Menstrual Disorders Study Guide

Question 1

1st Line Tx for Dysmenorrhea

Answer 1

NSAIDs (Naproxen is best)

Question 2

2nd Line Tx for Dysmenorrhea

Answer 2

Oral contraceptives

Question 3

3rd Line Tx for Dysmenorrhea

Answer 3

Medroxyprogesterone (MPA) (DepoProvera); or Levonorgestrel IUD (Mirena)

Question 4

OCP MoA for Tx of Dysmenorrhea

Answer 4

Reduces s/sx by inhibiting proliferation of endometrial tissue, leading to reduced prostaglandins

Question 5

Trial period required for evaluation of OCP in tx of dysmenorrhea

Answer 5

Trial of 2-3 months necessary to determine effectiveness

Question 6

Medroxyprogesterone MoA

Answer 6

Inhibits secretion of gonadotropins&raquo_space; prevention of ovulation&raquo_space; endometrial thinning

Question 7

Medroxyprogesterone Side Effects

Answer 7

Amenorrhea after several months of tx

Question 8

Tx options for Menorrhagia

Answer 8

OCP; Mirena; Progesterone therapy (Provera)

Question 9

Timing for Provera Effectiveness in Tx of Menorrhagia

Answer 9

Start during luteal phase of menstrual cycle, or for 21 days starting on day 5 of cycle

Question 10

1st Line Tx for Endometriosis

Answer 10

Combination OCPs or IM Medroxyprogesterone

Question 11

2nd Line Tx for Endometriosis

Answer 11

GnRH analogs

Question 12

3rd Line Tx for Endometriosis

Answer 12

Danazol

Question 13

Potential AE for Medroxyprogesterone

Answer 13

Bone density loss

Question 14

GnRH Agonist Limitations

Answer 14

Only for use in patients older than 16; limit to 6 months of therapy

Question 15

GnRH Agonist Adverse Effect

Answer 15

Bone density loss (use progestin or progestin/estrogen combo as add-back therapy); May cause a temporary increase in pain during initial therapy for endometriosis

Question 16

GnRH Agonists

Answer 16

Leuprolide (Lupron Depot); Goserelin (Zoladex); Nafarelin (Synarel);

Question 17

Leuprolide (Lupron Depot) Route

Answer 17

q3mo IM;

Question 18

Leuprolide (Lupron Depot) Adverse Effects

Answer 18

Hot flashes; Amenorrhea; HA, Depression; Bone loss

Question 19

Leuprolide (Lupron Depot) Monitoring

Answer 19

Bone density; Pregnancy prior to initiation

Question 20

Goserelin (Zoladex) Route

Answer 20

Implant sub-Q every 28 days

Question 21

Nafarelin (Synarel) Route

Answer 21

Nasal sol’n

Question 22

Danazol (Danocrine) Class & MoA

Answer 22

Androgen - suppresses output of LH & FSH&raquo_space; regression/atrophic of NL & ectopic endometrial tissue

Question 23

Danazol (Danocrine) Pregnancy Category

Answer 23

X!!!

Question 24

Danazol (Danocrine) Black Box

Answer 24

Thromboembolism; Intracranial HTN; Hepatitis & Hepatic adenoma; r/o preg prior to tx

Question 25

Danazol (Danocrine) Disadvantages

Answer 25

Avoid in hyperlipidemia/liver dz/preg; High rate of adrogenic side effects

Question 26

Tx options for PMS & PMDD

Answer 26

SSRIs, SNRIs; Tricyclics; OCPs; GnRH Agonists; Diuretics; NSAIDs

Question 27

1st Line Tx for PMS & PMDD

Answer 27

SSRIs. Fluoxetine (Sarafem/Prozac) preferred.

Question 28

SSRI with Preg Category D

Answer 28

Paroxetine (Paxil)

Question 29

2nd Line Tx for PMS & PMDD

Answer 29

SNRI - Venlafaxine (Effexor XR); or TCA - Clomipramine, Elavil

Question 30

AE of Venlafaxine (Effexor)

Answer 30

^ BP & HA with abrupt withdrawal

Question 31

Preferred OCPs for PMS or PMDD

Answer 31

Drospirenone-containing products (Yaz, Yasmin; Beyaz)

Question 32

Adverse Effects of Drospirenone-Containing OCPs

Answer 32

Thromboembolism; HA; peripheral edema; hyperkalemia

Question 33

Diuretic for PMS or PMDD tx

Answer 33

Spironolactone (Aldactone)

Question 34

Spironolactone MoA

Answer 34

Aldosterone antagonist; relieves breast tenderness & fluid retention

Question 35

Timing of spironolactone tx

Answer 35

Given during luteal phase

Question 36

Major AEs of Danazol

Answer 36

^ LFTs & ^ lipids

Question 37

Major AE of GnRH Agonists

Answer 37

^ risk of osteoporosis