Term
|
Definition
| increased BP, HR, RR, temp. blood fills nipples, clitoris, labia. Lubrication. Expansion of vagina. |
|
|
Term
|
Definition
| serotonin and oxytocin increase, rhythmic contractions of levators, uterus, vagina, generalized myotonia, gluteal and abdominal contractions, grimace |
|
|
Term
| changes during resolution 3 |
|
Definition
| reversal of all things in arousal and orgasm, perspiration, relaxation (all slower if no orgasm) |
|
|
Term
| % women with sexual dysfunction |
|
Definition
|
|
Term
| % women with sexual dysfunction that causes them distress |
|
Definition
|
|
Term
| definition sexual dysfunction |
|
Definition
| arousal, desire, orgasm, or pain disorder causing distress |
|
|
Term
| categories of sexual dysfunction 5 |
|
Definition
| hypoactive sexual desire disorder, sexual aversion disorder, sexual arousal disorder, orgasmic disorder, genitopelvic pain and penetration disorder |
|
|
Term
| 2 types of genitopelvic pain and penetration disorder |
|
Definition
|
|
Term
| 2 types of orgasmic disorder |
|
Definition
| primary - never had orgasm, secondary - had before cant now |
|
|
Term
| describe hypoactive sexual desire disorder |
|
Definition
| deficient or absent desire causing interpersonal difficulty |
|
|
Term
| describe sexual aversion disorder |
|
Definition
| adverse response to genital contact causing distress |
|
|
Term
| describe sexual arousal disorder |
|
Definition
| inability to attain or maintain excitement (lubrication, swelling) causing distress - no arousal phase |
|
|
Term
| describe orgasmic disorder |
|
Definition
| delay or absent orgasm following normal excitement phase |
|
|
Term
|
Definition
|
|
Term
|
Definition
| recurrent involuntary spasm of the outer 1/3 of the vagina |
|
|
Term
| prevalence of hypoactive sexual desire disorder |
|
Definition
|
|
Term
| average age hypoactivie sexual desire disorder |
|
Definition
|
|
Term
| how effective are we at treating hypoactive sexual desire disorder |
|
Definition
|
|
Term
| treatment options for hypoactive sexual desire disorder - 5 |
|
Definition
| HRT/OCPs, androgens, fibransterin, bremelanotide, buproprion |
|
|
Term
| medications that can cause hypoactive sexual desire disorder - 20 (categories) |
|
Definition
| antidepressant, steroids, antiHTN, statins, diuretics, immune suppressants, anticonvulsants, anticholinergics, antispasmodics, chemo, psychotropics, hypnotics, stimulants, sedatives, antiandrogens, decongestants, antivirals, antiarrhythmic, OCPs |
|
|
Term
| medical conditions that can cause hypoactive sexual desire disorder - 8 |
|
Definition
| surgical menopause, atrophy, endocrine disease, adrenal disease, pelvic surgery, depression, PTDS/hx trauma, pregnancy |
|
|
Term
| complications of androgen therapy for sexual desire - 5 |
|
Definition
| acne, facial hair, clitoromeagly, HLD, alopecia |
|
|
Term
| dosing and schedule of androgen therapy for sexual desire |
|
Definition
| 300mcg patch, DC if no response in 6mo |
|
|
Term
|
Definition
| serotonin agonist/antagonist, dopamine/NE receptor modulator |
|
|
Term
|
Definition
| dizziness, nausea, fatigue, weight loss, malignant mammary tumor, hypotension within 2h of ETOH |
|
|
Term
| contraindications fibransterin - 1 |
|
Definition
|
|
Term
|
Definition
| melatonin agonist promotes dopamine release giving perception of reward for sexual contact |
|
|
Term
|
Definition
| 1.75mg SQ 45m before intercourse |
|
|
Term
|
Definition
| nausea, flushing, site reaction, hypertension, hyperpigmentation, decreased gastric emptying |
|
|
Term
| contraindications bremelanotide - 4 |
|
Definition
| HTN, CVD, antibiotics, naloxone |
|
|
Term
|
Definition
|
|
Term
| cause of sexual aversion disorder |
|
Definition
|
|
Term
| tx sexual aversion disorder |
|
Definition
| psychotherapy, antidepressants for anxiety |
|
|
Term
| incidence of sexual arousal disorder |
|
Definition
|
|
Term
| risks for sexual arousal disorder - 8 |
|
Definition
| low SES, antidepressants, pelvic pain, relationship issues, spectorating, DM, MS, chronic disease |
|
|
Term
| incidence of genitopelvic pain disorder |
|
Definition
|
|
Term
| cause of primary orgasmic disorder - 2 |
|
Definition
|
|
Term
| treatment primary orgasmic disorder 2 |
|
Definition
|
|
Term
| cause of secondary orgasmic disorder - 7 |
|
Definition
| hypoactive sexual desire, pelvic sx, antidepressants, relationship issues, culture/religion, low SES, personality |
|
|
Term
| treatment secondary orgasmic disorder - 4 |
|
Definition
| therapy, masturabation, desensitization, communication |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypoactive sexual disorder, sexual aversion disorder, GYN pathologies, chronic disease, PTSD/trauma, psych disorders |
|
|
Term
|
Definition
|
|
Term
| diagnosis of genitopelvic pain disorder |
|
Definition
| pain with intercourse +1 -- muscle tightening, burning, hypoactive desire, avoidance, phobia of pain |
|
|
Term
|
Definition
|
|
Term
|
Definition
| atrophy, bartholins, OB lacerations, IBS, infection, endometriosis, fibroids, misplaced IUD, ovarian csyts |
|
|
Term
| treatment of dysparunea - 10 |
|
Definition
| PT, treat cause, E2, venlafaxine, TCA, luberication, intratosa, PV valium, PV vacifen, SERMS if PMP |
|
|
Term
| #1 sexual dysfunction disorder |
|
Definition
|
|
Term
| hardest sexual dysfunction disorder to treat |
|
Definition
|
|
Term
| % of PMP who have bothersome atrophy |
|
Definition
|
|
Term
| risks of vaginal atrophy 8 |
|
Definition
| age, oophorectomy, decreased sexual frequency, smoking, alcohol, lack of exercise, premature ovarian failure, absence of vaginal child birth |
|
|
Term
|
Definition
|
|
Term
| cellular changes vaginal atrophy |
|
Definition
| parabasal and intermediate cells, bacterial overgrowth |
|
|
Term
| treatment vaginal strophy - 5 |
|
Definition
| topical estrogen, intercourse, masturbation, osmpemifine, TCAs |
|
|
Term
| % that fail treatment for vaginal atrophy |
|
Definition
|
|
Term
| which form of vaginal estrogen has least side effects |
|
Definition
| tab and ring less than cream |
|
|
Term
| TCAs for vaginal atrophy will NOT help what symptom |
|
Definition
|
|
Term
|
Definition
| vulvar pain for 3mo without cause |
|
|
Term
|
Definition
|
|
Term
| how are OCPs related to vulvodynia |
|
Definition
| estrogen may affect sensory discrimination and pain sensitivity and innervation of estrogen related tissues increasing vulvodynia (+/- progesterone role?) |
|
|
Term
| algorythem for diagnosis of vulvodynia |
|
Definition
| rule out infection (KOH/WP/G/C/pH), do a swab test, if not painful consider MSK/psych, if painful get fungal culture, if positive treat fungus, if negative get biopsy to r/o dermatosis, if positive treat dermatosis, if negative teat vulvodynia |
|
|
Term
| muscles that may be involved in MSK origin of vulvodynia - 3 |
|
Definition
| pubovaginalis, urethrovaginal sphincter, obturator internus |
|
|
Term
| genitosensory analyzer,when is it used |
|
Definition
| used when patient is claiming vulvodynia but has a negative swab test or when has vestibulitis |
|
|
Term
| what is a genitosensory analyzers components - 4 |
|
Definition
| vaginal probe that measures temp, vibratory stimulation, pressure sensation, and neuro function |
|
|
Term
| initial treatment vulvodynia - 5 |
|
Definition
| vulvar acre, decrease dietary oxylates, stop OCP 3-6mo, pelvic PT, topical ointment |
|
|
Term
| what do they do at pelvic PT for vulvodynia - 6 |
|
Definition
| nerve stimulation, trigger point, joint manipulation, pelvic muscle PT, therapeutic US, dilation |
|
|
Term
|
Definition
| 100% cotton, no underwear at night, avoid irritants, mild soaps not applied to vulva, clean with water, pat dry, petroleum jelly or vegetable oil, lubication, cool gel packs, rinse and pat after urination |
|
|
Term
| topical treatment options for vu;vydynia - 2 |
|
Definition
|
|
Term
| PO treatment options for vulvodynia - 2 |
|
Definition
| TCA - #1 amytryptline, gabapentin |
|
|
Term
| procedural options for vulvydynia - 3 |
|
Definition
| steroid/bupivacaine injection, pudendal block, vesdibulectomy |
|
|
Term
| success rate for vestibulectomy for vulvydynia |
|
Definition
| 60-90% for secondary, less for primary |
|
|
Term
| success rate for non-surgical treatment of vulvydynia |
|
Definition
|
|
Term
| what is the #1 pre-qualification for vestibulectomy |
|
Definition
| no vaginismus or treated successfully |
|
|
Term
| where is a vestibulectomy done |
|
Definition
|
|
Term
| whas vestibulitis associated with |
|
Definition
| chronic pain disorders 1/3 |
|
|
Term
| work up for vestibulitis - 5 |
|
Definition
| genital sensory analyzer, PVR, cystourethroscopy, hormones if decreased desire, nerve eval |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| % that have early menopause |
|
Definition
|
|
Term
|
Definition
| cycle length 7d+ off occurring more than once within 10 cycles |
|
|
Term
|
Definition
|
|
Term
| define premature ovarian failure |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the stages of menopause |
|
Definition
-2 early premenopause
-1 late premenopause
+1a early PMP 1y
+1b early PMP 2y
+2c late PMP 3-6y
+2 PMP 2y+ |
|
|
Term
| changes in -2 menopause - definition, physiology, symptoms |
|
Definition
| early premenopause - intermittent ovulation, >3mo with amenorrhea at a time, no vasomotor yet |
|
|
Term
| changes in -1 menopause - definition, duration, symptoms |
|
Definition
| late premenopause - >60d without bleeding, 1-3y long, +vasomotor symptoms |
|
|
Term
| changes in +1a menopause - definition, labs, symptoms |
|
Definition
| 1y PMP, variable FSH, +vasomotor |
|
|
Term
| changes in +1b menopause - definition, labs, symptoms |
|
Definition
| 2y PMP, variable FSH, +vasomotor |
|
|
Term
| changes in 1+c menopause - definition, labs, symptoms |
|
Definition
| 3-6y PMP, stable FSH, +vasomotor less |
|
|
Term
| changes in +2 menopause - definition, symptoms, labs |
|
Definition
| 3-6y PMP, stable FSH, lesser vasomotor sx, increasing atrophy |
|
|
Term
| how long does a hot flash last |
|
Definition
|
|
Term
| how many years do hot flashes last for |
|
Definition
|
|
Term
| who has hot flashes for longer - 2 |
|
Definition
|
|
Term
| non-gyn changes in menopause - 8 |
|
Definition
| skin atrophy, decreased congnition, increased dementia/alzheimers, increased CVD, decreased HDL, increased TG/LDL, increased colon cancer |
|
|
Term
| why is there hair growth in PMP |
|
Definition
| previously estrogen was changed into testosterone which decreased DHT, now DHT can be high |
|
|
Term
|
Definition
| decreased collagen, thickness, GAG, elasticity, vascularity. Increased dryness and facial hair |
|
|
Term
|
Definition
| decreased superficial epithelial cells leading do decreased rugae, elasticity, vaginal shortening and narrowing, decreased SQ fat pads leading to narrow introitus and clutoral pupuce, decreased pH and secretions |
|
|
Term
| why does FSH increase in PMP - 3 |
|
Definition
| decreased granulosa cells, decreased follicles, decreased inhibin B (a FSH inhibitor) |
|
|
Term
| which decreases first in PMP FSH or LH |
|
Definition
|
|
Term
| 1st line treatment for PMP symptoms - 6 |
|
Definition
| decrease smoking, alcohol (<3/d), weight, stress. supplement D/Ca, increase exercise |
|
|
Term
| WHI - estrogen effects HRT - 1 |
|
Definition
|
|
Term
| WHI - progesterone effects HRT - 3 |
|
Definition
| increases breast cancer, decreases colon cancer, increases CVD/MI/CVA |
|
|
Term
| effectiveness of HRT for hot flashes |
|
Definition
|
|
Term
| who has increased risk of breast cancer with HRT |
|
Definition
|
|
Term
| who has decreased Fx with HRT |
|
Definition
|
|
Term
| who has decreased colon cancer with HRT |
|
Definition
|
|
Term
| who has increased CVD/MI/CVA with HRT |
|
Definition
|
|
Term
| who has decreased CVD/MI/CVA with HRT |
|
Definition
| potential patients recently PMP |
|
|
Term
| what does HRT do to lipids |
|
Definition
| increases HDL and decreases LDL |
|
|
Term
| percent of vaginal bleeding on HRT |
|
Definition
| 40% in first 4-6mo, 10-20% in 1y |
|
|
Term
| absolute contraindications to HRT - 5 |
|
Definition
| E2+ cancers, uterine cancer, active clot, undiagnosed vaginal bleeding, history of malignant melanoma |
|
|
Term
| relative contraindications to HRT - 6 |
|
Definition
| history of VTE, chronic liver disease, gall bladder disease, severe HLD, >60yo, endometriosis |
|
|
Term
| 3 types of progesterone for HRT - trade name, generic name, generation |
|
Definition
provera/medroxyprogesterone - 2nd gen
prometroim/micronized progesterone (medroxyprogesterone bioidentical) - 2nd gen
agystin/norethindrone - 1st gen
levenogesterol IUD - 2ng gen |
|
|
Term
| compare the "high dose" for all 3 forms of HRT estrogen |
|
Definition
| conjugated 0.625mg = E2 1mg = 0.05mg transdermal |
|
|
Term
| trade name and dosing for B2-E2 for HRT |
|
Definition
| estrace - 2-4g for 1-2wk --> 1-2g for 1-2wk --> 1g/d for 1-3wk |
|
|
Term
| trade name and dosing for conjugated equine estrogen HRT |
|
Definition
| Premarin - 0.5g for 21d --> 7d off --> 0.5g 2x/wk |
|
|
Term
| estrogen type in vaginal ring and dosing |
|
Definition
| B2-E2 - total 2mg - releases 7.5mg/d for 90d |
|
|
Term
| estrogen type and dosing for estrogen tabs |
|
Definition
| B2-E2 - 20mcg/d for 2wk --> 2x/wk |
|
|
Term
| types of HRT estrogen delivery that will improve UTI |
|
Definition
|
|
Term
| types of HRT estrogen delivery that will not improve UTI |
|
Definition
|
|
Term
| #1 for hot flashes on tamoxifen, why not others |
|
Definition
| venlafaxine, others have estrogen effect and paroxetine decreases tamoxifen efficacy |
|
|
Term
| only FDA approved non HRT for hot flashes |
|
Definition
|
|
Term
| drugs for PMP symptoms (non HRT) that need added progesterone for protection if a uterus |
|
Definition
|
|
Term
| #1 most effective non HRT for PMP symptoms with least side effects |
|
Definition
|
|
Term
| non HRT option for mood stability only |
|
Definition
|
|
Term
| non-HRT option for vaginal dysparunea and atrophy - 2 |
|
Definition
|
|
Term
| non-HRT options for hot flashes and their effectiveness - 5 |
|
Definition
| venlafaxine 40-60%, cloniine same as placebo, pareoxtine 50%, gabapentin 40-60%, bazedoxifine 52-86% (for comparison HRT is 40-60%) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 600-900 mg/d usually at night |
|
|
Term
| #1 non-HRT for night sweats |
|
Definition
|
|
Term
| #1 non-HRT for chronic pain comorbidity |
|
Definition
|
|
Term
| #1 non-HRT for HF if having SE that are intolerable |
|
Definition
| bazedoxifene decreased breast tenderness and vaginal bleeding |
|
|
Term
| method of treating HF that does not increase breast density |
|
Definition
|
|
Term
|
Definition
| SERM + conjugated estrogen |
|
|
Term
| which non-HRT methods for PMP sx decrease osteoporosis - |
|
Definition
| bazedoxifene, raloxefine (kinda not for PMP symptoms tho) |
|
|
Term
|
Definition
| hot flashes, muscle spasms, vaginal discharge, endometrial hyperplasia, CVA 1:1000, DVT 1:1000 |
|
|
Term
| non HRT PMP symptom drug with highest VTE risk |
|
Definition
| raloxefine 3x VTE from baseline |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| dry mouth, constipation, HA, dizziness |
|
|
Term
| 2 most common (non FDA approved) bioidenticals |
|
Definition
biest/biestrogen - 20% E2, 80% estrol
treist/triestrogen - 10% E2, 80% estrol |
|
|
Term
| FDA approved bioidentical - 2 |
|
Definition
| 17b-estradiol transdermal or oral, micronized progesterone (medroxyprogesterone) PO/PV |
|
|
Term
| does vaginal estrogen increase breast cancer |
|
Definition
|
|
Term
| % of women with osteoporosis >50yo |
|
Definition
|
|
Term
| % of women with osteopenia >50yo |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
cortical - 75% outer layer
testicular - 25% inner spongy layer |
|
|
Term
|
Definition
|
|
Term
|
Definition
| from 1y before to 3y PMP 6-7% loss |
|
|
Term
| drugs that increase risk of osteoporosis - 14 |
|
Definition
| steroids, GNRH agonists, heparin, PPT, antiseizure, cytotoxic drugs, supratheraputic thyroxine, lithium, SSRI, barbs, chemo, DPMA, calcinuein inhibitors, therzolinedione |
|
|
Term
| risk of osteoporosis by race |
|
Definition
| Caucasian > Asian > AA (who have 6% more bone mass) |
|
|
Term
| medical conditions that increase risk of osteoporosis - 12 |
|
Definition
| hypothyroid, DM, adrenal insufficiency, malabsorption disorders (caliac, gastric sx), pancreatic disease, RA, cancer, SLE, chronic renal disease |
|
|
Term
| prevention of osteoporosis in celiac disease |
|
Definition
|
|
Term
| social factors that increase risk of osteoporosis - 8 |
|
Definition
| smoking, thinness, >3 drinks/d, inactivity, low Ca intake, high caffeine, low D intake, falls |
|
|
Term
| recommended Ca per day - 3 categories |
|
Definition
30-50yo 1000 mg/d
>50yo on/has E2 1200 mg/d
>50yo no E2 1500 mg/d |
|
|
Term
| recommended daily vitamin D |
|
Definition
|
|
Term
| initial work up for osteoperosis - 5 |
|
Definition
| CBC, TSH, CMP, if starting on meds 24h urine Ca and vitamin D |
|
|
Term
| secondary work up for osteoporosis - 2 |
|
Definition
| protein electrophoresis, celiac pannel |
|
|
Term
|
Definition
|
|
Term
| factors for starting DEXA scans <65yo - 13 |
|
Definition
| fracture, family history of osteoporosis, dementia, smoker, BMI <27, low estrogen, low Ca intake lifetime, alcoholism, poor vision, inactive, falls, RA, FRAX 10y fx risk >9.3% |
|
|
Term
| after starting meds when do you repeat a DEXA |
|
Definition
|
|
Term
|
Definition
| T - normal young adult, Z- same age/sex/race |
|
|
Term
|
Definition
| (patient BMD - average BMD for age) / BMD SD for young adult |
|
|
Term
| what locations is a DEXA done for - 4 |
|
Definition
| hip, spine, forearm, shoulder |
|
|
Term
| contraindications to FRAX - 4 |
|
Definition
| <40yo, fracture, has osteoporosis, on osteoporosis meds |
|
|
Term
| components to a FRAX calculation - |
|
Definition
| age, sex, BMI, fragility fracture, FHX fracture, smoking, RA, steroids > 5mg/d for >3mo, >3 drinks/d |
|
|
Term
| where is a FRAX calculated from |
|
Definition
| T score of the femoral neck |
|
|
Term
| management of FRAX score - 3 scinerios |
|
Definition
>/=3% risk of hip fracture - treat
>/= 20% risk fracture in 10y - treat
>/= 9.3% risk fracture in 10y - start DEXA early |
|
|
Term
| management of DEXA results - 2 scenerios |
|
Definition
-1 to -1.5 - DEXA q15y
-1.5 to -1.99 treat if risks or FRAX >3% hip >20% major fx, DEXA q5y, start E2 if <10y PMP and risks
-2 to -2.5 TX if risks, FRAX >3% hip >20% fx, DEXA q1y, start E2 if PMP <10y
<-2.5+ - TX, DEXA q1y |
|
|
Term
| worst prognostic factor in osteoporosis |
|
Definition
| hip fracture >80yo = <60% of walking alone again |
|
|
Term
|
Definition
| aldronate, risedronate, zeldoeronate, ibandronate |
|
|
Term
|
Definition
| decrease osteoclast bone consumption |
|
|
Term
| effectiveness bisphosphonates |
|
Definition
|
|
Term
| where does each bisphosphone work best - 4 |
|
Definition
| aldronate - vertebrae, risedronate - non-vertebral, zeldoeronate - hip, ibandronate - no info |
|
|
Term
| #1 drug indicated for osteoporosis >60yo |
|
Definition
|
|
Term
| administration of the 4 bisphosphonates |
|
Definition
| aldronate PO Qwk, risedronate PO Qwk, zeldoeronate IV annual, ibandronate PO Qwk |
|
|
Term
| contraindications bisphosphonates - 3 |
|
Definition
| GI disorders for PO, inabilitity to sit 30 min for PO, CrCl <35 (esp for IV) |
|
|
Term
| complications bisphosphonates - 3 |
|
Definition
| jaw osteonecrosis (>8wk use, exposed jaw), bone pain, GERD/gastric ulcer |
|
|
Term
| in what scinerio are bisphosphonates most effective |
|
Definition
| T score <-2.5 in 3-5y use |
|
|
Term
|
Definition
| inhibits osteoclast consumption of bone, SERM |
|
|
Term
|
Definition
|
|
Term
| #1 osteoporosis drug <60yo |
|
Definition
|
|
Term
| #1 osteoporosis drug in breast cancer patietns |
|
Definition
|
|
Term
| #1 osteoporosis drug in severe osteoporosis |
|
Definition
|
|
Term
| where does raloxefine work best |
|
Definition
| spine > hip, dereases vertebral fx |
|
|
Term
| contraindications raloxefine - 2 |
|
Definition
|
|
Term
| complications of raloxefine - 1 |
|
Definition
|
|
Term
|
Definition
| causes RANK to decrease osteoclasts consumption of bone |
|
|
Term
| only osteoporosis medication that builds bone |
|
Definition
|
|
Term
| where does prolia work best, % effectiveness at each site |
|
Definition
|
|
Term
| indication for prolia in osteoporosis |
|
Definition
| high high risk of fractrue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypocalcemia, infection requiring hospitalization, osteonecrosis of the jaw |
|
|
Term
|
Definition
| inhibits osteoclasts consumption of bone |
|
|
Term
|
Definition
|
|
Term
| where does calcitonin work best |
|
Definition
|
|
Term
| #1 osteoporosis for bone pain |
|
Definition
|
|
Term
| #1 osteoporosis med for pagets pain |
|
Definition
|
|
Term
| administration calcitonin |
|
Definition
|
|
Term
| contraindications calcitonin |
|
Definition
|
|
Term
| complications calcitonin - 4 |
|
Definition
| flushing, nausea, local irritation, liver malignancy |
|
|
Term
|
Definition
| increases osteoblast building bone |
|
|
Term
| indication for rPTH/titraparatdc |
|
Definition
| T <-3.5 or T <-2.5 with fragility fracture |
|
|
Term
| contraindications rPTH/titraparatdc - 2 |
|
Definition
| non-severe disease, >2y use |
|
|
Term
| rPTH/titraparatdc complications - 1 |
|
Definition
|
|
