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Pharm Spring 2023 > Womens Health > Flashcards

Womens Health Flashcards

1
Q

What does follicular stimulating hormone (FSH) do?

A
  1. Spurs follicle development and causes estrogen surge
    *peaks on 14th day, triggers ovulation and locate release
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2
Q

What does estrogen and progesterone do to the uterus?

A
  1. The endometrium will thicken for an embryo
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3
Q

What happens to the uterus when estrogen and progesterone is low during the menstrual cycle?

A
  1. The blood sloughs off the lining causing spotting
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4
Q

What does progesterone do to the cervical mucus?

A
  1. Will thicken the cervical mucus and body temperature will increase
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5
Q

What does estrogen do to luteinizing hormone (LH) and follicular stimulating hormone (FSH)

A
  1. Estrogen causes LH and FSH to surge
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6
Q

What does the surge of LH and FSH do?

A
  1. Causes the oocyte (egg) to release from the ovary into the fallopian tube
    *egg lives here for 24 hours once released
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7
Q

What do you need to trigger ovulation?

A

LH and FSH

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8
Q

What is the MOA of hormonal contraceptives?

A
  1. They will inhibit production of FSH and LH to prevent ovulation
  2. They alter cervical mucus, inhibiting sperm from penetrating egg
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9
Q

What are the different types of hormonal contraceptions /

A
  1. Combined oral contraceptives (COCs)
    *Estrogen + Progestin
  2. Progestin only
  3. Non-oral combined hormonal
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10
Q

What do combined hormonal contraceptives contain? (COCs)

A
  1. Estrogen ethinyl estradiol (EE) and a progestin
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11
Q

What are the different formulations of combination oral contraceptives?

A
  1. Monophasic
    *Same dose of estrogen and progestin throughout the pack
  2. Biphasic, triphasic, and quadriphasic
    *mimic estrogen and progesterone levels during menstrual cycle
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12
Q

What does Lo mean for combined oral contraceptives?

A

<35mcg estrogen, which means there is less estrogen to cause less estrogenic side effects

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13
Q

What does Fe mean? For combined oral contraceptives

A

An iron supplement is included

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14
Q

What does 24 mean for combined oral contraceptives

A

There is a shorter placebo time (EX 24 active + 4 placebo = 28 d cycle)

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15
Q

What is Lo loestrin Fe?

A

This combined oral contraceptive is the lowest dosed estrogen on the market
*10 mg

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16
Q

What will extended cycle COCs have? (Period every 3 months)

A
  1. There will be >21 days of active hormone
    *will minimize blood loss
    *may improve menstruation-related problems (dysmenorrhea)
    *eliminated withdrawal bleeding
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17
Q

What type of pills are recommended for extended cycling?

A
  1. Monophasic pills (same dose of estrogen and progestin throughout the pack)
    *there is an increased risk for breakthrough bleeding with others
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18
Q

What would women do prior to the development of extended cycle COCs?

A
  1. Women on standard 21/7 days packs could choose to “skip a period” by not taking the placebo pills
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19
Q

What are the progestin only oral contraceptives?

A
  1. Mini pills
    *Errin
    *camilla
    *Nora BE
  2. Norethindrone 35mcg
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20
Q

How can progestin only OC be taken?

A
  1. Taken daily with no placebo or pill free interval
  2. Can start on any day of the cycle, just keep timing consistent
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21
Q

How long does it take for progestin only OC to start working?

A
  1. Works within 48 hours
    *If you miss a dose >3 hours use an alternative contraception for the next 48 hours
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22
Q

How do hormonal contraceptive primarily work by?

A

Inhibiting the production of LH and FSH
*inhibiting them will prevent ovulating by altering cervical mucus. Which will prevent the sperm from reaching the egg

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23
Q

What hormones are contained within a combined hormonal contraceptive?

A
  1. Progestin
  2. Estradiol (Estrogen)
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24
Q

What are the synthetic estrogens?

A
  1. Ethinyl estradiol
  2. Mestranol
  3. Estradiol valerate
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25
Q

What is primary amenorrhea?

A

Absence of spontaneous menstruation by 15 years old thereafter

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26
Q

What is secondary amenorrhea?

A
  1. Prior normal menses and absence of menses for 90+ days
    OR
  2. Irregular menses and absent for 6+ months
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27
Q

What are the common causes of secondary amenorrhea?

A
  1. Pregnancy
  2. MC for women in competitive sports
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28
Q

What do you need to rule out when a patient presents with amenorrhea?

A
  1. Pregnancy (get and hCG)
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29
Q

What is primary dysmenorrhea

A

Painful menstruation
1. There is excess prostaglandin and leukotriene levels which CREATES uterine cramping

30
Q

When is the onset of dysmenorrhea?

A
  1. Within 2 years of menarche
  2. Peaks late teens/ early 20s
31
Q

When does primary dysmenorrhea occur?

A
  1. During menses
32
Q

What is secondary dysmenorrhea?

A
  1. There is an underlying pathology
    *endometriosis, PID, etc
  2. It is less related to first day of flow
33
Q

What is the first-line treatment of dysmenorrhea?

A
  1. NSAIDS just before menses or with onset continue for 2-3 days (take with food)
  2. If a class of NSAIDS doesn’t work switch to another one
    *Ibuprofen for naproxen
  3. Oral contraceptives
34
Q

How are oral contraceptives used to treat dysmenorrhea?

A
  1. It will reduce ovulation which will decrease uterine prostaglandin levels and menstrual flow
35
Q

What can be used in adjunct and alternative forms of treatment for dysmenorrhea?

A

Adjunct: Heat and regular exercise
Alternative: Vitamin B, magnesium, acupuncture

36
Q

What forms of therapies may help a 17 year old patient living with dysmenorrhea for whom lifestyle changes have not proved helpful?

A

OTC ibuprofen

37
Q

What is Premenstrual syndrome? (PMS)

A
  1. Happens about 1-2 weeks prior to menses (luteal phase) and 1-2 days after onset
  2. There will be mood alteration and psychological effects
38
Q

What is premenstraul dysphoric disorder PMDD?

A
  1. PMS that is so severe enough to cause dysfunction in daily living
39
Q

What are the MC Affective signs and symptoms of PMS?

A
  1. Irritability
  2. Depression
  3. Anxiety
40
Q

What are the MC physical signs and symptoms of PMS?

A
  1. Fluid retention (bloating)
  2. Headache
  3. Breast pain
41
Q

What are the treatment options for PMS?

A

First-line: Non drug therapies (life-style changes)
Second-line: NSAIDS
Third-line: Prescription drug therapy (OC)

42
Q

What type of lifestyle modification may be helpful in the treatment of PMS?

A

1, caffeine reduction
2. Salt restrictions
3. Low dairy
4. Low-fat

43
Q

What is the preferred OC for treatment of PMS?

A
  1. Monophasic products preferred
44
Q

Can SSRIs be used for treatment of PMS?

A

Yes
*sertraline
*Fluoxetine
**start during lateral phase

45
Q

What to use for PMS when SSRIs do not relieve symptoms?

A

Anxiolytics
*Alprazolam
*Buspirone

46
Q

What are the adverse reactions of NSAIDS (PMS treatment)

A
  1. Stomach upset (take with food)
  2. Bleeding
  3. GI ulcer
  4. Worsening HTN
  5. Hyperkalemia
    6.Impaired renal function
47
Q

What are some (rare) serious reactions of NSAIDS (PMS treatment)

A
  1. Skin reaction
  2. Stevens Johnson Syndrome (disorder of the skin and mucous membranes)
  3. Risk of stroke/thrombotic events
48
Q

What does vitamin B6 100mg do for PMS?

A
  1. May improve symptoms (breast tenderness, depression )
  2. Do NOT recommend doses over 100mg/day
    *can cause peripheral neuropathy
49
Q

What does vitamin E 400 IU daily X 3 cycles do for PMS?

A
  1. May help mood, reduce anxiety, food cravings, and breast pain
50
Q

What are other Vitamins/mineral supplements that can be used to treat PMS?

A
  1. Calcium carbonate 1000-1200mg of elemental calcium daily
  2. Magnesium 360 mg/day
51
Q

What is an appropriate first line treatment for clinical dysmenorrhea in a patient with a history of a GI bleed 6 months ago?

A
  1. Loestrin 24 Fe
52
Q

What therapy can help an 18 year old patient living with PMS characterized by underlying symptoms of anxiety around menstruation?

A
  1. Vitamin E
  2. Sertraline
53
Q

What population of women is endometriosis common in?

A
  1. Nulliparous women
    *A woman who has never given birth either by choice or for any other reason
54
Q

What is the first-line treatment of endometriosis?

A
  1. Hormonal contraceptives +/- oral NSAIDS
55
Q

What type of Hormonal contraceptives are used for endometriosis?

A
  1. Combined or progestin only
    *reduce dysmenorrhea and heavy bleeding
56
Q

What are alternative forms of treatment after the first-line/ (endometriosis)

A
  1. Progestins
  2. Danazol
  3. GnRH-a
57
Q

What are the rules for starting an combined oral contraceptive?

A

Menstrual start
*within the first 5 days of menstruation (effective immediately)
Random start
*If the COC is started on any other days than the first 5 days of bleeding it will take 7 days to work

58
Q

What are the first-line treatments for a patient presenting with dysmenorrhea, dyschezia (difficulty pooping), intermittent spotting, pelvic pain, and infertility and all the s/Sx point to endometriosis?

A
  1. Estrogen + progestin
  2. Progestin only
59
Q

What are the treatment options for menopause?

A
  1. Estrogen-progestin products
    *most effective for vasomotor symptoms is systemic hormone therapy with estrogen
  2. Formulation consideration
    *transdermal, local (topical) and low-dose oral estrogen products
    *Lower risk of VTE
60
Q

What are the SE of estrogen?

A
  1. Mood changes
  2. Vaginal bleeding
  3. Bloating and breast tenderness
61
Q

What are the treatment options for local vaginal symptoms of Menopause?

A
  1. Local estrogen is preferred
    *lubrication
    *astroglide
62
Q

What are most estrogen effective for?

A

Vasomotor Sx
*women with a uterus they need to use estrogen with progesterone

63
Q

What does unopposed estrogen increase the risk of?

A

Endometrial cancer

64
Q

What are the BBB for estrogen

A
  1. VTE
  2. Stroke
  3. Dementia
  4. Breast cancer
65
Q

When is it okay to use hormone therapy for healthy symptomatic women (Menopause)

A
  1. When the women are within 10 years of menopause
  2. <60 years old
  3. no contraindications
    *if there are risk factors use non-hormonal tx
    *SSRI, SNRI, gabapentin, pregabalin
66
Q

What are the common hormone therapy products for local symptoms of menopause

A
  1. 17 Beta Estradiol
  2. Conjugated equine estrogens
67
Q

What are common hormone therapy products when there are systemic symptoms of menopause

A
  1. 17 beta estradiol
  2. Estradiol
  3. Conjugated Equine Estrogens
  4. Medroxyprogesterone
  5. Micronized progesterone
68
Q

What are the BBB of systemic hormone therapy for menopause?

A
  1. Endometrial cancer
  2. Dementia >65
  3. Increased risk of stroke and VTE
  4. Breast cancer
    *weight gain (SE)
69
Q

What are the CI of systemic hormone therapy for menopause?

A
  1. Estrogen- containing products
  2. Undiagnosed uterine bleeding
  3. Active VTE
  4. Pregnancy
70
Q

When is Paroextine used for menopause?

A
  1. During moderate-severe vasomotor symptoms
    *takes about 4 weeks to see effects
    BBB: suicide risk
    SE: Sexual (increased/decreased libido)
71
Q

What is Ospemifene (menopause treatment)

A
  1. Oral estrogen agonist/antagonist for dyspareunia
  2. 60mg PO with food
  3. Short term for moderate-severe symptoms of menopause
  4. Avoid in women with severe hepatic impairment

Pharm Spring 2023 (27 decks)

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