Treatment Flashcards
Microprolactinoma: Tx
Dopamine agonist (bromocriptine, cabergoline, pergolide) if patient wishes to get pregnant
Oral contraceptives if pregnancy not desired
**
Estrogen production is suppressed due to GnRH suppression; needed for bone health
PCOS: Tx
Weight loss & diet if obese
If pregnancy NOT desired:
Oral contraceptives or spironolactone
If pregnancy IS desired: letrozole or clomiphene citrate (clomid)
**
Oral contraceptives:
- estrogen component to counteract hyperandrogenism (estrogen increases SHBG production in liver)
- progesterone component counteracts effects of unopposed estrogen (= higher risk of endometrial cancer)
- Letrozole: aromatase inhibitor
- Clomiphene citrate: estrogen receptor antagonist
- Chronic unopposed estrogen is inhibiting FSH/LH levels in PCOS
Ectopic pregnancy: Tx
Surgery or methotrexate
Early pregnancy loss: Tx
D&C or misoprostol may be needed
Abortion: surgical options
First trimester:
- dilation and curettage (also called aspiration, uses cannula)
- extremely safe
Second trimester:
- dilation and evacuation (uses forceps)
- intact dilation and extraction (manual extraction with hands, very rarely done)
Abortion: medical options
Up to 9 weeks
- mifepristone and misoprostol
- ultrasound to ensure completion
Abortion: pros and cons of surgical vs medical
Surgical:
- higher efficacy
- done in one visit
- can be done at later time point
- patient does not need to see products of conception
Medical:
- more private, can pass as miscarriage
- avoid surgery and anesthesia
DVT or PE in pregnancy
IV heparin + O2 supplementation
Lovenox for outpatient administration
Do NOT use coumadin (teratogenic), unless mom was on it before and has mechanical heart valve
Gestational diabetes: Tx
Diet first Subcutaneous insulin (need to increase as GA increases)
Repeat glucose tolerance test at 6 wks
Chronic hypertension in pregnancy: Tx
Most women stop BP meds
If needed, use hydralazine, methyldopa, labetalol
Eclampsia/HELLP: Tx
Obstetric emergency - can induce labor
Meconium Aspiration Syndrome: Tx
Nitric oxide (reduce pulmonary vascular resistance)
Benign prostatic hyperplasia: Tx
First line: lifestyle
- restrict fluids before bedtime or going out
- decrease caffeine and alcohol intake
- double voiding to empty bladder completely
Medications:
- alpha adrenergic blocker (e.g. tamsulosin) - faster
- 5-alpha reductase inhibitor (e.g. finasteride) - longer-term
If refractory:
- transurethral resection of prostate (TURP)
Prostatic adenocarcinoma: Tx
If Gleason score = 6: active surveillance
Surgical:
- Radical prostatectomy
- External beam radiation, brachytherapy (local radiation)
If refractory:
- Androgen deprivation therapy (androgen receptor antagonists or testosterone/DHT synthesis inhibitors)
Fibroadenoma: Tx and prognosis
Monitor regularly; lumpectomy if pt desires
Prognosis:
- excellent, no increased future cancer risk
- hormonally sensitive: can regress after pregnancy or involute after menopause
