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PHRM 825 > PCOS > Flashcards

PCOS Flashcards

1
Q

T or F: PCOS is the leading cause of anovulatory infertility

A

True

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2
Q

T or F: PCOS has the potential for the development of endometrial cancer

A

True

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3
Q

T or F: PCOS can not cause miscarriage

A

False; can cause miscarriage

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4
Q

Clinical Presentation of PCOS

  • hyperandrogenism presenting as ___, ___, and ___
  • menstrual disturbances: ___ , ___ , and ___
  • overweight or obese
A
  • hirsutism, acne, alopecia
  • amenorrhea, oligomenorrhea, anovulation
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5
Q

Patho of PCOS

primary defect is unknown
3 possible mechanisms
* inappropraite ___ secretion
* ___ resisrance with hyper ___
* excessive ___ production

A
  • gonadotropin
  • insulin, hyperinsulinemia
  • androgen
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6
Q

Inappropriate Gonadotropin Secretion

  1. Increase in GnRH causes ___ to surge too soon.
  2. ___ will not rise, so there will not be a dominnant ___
  3. ___ will not occur, and unopposed ___ won’t allow us to enter the ___ phase
  4. levels of ___ then elevate
A
  • LH
  • FSH, follicle
  • ovulation, estrogens, luteal
  • androgens
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7
Q

T of F: in PCOS, baseline LH levels are high and FSH levels are normal/low

A

True

no dominant follicle will form

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8
Q

Insulin Resistance

Defect in insulin receptor causes insulin not to be recognized. The body thinks insulin is always ___ and compensates to make more. Increased insulin sensitivity in the ovaries causes ____

A
  • low
  • hyperandrogenism
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9
Q

Excess Androgen Production

Androgens are normally produced in the ovary to facilitate ___ growth
hypersecretion of LH and ___ causes raise in ___ production

A
  • folicular
  • insulin, androgen
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10
Q
  1. elevated ___
  2. early surge in ___ with low/normal ___
  3. no dominant ___, no ___
  4. unopposed estrogen, no ___ phase, elevated androgen (no FSH, increased ___)
  5. Normal ___, increased ___, overgrowth of ovarian follicles
A
  • GnRH
  • LH, FSH
  • follicle, ovulation
  • luteal, insulin
  • FSH, LH
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11
Q

PCOS Diagnosis Criteria

A
  • hyperandrogenism
  • chronic anovulation
  • polycystic ovaries
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12
Q

1st Line treatment for PCOS

Estrogen component
* ___ mcg EE of high risk VTE (obese or > age 39)
* less than or equal to ___ mcg EE
* LH suppression decreases ___ production

Progestin component
* prefer ___ and ___ only due to lower VTE risk
* avoid: desogestrel, cyproterone acetate, dropirenone, gestodene

A
  • 20 mcg
  • 35 mcg
  • androgen
  • norgestimate, norethindrone
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13
Q

T or F: monophasic COC is commonly used for PCOS

A

True

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14
Q

___ can be used as anti-androgen therapy

A

spironolactone

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15
Q

Spironolactone blocks androgenic effects at the ___

A

follicle

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16
Q

Spiranolactone SE:
* 50-100 mg ___ daily
* monitor ___ levels
* ___ bleeding
* ___ tenderness
* headache
* dizziness
* ___ - must use reliable forms of contraception
* used as an add on therapy for ___ / ___

A
  • twice
  • K+
  • vaginal
  • breast
  • teratogenic
  • hirsutism/acne
17
Q

Anti-androgen Therapy: 5- α Reductase Inhibitor

  • prevent formation of ___
  • used when COC and spiranolactone are ineffective for treating severe ___
  • finasteride (Proscar) ___mg daily
  • SE: headache, and ___ hypotension
  • must use reliabe forms if contraception
A
  • DHT
  • hisutism
  • 2.5-5 mg
  • orthostatic
18
Q

___ is the 1st line treatment in PCOS with type II DM and the 2nd line treatment for menstrual ___

A
  • Metformin
  • irregularity
19
Q
  • Metformin reduces ___ concentration and ___ production in ovary
  • 500 mg daily titrated to ___ mg BID
  • up to ___ months to see results
  • GI SE decrease after ___ weeks, taken with meal
  • discontinue if ___
A
  • insulin, androgen
  • 1000
  • 6 months
  • 2-3 weeks
  • pregnant
20
Q

T or F: Metformin is not endometrial protective until regular menses and ovulation are established

A

TRUE

21
Q

T or F: Metformin offers reliable endometrial protection

A

False

22
Q

Treatment for Insulin resistance (2)

A
  1. lifestyle modifications
  2. Metformin (PCOS with Type II DM)
23
Q

Treatment for Menstrual Irregularity (3)

A
  1. COC
  2. Progestin OC or levonorgestrel IUD
  3. metformin
24
Q

Treatment for Hyperandrogenism

A
  1. COC
  2. anti-androgens (spironolactone, finasteride)
  3. topical Vaniqa (for facial hair)
  4. cosmetic procedures
25
Q

If preganancy is desired, use ___ inhibitors (not-FDA approved for infertility)
* MOA: Nonsteroidal competitive inhibitor of the enzyme that turns androgens to ___
* by lowering this hormone, ___ is induced by triggering ___ and ___ secretion

A
  • aromatase
  • estrogen
  • ovulation, LH, FSH
26
Q

T or F: aromatase inhibitors like Letrozole (Femara) have better outcomes and less side effects than clomiphene

A

True

still not FDA approved

27
Q

T or F: aromatase inhibitors are irreversible and non-selective

A

False; aromatase inhibitors are reversible, highly selective, ad highly potent

28
Q

Aromatase inhibitors SE and contraindications

A
  • Hot flashes
  • edema
  • dizziness/fatigue
  • headache

Contraindication: pregnancy

29
Q

Letrozole (Femara) Dosing
* ___ mg po for 5 days, starting day __ of menses
* if ovulation does not occur, move up by ___ mg in next cycle
* can be used up to ___ cycles
* strong inhibitor of CYP ____ and weak inhibitor of CYP ___
* avoid use of ___ and CYP ___ substrate
* monitor use of ___ and ____

A
  • 2.5-7.5 mg, 3
  • 2.5 mg
  • 5 cycles
  • CYP2A6, CYP2C19
  • Tegafur, CYP2A6
  • tamoxifen and methadone
30
Q

Laparoscopic Ovarian Drilling decreases ___ leves and can improve ___ and ___

A
  • androgen
  • hirsutism
  • acne
31
Q

Treatment for Anovulation

A
  1. Letrozole
  2. low dose gonadotropin therapy and laparoscopic ovarian drilling
  3. IVF
32
Q

Best med for menstrual cycle irregularity, hirsutism, and acne

A

COC
* 1 active tab/day for 21-24 days

33
Q

Best med for Hirsutism, acne, and alopecia

A

Antiandrogens: Spironolactone and FInasteride
* Spiranolactone: 50-100 mg BID
* Finasteride: 2.5-5 mg daily

34
Q

Best med for PCOS with type II diabetes

A

Metformin
* 500 mg qd up to 2000 mg qd

35
Q

best med for anovulation and infertility

A

Letrozole
* 2.5-7.5 mg/day for 5 days

PHRM 825 (49 decks)

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