Pharm 1: Menstruation-Related Disorders

Question 1

Amenorrhea
Primary amenorrhea:

Secondary amenorrhea:

Answer 1

Primary amenorrhea: Absence of menses

Secondary amenorrhea: absence of menses for three cycles or for 6 months

Question 2

What are the goals of Amenorrhea therapy?

Answer 2

Bone density preservation
Bone loss prevention
Ovulation restoration
Improving fertility

Question 3

Treatment: Normal Amenorrhea treatment:

Answer 3

Normal Amenorrhea treatment:

• Vitamin D with Calcium
• Estrogen: Decreases osteoporosis risk and improved quality of life

Question 4

Treatment of: hyperprolactinemia and Amenorrhea

Answer 4

-Dopamine agonists, including bromocriptine and cabergoline if hyperprolactinemia is the cause of amenorrhea

Question 5

Treatment of PCOS and Amenorrhea

Answer 5

Metformin and thiazolidinedione if amenorrhea associated with PCOS

Question 6

Questions

Answer 6

Questions

Question 7

what is an advantage of estrogen?

Answer 7

Decreases osteoporosis risk and improved quality of life

Question 8

If a patient is experiencing hyperprolactemia what can you use for treatment?

Answer 8

Dopamine agonists, including bromocriptine and cabergoline if hyperprolactinemia is the cause of amenorrhea

Question 9

what is first line treatment for amenorrhea and PCOS?

Answer 9

Metformin or thiazolidinedione

Question 10

What do you need to look at before you perscrive metformin?

Answer 10

Creative clearance

Question 11

Management of pain associated with Menorrhea

Answer 11

Management of pain associated with Menorrhea

Question 12

-

Answer 12

• NSAIDS: the nonsteroidal antiinflammatory drugs (NSAIDs) have the advantage of administration only during menses. NSAID use is associated with a 20% to 50% reduction in blood loss in 75% of treated women.
• OC use is beneficial for menorrhagia and should be considered or women desiring to avoid pregnancy. Alternative choice levonorgestrel-releasing IUD

Question 13

Management of pain associated with Menorrhea :If someone is bleeding don’t give NSAIDs why?

Answer 13

Increased risk of miscarriage

Question 14

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Answer 14

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Question 15

Define PMS:

Answer 15

Constellation of symptoms including mild mood disturbances and physical symptoms occurring prior to menses and resolving with menses initiation

Question 16

Define PMDD

Answer 16

Severe depression symptoms, irritability, and tension before menstruation

Question 17

Treatment of PMS and PMDD:

Answer 17

o OTC options: Vitamin and mineral supplements, such as vitamin B6 and calcium carbonate, may help reduce the physical symptoms associated with PMS

oDrug of Choice: SSRI (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline)

Question 18

•What is the issue with giving SSRIs for the treatment of PMS and PMDD?

Answer 18

oSSRIs take up to four weeks to work so it may or may-not be helpful

Question 19

• When will an SSRI be helpful for PMS?

Answer 19

oIf the individual is depressed before the PMS issues

Question 20

Contraception

Answer 20

Contraception

Question 21

•Spermicides

Answer 21

most of which contain nonoxynol-9, are chemical surfactants that destroy sperm cell walls and act as barriers that prevent sperm from entering the cervical os to the fallopian tubes in women.

Question 22

•Progestins:

Answer 22

It provide most of the contraceptive effect, by thickening cervical mucus to prevent sperm penetration, slowing tubal motility and delaying sperm transport, and inducing endometrial atrophy. Progestins block the LH surge, therefore inhibiting ovulation

Question 23

Questions

Answer 23

Questions

Question 24

What do spermicides usually contain?

Answer 24

most of which contain nonoxynol-9

Question 25

what is the function of Spermicides?

Answer 25

are chemical surfactants that destroy sperm cell walls and act as barriers that prevent sperm from entering the cervical os to the fallopian tubes in women.

Question 26

How does progestins effect contraception?

Answer 26

by thickening cervical mucus to prevent sperm penetration, slowing tubal motility and delaying sperm transport, and inducing endometrial atrophy. Progestins block the LH surge, therefore inhibiting ovulation

Question 27

What is the estrogen part of the combo oral contraceptives?

Answer 27

Ethinyl estradiol (EE)

Question 28

What is the progesterone part of the combo oral contraceptives?

Answer 28

mestranol

Question 29

Ethinyl estradiol (EE) and mestranol. Mestranol, must be converted

Answer 29

by the liver to EE before it is pharmacologically active and is 50% less potent than EE

Question 30

What are some advantages of condoms?

Answer 30

Cheap, protection from stds

Question 31

What are some disadvantages of condoms?

Answer 31

Failure rate is high

Question 32

If a patient is experiencing neausa, breast tenderness, HA ,cyclic weight gain what are you thinking?

Answer 32

The patient is experiencing Estrogen excess

Question 33

What would you give to this patient experiencing Estrogen excess?

Answer 33

• A combination durg with more progesterone than estrogen
• Progesterone only drug
• IUDs

Question 34

• If you have a patients experiencing break through bleeding days 1-9 (early in the cycle) or the absence of withdrawal bleeding what are you thinking?
• What would you give to this patient?

Answer 34

o Estrogen deficiency

•Give an OC that has a higher estrogen content

Question 35

• If a patient is experiencing acne, oily skin and histuism, increased weight gain and increased appetite what are you thinking?
• What would you want to do for this paitent?

Answer 35

oProgestin excess

Decreased the progesting content

Question 36

If you have a patient with break through bleeding from days 10-21 (late cycle) what are you thinking?

What would you do for this patient?

Answer 36

Progestin deficiency

Increase progestin content

Question 37

WHO recommended Precautions

Answer 37

WHO recommended Precautions

Question 38

•Notes on the use of CHC combinded hormonal contraceptives 
Women > 35 : 
Smoking
Hypertension
Dyslipidemia

Answer 38

• Women > 35 : Increased risk of cardiovascular disease and VTE
• Smoking- increased risk of VTE
• Hypertension: Increased levels of potassium if they are also using an OC containing drospirenone, which has antialdosterone properties (Avoid in patient on potassium sparing BP meds)
• Dyslipidemia: Estrogens tend to have more beneficial effects by enhancing removal of LDL, increased HDL levels and moderately increase triglycerides. Low estrogens containing CHC may not provide such benefit

Question 39

• Diabetes
• Migraine
• Breast Cancer:
• Thromboembolism
• SLE

Answer 39

• Diabetes: Effects of CHCs on carbohydrate and lipid metabolism is believed to be due to the progestin component. Diabetic women with vascular disease (e.g. nephropathy, retinopathy, neuropathy, or other vascular disease or diabetes of more than 20 years’ duration) should not use CHCs.
• Migraine: Women of any age who have migraine with aura should not use CHC. Women who develop migraines (with or without aura) while receiving CHC should discontinue use and consider a progestin-only option.
• Breast Cancer: Association with risk of cancer inconsistent. Not recommended in patient with personal history of cancer
• Thromboembolism: Estrogens increase hepatic production of factor VII, factor X, and fibrinogen in the coagulation cascade, therefore increasing the risk of thromboembolic events (deep vein thrombosis, pulmonary embolism
• SLE: CHCs should be avoided in women with SLE and antiphospholipid antibodies or vascular complications