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Therapeutics Other Lynch
Final PMS and PMDD
24
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04/26/2011

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Cards

Term
ACOG PMS Diagnosis
Definition

Patient must have:

  • > 1 affective symptoms
  • > 1 somatic symptoms
  • Begins at least 5 days prior to onset of menses, for 3 consecutive cycles, and ceases within 4 days of the onset of menses
Term
Affective Symptoms
Definition
  • Depression
  • Angry outbursts
  • Irritability
  • Anxiety
  • Confusion
  • Social withdrawal
Term
Somatic Symptoms
Definition
  • Breast tenderness
  • Abdominal bloating
  • Headache
  • Swelling of extremities
Term
Other symptoms of PMS
Definition
  • Insomnia
  • Hypersomnia
  • Mastalgia
  • Bloatedness
  • Weight gain
  • Joint pain
  • Generalized pain
  • Relationship issues
  • Worsening of underlying disorders (criminal behavior, suicidal ideation, absenteeism)
Term
PMDD Diagnosis
Definition
  • PMS symptoms must persist for a year
  • Must clearly differentiate from a catamenial trigger of other underlying disorders
Term
Risk Factors for PMS and PMDD
Definition
  • Age > 30 yrs
  • Family history (mother and sisters)
  • Stress (?) or response to stress
  • History of traumatic events (childhood sexual abuse, severe accidents, severe physical threat history)
Term
PMS and PMDD appear to be mediated by a sensitivity to the _______ levels in the luteal phase
Definition
Progesterone
Term
PMS and PMDD only occur in ________ women
Definition
Ovulating
Term
Catamenial Disorders
Definition

Triggered by premenstrual period and do not count as diagnosis of PMS or PMDD

  • Seizures
  • Migraines
  • Irritable bowel disease
  • Diabetes
  • Asthma
  • Rheumatoid arthritis
Term
Treatment of PMS and PMDD: Non-Pharm
Definition
  • Education of expectations
  • Aerobic exercise
  • Stress management
  • Accupressure and accupuncture
  • Chiropractic adjustment (?)
  • Phototherapy
  • Cognitive behavioral therapy
Term
Dietary Modifications for PMS
Definition

Increase carbs

  • Helps with mood, memory, carbohydrate craving
  • Complex carbs are less likely to be craved, but may satisfy cravings with less weight gain

Decrease sodium, alcohol, and caffeine

  • Helps with water retention and mood
  • May be related to magnesium deficiency

Low fat high figer diet throughout the month

  • May lessen excursions of estrogen and progesterone through the cycle
Term
Vitamin supplementation for PMS
Definition

Vitamin B6

  • 50-100mg/day
  • >100mg/day may lead to neuropathies

Calcium

  • Shows benefit in reduction of water retention, food cravings, and generalized pain
  • 1200-1500mg/day (divided) of calcium carbonate
Term
Chasteberry
Definition
  • May reduce irritability, mood alteration, anger, headache, and breast tenderness
  • May alter estrogen and progesterone production by corpus luteum
  • Should NOT be used during pregnancy or lactation
  • 20mg/day MAX dose
Term
Ginkgo biloba
Definition
  • Improve breast tenderness, fluid retention, mood
  • May increase bleeding risk, and has multiple CYP450 interactions
Term
St. John's Wort
Definition
  • Similar but less side effects as SSRI's
  • More drug interactions than SSRI's
  • Should not generally be recommended
Term
Evening Primrose Oil
Definition
  • Used to treat PMS symptoms for centuries
  • Not effective in clinical trials, except for the reduction of breast pain and tenderness
Term
NSAIDs
Definition
  • May help reduce generalized pain and breast tenderness
  • Dose starting on day 15 through 5 of cycle
  • Dose around the clock rather than PRN
  • Naproxen is moderately superior to ibuprofen
Term
Spironolactone
Definition
  • May help treat the symptoms of breast tenderness, bloating, and fluid weight gain
  • Some sources suggest using only in women with regular weight gain > 3 lbs during luteal phase of cycle
Term
Bromocriptine
Definition
  • Dopamine agonist
  • Reduces prolactin levels
  • Usefulk only to treat breast symptoms (pain, tenderness, fullness)
  • Cautious use in those with HTN
  • Should NOT use in those with seizure disorders
Term
SSRIs
Definition
  • DOC for severe PMS and PMDD
  • Improves all psychological and many physical manifestations of the disease
  • PMS symptoms respond much quicker than does depression to SSRI therapy
  • The use of intermittent SSRIs is typically as effective with fewer toxicities
Term
SSRI used for PMS and PMDD
Definition
Fluoxetine
Term
Which OC is superior to other OC containing other progestins?
Definition
  • COP containing drosperinone (YAZ)
  • Has anti-mineralocorticoid and pro-estrogenic effects
Term
What drugs cause chemical oopherectomy and is used for PMS and PMDD?
Definition
  • GnRH Agonists
  • Leuprolide, Danazol
  • Results in initial surge of LH and FSH, but within 1-4 weeks, results in suppression of LH and FSH
Term
How long are GnRH agonists used for?
Definition
  • No more than 6 months 
  • Will cause hot flashes and may cause osteoporosis