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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
first line treatment of dysmenorrhea
NSAIDs (celecoxib, diclofenac, ibuprofen, naproxen) Oral contraceptives Non-pharmacologic -- heating pad, exercise, nutritional supplementation, smoking cessation, and acupuncture
26
NSAIDs for dysmenorrhea pros/cons
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
OCs for dysmenorrhea pros/cons
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
second line treatment for dysmenorrhea
depo shot levonorgestrel-releasing IUD (try first)
29
When would you refer for dysmenorrhea?
if symptoms have not lessened in severity or resolved in 3 to 6 months of traditional therapy
30
first line treatment of amenorrhea
rule out pregnancy determine underlying cause (anorexia, excessive exercise, medications, hypoestrogenic)
31
treatment of amenorrhea due to anorexia
all non-pharmacological options weight gain consider work-up for eating disorder cognitive behavioral therapy
32
treatment of amenorrhea due to excessive exercise
non-pharmacological option reduction in exercise quantity and intensity
33
treatment of amenorrhea due to medications
1. consider alternative agents that do not inhibit dopamine receptor or increase prolactin levels 2. initiate dopamine agonist
34
dopamine agonists
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
treatment of amenorrhea due to hypoestrogenic state
provide supplemental estrogen either conjugated equine estrogens (Premarin, Cenestin, Enjuvia) or estradiol patch (Climara, Vivelle-Dot)
36
treatment of oligomenorrhea
similar to that of amenorrhea
37
treatment of ACUTE polymenorrhea
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
treatment of CHRONIC polymenorrhea with HORMONES
CHC (30 to 60% reduction) Progestins (up to 80%) LNG IUD (up to 97% for 1 year) Danazol GnRH agonists
39
treatment of CHRONIC polymenorrhea with NO HORMONES
NSAIDS (10-51%) Tranexamic Acid (50%) Iron (not indicated to less bleeding, but to treat iron-deficieny anemia if applicable)
40
Tranexamic Acid usage in polymenorrhea
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
treatment of metrorrhagia
treat underlying cause hormonal contraceptive
42
nonpharmacologic treatment of endometriosis
exercise acupuncture massage CBT surgery
43
first treatment of endometriosis
NSAIDs CHCs Progestins
44
second treatment of endometriosis
GnRH agonists/antagonists Danazol
45
Danazol usage in Endometriosis treatment
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
third line treatment for endometriosis
aromatase inhibitors
47
treatment of uterine fibroids
consider severe of symptoms, patient age, and reproductive plans
48
treatment of uterine fibroids if PREGNANT
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
non-pharmacologic treatment of uterine fibroids
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
pharmacologic treatment of uterine fibroids
NSAIDs hormonal contraceptives Tranexamic acid GnRH agonist selective progesterone receptor modulators (SPRMs)
51
GnRH agonist usage in treatment of uterine fibroids
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
SPRM usage in treatment of uterine fibroids (Mifepristone, Ulipristal)
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
non-pharmacologic treatment of PMS/PMDD
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
first line treatment of PMS/PMDD
SSRIs (PMD only) NSAIDs Spironolactone
55
SSRI usage in treatment of PMDD
FDA approved -- Fluoxetine, sertraline, Paroxetine Not FDA approved -- Citalopram, Escitalopram SE -- nausea, drowsiness, sexual dysfunction, sweating, insomnia, diarrhea, headache, weight gain
56
When would a pt use SSRIs continuously?
during PMDD if mood symptoms outside of luteal phase irregular menstrual cycle intolerable side effects upon d/c difficulties with on/off schedule
57
spironolactone usage in treatment of PMS/PMDD
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
second line treatment of PMS/PMDD
in this order --> venlafaxine, duloxetine (SNRIs) COCs Clomipramine Alprazolam
59
COC usage in treatment of PMS/PMDD
helps with physical symptoms, social functioning, and productivity
60
last line treatment of PMS/PMDD
GnRH agonists surgery
61
complementary treatment of PMS/PMDD
Ginkgo St. John's Worts

Therapeutics - Exam 5 (8 decks)

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