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Stack #140092
menstrual stuff
| Question | Answer |
|---|---|
| menstrual cycle | day 1 of menstruation is day one of cycle |
| hormones | FSH, Estradiol, Luteinizing Hormone LH, Progeterone |
| plan B | levonorgestrel 0.75. there are two tablets. it PREVENTS pregnancy it won't stop a pregnancy |
| MOA of | Levonorgestrel inhibits ovulationf from occurring, immobilize sperm by altering uterine pH, disruption the lining and thickening cervical mucus |
| counseling points for plan B | take asap after unprotected intercourse of contraceptive failure, package contains 2 tablets: take 1st dose within 72 hours followed by 2nd dose 12 hours later |
| ADRs for plan B | N/V breast tenderness, abdominal pain/cramping, headache, menstrual changes menses may be delayed or early by up to 7 days, does not disrupt an established pregnancy. If patient is already pregnancy won't have any effect on |
| why not use for birth control | cost and not as effective |
| if they vomit the dose they may need the refill | also may see the Rx for nausea |
| how common is dismenorrhea | 90% in the beginning. painful in the beginning |
| primary dysmenorrhea and epidemiology idiopathic and associated with cramp like abodominal pain at the same time of menstruation. | highest in adolescence with up to 90% of young women being affected. usually develops within 6-12 months of menarche, only occurs during ovulatory cycles; prevalence decrease 25. 15% of young women report having it. single most cause of absenteeism/work |
| why does primary dysmenorrhea happen not fully understood but | at end of luteal phase get decrease progeterone & increase arachidonic acid related to increased lvs of prostaglandin (PG), leukotriences and vasopression all responsible for strong utirine contractions and significant vasoconstriction urt ischemia/pai |
| PGs- synthesized from where? how much higher? when is it higher? what does it release? | from endometrium, 3-4X higher, during first 2 days, releases vasopression |
| signs and symptoms of primary dysmenorrhea | nsaids are first choice |
| SX SS of primary dysmenorrhea continuous dull aching pain with spamodic cramping in the lower midabdominal or supra region which my raidate to lower back and upper thights. | uterine contraction can force prostaglandins into systemic circulation causing additional symptoms NV, fattigue, dizziness, irritablity, diarrhea, and headache (about 50%) of women. the onset several hours prior or with. duration <48 hrs but can =72 |
| Dx of secondary dysmenorrhea is suggested if dysmenorrhea initially begins after menarach or | begins after 25 yo, if pelvic pain ocurs at times other than during menses/related to first day, irregular mestrual cycles, excessive or prolonged or profuse menses, history of PID, dyspareunia, or infertility |
| Leukotriences is an inflammotory mediator made from what precursor? causes what in the uteris, will NSAID treatment work against these | precursor is arachidonic acid, causes vasoconstriction and uterine contractions, NSAIDS may not work, these are elevated above normal levels in dsymenorrhea |
| vasopressin causes what? and is how much higher with dysmenorrhea | causes dysrhythmic uterine contractions and levels are 4x's higher in women with dysmenorrhea |
| causes of secondary dysmenorrhea include | endometriosis, PID ovarian cysts, uterine tumors, uterine fibroids, cervical os stenosis, inflammatory bowel disease, and congenital abnormalities, or caused by IUD |
| differentiation of primary (1)vs secondary (2) dysmenorrhea | (1) younger than (2). Menses (1) more likely to be regular with normal blood loss as apossed to (2) with irregular and heavier.pattern (1) prior to or with, pain in most, last 2-3 days, NSAIDS work, Nausea (2)varies & doesn't respond to NSAID,pelvic tndr |
| what are some nonpharmacologic therapies of dysmenorrhea | rest, heat, termacare patches for 8 hrs which is better than APAP, use with NAIDS, wear loose clothes, exercise, message, quite smoking constricts veins |
| are most people satisfied with self treatment? how many | yes 92% were satisfied and didn't see clinician |
| what are the goals of treating primary dysmenorrhea | provide relief or significant improve in symptoms and minimize the disruption of ussual activites |
| when is self-care appropiate for an otherwise healthy young woman | consistant primary dysmenorrhea, not sexually active or someone who has been diagnosed with primary dysmenorrhea |
| when should they be referred to the doc | adolescents with pelvie pain who are sexually active or at risk for PID and women with characteristics indicationg secondary dysmenorrhea should be referred for medical evluation |
| other reason why they should be referred to doc | more sever dysmennorrhea, a change in pattern or intensity of pain, intolerance to NSAIDS, or dysmenorrhea that does not respond to nonpresciption therapy |
| what are some pharmacologic therapy recommendation | NSAIDS are more effective than APAP and ASA. even though more take APAP, most take sub therapeutic doses, delaying treament is associated with failure |
| aspirin | caution with reyes, baby aspirin in not enough to decrease prostaglandin synthesis, may increase flow need dose of 650-1000mg q4-6 hours with max of 4g/day |
| what are some contraindications of ASA | young girls with viral infections, PUD, GI distress, ulcerative colitis (UC) allergic to salicylates or NSAIDS, drug interactions with warfarin, heparin, lithium, or bleeding disorders |
| therapy with nonsalicylate NSAIDS | if suspect pregnancy don't begin therapy until after mnses, starting one to two days before menses or pain may reduce prbs, ibuprogenq 4-6, ketoprofen q 4-8 and naproxen sodium q8-12 for the first 48-72 hours of menstration. ATC not PRN |
| symptoms of premenstrual menstration (medical term-molimina) | breast tenderness, bloating, lower backache, food craving. (mild physical or mood symptoms) lowerd mood, increased engergy or creativity changes before the onset of menses that do not interfer with normal life functions |
| premenstrual syndrome | one mood or physical symptom during the 5 days prior to menses. symtoms are virtually absent during cycle day 5-10. has negative effect on lifestyle or fx, severity is mild to moderate |
| premenstrual dysphoric disorder (must not be due to another other disorder) | 5 or more symtoms of mood or physicla present in last week of luteal phase of menstrual cycle with at least one symtom begin sigificant depression, anxiety, affective lability or anger. the intensity interfere with life, sym are absent during menses |
| premenstrual exacerbation | worseing of the premenstral symptoms typically psychiatric disorders. conditions such as endometriosis, hypothyroidism. ADD, DM, HA, perimenopause can worsen, THERE are no symptom free intervals |
| PMS happens in | luteal phase witch is last phase of mentrual cycle |
| symptoms of PMS occur when | only during ovulatory cycles and disappera during pregnancy and menopause |
| factors that predict severe PMS or PMDD | working out side home, depression, less education, tobacco use |
| what is the etiology/pathophysiology | unknow, NOT AN IMBALANCE, but there is a cyclic regulations of hormones, |
| what is affected by fluctuation and hormones | 5HT serotonic, there is a decrease in serotonin |
| signs and symptoms of PMS | not unique but occurrence of specific symptoms and fluctuation with phases of menstrual cycles will allow us to diagnos |
| the onset of duration | begin or intensity 1 week before and greater ... |
| most common symptoms of PMS are | mood tends to cause more impairment than physical ones, they are mild to moderate and not interfere with life adn symptoms ypically remain the same month to month |
| pneumoic for symptoms | perpetual munching spree, puffy mide- section, pardon my sobbing, pimples may surface, people make me sick, pass my sweat pants,... |
| PMDD vs PMS | similar but with PMDD more symptoms and sever, symptoms impair work or social function in some way, needs to happen on regular basis for dx |
| Primarily mood sysmtoms is associated with | PMDD not PMS |
| difficulties with everyday | PMDD yes, no so with PMS |
| timing of symptoms | premenstrual phase only with PMS adn premenstrual phase only but occuras for at least 2 consecutive cycle with PMDD |
| conditions aggravated during premenstrual phase are and see table 9-3 | MAJOR DEPRESSION, anxiety/panic attacks, migraines, asthma, seizures. important to distinguish if cyclic during the luteal phase. lack of symtom free ... |
| non pharmacologic treatment | managing schedule/planning, aerobic exercise, dietary modifications such as avoid salty foods because they cause water retention and blooting, alcohol can cause depression and excerbate other stuff , avoid caffeine , Cog Behav Thep relax cope |
| what will complex carbohydrates do for PMS | reduce cravings and improve mood, tryptophan levels and increase serotonin, carbohydrate rish beverage with tryptophan, maintating regular sleep schedual... |
| treatmetn based on symptoms are : NSAIDS Diurectics or combination | NSAIDS will reduce physical symptoms (headache, fatigue, other pain), take one week prior to and druing first several days of meanses,diurectics are unlik |
| ammonium chloride and acid forming salt | short DOA, 3g/day in divided doses for no more than 6 days, watch out for OD get GI, CNS, ADRs, C-1 with reneal or hepatic impairment, may cuase metabolic acidosis |
| what are four weak diuretics | ammonium chloride, caffeine, pamabrom, pyrilamine |
| if patient has anxiety what is the best form of diuretics | pyrilamine, just NOT caffeine |
| pyridoxine and B6 | might help by a mechan similar to dopamine production, other theories on |
| calcium | evidence of efficacy from clinical trials likely effectiv, calcium deficiency similar symptoms as PMS, women with PMS have low calcium levels at time of ovulation, decrease calcium and increase parathyroid... |
| magnesium | may help with PMS but not as good as calcium |
| what does the evidency say about herbal meds for PMS symptoms | calcium has very good evdence as far as effecacy 600mg BID, other three thing well B6 and mag, some evidence |
| CAM adn PMS | --- |
| TSS toxic shock syndrome | severe multi-system illness characterized by high fever, profound hypotension, sever diarrhea, mental confusion, renal failure, erthroderma, skin desqua.... |
| epidemiology, etiology, and pathphysiology | menstrual TSS is associated with high absorbency tampon use, cases on decline, severe life-threaten...two bacteria |
| prevention of TSS | use pads, change tampon 4-6 day and don't wear one more than 8 hr, wash hands before and after inserting anything into vagina, dont not use things more than recommend |
| menopause | defined as the cessation of menstrual cycle for 12 consecutive months, ovaries shut down after about 50 years and get diminish estrogen, diminish FSH, the natural age of onset is 40-58 |
| what to hormones are important for dx menopause | estrogen and FSH diminshed |
| symptoms of menopause | may persist for week, months, or years, early signs, irregular or prolonged menstrual bleeding ca be severe, vasomotor symptoms: HOT FLASHES adn night sweats (drenching) trigger to avoid are.... |
| non vasomotor symptoms of meopause are | vaginal dryness, insomnia, tiredness, headaches, joint pain, anxiety, irritability... |
| atrophic vaginitis chapter 8 in book | atrophy of vaginal mucosa (secondary to decrease estrogen) baginal epithelium becomes thin, vaginal lub declines, leads to inflammation of vigina |
| what should be recommend for treatment of atrophic vaginitis | estrogen replacment, vaginal lubricant... see tabel 8-5 |
| non-pharmacologic treatment optional for hot flashes | weight loss if overweight, smoking cessation, recommend exercise... |
Created by:
lainylaina
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