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PHRM 825 Exam 5 > PCOS > Flashcards

PCOS Flashcards

1
Q

Clinical presentation

A

Hyperandrogenism: Hirsutism, Acne, Alopecia

Menstrual disturbances: amenorrhea, oligomenorrhea, anovulation

Overweight or obese

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2
Q

Pathophysiology

A

Primary defect is unknown

  1. inappropriate gonadotropin secretion
  2. insulin resistance with hyperinsulinemia
  3. Excessive androgen production
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3
Q

Inappropriate gonadotropin secretion

A
  1. increase in GnRH
  2. Cause increase in LH surge too soon
  3. No rise in FSH
  4. No dominant follicle
  5. No ovulation
  6. Unopposed estrogen
  7. Luteal phase never happens
  8. Elevated levels of androgen
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4
Q

Regular Menstrual cycle vs. PCOS Cycle

A

Normal: normal GnRH level
LH and FSH levels spike during the cycle
One dominant follicle form

PCOS: Increase in GnRH
High LH level in baseline
FSH levels stay normal
No dominant follicle form

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5
Q

Insulin resistance

A

occurs in obese and non-obese women
potential defects in insulin receptor

In ovary: Insulin +/- LH increase androgens

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6
Q

Excess Androgen production

A

normally produced in ovary to facilitate follicular growth

Hypersecretion of LH and insulin leads to increase androgen production
-abnormal sex steroid synthesis
-hyperandrogenism
-hyperandrogenemia

increase in free testosterone concentrations

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7
Q

PCOS Diagnosis criteria

A
  1. Hyperandrogenism
  2. Chronic anovulation
  3. Polycystic ovaries

2 of the 3 must be present

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8
Q

Complications from PCOS

A

Infertility
CV
VTE
Type 2 diabetes
Dyslipidemia
Hypertension
Non-alcoholic fatty liver disease
Endometrial hyperplasia and cancer
Depression and anxiety
Obstructive sleep apnea
Pregnancy complications

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9
Q

Treatment decision considerations

A
  1. patient priorities
  2. efficacy vs. risks of treatment
  3. desire to become pregnant
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10
Q

NON PHARM TREATMENT

A

WEIGHT LOSS–> 5-15% (or more)
-improved pregnancy rates/reduce miscarriages
-improve ovarian function
-reduce free testosterone
-reduce hyperinsulinemia

EXERCISE
-30 minutes of moderate-vigorous physical activity daily
-reduce blood pressure and insulin levels

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11
Q

PHARMACOLOGIC TREATMENT

A

1ST LINE: COC
Estrogen component: lowest effective dose (20 mcg-30 mcg EE)
20 mcg EE for high risk VTE (obese or >39
< 35 mcg EE
LH suppression decrease androgen production

Progestin component: prefer low androgenic effects: norgestimate, norethindrone LOWER VTE RISK

NO COC HAS PROVEN SUPERIORITY FOR CLINICAL HYPERANDROGENISM
MONOPHASIC COC COMMON

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12
Q

Pharmacologic Treatment anti-androgen therapy

A

Spironolactone
50-100 mg BID
Blocks androgenic effects at follicle

Adverse effects: vaginal bleeding, beast tenderness, headache, dizziness
Takes 6-9 months to work
Used as an add on therapy

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13
Q

5 alpha reductase inhibitor

A

prevent conversion of testosterone to DHT

when COC and spironolactone are relatively ineffective for severe hirsutism

Finasteride 2.5-5 mg daily

headache, orthostasis

MUST use reliable forms of contraception

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14
Q

Insulin sensitizer

A

Metformin is 1st line of treatment in PCOS with type 2 diabetes and failed lifestyle modifications

2nd line: reduces insulin concentration and androgen production in ovary

500 mg PO DAILY or 100 mg BID
Up to 6 months to see results
GI side effects decrease after 2-3 weeks, taken with meal
Consider d/c if pregnant
No endometrial protection until regular menses and ovulation is reached

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15
Q

Treatment: insulin resistance

A
  1. Lifestyle modifications
  2. Metformin
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16
Q

Treatment: menstrual irregularity

A
  1. COC
  2. Cyclic progestin therapy
    - DEPOT SHOT
    - Micronized progestin
    - POP
    - Levonorgestrel IUD
    -Metformin
17
Q

Treatment: hyperandrogenism

A
  1. COC
  2. Spironolactone, Finasteride
  3. Topical Vaniqa
  4. Cosmetic procedures
18
Q

Pharmacologic treatment if pregnancy is desired

Aromatase inhibitors

A

Letrozole

MOA: Nonsteroidal competitive inhibitor of the aromatase enzyme
Inhibition stops conversion of androgens to estrogen

19
Q

Aromatase inhibitors

A

highly selective, reversible, highly potent

Inhibit aromatase activity

Induce ovulation by trigger hypothalamus to increase LH and FSH

Side effects: hot flashes, edema, dizziness, headache

20
Q

Letrozole

A

2.5-7.5 mg po for 5 days, starting day 3 of menses

21
Q

Treatment: anovulation

A
  1. Letrozole
  2. Low dose gonadotropin therapy, drilling
  3. IVF

PHRM 825 Exam 5 (7 decks)

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