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Women's Health
Pharmacotherapy Exam 3
107
Pharmacology
Professional
03/29/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
PMS
Definition
physical and behavioral symptoms that occur repetitively in the SECOND HALF of the menstrual cycle
Term
PMDD
Definition
most sever form of PMS, quality of life is significantly affected
Term
causes of PMS and PMDD
Definition
not fully known, interaction of hormones and seratonin NT, hypothalamic-pituitary-gonadal (HPG) axis involvement, stress and poor eating habits
Term
2-3 days after menses begin
Definition
symptoms of PMS/PMDD subside
Term
7-10 days before start of next period (days 14-28 in a 28 day cycle)
Definition
luteal phase in which common symptoms of PMS/PMDD begin
Term
less mood symptoms and daily activity impairment
Definition
PMS
Term
non-pharmacologic
Definition
increase complex carbs, increase aerobic exercise, nutritional supplements, and reduce alcohol, caffeine, salt, and smoking, increase adequate sleep
Term
modification of neurotransmitters
Definition
sertraline or fluoxetine (SSRIs) and consider anxiolytic for specific symptoms for those who do not respond
Term
hormonal ovulation suppression or removal of ovaries
Definition
oral contraceptives or GnRH agonists (Lupron)
Term
backpain
Definition
NSAID
Term
Mastalgia
Definition
caffeine restriction, Vit E and NSAID
Term
Headache
Definition
caffeine restriction and NSAID
Term
isomnia
Definition
caffeine restriction, melatonin
Term
water retention
Definition
Na restriction, spironolactone
Term
anxiety
Definition
caffeine restriction, SSRI
Term
SSRI
Definition
irritability/anger, low self esteem, oversensitivity, crying episodes
Term
PMDD approved
Definition
fluoxetine, sertraline and paroxetine
Term
dosing of SSRI for PMDD
Definition
faster onset than depression, can be given intermittently or continuously
Term
ADRs for SSRI
Definition
sedation, GI, HA, nervousness, sexual dysfunction and fatigue
Term
5 weeks
Definition
period of time for switching from fluoxetine to MAOI
Term
3 weeks
Definition
period of time for switching from MAOI to fluoxetine
Term
counseling on fluoxetine
Definition
can be activating so take in the morning
Term
counseling for paroxetine
Definition
most sedating and most anticholinergic (dry mouth and urinary retention)
Term
advantages of SSRI over TCAs
Definition
less sedating, less wt gain, CV changes and anticholinergic effects
Term
other antidepressants used
Definition
more SEs, less effective for indication
Term
serotonergics used alternatively to SSRI for PMDD
Definition
nefazodone and venlafaxine
Term
TCA-5HT and NE reuptake inhib used alternatively to SSRI for PMDD
Definition
clomipramine and nortryptyline
Term
TCA-5HT and NE reuptake inhib SEs
Definition
anticholinergic, QT prolongation, orthostatic hypotension, tachycardia
Term
anxiolytic therapies
Definition
alprazolam, buspirone
Term
alprazolam for PMDD-associated anxiety
Definition
potentiate GABA, causing CNS depression; quick onset, sedation, reduce, cognitive and motor skills, dependence/ tolerance...should be used short term use recommended
Term
buspirone-5HT partial agonist for PMDD-associated anxiety
Definition
no sedation or cognitive impairment, no abuse of physical dependence, avoid use with MAOIs; Nausea, HA,light headedness
Term
PMDD-associated insomnia
Definition
diphenhydramine, TCAs, and trazadone
Term
TCAs for PMDD-associated insomnia
Definition
Doxepin, amitriptyline
Term
Trazadone for PMDD-associated insomnia
Definition
serotonin receptor antagonist; orthostatic HypoTN, GI SEs
Term
weight gain options
Definition
spironolactone (first line), HCTZ, metolazone, triamterene
Term
YAZ (ethinyl estradiol and drospirenone)
Definition
improved mood and physical symptoms, hyperkalemia, increased clotting
Term
alternative hormonal contraceptive
Definition
estradiol implants, high doses of progesterones, and GnRH-As
Term
Leuprolide
Definition
GnRH agonist regulating release of FSH and LH from pituitary which inhibits the normal menstrual cycle/hormone fluctuation
Term
Risks for Leuprolide
Definition
menopausal symptoms, osteoporosis and CV disease
Term
common analgesic and anti-inflam agents (natural)
Definition
evening primrose oil and ginko
Term
natural antidepressant agents
Definition
5-HTP, L-tryptophan, SAMe, St. John's wart
Term
natural hormonal agents
Definition
black cohosh, chasteberry, Dong quai, progesterone, red clover, and soy glycine max
Term
calcium benefits
Definition
water retension, food cravings, pain and emotional symptoms
Term
magnesium benefits
Definition
fluid retention, bloating
Term
pyridoxine benefits
Definition
depression, fatigue, irritability and HA
Term
vitamine E benefits
Definition
mastalgia
Term
manganese and potassium benefits
Definition
insuff
Term
continuous therapy
Definition
SSRIs, Leuprolide, OCs, TCAs and vit/mineral
Term
intermittent therapy
Definition
NSAIDs, Alprazolam, Spironolactone, Diphenhydramine
Term
women with out uterus
Definition
should receive only estrogen
Term
women with uterus
Definition
should receive BOTH estrogen and progestin
Term
Estrogen risks
Definition
endometrial cancer, increased cardiovascular outcomes
Term
continuous cycle
Definition
estrogen daily, progestogen co-admin 12-14 days of the 28 day cycle
Term
continuous combinde
Definition
results in absence of vaginal bleeding but spotting can occur
Term
continuous long cycle
Definition
designed to decrease uterine bleeding
Term
intermittent long cycle
Definition
pulse progestogen; 3 days of estrogen only then 3 days of combo and repeat: prevent down regulation of progestogen that can occur with continuous combined regimen
Term
bio-identical hormon replacement therapy
Definition
synthetic hormone replacement with similar chemical structure to human hormone; no confirmed benefit but some suggest it is safer
Term
non-HRT pharmacotherapy alternatives
Definition
SSRIs, Megestrol, clonidine, gabapentin
Term
menopause
Definition
ovaries stop producing eggs and menstrual cycle stops
Term
late reproductive years
Definition
serum inhibin B begins to decrease, serum FSH increases slightly, estradiol levels are preserved, luteal progesterone levels decrease as fertility potential begins to decline
Term
premenopaus
Definition
lengthening of intermenstrual interval, early folicular phase FSH levels are high but variable
Term
after lengthening of intermenstrual interval more dramatic menstrual cycle changes
Definition
skipped cycles, episodes of amenorrhea, increased freq of anovulatory cycles
Term
Estrogens for menopause
Definition
short-term for hot flashes and sweating and vaginal atrophy, osteoporosis
Term
women with intact uterus
Definition
BOTH estrogen and progestin
Term
women without uterus
Definition
estrogen only
Term
progestins
Definition
prevents endometrial hyperplasia, usually administered 12-14 days per mo
Term
ADRs fo progestin
Definition
mood swings, bloating, sleep distrubances, irritability, depression HA
Term
ADRs for estrogen
Definition
N, HA, breast tenderness, heavy bleeding
Term
medroxyprogesterone acetate
Definition
provera
Term
prempro
Definition
medroxyprogesterone + estrogen
Term
continous E and cyclic P
Definition
no return of menopausal symptoms because constant E, bleeding each month continues
Term
Continuous E and P
Definition
most women experience amenorrhea for one year, umpredictable spotting or breakthrough bleeding when therapy initiated
Term
Continuous long cycle E+P
Definition
E constant, P given 6 times per year for 12 intervals; known bleeding times, still causes withdrawal bleeding that is heavier than cyclic P
Term
androgen
Definition
goes to testosterone goes to estrogen
Term
raloxifene (evista)
Definition
selective estrogen receptor modulator
Term
indications for raloxifene
Definition
invasive breast cancer in postmenopausal women with or without osteoporosis
Term
raloxifine outcomes
Definition
prevention of osteoporosis (30-50%), decrease in LDL and total cholesterol, decrease incidence of breast cancer and increase risks of VTE and stroke
Term
osteoporosis options
Definition
bisphosphonates and Denosumab (Prolia)
Term
bisphosphonates
Definition
decrease in vertebral and hip fractures, no impact on CVD or breast/ endometrial CAs
Term
side effects of bisphosphonates
Definition
GI effects, osteonecrosis of jaw and femur fractures
Term
endometriosis
Definition
common cause of chronic pelvic pain in women, associated with infertility; charaterized by the presence of endometrial tissue outside the uterus, chronic, reoccurring disease
Term
endometriosis-associated pain is secondary to structural or inflammatory cause
Definition
direct compression of nerve fivers or increased pressure within endometriosis
Term
symptoms of endometriosis may correlated with the cyclic release of hormones during the menstrual cycle
Definition
endometrial lesions contain estrogen and progesterone receptors
Term
in severe endometriosis
Definition
infertility may result from distortion of the pelvic structure secondary to endometrial lesions, inflammation and adhesion
Term
symptoms of endometriosis
Definition
asymptomatic, to dispareunia, chronic pelvic pain (cyclic/acyclic) premenstrual spotting, GI disturbance, urinary distrubance, lower back pain and infertility
Term
treatment goals for endometriosis
Definition
removal of deposits, prevention of progression, minimize pain, prevent or correct associated infertility
Term
treatment for endometriosis
Definition
NSAIDs, combined hormone contraceptives, GnRH agonist
Term
GnRH for endometriosis
Definition
inhibits FSH and LH which diminishes endometrial implants
Term
Leuprolide, Goserelin, Nafarelin
Definition
GnRH for endometriosis
Term
Testosterone therapy
Definition
hypogonadism; used for surgeries, increasing muscle mass in men, libido, energy etc. but controversial in "androgen deficient" women
Term
risk of testosterone therapy
Definition
increased risk of prostate cancer, liver damage and increased cholesterol
Term
testim gel, andro gel, androder patch, axiron, striant buccal tabs
Definition
testosterone therapies
Term
black box for testosterone
Definition
worsens signs and symptoms of BPH, secondary exposure of risk
Term
side effects of testosterone
Definition
increase creatinine, appetite, sensitive nipples, acne, hepatotoxicity; not to be used in women or children due to developmental risks and defects in unborn babies
Term
side effects of topical testosterone
Definition
can burn skin when wearing it during MRI and flammable, wait until dry before going near open flame or smoke
Term
does NOT increase with combined hormone replacement therapy used for menopause
Definition
LDL
Term
combined hormone therapy replacement for menopause results in
Definition
increased rate of dementia, greatest risk of invasive breast cancer in 1st year, greatest risk of VTE seen after more than 3-5yr therapy
Term
used to offset Goserelin side effects
Definition
low dose progesterone or combo HTR
Term
polycystic ovary syndrome associated with
Definition
obesity, alopecia, hirutism, infertility
Term
NOT associate with PCOS
Definition
menorrhagia
Term
for treatment of PCOS, combined HRT can be given with
Definition
spironalactone
Term
nafarelin
Definition
only med in class that is intranasal
Term
GnRH are FDA approved for use
Definition
for one year (limit to <6 mo)
Term
caffeine does NOT improved
Definition
vasomotor symptoms of menopause
Term
common side effects of GnRH
Definition
hirsutism, bone demineralization, vasomotor symptoms
Term
NOT an SE of GnRH
Definition
menorrhagia
Term
increased risk associated with combo HRT
Definition
gallbladder disease
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