Week 2: Disorders related to Menstruation

Question 1

Patients excluded from self treatment are those that have ____.

Answer 1

1. severe dysmenorrhea and or heavy bleeding
2. secondary dysmenorrhea
3. using if IUD
4. bleeding disorders (NSAIDs increase the risk of bleeding)
5. active GI disease (NSAIDs can cause or worsen ulcers)

Question 2

The pharmacologic therapy _____ is used to DECREASE PROSTAGLANDIN PRODUCTION for treatment of primary dysmenorrhea.

Answer 2

NSAIDs

Question 3

Using ____ for primary dysmenorrhea should begin the DAY BEFORE MENSES or as soon as menses begins. It is NOT PRN and should be taken as regular, scheduled doses for 3-5 days.

Answer 3

NSAIDs

Question 4

What are 3 non-pharmacologic ways to TREAT primary dysmenorrhea?

Answer 4

1. hot baths
2. heating pads
3. massage

Question 5

What are 3 non-pharmacologic ways to PREVENT primary dysmenorrhea?

Answer 5

1. smoking cessation
2. fish oil supplement
3. regular exercise

Question 6

Take calcium in ____.

Answer 6

divided doses

Question 7

Non-Rx doses are usually insufficient. What should you recommend?

Answer 7

approach the max non-Rx dose first - then go to Rx dosing if not sufficient.

example: Advil 600 mg (3 tabs) PO TID-QUID

Non-Rx max = 1200 mg
Rx max = 3200 mg

Question 8

Describe the rational behind using NSAIDs over APAP/ASA for dysmenorrhea.

Answer 8

Acetaminophen is a:

• WEAK inhibitor of prostaglandin synthesis.
• used only for MILD symptoms
• the max dosage of 4 g/day is LESS effective than ibuprofen

Question 9

Counsel a patient on use of a heat patch.

Answer 9

1. do NOT apply on the skin
2. apply adhesive side on UNDERGARMENT
3. it takes about 30 minutes to reach max temperature
4. each patch lasts for 8 hours
5. do NOT apply the patch for more than 8 hours in the same location in 24 hours
6. do NOT microwave or reheat the patch
7. follow instructions to PREVENT BURN
8. caution in patients with PERIPHERAL NEUROPATHY

Question 10

Other therapies that might help with PMS is _____ which is also helpful in prevention of osteoporosis.

Answer 10

calcium (1200 mg/day) + vitamin D (600 IU/day)

Question 11

Dysmenorrhea are menstrual cramps that cause pain DUE TO _____.

Answer 11

increase in PROSTAGLANDINS leading to uterine contraction

Question 12

____ dysmenorrhea symptoms begin 6-12 months after menarche. They are cyclic in nature and are directly related to the onset of menstruation. You may self treat.

Answer 12

primary

Question 13

In primary dysmenorrhea, there are cramp-like lower abdominal pains at the time of menstruation in the ____.

Answer 13

absence of pelvic disease

Question 14

___ dysmenorrhea is associated with pelvic pathology. You do NOT self treat.

Answer 14

secondary

Question 15

What is the rational behind using the pharmacologic therapy of PAMABROM and CAFFEINE for dysmenorrhea?

Answer 15

pamabrom and caffeine are diuretics and reduce bloating

Question 16

What is the rational behind using the pharmacological therapy of PYRILAMINE for dysmenorrhea?

Answer 16

pyrilamine is an antihistamine and reduces irritability

Question 17

Pamprin All day is the same as _____.

Answer 17

Naproxen sodium 220 mg

Question 18

Other therapies that might help with PMS is _____ in which you CANNOT EXCEED 100 mg/day due to risk of peripheral neuropathy (which is the sensation of prickling, tingling, creeping on skin; also muscle weakness, stinging, burning, itching sensation)

Answer 18

Pyridoxine (Vitamin B6)

Question 19

____ is recommend for patients who are on PPI.

Answer 19

calcium citrate

Question 20

____ is FAT soluble and is needed for calcium absorption. Counsel the patient to take with food that has some fat (Egg, salad dressing).

Answer 20

Vitamin D