PMS/inferitlity

Question 0

PMS/PMDD treatment

Answer 0

Decrease caffeine, sodium
Exercise, cog-behavioral therapy

Vitamin B6 (pyridoxine)
CaCO3 600mg BID

1) SSRI fluoxetine
2) oral contraceptive, leuprolide (GnRH agonist)

Question 1

Premenstrual dysphoric disorder

Answer 1

Depressed mood, feelings of hopelessness, self-deprecating thoughts

Anxiety, anger, interfere @work

Question 2

Dysmenorrhea

Answer 2

Painful menstruation due to release of prostaglandins and leukotrienes

1) oral NSAIDs, ibuprofen Kim
2) combined oral contraception

Question 3

Endometriosis

Answer 3

Presence of functioning, proliferating endometrial tissue has progesterone receptor

Estrogen stimulates

Androgen causes endometrial atrophy

NSAIDs for symptoms but long term GI ulcer and renal toxicity

1) oral contraceptive to induce amenorrhea (lack menstruation)
DMPA medroxyprogesterone
Danazol: synthetic androgen
2) continuous GnRH agonist leuprolide, -relin

Question 4

Infertility (female)

Answer 4

30% Sperm defect
Ovulation failure
Tubal damage
25% unknown

Ovulation fail: hyperprolactinemia, thyroid dysfunction, weight loss

Tubal: endometriosis, PID

Neuroleptics can cause hyperprolactinemia and inhibit ovulation

NSAIDs LUFS fail to release ovum
Tamoxifen

Question 5

Male infertility

Answer 5

Smoking, alcohol, hot tub, tight underwear, over-training, DHEA supplement, antihypertensive, colchicine, cyclophosphamide

Androgens suppress gonadotropin and testicular function

Antidepressants decrease libido

Variocele-vasodilation temperature

Question 6

Ovulation induction

Answer 6

For ART procedures like in vitro fertilization

1) Clomiphene binds estrogen and inhibits negative feedback to hypothalamus and release FSH/LH
2) gonadotropin
3) IM menotropin
4) SC follitropin
5) hCG LH mimic, cheapest
6) SC choriogonadotropin 3 days after clomiphene

Question 7

Polycystic ovary syndrome (PCOS)

Answer 7

More androgen, stop ovulating, acne, body hair, insulin resistance

Obesity, lifestyle modification

1) Clomiphene

Metformin no benefit

Question 8

GnRH regulation

Answer 8

Regulate before manipulating LH/FSH

Continuous GnRH results in down regulation of LH/FSH

Pulsatile to stimulate LH/FSH

GnRH agonists: leuprolide, nafarelin
Antagonists: -relix

Question 9

Major adverse effects of ovulation induction/ GnRH a regulation

Answer 9

Ovarian hyperstimulation syndrome:
Ovarian enlargement, pelvic pain, NV, weight gain

Multiple gestations

Question 10

Luteal support

Answer 10

Ovulation induction ART may affect endometrium development

1) Progesterone gel for luteal support

Question 11

Pharmacist’s role

Answer 11

Product purchases
Pre-conceptual guidance
Education/administration technique
Weed out erroneous information 
Counsel alternative therapies 
Risk/benefit discussion