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NMT 250 > Pharm - PCOS Wk2 > Flashcards

Pharm - PCOS Wk2 Flashcards

1
Q

What is the MOST COMMON endocrine abnormality in patients of childbearing age?

A

Polycystic Ovary Syndrome PCOS

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2
Q

the Clinical presentation of PCOS is quite variable but manifests with some degree of…

A

hyperandrogenism, ovulatory dysfunction, polycystic ovaries, and insulin resistance

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3
Q

Many patients with PCOS will present with concerns related to…

A

acne, hirsutism, fertility, menstrual irregularities, obesity and dysglycemia

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4
Q

Pathophysiology of PCOS is complex but involves…

A

inappropriate gonadotropin secretion, insulin resistance with hyperinsulinemia, and excessive androgen production

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5
Q

High levels of estrogen and progesterone results in what?

A

suppress GnRH (Gonadotropin Releasing Hormones) release from the hypothalamus

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6
Q

Reduced GnRH results in what?

A

reduced FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone) release from the pituitary

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7
Q

Combined Oral Contraceptives are a combination of what?

A

estrogen and a progestin

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8
Q

the combined oral contraceptives in PCOS patients, the estrogen component does what?

A

suppresses LH resulting in a reduction of androgen production and increases production of SHBG in the liver (which reduces free testosterone)

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9
Q

the combined oral contraceptives in PCOS patients, the progestin component does what?

A

inhibits the LH surge resulting in reduced ovarian androgen production

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10
Q

What is first generation progrestin called?

A

nonrethindrone

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11
Q

what is second generation progrestin called?

A

norgestrel and levonorgestrel

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12
Q

First and second generation progrestins have what?

A

a higher risk of metabolic side effects and higher androgenic activity

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13
Q

What is third generation progrestin called?

A

norgestimate

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14
Q

what is the fourth generation progrestin called?

A

drospirenone

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15
Q

third and fourth generation progestins…?

A

cause fewer metabolic adverse effects

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16
Q

what generation of progestins are anti-androgenic?

A

fourth-generation progestins

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17
Q

what progestins has the greatest anti-androgenic activity among all progestins?

A

cyproterone acetate

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18
Q

When choosing an oral contraceptive beyond simple contraception, what will ultimately guide the selection

A

the activity of the progestin

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19
Q

what are the types of combinations of oral contraceptives?

A
  • monophasic pills
  • biphasic pills
  • triphasic pills
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20
Q

what are monophasic pills?

A

the most common and provide a steady dose of hormones throughout the entire pack

21
Q

what are biphasic pills?

A

contain two sets of pills at different strengths. Usually the dose of estrogen is the same throughout but the dose of the progestin changes

22
Q

What are triphasic pills?

A

steady estrogen and three progestin dosages

23
Q

what are the non-contraceptive benefits of oral contraceptives?

A
  • increased bone mineral density
  • decreased acne
  • decreased ovarian, endometrial, colorectal cancers
  • decreased peri-menopausal symptoms
  • decreased risk of fibroids
  • decreased benign breast disease
24
Q

when using oral contraceptives what is the danger signal to watch for?

A

ACHES - abdominal pain, chest pain, headaches, eye problems, severe leg pain

25
Q

Progestin only pills are sometimes referred to as ?

A

“mini pills”

26
Q

progestins does what?

A

inhibit the LH surge preventing ovulation, thicken cervical mucus, and decrease motility of an ovum in the fallopian tubes

27
Q

what are the two emergency postcoital contraceptions?

A

levonorgestrel and ulipristal acetate

28
Q

a single does of levonorgestrel used within 24 hours of unprotected intercourse prevents ? of expected pregnancies

A

95%

29
Q

efficacy of levonorgestrel is highest if treatment is ?

A

provided within 24 hours, but can be taken up to 5 days after unprotected intercourse

30
Q

Health Canada has issued an advisory that levonorgestrel is less effective in individuals weighing ? and ineffective in those weighing more than ?

A

75 – 80 kg
80 kg

31
Q

what are the adverse effects of levonorgestrel

A
  • nausea
  • vomiting
  • dizziness
  • fatigue
32
Q

Ulipristal acetate needs to be taken…

A

5 days of unprotected intercourse or contraceptive failure

33
Q

Ulipristal acetate is a ? that prevents ? from occupying its receptor by competitive inhibition and is believed to inhibit or delay ovulation

A
  • selective progesterone receptor modulator
  • progesterone
34
Q

which emergency postcoital contraception is more effective when used 72-120 hours after unprotected intercourse

A

ulipristal is more effective than levonorgestrel

35
Q

Ulipristal may be the better option when contraception is required after ? or in those with a ?

A
  • 72 hours
  • BMI over 25
36
Q

what are the adverse effects of ulipristal acetate

A
  • nausea
  • headache
  • dysmenorrhea
  • abdominal pain
  • fatigue
  • dizziness
37
Q

combined oral contraceptives help with…?

A

help with menstrual cyclicity, hirsutism, and acne

38
Q

insulin sensitizers do what?

A

reduce concentrations and can ameliorate the consequences of hyperinsulinemia and hyperandrogenemia

39
Q

what are the main insulin sensitizers?

A

metformin and thiazolidinediones

40
Q

what does metformin do?

A

inhibits hepatic gluconeogenesis and reduces insulin concentrations and androgen production in the ovary

41
Q

what is the first-line for dermatologic signs and symptoms of hyperandrogenism (hirsutism)

A

pharmacologic therapy with oral contraceptive therapy

42
Q

what is the antiandrogen medication most often used for hirsutism?

A

spironolactone

43
Q

what does spironolactone do?

A

Inhibits ovarian and adrenal steroidogenesis, competes for androgen receptors in hair follicles, and inhibits 5α-reductase activity

44
Q

what does finasteride do?

A

Reduces 5α-dihydrotestosterone concentrations by 50% to 60% by inhibiting 5α-reductase in the skin and reproductive tissues

45
Q

what does aromatase inhibitors do?

A

work by blocking the conversion of androgens to estrogens
- decreases estrogenic activity and reduces the negative feedback inhibition on the hypothalamus and pituitary allowing for an increase in FSH

46
Q

what are the 2 main drug options of aromatase inhibitors

A

letrozole and clomiphene citrate

47
Q

what is the only option available in Canada for aromatase inhibitors?

A

Letrozole

48
Q

what are the adverse effects of letrozole?

A
  • fatigue
  • dizziness
  • hot flashes
  • edema
  • nausea

NMT 250 (4 decks)

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