or insomnia
feeling overwhelmed or out of control
physical symptoms of breast tenderness/swelling, joint or muscle pain, bloating, weight gain

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23
Q

somatic symptoms of premenstrual disorders

A

abdominal bloating
breast swelling/tenderness
headache
muscle pain
edema
weight gain
fatigue
dizziness
nausea/vomiting
constipation or diarrhea
migraines
appetite changes
acne

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24
Q

affective common symptoms of premenstrual disorders

A

angry outburt
anxiety
depression
confusion
difficulty concentrating
social withdrawal
forgetfullness
sadness
tension
tearfulness
restlessness
loneliness
food cravings
change in libido

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25
Q

first line treatment of dysmenorrhea

A

NSAIDs (celecoxib, diclofenac, ibuprofen, naproxen)
Oral contraceptives
Non-pharmacologic – heating pad, exercise, nutritional supplementation, smoking cessation, and acupuncture

26
Q

NSAIDs for dysmenorrhea pros/cons

A

PROS – good option for those wanting to conceive; short term use; pain relief within hours; cheap, no RX
CONS – intolerable SE; not a great option for those with CV risk

27
Q

OCs for dysmenorrhea pros/cons

A

PROS – appropiate for those seeking contraception; can be used in conjunction with NSAIDs
CONS – not appropriate for pt desiring pregnancy; RX needed; delayed relief of 1-2 months

28
Q

second line treatment for dysmenorrhea

A

depo shot
levonorgestrel-releasing IUD (try first)

29
Q

When would you refer for dysmenorrhea?

A

if symptoms have not lessened in severity or resolved in 3 to 6 months of traditional therapy

30
Q

first line treatment of amenorrhea

A

rule out pregnancy
determine underlying cause (anorexia, excessive exercise, medications, hypoestrogenic)

31
Q

treatment of amenorrhea due to anorexia

A

all non-pharmacological options
weight gain
consider work-up for eating disorder
cognitive behavioral therapy

32
Q

treatment of amenorrhea due to excessive exercise

A

non-pharmacological option
reduction in exercise quantity and intensity

33
Q

treatment of amenorrhea due to medications

A
  1. consider alternative agents that do not inhibit dopamine receptor or increase prolactin levels
  2. initiate dopamine agonist
34
Q

dopamine agonists

A

treats amenorrhea caused by other medications
either bromocriptine (multiple day dosing) or cabergoline (weekly or twice weekly dosing)
CI with breastfeeding and uncontrolled HTN

35
Q

treatment of amenorrhea due to hypoestrogenic state

A

provide supplemental estrogen
either conjugated equine estrogens (Premarin, Cenestin, Enjuvia) or estradiol patch (Climara, Vivelle-Dot)

36
Q

treatment of oligomenorrhea

A

similar to that of amenorrhea

37
Q

treatment of ACUTE polymenorrhea

A

prefered agent – high dose estrogen (either conjugated equin estrogen for 24h or monophasic OC until bleeding stops)
if CI to estrogen, medroxyprogesterone x7d
if CI to hormone therapy, tranexamic acid x5d

38
Q

treatment of CHRONIC polymenorrhea with HORMONES

A

CHC (30 to 60% reduction)
Progestins (up to 80%)
LNG IUD (up to 97% for 1 year)
Danazol
GnRH agonists

39
Q

treatment of CHRONIC polymenorrhea with NO HORMONES

A

NSAIDS (10-51%)
Tranexamic Acid (50%)
Iron (not indicated to less bleeding, but to treat iron-deficieny anemia if applicable)

40
Q

Tranexamic Acid usage in polymenorrhea

A

Pros – usable if unable to take CHCs or wanting to conceive; intended for short-term use; up to 50% reduction of blood loss
SE – generally well tolerate but can cause headache or nasal symptoms
CI – active and/or history of DVT or PE; history of seizure

41
Q

treatment of metrorrhagia

A

treat underlying cause
hormonal contraceptive

42
Q

nonpharmacologic treatment of endometriosis

A

exercise
acupuncture
massage
CBT
surgery

43
Q

first treatment of endometriosis

A

NSAIDs
CHCs
Progestins

44
Q

second treatment of endometriosis

A

GnRH agonists/antagonists
Danazol

45
Q

Danazol usage in Endometriosis treatment

A

Cons – intolerable side effect profile (weight gain, acne, hirsutism, lipid abnormalities, liver dysfunction, changes in blood glucose)
Black Box Warning – warning for thromboembolism
CI – pregnancy and breastfeeding

46
Q

third line treatment for endometriosis

A

aromatase inhibitors

47
Q

treatment of uterine fibroids

A

consider severe of symptoms, patient age, and reproductive plans

48
Q

treatment of uterine fibroids if PREGNANT

A

avoid myomectomy unless it cannot be safely delayed
pain management – acetaminophen, short term opioids, short term NSAIDs
could increase risk of miscarriage, premature labor/delivery, abnormal fetal position, and placental abruption

49
Q

non-pharmacologic treatment of uterine fibroids

A

expectant therapy (no action unless changes; used in asymptomatic/mildly symptomatic; fertility preserved)
myomectomy (removal of fibroids; resolution of symptoms while preserving uterus; fertility preserved)
hysterectomy (removal of uterus; definite treatment; infertility)

50
Q

pharmacologic treatment of uterine fibroids

A

NSAIDs
hormonal contraceptives
Tranexamic acid
GnRH agonist
selective progesterone receptor modulators (SPRMs)

51
Q

GnRH agonist usage in treatment of uterine fibroids

A

PROS – decreases blood loss, operative time, and surgical recovery time
CONS – long term management associated with higher cost, menopausal symptoms, and bone loss; increased recurrence risk with myomectomy

52
Q

SPRM usage in treatment of uterine fibroids (Mifepristone, Ulipristal)

A

PROS – decrease blood loss, operative time, and surgical recovery time; not associated with hypo-estrogenic effects
CONS – headache and breast tenderness; PRM-associated endometrial changes; increased fibroid recurrence risk with myomectomy

53
Q

non-pharmacologic treatment of PMS/PMDD

A

limit sodium, caffeine, and alcohol consumption
aerobic exercise
relaxation techniques (yoga, meditation)
structured sleep schedule
calcium (elemental of 1200mg/day)
magnesium (200 to 400mg/day)
vitamin B,D,E

54
Q

first line treatment of PMS/PMDD

A

SSRIs (PMD only)
NSAIDs
Spironolactone

55
Q

SSRI usage in treatment of PMDD

A

FDA approved – Fluoxetine, sertraline, Paroxetine
Not FDA approved – Citalopram, Escitalopram
SE – nausea, drowsiness, sexual dysfunction, sweating, insomnia, diarrhea, headache, weight gain

56
Q

When would a pt use SSRIs continuously?

A

during PMDD if
mood symptoms outside of luteal phase
irregular menstrual cycle
intolerable side effects upon d/c
difficulties with on/off schedule

57
Q

spironolactone usage in treatment of PMS/PMDD

A

non-FDA approved indication
PROS – decreases weight gain (fluid retention), somatic symptoms (breast tendereness, bloating), and negative mood
SE – hyperkalemia, somnolence, irregular menses, diarrhea, nausea, headache

58
Q

second line treatment of PMS/PMDD

A

in this order –>
venlafaxine, duloxetine (SNRIs)
COCs
Clomipramine
Alprazolam

59
Q

COC usage in treatment of PMS/PMDD

A

helps with physical symptoms, social functioning, and productivity

60
Q

last line treatment of PMS/PMDD

A

GnRH agonists
surgery

61
Q

complementary treatment of PMS/PMDD

A

Ginkgo
St. John’s Worts

Therapeutics - Exam 5 (8 decks)

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