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Pharm 2 > Reproductive pharm > Flashcards

Reproductive pharm Flashcards

1
Q

Overview of topics

A
  1. Contraception
    -short acting
    -long acting
  2. Menopausal hormone therapy (HRT)
    -systemic
    -vaginal local
  3. Menstrual disorders
    -pms and pmdd
    -heavy/abn menstrual bleeding
    -Endometriosis/adenomyosis
    -PCOS
  4. Infertility
  5. Vaginitis
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2
Q

what is contraception?

A

-prevents fertilization
1. prevent sperm from reaching ovum
2. prevent implantation of fertilized ovum

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3
Q

types of bc methods

A
  1. sterilization
    -vasectomy = male
    -tubal ligation= female
  2. Barrier methods
    -condoms, diaphragms, sponge, cervical cap, gel
  3. Short-acting hormonal
    -pill, patch, shot, vaginal ring
  4. Long acting reversible
    -IUD, non hormonal IUD, implantable rod
    5.Natural rhythm methods
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4
Q

Short-acting reversible contraception

A

the pill
the mini pill
the patch
the shot
the ring

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5
Q

endogenous hormones

A
  1. estrogen: causes endometrial thickening and stabilizes lining
    MOA: suppresses FSH release-> stabilizes lining-> controls the cycle
  2. Progesterone: thickens cervical mucus
    MOA: blocks LH surge-> thickens cervical mucus (decrease sperm penetration, slows tubal mobility, delays sperm transport)-> causes endometrial thinning/atrophy
  3. FSH: stimulates follicles to mature
  4. LH: triggers ovulation
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6
Q

Types of bc pills

A
  1. Combined oral contraception COC= estrogen + progestin
    -estrogens= Ethinyl estradiol (synth) and Estradiol valerate (bioidentical)
  2. Progestin only pills= POP
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7
Q

Bioidentical

A

“compounds that have exactly the same chem and molecular structure as hormones that are produced in the human body”

it is not: compounded, safer, natural, plant sourced

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8
Q

Progestin

A

synthetic form of progesterone
MOST IMPORTANT AGENT IN CONTRACEPTION BC SUPPRESSES OVULATION BY PREVENTING LH SURGE
-acts like testosterone - hirusitism, voice changes

by generations:
1st gen= oldest= minimize risk of clots in pts >35 but more andro
-Norethindrone acetate
-ethynodiol diacetate
-lynestrenol
-norethynodrel
2nd gen: less clots more andro
-LEVONORGESTREL= mc prescribe LOWEST RISK OF CLOTS
-di-norgestrel
3rd gen: less andro but HIGHER RISK CLOTS
-norgestimate
-gestodene
-desogestrel
4th gen= newest= decrease androgenic SE in those w/ PCOS, HIGHER RISK OF CLOTS
-Drospirenone
-Cyproterone acetate

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9
Q

Dosing regimen

A
  1. Monophasic/multiphasic
    -mono= same dose of E+P in each of the 21-24 active pills
    -bi or triphasic= varying dose by week= more SE and unscheduled bleeding
  2. Cycle use
    -original= 21 active 7 placebo
    -new= 24 active 4 placebo
  3. Continuous
    -pt has control over when they have withdrawal bleeding = always or for 3 mo stents
    -taken too long (over a year)= unscheduled breakthrough bleeding
    -helpful for PMDD, endometriosis, hyperandrogenism, dysmenorrhea, perimenopause
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10
Q

examples of mono, multiphasic

A
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11
Q

Side effects of COC

A

Estrogen: N/V, breast tenderness, melasma, VTE, increase in migraines

Progestin: fluid retention, acne, anxiety/depression, amenorrhea, breakthrough bleeding, cholestatic jaundice

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12
Q

Pearls for COC

A
  1. having breakthrough bleeding? increase estrogen
  2. heavier bleeding? increase estrogen
  3. HA? decrease estrogen
  4. Mood swings? change progestin type
  5. Nausea? change progestin type or lower estrogen
  6. Decrease libido? switch ethynyl estradiol to estradiol valerate
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13
Q

Sexual health and COC

A

SE of COC: decreased libido and vestibulitis
First pass metab-> increases sex hormone binding globulin SHBG-> binds extra androgens w/ higher aff for Testosterone than estrogen but binds both-> less available testosterone= vestibulitis

INFLAMMATION OF VESTIBULE (LABIA TO EDGE OF VAGINAL OPENING) IS THE #1 CAUSE OF PELVIC PAIN/DYSPAREUNIA in premenopausal women-> burning, itchy, pain, pain with sex

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14
Q

Contraind for COC

A

breast cancer
BREAST FEEDING BC ESTROGEN THRU BREASTMILK
severe cirrhosis
history of dvt/pe
MIGRAINE W/ AURA
DIABETES W/ NEPHROPATHY, RETINOPATHY, NEUROPATHY= COMPLICATED
current gall bladder dz
history of bariatric surg w/ malabsorptive procedures
htn
ischemic heart dz
postpartum w/in 21 days
SMOKING UNDER 35
history of CVA
solid organ transplant
Lupus
complicated valvular heart dz

DONT MEM BUT KNOW WHERE TO GO= CDC

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15
Q

COC drug interactions

A

Antiretrovirals for PrEP or HIV
Anticonvulsants
-phenytoin, carbamazepine, barbiturates
RIFAMPIN IS THE ONLY ONE W/ DIRECT INTERACTION W/ BC
okay w/ SSRIs

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16
Q

Starting BC

A

start anytime
- started w/in first 5 days since period= no additional contraception
-started w/in over 5 days since period= abstain or use back up for 7 days
unsure if prego? start COC and do a prego test in 2-4 wks

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17
Q

Missed a dose?

A

late= <24 hours since last dose
Missed=>24 hours since last dose
-late or one missed= TAKE ASAP AND CONTINUE TAKING REMAINING PILLS = NO BACKUP NEEDED
-two or more missed= take most recent pill and discard the rest and continue pack -> USE BACKUP OR ABSTINENCE FOR 7 days
-missed on days 15-21= omit the placebo period and finish current pack and begin next pack the next day + possible emergency contraception

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18
Q

Progestin only pill aka POP or Mini pill

A

Indications: breastfeeding, estrogen contrain, worsened migraines, high bp w/ COC

Daily w/ no “free period”-> as effective as COC if taken at same time every day-> higher failure if 3 hours late-> use backup for 7 days

Downside: less effective than COC, not as CONSISTENT inhibitor of ovulation-> higher incidence of Breakthrough bleeding and ectopic pregnancies

SE: HA, depression, weight gain, acne, hirsuitism

POP:
Norethindrone
-Ortho micronor
-Camila
-Errin
-Heather

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19
Q

Short acting hormonal contraception: patches

A

Patches= Ethinyl estradiol + norelgestromin (Xulane, Zafemy_
rotate sites- abd, back, butt, upper arm-> change weekly for 3 weeks then skip for withdrawal
HIGHER RISK FOR VTE BC HIGH DOSE
not as effective in obesity

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20
Q

Short acting hormonal contraception: vaginal ring

A
  1. Monthly ring= Ethinyl estradiol + etonogestrel= NuvaRing or EluRyng-> insert for 3 weeks and remove for bleed
  2. Annual vag ring= Ethinyl estradiol + segesterone acetate-> 3 wk on and 1 off-> reused for a total of 13 cycles
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21
Q

Short acting hormonal contraception: shot

A

Depo-Provera IM inj: medroxyprogesterone acetate
MOA: prevents ovulation
Can be given immediately postpartum in females who are breastfeeding
SE: weight gain, mestrual irreg, breast tenderness, depression

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22
Q

Short acting non-hormonal contraception

A

Phexxi gel- lactic acid, citric acid, potassium bitartrate
insert up to 1 hr prior to intercourse
MOA: maintains vaginal pH 3.5-4.5 so that sperm does not increase pH to 6.5-7.5= acid prevents swimming

86% w/ typical use, 99% w/ perfect use
SE: vaginal discharge, vaginal irritating, kidney/bladder infxn (rare)

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23
Q

Long acting reversible contraception (LARC)

A
  1. Hormonal
    -IUD
    -Implant
  2. Non-hormonal
    -Copper IUD
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24
Q

Non hormonal IUD

A

ParaGard (copper) IUD-> up to 10 yrs
Device: copper wire coiled around device
MOA: copper produces inflam reaction that is toxic to sperm and egg-> detaches sperm from its tail
SE: HEAVIER MENSTRUAL CYCLES, cramp, breakthrough bleeding, explusion
considerations: menorrhagia/dysmenorrhea-> not be a best choice

25
Q

Hormonal IUD

A

all= Levonorgestrel
Liletta= 8 yrs
Mirena= 8 yrs
Both are more likely to not have period

Kyleena= 5 yrs
Skyla= 3 yrs

MOA: not fully demonstrated-> prob prevent fert by thickening cervical mucus to inhibit sperm or mobility or thin endometrium

DOES NOT EFFECT FOLLICULAR DEVELOPMENT OR OVULATION SO RETURN TO FERTILE VERY QUICK-> NOT FOR PMS OR PMDD OR ENDOMETRIOSIS BC DOESNT STOP OVULATION

Benefits: decreases dysmenorrhea (after 6 months), menorrhagia, 99% effective, higher dose IUD can cause amenorrhea
SE: irregular bleeding (breakthrough), uterine perforation, expulsion, PID, ectopic prego
Contrain: liver dz, leiomyoma, unexplained vag bleeding, active pelvic infxn

26
Q

Hormonal implant

A

Etonogestrel- Nexplanon
3 yr effectiveness-> 99% effective
MOA: SUPPRESS OVULATION-> increase viscosity of cervical mucus-> alterations in endometrium

SE: HA, acne, mastalgia, weight gain, irregular menses

Clinical pearl: third of women have no bleeding, third of women regular/irregular spotting, third of women have heavy persistent bleeding

Contra: DVT, MI, CVA, liver dz, breast CA, unexplained vag bleeding

27
Q

Emergency contraception

A

Ulipristal (Ella) and Levonorgestrel (Plan B)
-up to 5 days after unprotected sex

Copper or LNG IUD
-w/in 5 days of unprotected sex w/ negative pregnancy test

28
Q

Menopause basics

A

average age= 52.54
Perimenopause= start 10 yrs prior to final Menstrual period (FMP)
-early perimeno= irregular cycles, heavy
-later perimeno= 2-13 months of amenorrhea
Postmenopause= final menstrual period after 1 year of no menstrual bleeding-> from loss of ovarian follicular fxn-> due to aging or primary ovarian failure or surgical removal of ovaries

Terminology:
-early meno= FMP b4 age 45
-late meno= FMP after age 54
-Premenopause= reproductive stages btwn menarche and onset of perimenopause

29
Q

Meno is a consequence of reproductive aging

A

repro aging= loss of oocytes by ovulation and atresia
finite # of oocytes lost thru apoptosis-> ovulate about 400-500 eggs
20 wks gestation= 6-7 million
Birth= 1-2 million
Puberty= 300,000-500,00
meno= 300-400 remaining

patho:
FSH GOES UP AND ESTRADIOL GOES DOWN
-FSH - very high= predicting meno but not to predict time of meno-> rises several years b4 meno and stabilizes 2 yrs after meno

ESTRADIOL WILL VARY DRASTICALLY DURING PERIMENO-> decline 2 yrs b4 FMP

30
Q

Menopause Syndrome

A
  1. Genitourinary: changes in menstrual bleeding pattern, vulvovaginal symp (dry, dysuria), dyspareunia, constipation
  2. Psychiatric/nervous sys: Insomnia, depression, anxiety, “brain fog”, memory changes, hot flashes, night sweats
  3. Cardiovascular: palpitations, increase in BP, changes in lipid panel
  4. MSK: joint pain, myalgias
  5. Other: changes in weight distribution, dry eyes

PEARL: CRUCIAL TO IDENTIFY WHAT BOTHERSOME SYMPTOMS SHE HAS BC THIS IS GOING TO DICTATE WHAT TX YOU RECOMMEND

31
Q

Hot flashes?

A

Hypothalamus= thermoregulatory center for the body= unknown MOA
bothersome hot flashes= increased risk for CVD, OSTEOPOROSIS, BREAST CANCER

UP TO 70% OF WOMEN WILL REMAIN UNTX

WHI hormone therapy findings: use fo E+P hormone therapy after menopause = increased risk of heart disease, stroke, blood clots, breast cancer, dementia= NOT FOR USE IN POSTMENOPAUSAL WOMEN TO PREVENT HEART DISEASE OR LOWER CHOLESTEROL LEVELS

basically:
FOCUS OF TRIAL WAS TO ASSESS PREVENTION OF HEART DZ, BREAST CA, COLORECTAL CA, OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN-> LOOKING AT CONJUGATED EQUINE ESTROGEN W/ OR W/OUT MEDROXYPROGESTERONE ACETATE-> no formal recommendation from USPSTF on HRT in sympt women

32
Q

FDA indications for Hormone replacement therapy (HRT)

A
  1. Vasomotor sympt
  2. Prevention of bone loss
  3. Premature hypoestrogenism- caused by hypogonadism, castration, or premature ovarian insuff
  4. Genitourinary synd of menopause

NO INDICATIONS FOR PREVENTION OF HEART DISEASE, MOOD AUGMENTATION, DEMENTIA PREVENTION

33
Q

Contrain for starting estrogen hormone therapy

A

undiag abn gental bleeding
known, suspected, hx of Breast ca
suspected estrogen-dependent neoplasia= endometrial cancer not cervical cancer
active/hx of DVT OR PE
thromboembolic dz
liver dysfxn
pregnancy
hypersens to estrogen therapy
porphyria cutanea tardis
hypertriglyceridemia

34
Q

Estrogen formulations

A
  1. Conjugated equine estrogens (CEE)-> most research about efficacy and safety
  2. 17 beta Estradiol-> mc used estrogen in europe= BIOIDENTICAL FORMULA
  3. Ethinyl estradiol-> MC in combo contraceptives and some HRT prep

IF SHE HAS AN INTACT UTERUS= ESTROGEN MUST ALSO HAVE PROGESTERONE THERAPY TO PREVENT ENDOMETRIAL HYPERPLASIA AND ENDOMETRIAL CANCER

35
Q

Progesterone formulation

A
  1. Micronized progesterone
    -bioidentical
    -sedating effect bc 1st pass metab makes a GABA agonistic effect= SEDATING
    Contraind: PEANUT ALLERGY BC PEANUT OIL USED IN IT
  2. Medrozyprogestrone acetate (MPA)= MC USED/STUDIED
  3. Norethindrone acetate- not in US by itself for HRT but is in combo pills

no patches available, only oral or IUD (endometrial protection)

36
Q

Administraiton of EPT- expedition of partner therapy

A
  1. Continuous combined
    -MC bc dont have to remember timing -> estrogen and progestin-> highest rates of amenorrhea and lowest of endometrial hyperplasia
  2. Continuous- cyclic
    -daily estrogen plus Progestin cyclically for 12-14 days each month-> can cause bleeding w/ progestin w/drawal
  3. Continuous-cyclic long cycle
    -not recommended-> daily estrogen + progestin for 14 days every 2-6 months= heavier/longer bleeding but less frequent
    -REQUIRES ENDOMETRIAL MONITORING AND BIOPSY
37
Q

How to Dose?

A

start lowest of estrogen and titrate up-> notice in 2 wks but say 6-8 weeks BEFORE WE KNOW IF WORKING

all combined HRT have Progestin for Endometrial protection

38
Q

When to start HRT?

A

NOT FOR CONTRACEPTION TOO - - ONLY FOR SYMPTOMS
1. Within 10 years of FMP (final menstrual period)-> DO NOT HAVE TO WAIT UNTIL THEY ARE OFFICIALLY 1 YEAR POST MENOPAUSAL
can take 2-4 wks b4 noticing -> follow up in 6 weeks

any vaginal bleeding is CA until proven otherwise= biopsy

WINDOW OF OPPORTUNITY OR TIMING HYPOTHESIS

39
Q

Continuing HRT?

A

BASED ON SYMPTOMS-> if controlled= CONTINUE CURRENT DOSE
uncontrolled? titrate up Estrogen component + sleep effects

Efficacy 2 weeks-> re eval 6-12 wks-> reval annually if on steady dose or if AE

assessment is clinical 6-12 months and dont need lab values

40
Q

Discontinue HRT?

A

Age 65= START TO TAPER and MUST ATLEAST ATTEMPT TO TAPER
some will not be able to get off HRT w/out RESUMPTION OF SIGNIFICANT HOT FLASHES-> but okay to ongo if started b4 65

risks: DEMENTIA, MI, CEREBROVASCULAR ACCIDENTS AFTER AGE 65

DONT START HRT AFTER 65 OR OVER 10 YRS BC OF RISKS

41
Q

Bioidentical hormones

A

Estradiol, estrone, and micronized progesterone
demand increased after Womens Health Initiative said women felt safer with them
some may go to compounding pharmacies to get bioidentical hormones or biodient hormones non fda approved pellets inserted SQ
COMPOUNDED BIOIDENT= UNTESTED AND MAY OR MAY NOT CONTAIN % OF HORMONE

Pros: for individuals sensitive to different vehicles in meds
Cons: no FDA approval process, not covered by insurance…efficacy…safety?

42
Q

Perimenopause is when most likely to see women w/ symptomatology

A

Patho: decrease ovarian reserve and follicles-> reduction in Inhibin B and AMH -> increases FSH= 1. faster growth of remaining follicles 2. Increased follicular atresia 3. maybe Luteal Out of Phase event LOOP= excess estradiol produciton as new follicles start growing

explains symp: mastalgia, worsening migraine, fibroid growth, irregular bleeding, risk of endometrial hyperplasia

Early perimenopause: irregular cycle, skipped cycles, worsening PMS
Late perimenopause: ovulation more sporadic, follicular development goes way down leads to estradiol deficiency

43
Q

Perimenopause tx

A
  1. Oral BC pills
    -Continuous COC or 24/4 form to cut down on prolonged bleeding -> keep on till 55 yo then switch to HRT bc 90% women will have menopause at 55
    20MCG OR LESS to control symp and CONTRACEPTIVE BC MOST LIKELY TO HAVE TWINS DURING THIS LAST CALL
  2. IUD for HEAVY bleeding
  3. Serotonin reuptake inhibitors- GREAT FOR IRRITABILTY but decrease libido
  4. Conservative management
    -diet= complex carbs can stabilize mood, cravings, insulin
    -exercise= healthy endorphins-> low impact
    -Relaxation and meditation practice
44
Q

Genitourinary syndrome of Menopause

A

aka vulvovaginal atrophy VVA
estrogen deficiency can lead to changes in labia, introitus, vagina, clitoris, bladder, urethra-> lose elasticity, shorten vaginal vault, narrow introitus, loss rugae, thin vaginal tissue-> dryness, irritation, burning, soreness, tightness= all bc of decreased Estrogen and Testosterone

Not only caused by menopause-> caused by any condition = low estrogen state (hypothalamic amenorrhea, prolonged lactation, pelvic radiation, tx w/ aromatase inhibitors-»> most will say they have a UTI OR A YEAST INFECTION but post meno rarely get yeast infxns

PE:
-vaginal pH will be elevated
-UA, wet prep, STI,
-biopsy unusual lesion

Tx:
-lube for sex
-topical estrogen
-nonhormonal options

45
Q

Hormonal treatment for Genitourinary syndrome

A
  1. Low dose vaginal estrogen
    -No progestin needed bc local -> full effic 2-3 months and notice diff in 2-4 wks
    -cream (Estrace or Premarin), inserts (Imvexxy or Vagifem), ring (Estring or Femring)= 17 Beta estradiol
  2. Vaginal DHEA
    Prasterone= FOR PAINFUL INTERCOURSE-> for mod to severe dyspareunia secondary to atrophy
    MOA: dehydroepiandrosterone converted to androgens and sestrogens
    AE: vaginal discharge and abnormal pap ~2%
  3. Oral ospemifene
    for severe dyspareunia assoc w/ GUSM
    MOA: selective estrogen receptor modulator (SERM)
    Agonistic effects on endometrium and vaginal tissue but Antagonistic effects on Breast
  4. Systemic estrogen therapy
    doesnt always work for GUFM bc doesnt penetrate well
    PEARL: IF HAVING HOT FLASHES AND PO IS WORKING FOR THAT, CAN STILL ADD VAGINAL PREP TO HELP W/ GUSM
46
Q

Non hormonal pharmaceutic options for Hot Flashes

A

only non hormonal option w/ FDA to tx hot flashes is Paroxetine salt (Brisdelle)

Off label:
venlafaxine
gabapentin
clonidine
other SSRI

47
Q

safety of HRT and CVD?

A

HRT started w/in 10 yrs of menopause or less than 60 yo= lower all cause mortality and not increase risk of coronary events, stroke risk not increased

both heart dz and stroke risk increases in HRT AFTER AGE 60 BUT NOT NECESSARILY IF CONTINUED AFTER 60

48
Q

Menstrual disorders

A

70-91% report painful periods and 25% experiencing menstrual disturbances
58% use BC for something other than prevent prego

Disorders:
1. Premenstrual syndrome
2. Premenstrual dysphoric disorder
3. Heavy menstrual bleeding & abnormal uterine bleeding
4. Polycystic Ovarian syndrome (PCOS)
5. Endometriosis/adenomyosis

49
Q

Premenstrual syndrome PMS

A

Recurrent variable cluster of PHYSICAL and Emotional symptoms
during the 5 days b4 the onset of menses and ends 4 days after menstruation

40% of all premenopausal women from 25-40

Symp: bloating, breast pain, ankle swelling, sense of increased weight, irritability, aggressiveness, depression, libido change, lethargy, food cravings

50
Q

Premenstrual Dysphoric Disorder PMDD

A

EMOTIONAL OR MOOD SYMPTOMS during luteal phase plus some physical symp
COMPLETELY RESOLVES W/ ONSET OF MENSES
CLEAR FUNCTIONAL IMPAIRMENT W/ WORK OR PERSONAL RELATIONSHIPS
-possible abn/fault building of progesterone in the brain= sedating
-abn serotonergic response in relation to sex hormones

track mood w/ cycle for 2 months

51
Q

tx of PMS and PMDD: lifestyle

A
  1. Exercise
  2. Reduce caffeine, salt, alcohol intake
  3. Increase dietary calcium, Vitamin D3, magnesium, complex carbohydrates
52
Q

tx of pms and pmdd: medications

A
  1. meds that PREVENT OVULATION= COC, patch, vaginal ring
  2. SSRIs for MOOD DISORDERS
  3. Magnesium + Vitamin B6
    -mag citrate= diarrhea so use Magnesium Glycinate
53
Q

Abnormal Uterine Bleeding/Heavy Menstrual Bleeding

A

Goal: decrease bleeding and decrease risk of endometrial hyperplasia or CA
ALERT: ALL AUB IN >35 YO IS CA UNTIL PROVEN OTHERWISE

definition of heavy menstrual bleeding
1. bleeding for >7 days
2. changing tampon/pad after less than 2 hours or
3. passing clots quarter size or larger

Ddx: PALM-COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulary dysfxn
Endometrial hyperplasia
Iatrogenic
Not yet classified

tx:
1st line:
COC
Progestin therapy= medroxyprogesterone acetate MPA, Prometrium OMP, Norethindrone (Aygestin)
Mirena IUD

Other:
NSAIDS to reduce blood loss by decline in protaglandin synth= VC = less effective than IUD or tranexamic acid

cant take hormone? = tranexamic acid

54
Q

Tranexamic acid

A

indication: HEAVY MENSTRUAL BLEEDING
class: antifibrinolytic agent
MOA: competitively blocks the conversion of plasminogen to plasmin-> reduction in fibrinolysis
taken only during menses
Contraind: prior DVT/PE, coagulopathy

55
Q

Endometriosis

A

Endometriosis= condition in which the type of tissue that forms the lining of the uterus is found outside the uterus-> plaques can breakdown and cause scar tissue= increase pelvic/abd pain
Adenomyosis: endometrium grows into the wall of the uterus
symp: heavy bleeding, painful periods, pelvic pain
Gold standard: DIAGNOSTIC LAPAOSCOPY

AMOUNT OF VISUAL DZ DOES NOT CORRELATE TO THE PAIN PT EXPERIENCES

TX: not a cure or decrease tissue= for pain only
1. NSAIDS= low cost, easily available-> celecoxib in pts desiring to get prego
Progestin only- good for those who cant have estrogen
1.COC= STOPS OVULATION bc ovulation feeds endometriotic plaques
Gonadotropin releasing hormone agonist or antagonist

Severe: tx causes long term bone loss
GNRH agonist= Lupron (leuprolide acetate)
GNRH antagonist= Orilissa (elagolix)
Aromatase inhibitors
surgery

56
Q

Polycystic ovarian syndrome

A

Clinical diagnosis
Rotterdam criteria: need 2 of the 3
1. Oligomenorrhea
2. Hyperandrogenism
3. Polycystic ovaries
symp:
Hyperandrogenism, hirsutism
nestrual dysfxn
tx:
1st line: COC for 6 months-> if hyperandrogenic symp then add
-Spironolactone- antiandrogen and diuretic
-finasteride- 5 alpha reductase type 2 inhibitor
-dutasteride- inhibits both 5-alpha reductase types 1 and 2
if insulin resistance
-metformin
-lifestyle = exercise, diet, adequate sleep, stress reduction

57
Q

Infertility: endometriosis and PCOS can cause infert

A

MOA of tx:
1. increase # of mature eggs
-Clomid=Selective estrogen receptor modulator (SERM)
-Femara= aromatase inhib= production of fewer follicles= less risk of multiple gestation
2. Induce ovulation
-GNRH releasing hormone analogs and antag
3. Acting directly of ovary to stimulate development of mature eggs
-human menopausal gonadotropin or hMG
-FSH

Metformin= for hyperinsulinemia can lead to increase in mestrual cyclicity

58
Q

Cervicitis/Vaginitis overview

A

inflammatorry vs infectious
symp: discharge, bleeding, dysuria, dyspareunia, irritation, edema
must do physical exam and approp swabs/testing to diag
DOWNLOAD CDC STI Tx app

59
Q

Cervicitis/vaginitis tx

A

EDUCATION: TX PT AND PARTNER= ABSTAIN FROM SEX DURING TX AND 7 DAYS AFTER TX= EXPEDIATED PARTNER THERAPY (EPT)
1. Chlamydia trachomatis- Doxycycline
2. Neisseria gonorrhea- Ceftriaxone
3. Mycoplasma genitalium- do Mgen resistance testing or Doxy followed by Moxifloxacin
if resistance testing:
-Macrolide sens: Doxy followed by Azithromycin
-Macrolide resistant: Doxy followed by moxiflozacin
4. Trichomonas vaginalis
-Men: Metronidazole 2 g
-Women- Metronidazole 500 mg
5. Herpes simplex virus-> look it up
6. Candida
-OTC: Clotrimazole, Miconazole
-script: diflucan
7. Bacterial Vaginosis (BV)- Metronidazole

Pharm 2 (15 decks)

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