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PHRM 825 > O'keefe > Flashcards

O'keefe Flashcards

1
Q

what is normal bleeding?

A

cycle length of 22-35 days
menstruation lasting 3-7 days
35 mL of blood per day

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2
Q

dysmenorrhea

A

painful menstrual cycle

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3
Q

pathopys of dysmenorrhea

A

buildup of fatty acids in cell membrnes, then released
prostaglandins and leukotrienes released in uterus
inflammatory response causes symptoms

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4
Q

symptoms of dysmenorrhea

A

dizziness, crampy pelvic pain, nausea, vomiting, diarrhea, headache

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5
Q

goals of therapy for dysmenorrhea

A

provide symptomatic relief
reduce lost school/word productivity
improve qol

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6
Q

FIRST LINE Tx for dysmenorrhea

A

NSAID, oral contraceptive, non-pharmacologic

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7
Q

SECOND LINE tx for dysmenorrhea

A

depot medroxyprogesterone acetate
Levonorgestrel-releasing IUD

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8
Q

non-pharmacological tx for dysmenorrhea

A

heating pad, exercise, nutrional supplementation: omega 3 fatty acids, vitamin b, ginger
smoking cessation
acupuncture

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9
Q

MOA for nsaid tx of dysmeorrhea

A

inhibits cycloxygenase (cox) enxyme (1+2), leading to decrease in prostaglandin (bad guys) production

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10
Q

celexoib

A

rx only, 400 mg for 1 day, then 200 mg PO q12h

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11
Q

diclofenac

A

rx only, 100 mg for 1, thne 50 mg po q8h

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12
Q

ibuprofen

A

both, 800 mg for 1, then 400-800 mg PO q8h

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13
Q

naproxen

A

both, 500 mg for 1, then 220-550 mg po q12h

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14
Q

NSAID therapy pros

A

good option for those wanting to concieve
short term use
pain relief within hours
cheap, non rx

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15
Q

nsaid therapy cons

A

side effects can be intolerable
not a great option for those with CV history

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16
Q

nsaid therapy SE

A

GI bleeding/ulcers and upset
renal injury
onset of CV events, exacerbate HTN

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17
Q

Patient counseling and education

A

take with food or milk to minimize gi upset
monitor for abnormal bleeding
scheduled dosing vs. prn

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18
Q

Oral contraceptive therapy

A

MOA: inhibition of endometrial tissue proliferation, leading decreased endometrial production of prostaglandins and leukotrienes

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19
Q

hormone therapy pros

A

appropriate for those seeking contraception
can be used in conjuction with NSAIDs

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20
Q

hormone therpay cons

A

not appropriate for patient desiring pregnancy
rx needed sometimes
delayed relief (1-2 months)

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21
Q

hormone therapy side effects and precautious

A

increased blood pressure
weight gain
fluid retention
risk of blood clots/stroke

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22
Q

hormone therapy patient counseling and education

A

monitor for nausea, HA, breast discomfort, changes in mood

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23
Q

if symptoms have not lessened in severity or resolved in 3-6 months of traditional therapy….

A

REFERRRRRRRR

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24
Q

amorrhea

A

the absense of menstrual cycle

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25
amenorrhea symptoms
can be accompanied by weight loss or weight gain
26
often a symptom rather than a condition itself
lab tests: pregnancy test, FSH/LH levels, TSH, prolactin, estrogen PCOS, low BMI, eating disorder, excessive exercise MEDICATIONS!!!!!
27
pathopysiology
uterus- anatomic abnormalities ovaries- anatomic abnormalities pituitary gland- disruption to GnRH, LH, FSH, and prolactin hormones Hypothalamus- anorexia nervosa, bulimis, intense exercise, stress
28
drug induced amenorrhea
first gen antipsychotics second gen antipsychotics antidepressants monoamine oxidase inhibitors antihypertensives GI promotility agents
29
******first gen antipsychotics that cause amenorrhea
******prochloperazine, chlopromazone, haloperidol, chlorprothixene
30
****second gen antipsychotics
***risperidone *****and molidone
31
antidepressants that cause amenorrhea
clomipramine
32
monoamine oxidase inhibitors
pargyline and clorgyline
33
******antihypertensives
*****verapamil
34
****GI promotility agents
*****metoclopramide***** and domperidone
35
goals of therapy for amenorrhea
ovulation restoration, bone density preservation, bone loss prevention
36
non-pharmacologic tx for amenorrhea casued by anorexia
weight gain, consider work-up for eating disorder cognitive behavioral therapy (CBT)
37
non-pharmacologic tx for amenorrhea casued by excessive exercise
reduction in exercise quantity and intensity
38
non-pharmacologic tx for amenorrhea casued by medications
may consider alt. agents that do NOT inhibit dopamine receptor or increase prolactin levels or initiate dopamine agonist
39
tx of amenorrhea pharmacologic
conjugated equine estrogen (premarin, cenestin, enjuvia) estradiol (patch),
40
bromocriptine
dopamine agonist for tx of amenorrhea
41
cabergoline
dopamine agonist for tx of amenorrhea
42
CONTRAINDICATIONS OF USING DOPAMINE AGONIST FOR THE TX OF AMENORRHEA
breastfeeding, uncontrolled HTN
43
Mild side effect of dopamine agonist
N/D, HA, orthostatic hypotension, fatigue
44
oligomenorrhea
menstrual cycle interval >35 days (but less than 90 days)
45
polymenorrhea
menstrual cycle that lasts <21 days
46
heavy menstrual bleeding (HMB)
bleeding >80 mL or lasting >7 days excessive blood loss
47
pathophys of HMB
must rule out: pregnancy, ectopic pregnancy, miscarriage
48
HMB- symptoms
heavy blood flow with menstruation, with or without pain, fatigue and lightheadedness
49
goals of therapy for HmB
reduce mestrual blood flow, correct iron deficiency anemia or underlying disorders, improve QOL
50
chronic hormonal management of HMB
CHC, progestins, levonorgestrel IUD, danazol, GnRH agonists
51
chronic NONHORMONAL management of HMB
NSAIDS, tranexamic acid, iron
52
tranexamic acid
MOA: antifibrinolytic- prevents the degradation of blood clots Dosing 1300 mg PO TID x 5 days intended for short term use (duration of menses) NONHORMONAL
53
Contraindications of TRANEXAMIC acid
active and or h/o deep vein thrombosis or pulmonary embolism Seizure
54
side effects of TRANEXAMIC acid
generally well tolerated, can cause HA, nasal symptoms
55
metorrhagia
irregular menstrual bleeding between cycles
56
causes of metrorrhagia
hormone imbalance, fibroids, medications, iuds, infections
57
tx for metrorrhagia
target underlying cause hormonal contraceptive
58
endometriosis
pelvic inflammatory condition associated with growth of endometrial tissue found outsid eof uterus
59
sx of endometriosis
asymptomatic to severe sx most common: dysmenorrhea, infertility, dyspareunia
60

PHRM 825 (11 decks)

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