Brainscape's Knowledge GenomeTM

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


See full index

Pharmacy Practice III > Mensural Disorders > Flashcards

Mensural Disorders Flashcards

1
Q

What causes menstrual cycles?

A

Hormonal activity of the hypothalamus, pituitary gland, and ovaries (HPO)

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

What is a single menstrual cycle?

A

the onset time between two menstrual flow periods

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

What is the average age for menarche (initial cycle) in the US?

A

12 years old (11-14.5 years old)

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

What is the median cycle length and what is the range for adults?

A

28 days (range from 25 - 34 days for adults)

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

How long is the median cycle length? When does the most blood loss occur?

A

Menstrual period lasts 3-7 days; most blood loss during days 1 and 2

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

Which menstrual disorders are appropriate for self-care?

A

Primary dysmenorrhea and premenstrual syndrome

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

Which major events occur during the menstruation period?

A
  1. Maturation/ Release of ovum

2. Preparation of uterine endometrial lining for implantation by fertilized ovum

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

What is the timing and onset age of symptoms for primary and secondary dysmenorrhea?

A

1: 6-12 months after menarche but typically several years later,
age: 13-17

2: ≥2 yrs after menarche OR begins after years of normal cycles
Age: typically midlate 20s or older

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

What are the causes for primary and secondary dysmenorrhea?

A
  1. Idiopathic (no identifiable causes)
    No pelvic pathology
    associated with cramps at time of menstruation
  2. Associated with pelvic pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the menses for primary and secondary dysmenorrhea?

A
  1. Regular with normal blood loss
  2. Irregular
    Menorrhagia (heavy/prolonged bleeding) and intermenstrual bleeding is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the pattern and pain for primary and secondary dysmenorrhea?

A
  1. Onset before/during menses
    Pain with most periods
    Lasts 2-3 days
  2. Yes, occurs any time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is there a response to NSAIDS and OTCs for primary and secondary dysmenorrhea?

A
  1. Yes

2. Depends on cause of pain

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

What are some other symptoms of primary and secondary dysmenorrhea?

A
  1. Fatigue, headache, nausea, change in appetite, backache, dizziness, irritability, depression
  2. Vary according to cause of pain. May include dyspareunia (painful intercourse) and pelvic tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are counseling points for patients taking NSAIDS for primary dysmenorrhea?

A

Regimen: Ibuprofen or naproxen are first line options
Ibuprofen 200-400 mg every 4-6h (max 1200 mg/day)
Naproxen 220-440 mg initially, then 220 mg q8-12h (max 660
mg/day)
Timing: use for first 48-72h of menses
Optimal relief when taken on a schedule (vs PRN)
Treat 3-6 menstrual cycles w/ changes in agent, dosage, or
both before determining efficacy
If one does not work, try the other
Adverse Effects: Analgesic effect plateaus (further dose increases may
only increase ADRs)
ADRs: GI (dyspepsia, vomiting, heartburn, abdominal pain,
diarrhea, constipation)
Pregnancy/Lactating: Ibuprofen ok in lactating patients; naproxen half
life is concerning
Avoid if trying to get pregnant

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

What is the dosing regimen for NSAIDS (Ibuprofen, Naproxen) used to treat primary dysmenorrhea?

A

Ibuprofen or naproxen are first line options (use for first 48-72h of menses)
Ibuprofen 200-400 mg every 4-6h (max 1200 mg/day)
Naproxen 220-440 mg initially, then 220 mg q8-12h (max 660 mg/day

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

What is the timing for NSAIDS (Ibuprofen, Naproxen) used to treat primary dysmenorrhea?

A

-use for first 48-72h of menses
-Use at onset of menses or pain; if inadequate relief, begin 1-2 days before expected menses
-Optimal relief when taken on a schedule (vs PRN)
-Treat 3-6 menstrual cycles w/ changes in agent, dosage, or both before determining efficacy
o If one does not work, try the other

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

What are the adverse effects associated with NSAIDS (Ibuprofen, Naproxen) used to treat primary dysmenorrhea?

A
  • Analgesic effect plateaus (further dose increases may only increase ADRs)
  • ADRs: GI (dyspepsia, vomiting, heartburn, abdominal pain, diarrhea, constipation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some concerns associated with pregnant/lactating people when taking NSAIDS (Ibuprofen, Naproxen) used to treat primary dysmenorrhea?

A

o Ibuprofen ok in lactating patients; naproxen half life is concerning
o Avoid if trying to get pregnant

19
Q

What are some counseling points for patients taking Aspirin used to treat primary dysmenorrhea?

A

o Adequate for mild pain but limited effect on prostaglandins
(moderately effective)
o May increase menstrual flow
o Avoid in children and adolescents

20
Q

What are some counseling points for patients taking hormonal contraceptives used to treat primary dysmenorrhea?

A

o Combination oral contraceptive, vaginal ring, transdermal patch, etc

21
Q

What are some counseling points for patients taking dietary supplements used to treat primary dysmenorrhea?

A

o Very limited evidence for many supplements!
o May consider
 Omega-3 fatty acids (180 mg eicosapentaenoic acid + 120 mg
docosahexaenoic acid)
 Cholecalciferol (vitamin D3) 600 units daily

22
Q

Differentiate premenstrual syndrome from typical premenstrual symptoms and premenstrual dysphoric disorder

A

• Typical premenstrual symptoms: Symptoms do not interfere with
normal life functions
• Premenstrual syndrome (PMS): ≥1 symptom during 5 days before
menses + negative effect on daily functioning and distress
• Premenstrual dysphoric disorder (PMDD): Severe form of PMS with ≥5
symptoms that interferes w/ relationships and/or work

23
Q

What are the common negative and positive symptoms associated with premenstrual syndrome (PMS)?

A 
o	Common negative symptoms
	Fatigue, lack of energy
	Irritability, anger
	Labile mood (alternating sadness/anger)
	Depression, decreased interest in usual activities
	Anxiety, feeling stressed
	Crying spells, oversensitivity
	Difficulty concentrating
	Abdominal bloating, pedal edema
	Breast tenderness
	Appetite changes (overeating/cravings)
	Headache
	Hypersomnia/insomnia
	Joint/muscle pain
	Feeling out of control/overwhelmed
o	Common positive symptoms 
	Increased energy, more efficient at work 
	Increased libido, more affectionate 	Increased sense of control 
        Greater self-assurance
24
Q

What is premenstrual dysphoric disorder?

A

Severe form of PMS with ≥5 symptoms that interferes w/ relationships and/or work
o Similar to PMS but greater severity
o Impairs relationships or ability to function well at work/school greater than PMS

25
Q

What are the common symptoms of premenstrual dysphoric disorder (PMDD)? Also what symptoms are required for diagnosis of this disorder?

A

o Most common symptoms are mood-based; diagnosis requires:
Marked anger or irritability or depressed mood, anxiety or emotional lability
Difficulty concentrating, lethargy, hypersomnia/insomnia, breast tenderness, bloating
Significant impairment in functioning socially or at work week before
menses
Occur during most cycles in previous year and symptoms during last 7 days of cycle should be ≥30% worse than during days 3-9
o Refer to PCP to ensure proper diagnosis and management

26
Q

What is the relationship between Calcium and Vitamin D treatments to premenstrual syndrome?

A

o Inverse relationship between both milk and vitamin D intake and PMS
o High dietary intake of both Ca and vitamin D may prevent PMS sx
o Improvement/efficacy of emotional and physical symptoms with
600mg BID
—-> >50-75% symptom improvement

27
Q

What are the adverse effects associated with taking Calcium and Vitamin D for premenstrual syndrome?

A

Constipation. nausea

28
Q

What is the dosing regimen for taking Calcium and Vitamin D for premenstrual syndrome?

A
  • 1000 - 1300mg (Meet daily recommendations in diet first; supplement PRM)
  • Good initial treatment: 500 - 600mg calcium BID + 600 IU vit D daily
29
Q

What are counseling points for Pyridoxine treating premenstrual syndrome? Include the dosing regimen and potential risks associated with this treatment.

A

Dosing: 100mg daily
Max: 100mg/day
-risk of peripheral neuropathy above the daily max)
Mixed results; one study found that daily use improved mood

30
Q

What are counseling points for Magnesium treating premenstrual syndrome? Include the dosing regimen and potential risks associated with this treatment.

A

Dosing: 360mg daily during luteal phase
AEs: Diarrhea
-Deficiency leads to PMS symptoms (e.g. irritability)
-Affective symptoms reduced with magnesium pyrrolidine carboxylic acid
-Magnesium oxide not helpful

31
Q

What are counseling points for Vitamin E treating premenstrual syndrome? Include the dosing regimen associated with this treatment.

A

Dosing: 100mg daily
–>Use for 3 cycles to reduce physical/mental symptoms
Deficiency not established with PMS
Limited evidence that supplements help

32
Q

What are counseling points for NSAIDs treating premenstrual syndrome?

A

-Reduce physical sx only (headache, MSK pains)
-Take several days before/during menses
-Benefit may reflect coexistence of dysmenorrhea and PMS or PMS as
primarily physical symptoms

33
Q

What are the diuretics used to treat premenstrual symptoms? What causes/symptoms would cause PMS patients to use diuretics?

A
  • 3 products: caffeine, pamabrom, ammonium chloride
  • Abdominal bloating due to fluid shift/redistribution (not sodium or water
    retention)
  • Distention may be due to relaxation of gut muscle by progesterone
  • Diuretics unlikely to be helpful for most patients (may benefit few
    patients with true water retention/weight gain)
34
Q

What are counseling points for Caffeine, a diuretic treating premenstrual syndrome?

A

Dosing: 100 - 200mg q3-4h
MOA: promotes diuresis by inhibiting renal tubular reabsorption of Na+ and water
Safe/effective though may develop tolerance to diuresis
AEs: Anxiety, restlessness, insomnia, worsened irritability
- additive AEs with other caffeine products
- may cause GI irritation
CI: Pts taking MAOIs or theophelline

35
Q

What are counseling points for Pamabrom, a diuretic treating premenstrual syndrome?

A

Theophylline derivative in combo products or standalone agent
Dose: up to 50mg QID
AEs: GI irritation
CI: MAOIS or Theophylline

36
Q

What are counseling points for Ammonium Chloride, a diuretic treating premenstrual syndrome?

A

• Acid-forming salt with short duration in oral dosages up to 3 g daily
divided into 3 doses (max 6 consecutive days)
• Larger amounts can produce significant GI and CNS AEs
• CI: renal or liver impairment (concern of metabolic acidosis)

37
Q

What are counseling points for Combination Products treating premenstrual syndrome?

A

Common examples: Midol, Pamprin
Some contain APAP, caffeine/pamabrom, and pyrilamine (antihistamine)
Some contains NSAIDs or combo of analgesic + diuretic or antihistamine
Pain not common symptom
No evidence that antihistamine treats emotional symptoms
Not recommended routinely for PMS; reserved for headaches, MSK pain, concomitant dysmenorrhea

38
Q

What are complementary therapies and what are their associated counseling points

A

o Chasteberry
- Efficacy in decreasing mild-moderate sx though effect possibly
overestimated
- Avoid in pregnant and lactating patients (affects estrogen receptors
and prolactin)
- Caution in patients taking hormones or who have hormone-sensitive
cancers
o St. John’s wort
- contraceptive effectiveness reduction
o Ginkgo
- One trial showed improved breast pain, anxiety, irritability, and
depression
- Antiplatelet effects (may increase risk of bleeding) and drug-drug
interactions
o Saffron
- One trial found 30 mg reduced PMS and depression sx

39
Q

What are the risk factors associated with toxic shock syndrome?

A

o Strongest predictor is tampon use, especially high-absorbency
tampons
o Continuous uninterrupted use of tampons for ≥1 day during menses
o Using tampons to manage discharge or non-menstrual bleeding

40
Q

What are the signs and symptoms associated with toxic shock syndrome?

A

o Primarily affects young patients 13-19 years old
o Characterized by high fever, profound hypotension, severe
diarrhea, mental confusion, renal failure, erythroderma, and skin
desquamation
o Prodromal symptoms 2-3 days before onset of full-blown syndrome
Malaise, myalgias, chills, vomiting, diarrhea, and abdominal pain
o Evolves quickly
High fever, myalgias, severe vomiting and diarrhea, erythroderma,
decreased urine output, severe hypotension, and shock
Neurologic manifestations (headache, confusion, agitation, lethargy,
seizures)
Acute renal failure, cardiac involvement, adult respiratory distress
syndrome
o Dermatologic manifestations are characteristic
Early rash (described as sunburn, diffuse, macular erythroderma,
non-itchy)
Skin sloughs off after 5-12 days on face, trunk, extremities

41
Q

What are prevention strategies associated with toxic shock syndrome?

A

o Use sanitary pads instead of tampons during menstruation
o If must use tampons:
Use lowest-absorbency tampons compatible with needs
Alternate with pads (e.g., use pads at night) so tampons not
continuously used
Change 4-6x a day at least q6h, overnight use <8hours
o Wash hands before inserting anything into vagina (tampon,
diaphragm, sponge, medication, etc) – staph on skin
o Don’t leave contraceptive sponge, diaphragm, or cap in vagina
longer than recommended nor during menstruation
o Do not use tampons, sponges, or cervical caps during 12 weeks
after childbirth; may also be best to avoid diaphragm
o Patients with symptoms of TSS should remove tampon or device
immediately and seek emergency care
o Patients with history of TSS are at risk for recurrence (28-64%);
avoid tampons, IUCs, diaphragms, caps, sponges

42
Q

Counsel patients on the treatment for primary dysmenorrhea

A

o Inadequate management can lead to increased pain sensitivity during times other than menses and increased sensitivity to nonuterine pain
o Goals: resolve or provide significant improvement in pain and minimize disruption of usual activities
o Self care appropriate for:
 Healthy young patients with history consistent with primary dysmenorrhea AND are not sexually active
 Previously diagnosed with primary dysmenorrhea
o NSAIDs and hormonal contraceptives are first line options (80-90% success)
o Treatment choice influenced by desire for contraception, previous medication experiences, and other preferences

43
Q

Counsel patients on the treatment for premenstrual syndrome

A

o Single agent unlikely to address all symptoms
o Treat most bothersome symptoms (≥50% reduction ideal)
o Symptom log or calendars may be helpful and allow tracking
o Cost, future pregnancy, and adverse effects should be considered
o Mild-moderate generally appropriate for self-treatment
o Goals
 Better understand premenstrual disorders
 Improve or resolve symptoms to reduce impact on activities and relationships

44
Q

Counsel patients on the treatment for premenstrual syndrome

A

o Use sanitary pads instead of tampons during menstruation
o If must use tampons:
 Use lowest-absorbency tampons compatible with needs
 Alternate with pads (e.g., use pads at night) so tampons not continuously used
 Change 4-6x a day at least q6h, overnight use <8hours
o Wash hands before inserting anything into vagina (tampon, diaphragm, sponge, medication, etc) – staph on skin
o Don’t leave contraceptive sponge, diaphragm, or cap in vagina longer than recommended nor during menstruation
o Do not use tampons, sponges, or cervical caps during 12 weeks after childbirth; may also be best to avoid diaphragm
o Patients with symptoms of TSS should remove tampon or device immediately and seek emergency care
o Patients with history of TSS are at risk for recurrence (28-64%); avoid tampons, IUCs, diaphragms, caps, sponges

Pharmacy Practice III (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions