Menstrual Disorders, Endometriosis, and Infertility Flashcards


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1

Defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation (sx-free interval necessary for diagnosis)

PMS

2

List symptoms of PMS:

  • Depressed mood
  • Anxiety
  • Labile mood
  • Irritability/anger
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Fatigue
  • Appetite changes
  • Hypersomnia/insomnia
  • Feeling out of control/overwhelmed
  • physical/somatic sx
3

Defined as a multifactorial psychiatric disorder (more severe; sx-free period necessary for diagnosis)

PMDD

4

For PMDD, at least how many sxs must be present and how many core sx?

5; 1

5

List the symptoms that may be present for PMDD

  • Markedly depressed mood*
  • Marked anxiety*
  • Marked affective lability*
  • Marked anger or irritability*
  • Decreased interest in usual activity
6

Possible differential diagnosis for PMS/PMDD:

  • Hypothyroidism
  • Anemia
  • Endometriosis
7

Nonpharm tx for PMS/PMDD:

  • Increase exercise
  • Increase carbs
  • Vitamin and minerals
  • decrease caffeine, sugar, sodium
  • Smoking cessation
  • Alcohol restriction
8

Which supplements improve symptoms of PMS?

  • Calcium carbonate (1200 mg/d)
  • Vitamin B6 (50-100 mg/d)
9

What is the first line tx for PMS/PMDD?

SSRIs (Fluoxetine, paroxetine, sertraline)

10

Which SSRI should you make sure the woman is on adequate contraception before using?

Paroxetine

11

List alternative pharmacologic options for PMS/PMDD

  • SNRI (venlafaxine)
  • COC (Yaz)
  • GnRH agonist (Leuprolide)
  • Alprazolam
  • Buspirone
  • Spironolactone
12

PCOS increases the risk of which disease states?

  • Metabolic syndrome
  • HTN
  • Dyslipidemia
  • T2DM
  • CVD
13

PCOS is characterized by:

  • Hyperandrogenism
  • Ovulatory dysfxn
  • Polycystic ovaries
14

Which oral contraceptive is approved for PMS/PMDD and has antiandrogenic effects?

Yaz

15

Clinical presentation of PCOS:

  • Menstrual disorders
  • Infertility
  • Hirsutism
  • Acne
  • Male pattern hair loss
  • Abdominal obesity
  • Pregnancy complications
  • Insulin resistance
  • Mood disturbances
16

PCOS is diagnosed with at least two of the following:

  • Hyperandrogenism
  • Polycystic ovaries
  • Oligomenorrhea / amenorrhea
17

Nonpharm tx for PCOS:

  • weight loss
  • exercise
18

First line agent in PCOS for ovulation induction in pts wanting to become pregnant:

Clomiphene (Clomid)

19

Clomiphene MOA

increases LH/FSH leading to ovulation

20

Clomiphene SE:

  • Hot flashes
  • Breast discomfort
  • Increased risk of multiple births
21

Metformin MOA

  • Inhibits hepatic glucose production = decreased insulin and androgen levels
  • May increase ovulation in some women
22

List insulin sensitizing agents that may be used in PCOS

  • Metformin
  • Thiazolidinediones
23

List pharmacologic agents that may be used for PCOS

  • Clomiphene
  • Metformin
  • TZDs
  • Spironolactone
  • COCs
24

TZD MOA

  • Reduce reduction of androgen production in ovaries
  • May increase ovulation in some women
25

Which PCOS agent should be used with an oral contraceptive due to risk of causing feminization of the male fetus in pregnancy?

Spironolactone

26

T/F: COCs with nonandrogenic progestin (i.e. drospirenone) is useful in treating hyperandrogenisms and hirsutism.

True

27

Define endometriosis

Endometrial-like tissue outside of the uterus causing chronic pain and infertility

28

Endometrial lesions are caused by overproduction of ______________

Prostaglandins and estrogen

29

List the three forms of endometriosis

  • Peritoneal
  • Endometriomas
  • Rectovaginal endometriotic nodule
30

Which form of endometriosis:

Endometriotic implants on the surface of pelvic peritoneum and ovaries

Peritoneal

31

Which form of endometriosis:

Ovarian cysts lined by endometroid mucosa

Endometriomas

32

Which form of endometriosis:

Solid mass of endometriotic tissue w adipose and fibromuscular tissue bw the rectum and vagina

Rectovaginal endometriotic nodule

33

Risk factors for endometriosis:

  • Genetics
  • Low birth weight
  • Short menstrual cycle
  • Obstruction of menstrual outflow
  • Exposure to DES in utero
  • Exposure to endocrine-disrupting chemicals
  • Prolonged exposure to endogenous estrogen
34

Protective factors for endometriosis

  • Prolonged lactation
  • Multiple pregnancies
  • Regular exercise (>4hrs/wk)
  • Diets high in fruits and vegetables
35

T/F: the only way to definitively diagnose endometriosis is via surgical peeping at them lesions

True

36

List signs and symptoms of endometriosis

  • Asymptomatic
  • infertility
  • Dyschezia
  • dysmenorrhea
  • dyspareunia
  • chronic pelvic pain
  • Enlarged ovaries
  • Pelvic tenderness
  • Lesions
  • retroverted uterus
37

First line tx for endometriosis

  • Combined hormonal contraceptives (CHC) -- most common
  • Oral progestins
  • Depo-Provera (DMPA)
38

Alternative drug therapies for endometriosis

  • Transdermal/vaginal CHCs
  • Mirena (FDA approved)
  • GnRH agonists
  • Danazol
  • NSAIDs
  • Aromatase inhibitors
39

Which type of dosing is most effective for oral CHCs in endometriosis?

Continuous

40

MOA of CHC therapy in endometriosis

↓ menstrual flow and endometrial implants; leads to hypoestrogenic state; causes decidualization of endometrial tissue

41

MOA of progestins in endometriosis

  • May inhibit ovulation
  • Causes decidualization of endometrial tissue reducing INF
  • Creates hypoestrogenic state
42

MOA of GnRH agonists in endometriosis

Creates fxnl oophorectomy via inhibition of FSH and LH = ↓ estrogen levels

43

List the AEs that limit the use of GnRH agonists in endometriosis

  • Bone loss
  • Depression
  • insomnia
  • skin texture changes
  • ↓ libido
  • vasomotor sx
44

MOA for danazol in endometriosis

inhibits FSH and LH creating a high androgen, low estrogen environment

45

Danazol AEs:

  • Teratogenic
  • Androgenic SEs
    • Weight gain
    • acne
    • hot flashes
    • ↓ breast size
    • hirsutism
    • increased LDL
46

Danazol BBW

  • Hepatic effects
  • intracranial HTN
  • TE
  • pregnancy
47

LT use of NSAIDs in endometriosis is limited by:

GI and renal toxicity

48

MOA of aromatase inhibitors in endometriosis

Inhibits estrogen production

49

List examples of aromatase inhibitors

  • Anastrozole
  • Letrosole
50

Aromatase inhibitor SEs

  • Hot flashes
  • Vaginal dryness
  • Loss of BMD
51

T/F: Laparoscopy is recommended in adolescents after first-line medical tx failure

True

52

T/F: Pain should be relieved w/in 2 mo of initiating medical therapy for endometriosis

True

53

List risk factors for infertility in women:

  • Age
  • Exercise
  • Smoking
  • Alcohol/drug use
  • Over/underweight
  • Hx of pelvic inflammatory dz (PID) or sexually transmitted infections
54

List risk factors for infertility in men

  • Age
  • Smoking
  • Alcohol/drug abuse
  • Overweight
55

List medications known to increase prolactin levels

  1. Chlorpromazine
  2. Cimetidine
  3. Estrogen
  4. Haloperidol
  5. Medroxyprogesterone acetate
  6. Phenothiazines
  7. Pimozide
  8. Reserpine
  9. TCAs
  10. Methyldopa
56

List meds and substances known to decrease sperm activity

  1. Allopurinol
  2. Colchicine
  3. Anabolic/adrogenic steroids
  4. Nitrofuratoin
  5. Caffeine
  6. Spironolactone
  7. CCBs
  8. Sulfasalazine
  9. Chemo
  10. Tetracycline
57

Which infertility pharmacotherapy agents would be used for inducing ovulation?

  • Human chorionic gonadotropin (hCG)
  • Recombinant hCG (r-hCG)
  • SERM (clomiphene)
  • Follitropins
  • Gonadotropins Menotropins
  • Aromatase inhibitors
58

Non-pharm tx for infertility:

  • BMI <27 (avoid excess dieting/overstrenuous exercise)
  • Avoid activities known to interfere w fertility
  • Take multivitamin
  • Avoid water-based lubricants
59

Risks associated w infertility tx:

  • Multiple gestation (twins)
  • Ovarian hyperstimulation syndrome
    • weight gain >2.25 kg
    • ab/pelvic pain
    • N/V/D
    • Dyspnea, dizz
    • Oliguria
60

Which infertility pharmacotherapy agents would be used for hyperprolactinemia?

DA agonist

61

Which infertility pharmacotherapy agents would be used for hyperinsulinemia?

Biguanide

62

Which infertility pharmacotherapy agents would be used for hypogonadotropic hypogonadism?

  • Human chorionic gonadotropin (hCG)
  • Recombinant hCG (r-hCG)
63

Which infertility pharmacotherapy agents would be used as an adjunct to ART?

  • Progesterone
  • GnRH agonist
64

Which infertility pharmacotherapy agents would be used as an adjunct to controlled ovarian hyperstimulation (COH)?

GnRH agonist/antagonist

65

Examples of gonadotropins used for infertility tx:

Menotropins for injection

66

Menotropins for injection counseling:

↑ risk of ovarian hyperstimulation syndrome (OHSS) ad multiple births

67

List examples of hCG and r-hCG

Novarel (hCG) and Pregnyl (r-hCG)

68

hCG and r-hCG counseling

May result in false positive pregnancy test; r-hCG preferred

69

hCG and r-hCG dosage form

IM

70

Clomiphene dosage form

Oral

71

Menotropins dosage form

SQ, IM

72

Follitropins indication

Infertility when clomiphene is inadequate

73

Follitropins dosage form

SQ, IM

74

Follitropins counseling

↑ risk of OHSS and multiple births; Gonal-F only available SQ

75

List examples of GnRH agonists

  • Leuprolide (Leupron Dot)
  • Triptorelin (Trelstar)
76

GnRH agonists indication

Adjunct tx to COH (leuprolide) and adjunct to ART (Triptorelin) in infertility tx

77

GnRH agonists counseling

Causes vasomotor sx, monitor bone loss

78

GnRH agonists dosage form

IM

79

List examples of GnRH antagonists

  • Ganireliz (Antagon)
  • Cetorelix (Cetrotide)
80

GnRH antagonists indication

Adjunct to COH in infertility tx

81

GnRH antagonists dosage form

SQ

82

GnRH antagonists counseling

↑ risk of OHSS and ab pain

83

Progesterone indication in infertility:

Adjunct to ART

84

Progesterone dosage form (infertility tx)

Intravaginal gel

85

Progesterone counseling

May cause ab cramps, bloating, vaginal discharge, and breast pain

86

List examples of DA agonists used in infertility

  • Bromocriptine (Parlodel)
  • Cabergoline (Dostinex)
87

DA agonists indication (infertility)

Hyperprolactinemia only

88

DA agonists dosage form

Oral

89

DA agonists counseling

Generally well tolerate, may cause N/V

90

List examples of aromatase inhibitors

  • Letrozole
  • Anastrazole
91

Indication for aromatase inhibitors

Ovulation induction

92

aromatase inhibitors dosage form

Oral

93

aromatase inhibitors counseling

May cause hot flashes, vaginal dryness, loss of BMD

94

Indication for metformin in infertility

Hyperinsulinemia

95

Metformin counseling

May cause D/N/V

96

When should a physician be notified in regards to infertility tx (Signs of OHHS)?

  • Nausea
  • Pelvic pain
  • Decreased urine output
  • Weight gain >2.25 kg
  • Dizziness
  • Short of breath