GYN DM
Help!
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| endometrial carcinoma is the X most common cancer worldwide; cervical cancer is X most common cancer worldwide | endometrial #1
cervical #2
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| cervical cancer is greatest between this age range | mid 20’s to the Fifth decade
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| Am college Gyn recommendation for paps | The American College of Ob/Gyn- annual paps starting at 21 or within 3 years of sexual debut. Women over 30 with 3 normal paps can drop to q 2-3 years.
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| USPSTF recommendation for paps | USPSTF recommends at least every 3 years. Beginning at age 21 or 3 years post sexual debut through 65.
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| The AAFP recommendation for pap | strongly recommends that a Pap smear be completed at least every 3 years to screen for cervical cancer for women who have ever had sex and have a cervix.
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| ASCUS-stands for | Atypical squamous cells of undetermined significance
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| Colposcopy definition | Method of looking at the cervix under magnification
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| meds that are risks for osteoporosis | predisone, Depo Provera, chemo
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| genitourinary changes in menopause - what percentage and improve with HRT? | 75%, NO
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| Insomnia improved with estrogen? | YES
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| beefy red and bleed easily and no lymphadenopathy | Granuloma Inguinale (Donovanosis)
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| f/u for abortion - time fram and how do it | Two-four weeks
Can also do phone follow-up 24-48 hrs later with patient education, unless 2nd trimester procedure
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| Chlamydia tx and what if pregnant? | azithromycin - SINGLE DOSE or doxycycine bid x 7 days; pregnancy: azithromycin SINGLE DOSE or amoxicillin tid x 7 days
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| Gonnorhea tx | Ceftriaxone - SINGLE DOSE IM, Cefixime, Ciprofloxacin, Ofloxacin , Levofloxacin, Gentamicin, Cefpodoxime or Azithromycin 2 g - ALL SINGLE DOSE- PLUS If chlamydia not ruled out: Azithromycin 1 g single dose + doxycycline bid x 7 days
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| pharyngeal gonorrhea tx | Ceftriaxone - SINGLE DOSE or Ciprofloxacin - SINGLE DOSE + treat chlamydial infection if not ruled out
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| which STD is becoming quinolone resistant, rate in Asia and US, how tell if resistant | Gonnorhea Check local antibiograms, resistance to cipro indicates pan-quinolone resistance, 70% asian, 13% US
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| gonnorhea in pregnancy | Cephalosporin regimen
No quinolones or tetracyclines!!
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| Frequently causes pustular or petechial skin lesions, asymmetric arthralgias Can cause hepatitis, meningitis Hospitalization recommended | disseminated gonnorhea
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| disseminated gonnorhea - how long treat? | Continue treatment 24-48 hours after clinical improvement; need at least one week of tx
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| hospitalize PID under these circumstances | surgical emergencies (e.g., appendicitis) cannot be excluded, pregnancy, does not respond to oral meds or cant , follow/tolerate, severe illness, nausea and vomiting, or high fever, tubo-ovarian abscess, adoolescents, nulliparity, WBC<4 or >20,000
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| Provide empiric, broad coverage of likely microbes: C. Trachomatis N. gonorrhoeae Anaerobes B. fragilis for what disease? | PID
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| PID inpatient tx | Cefotetan or Cefoxitin PLUS
Doxycycline -PO!! Ampillicin/Gentamycin also can be used; May D/C parenteral 24 h after improvement, and
Doxycycline x 14 days
OR
Clindamycin PLUS
Gentamicin till 24 hours after improve;
Doxycycline OR
Clindamycin x 14
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| uretral blockage and bladder unable to empty properly as in post surgery in acute setting or elderly | overflow
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| relaxed pelvic floor, increased abdominal pressure | stress
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| bladder oversensitivity from infection, neurologic disorders, inappropriate contraction of contrussor muscle | urge
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| tx for stress incontinence | pelvic muscle exercises and biofeedback (also drugs impipramine -slpha agonist, and estrogen but not widely used -increase uretral tone) and surgical - 150 procedures - Gynecare TVT is a minimally invasive outpatient surgery, Pessary
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| surgery for anatomical abnormalities fix hypermobility or intrinsic sphincter deficiency; what fixes other | hypermobility only; suburetral hammock at mid-reetral level (GYNECARE TVT) = surgery
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| tx for urge incontinence | BEHAVIORAL tx, meds (anticholinergics) - work to relax bladder muscle, peripheral neuromodulation, botox injections?
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| outpatient tx for PID | Ceftriaxone - ONE TIME TREATMENT IM or Cefoxitin and Probenecid or Genetamicin - ALL SINGLE DOSE
PLUS Doxycycline or Clindamycin x 14 days WITH OR WITHOUT Metronidazole x 14 days
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| vaginal candidiasis single dose regimens | Butoconazole, Tioconazole, Miconazole
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| 3 day regimens for vaginal candidiasis | Clotrimazole, Butoconazole, Miconazole, Terconazole, Terconazole
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| 7 day regimens for vaginal candidiasis | miconazole, clotrimazole, terconazole
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| Longer regimens for vaginal candidia | clotrimazole, nystatin (nystatin less effective than topical azoles)
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| candida vaginitis tx in pregnancy | Only topical intravaginal regimens are recommended (think CANDY you suck so so it is topical)
Most specialists recommend 7 days of therapy
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| what is tx for bacterial vaginitis? What is counseling? | METRONIDAZOLE (Flagyl) x 7 days (or Clindamyin cream x 7 days or Metronidazole gel x 5 days); NO EtOH - wait at least 24 hours after last dose!! Disulfiram-like Reaction
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| Which drug and for what can you not drink EtOH at all? | Metronidazole (Flagyl) for bacterial vaginitis
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| bacterial vaginitis in pregnancy | Symptomatic treatment should be treated
data do not support use of topical agents
Some experts recommend screening and treatment of asymptomatic women at high risk for preterm delivery
METRONIDAZOLE x 7 days or other options same as if not pregnant
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| malodorous, yellow-green discharge | trichomonis
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| DM, obese - what vaginal disease? | yeast (candidiasis)
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| What is metronidazole (Flagyl) used for? | BACTERIAL VAGINOSIS AND TRICHOMONIS
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| Metronidazole in pregnancy - yes or no? | Yes, category B so use it
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| Trichomonis Tx | Metronidazole - SINGLE DOSE
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| Syphillis Tx - Primary, Secondary, and Early Latent | Benzathine penicillin G IM - SINGLE DOSE
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| Late Latent Syphillis Tx | Benzathine penicillin G IM - 3 doses IM at one week intervals
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| Tertiary (Neuro) Syphillis Tx | Aqueous crystalline penicillin G infusion 10-14 days IV every 4 hours or continuous infusion (or Procain penicillin once daily IM plus probenecid - both for 10-14 days)
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| Syphillis tx if Pen allergic | If positive, use de-sensitization protocol
;For primary and secondary syphilis, can use doxycycline 100 mg BID for 14 days
Neurosyphilis: ceftriaxone (says this in PP but not handout)
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| Jarisch-Herxheimer Reaction | 50% of pts with early syphilis (90% secondary) have a this within 6-12 hours after initial tx
General malaise, fever, headache, sweating, rigors, temporary exacerbation of lesions
Subsides with 24 hours and poses no danger
NOT dose-related
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| how long treat herpes (HSV)? | 7-10 days
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| when think about suppressive therapy for herpes (> or equal to how many recurrences per year) and how much reduce recurrences by | frequent recurrences (i.e., ≥6 recurrences per year)
reduces the frequency of genital herpes recurrences by 70%–80%
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| Active HSV infection in pregnancy - what do? what drug use? birth defects? risk of transmission to neonate in X-X% of women who aquire HSV near delivery? | C section; Acyclovir (limited data on others); Risk of transmission to neonate in 30-50% among women who acquire HSV near delivery; Data does not indicate increased risk of major birth defects (first trimester)
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| What disease do not treat sex partners? what about Trichomonis, HSV, C, G, and PID? | Bacterial vaginosis and candidiasis not recommended to treat; trichomonis - treat, avoid sex till cured; HSV - offer test, if pos, treat; C,G, and PID - treat contacts within last 60 days
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| Syphillis - Tx of sex partners? | At risk partners:
1) 3 months plus duration of symptoms for primary syphilis
2) 6 months plus duration of symptoms for 2nd syphilis
3) 1 year for early latent syphilis
Evaluate long-term partners of tertiary syphilis
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| XXY | Klinefelter’s
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| Hypergonadotropic hypogonadism - elevated LH or FSH | Azospermia; testicle failed for one reason or another
Elev. LH = Leydig cell dysfunction
Elev. FSH =spermatogenic dysfunction
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| Tx for mild male factor | antibodies/agglutination intrauterine insemination (IUI)
WBC without infection vit E to decrease ROS
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| Tx for severe male factor | intracytoplasmic sperm injection (ICSI) with or without TESA (Testicular sperm aspiration)
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| evaluate prior to 1 yr - fertility - for what age | age>35
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| Anovulation WHO classifications | WHO I: no E, low/normal FSH, normal Prl, no hypo-pit lesion
WHO II: E, normal FSH, normal Prl
WHO III: low E, high FSH, normal Prl
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| tx for prolactin high | dopamine agonist
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| biomarkers for ovarian reserve | Day 3 FSH, estradiol - FSH rises if not many eggs left b/c less feedback - many false normals (so higher FSH, lower ability to get pregnant)
Inhibin B (Clomid challenge test)
Anti-mullerian hormone
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| AMH X with age AMH predicts X | declines; ovarian response to fertility drugs
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| Hysterosalpingogram checks for | tubal patency
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| If HSG shows cavity, do what test? | US to check for fibroids
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| when do laparoscopy? | Abnormalities on HSG – do this test then
Pelvic Pain, high suspicion for endometriosis
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| When do laparoscopy? | when high risk for endometriosis (abnormalities on HSG or pelvic pain)
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| where does spermatogenesis occur? | seminiferous tubules
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| ABP to concentrate T and DHT in seminiferous epithelium and epididymis (produces androgen binding protein and inhibin does neg. FB) - FSH goes to it - which cells? | Sertoli
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| testosterone - which cells? LH to it | Lydwig - think Lida is manly, think LH = Lydwig
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| LH stimulates X synthesis/secretion FSH increases X | testosterone; LH receptor #
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| how many days sperm in ST, epididymis, vas deferens? | 50 d in seminiferous tubule, 12-21 days epididymis, vas deferens = approx 70 d
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| Semen analysis - abstinent for how long prior? how long have to get it to lab? how many samples before secure diagnosis? | 2-5 days abstinence prior
To lab within one hour of collection
2-3 samples before diagnosis secure
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| oligospermia: Asthenospermia: Teratospermia: Azospermia: | oligospermia: low count
Asthenospermia: low motility
Teratospermia: low morphology
Azospermia: no sperm in ejaculate
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| Round cells in semen analysis | WBC or immature sperm; need stains to differentiate
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| Agglutination in semen analysis suggests | immunologic source or infection
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| are serum antibodies in sperm associated with infertility? | NO
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| OCP decrease risk of which cancers and increase risk of which? Which does unopposed estrogen increase risk of? KNOW THIS | increase risk of breast and cervical but decrease risk of OVARIAN and ENDOMETRIAL (for endometrial this is due to progesterone effect) (but unopposed estrogen increases risk of ENDOMETRIAL)
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| secondary complications of PID | tubo-ovarian syndrome and Fitz-Hugh-Curtis syndrome (perihepatitis)
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| hx of breast cancer is a risk for what other type of cancer and why? | endometrial cancer (probably b/c share some common risk factors - obesity, nulliparity)
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| smoking is decreased risk for which type of cancer and increased for what type | endometrial cancer; increased for cervical
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| preferred initial diagnostic test to r/o endometrial cancer | biopsy
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| transvaginal US - useful for evaluating endometrium of premenopausal women? | NO b/c these women normally have a thick endometrium
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| cardinal sx of endometrial cancer (occurs in 90% of cases) | abnormal uterine bleeding
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| presence of endometrial cells on cervical cytology is noted if X; is cervical cytology a sensitive test for endometrial cancer? | woman is > or equal to 40 years of age; NO
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| hormones, DES, poor SES, multiple pregnancies, chlamydia, HIV, diet low in fruits and veggies risk for what type of cancer | cervical
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| risk of high risk HPV X as age; risk of cervical cancer X as age | decreases; increases
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| gardasil approved for what ages | 9-26
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| highest rate of HPV in this age bracket and what percentage | 20-24 ; 45%
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| 4 things that contribute to miscarriage - one anatomic, one infection, 2 others | fibroids, clamydia, trauma, improper nutrition
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| miscarriage vs stillborn | miscarriage = spontaneous abortion = <20 weeks, <500 grams
stillborn = fetal death/demise = >20 weeks
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| RU486 is the medical abortifactant - how does it work? | is an anti progesterone – since corpus luteum secretes progesterone this blocks secretion of progesterone so implantation cannot occur
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| age of viability | 24 weeks
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| SE of RU486 | cramping
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| what is methotrexate? | another abortifactant
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| need to give RU486 within how much time and what happens as give it earlier | within 49 days from last menstrual period or 7 weeks ; less SE (cramping)
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| States may regulate induced abortion after X months | X (20 weeks, more if threatens mothers health)
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| gestational size - fruits | Firm, walnut – nulliparous, not pregnant
Small lime - 6 weeks
Small lemon - 8 weeks
Orange - 10 weeks
Grapefruit - 12 weeks
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| miscarriage rate is X-X | 15-40%
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| LOOK UP CLIN MED REA ANSWER INCORRECT (1) | X
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| Risk of death increases by X% for each additional week of pregnancy | 38
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| Mifepristone (RU-486): Misoprostol: Methotrexate: | Mifepristone (RU-486): antiprogesterone - Miffed - anti progesterone
Misoprostol: prostaglandin E1 analog - MISO soup is an analog of food
Methotrexate: antimetabolite - TREK gets your metabolism going
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| FDA approved regimen for Mifepristone, Misoprostol, Methotrexate | Day 1: Mifepristone (Rhogam® if Rh negative)
Day 3: Misoprostol
(Passage of POC at home)
Day 14: follow up visit with ultrasound, surgical completion if necessary
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| risk after multiple abortions | possible risk of incompetent cervix (mechanical vs. osmotic?)
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| effects of progesterone in OCP | Inhibit ovulation (usually)
Thickened cervical mucus
Sperm become less effective
Hampers implantation
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| effects of estrogen in OCP | Inhibit ovulation (usually)
Alters endometrium
Luteolysis (degeneration of corpus luteum)
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| Active liver disease or adenoma is an absolute or relative indication for OCP | absolute
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| Relative indications of OCPS | Hypertension
Diabetes without CAD or PVD
Gall bladder disease
History of cholestatic jaundice in pregnancy
Epilepsy
Leg injury or cast, immobilization
Elective surgery
Sickle cell disease (SS or SC)
Migraine headaches
Obesity
Family History of C
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| negative effects to OCPs | Benign liver tumors
Worsening gallbladder problems
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| OCPs help these disorders | Ovarian cysts (except triphasic ones may not help)
Uterine fibroids
Fibroadenomas and fibrocystic breast disease
Ectopic pregnancy
Acute PID
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| OK if smoker or nursing | DepoProvera
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| Causes bleeding abnormalities (80%) | DepoProvera
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| biggest risk with DepoProvera | OSTEOPOROSIS - BLACK BOX WARNING
Only use > 2 yrs if no other options
Most concerning in adolescents and young adults
Routine bone density scan after 2 years of use?
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| all these SE are associated with what hormone and in implants | Menstrual irregularities
Major reason for discontinuation
Amenorrhea
Weight gain
Acne
Depression
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| May be less effective if obese patient | IMPLANT
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| Less effective for patients weighing more than 90 kg | OrthoEvra
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| May cause an increase risk of venous thromboembolic events than OCPs due to higher consistent estrogen blood levels | OrthoEvra
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| Major concern with OrthoEvra | FDA BLACK BOX WARNING
Higher consistent estrogen blood levels
Use with caution in smokers at any age
Greater risk of thrombotic events (CVA,MI) than OCPs
Do not use in smokers > 35
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| emergency contraception can be taken up to X days; reduces pregnancy risk by | Can be taken up to 5 days (120 hours) after unprotected intercourse; 75-80%
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| SE of emergency contraception | Rare side effects/risk (even in smokers over age 35)
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| Emergency contraception - delay of ovulation and when given | If given before ovulation, menses is 3-7 days earlier than expected
If given after ovulation, menses is at expected time or delayed
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| tubal ligation decreases risk of X and maybe X cancer | ovarian and maybe breast
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| do you usually want to do cytology on cyst fluid? | NO (unless bloody or residual mass)
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| Mucopurulent Cervicitis tx | Recommend empiric chlamydia treatment; Consider empiric gonorrhea treatment if prevalence is high (most NC Counties and all STD Clinics)
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| Nongonococcal Urethritis Tx | Tx same as Chlamydia
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| Epididymitis tx | Ceftriaxone single dose + doxycycline x 10 days (for acute epididymitit smost likely caused by gonorrhea or chlamydial infection); For acute epididymitis most likely caused by enteric organisms, or allergic, Ofloxacin x 10 days or Levofloacin x 10 days
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| Heb B vaccine is recommended for | all unvaccinated uninfected persons being evaluated for an STD
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| Chancroid tx | Azithromycin single dose or ceftriaxone IM single dose or Cipro x 3 days or erythromycin x 7 days
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| Lymphogranuloma Venereum tx | Doxycycline x 21 days (think DOC looks at Lymph nodes a long time) - alternative is Erythromycin x 21 days
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| HPV tx (external genital and perianal warts) - drug therapy | Podofilox solution or gel x 3 days, rest for 4 days, repeasts for 4 cycles max or Imiqiumod cream 3x/wk x 16 weeks max, repeat every 1-2 weeks as necessary
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| What is recommended tx for HPV | PROVIDER ADMINISTERED = RECOMMENDED = cryotherapy, liquid nitrogen or cyroprobe, repeat application every 1-2 weeks OR Podophyllin Resin etc
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| Pediculosis Pubis Tx | Permetrin cream, apply to area, wash off after 10 min
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| Scabies Tx | Permetrin - apply to all areas of body from neck down, wash off after 8-14 hours or Ivermectin orally repeated in 2 weeks
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| what is tx for lichen sclerosis? | Biopsy! Refer!
Risk of squamous cell cancer 4 to 6%
Treatment potent topical steroids
Possibly topical testosterone, progesterone (not EBM)
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| Chronic, intense vulvar pruritus Thin, white “onion skin” or “cigarette paper” Disfigurement, stenosis of vaginal introitus WHAT DISEASE IS THIS? | Lichen Sclerosis
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| GXPXXXX meand | gestational (been pregnant), TPAL – term, premi, abortions,live
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| Thickened; can be caused from feminine deodorants – vicious cycle | Lichen simplex chronicus
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| “An itch that rashes” Vicious cycle of itch, scratch, itch Original trigger often unknown Progressive vulvar pruritus and burning Thickened, white, unilateral/localized | Lichen simplex chronicus
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| Tx for lichen simplex chronicus | Biopsy!
Topical steroids (medium potency), hydroxyzine (an antihistamine), SSRIs
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| Violaceous, flat topped papules (erosive type) White patches, ulcerations May have oral, vaginal lesions Chronic burning and itching-autoimmune What DISEASE? | Lichen Planus
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| Lichen Planus Tx | Biopsy, refer
Topical steroids, douches, suppositories
Vaginal estrogen cream if atrophic
Beware adhesions, introital stenosis
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| Cervical polyps tx | Remove with ring forceps as office procedure
May require OR or hysteroscopy
Biopsy
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| what is a fibroid? | a benign uterine neoplasm; Leiomyomas
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| what percentage go into menopause by age 50 | %50
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| most common sx of fibroids | bleeding (very often asymptomatic)
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| Progressive increase in pelvic pressure, fullness Pelvic pain Acute pain associated with “red degeneration” or torsion of pedunculated myoma What disease? | Fibroids
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| Irregular, enlarged uterus If large enough, palpable abdominally Size referred to in gestational weeks pregnancy size | Fibroids
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| How dx fibroids and what is not helpful | US is diagnostic; MRI, CT, and biopsy not helpful
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| red degeneration is indicative of what and most associated with what | FIBROIDS; Most frequently associated with pregnancy
Rapidly outgrow blood supply and die off
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| Fibroids Tx | Most don’t require treatment
Myomectomy (L/S vs laparotomy)
Hysterectomy only if symptomatic
Will usually involute with menopause
Menopause mimicking treatments (GnRH)
Uterine artery embolization
MRI-guided focused ultrasound
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| Functional ovarian cysts | Not really neoplasms but exaggeration of normal process
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| RPR test is for | syphillis
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| what test do for herpes? | PCR more accurate than viral culture
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| Functional ovarian cysts must be differentiated from X, usually go away or not?, common or uncommon?, aka X | Must be differentiated from malignancy
Usually spontaneously regress
Very common
Also called “physiologic ovarian cysts”
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| mucopurulent discharge from her cervix, positive cervical motion tenderness and adnexal tenderness | PID
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| Fitz Hughes Jenson ? | can have this with PID; inflammation of capsule of liver (severe R upper quadrant pain) – can resemble cholecystitis
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| May be felt on exam, refer to ultrasound, ultrasound no cyst but “free fluid in cul de sac” | Follicular cyst
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| Failure of ovulation, follicle continues to grow May rupture and cause acute pelvic pain Surgery not indicated | Follicular cyst
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| foamy, malodorous discharge | trichomonis
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| Missed onset of menses Adnexal enlargement One-sided pain | persistent corpus luteum cyst - Corpus luteum fails to involute and continues to enlarge after ovulation
Secretes progesterone
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| probably benign US of cysts (size in cm, septations?, uni or bi lateral, ascites?, doppler blood flow)? | <10 cm
Minimal septations
Unilateral
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| probably malignant US of cysts (size in cm, septations?, uni or bi lateral?, ascites?, doppler blood flow?) | >10 cm
Solid
Multiple septations > 3 mm
Bilateral
Ascites
Doppler blood flow? – a lot of blood on doppler
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| Asymptomatic, unilateral cystic adnexal mass Mobile, nontender, often high in pelvis | Dermoid (Teratoma)
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| Treatment: functional ovarian cysts (recurrent) | Symptomatic
No EBM for oral contraceptives to resolve or prevent (maybe it worked in the 70s)
Warnings: risk of torsion if large
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| Oligo- or amenorrhea Obesity (not always!) Infertility Hirsutism, acanthosis nigricans, acne Insulin resistance Reproductive age | Polycystic Ovarian Syndrome (PCOS)
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| Functional disorder of ? etiology Complex genetic trait, related to type 2 DM Hyperandrogenism Insulin resistance, increased LH | Polycystic Ovarian Syndrome (PCOS)
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| PCOS treatment | Oral contraceptives
Medroxyprogesterone for W/D bleed if contraception not needed
Spironolactone for hirsutism, Yasmin
Weight loss
Metformin
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| PCOS complications | Type 2 DM
Hypertension
Hyperlipidemia
CV disease
Infertility, recurrent SAB
Depression
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| tx for vulvodynia | Bland hygiene and general measures
Emotional support
Treat any underlying conditions (HSV, HPV)
Dietary changes (low oxalate)
TCAs, SSRIs, gabapentin, lidocaine, biofeedback, surgery
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| chronic pelvic pain lasts how long | >6 months
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| what tests do for chronic pelvic pain? | CBC, UA, HCG, GC/chlamydia
Imaging: U/S
Laparoscopy
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| Tx of chronic pelvic pain | Definitely refer for definitive evaluation
Treat etiology identified
NSAIDs?
OCs? Depo-Provera?
Mirena IUD
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| Vulvar cancer is proceeded by what | VIN (Vulvar Intraepithelial Neoplasia)
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| VIN (Vulvar Intraepithelial Neoplasm) sx | Vulvar pruritus
Chronic irritation
Raised lesions, often white or grey
Most frequent on posterior vulva and perineum
Sound a lot like benign vulvar conditions?
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| Tx for VIN (Vulvar Intraepithelial Neoplasia) | BIOPSY!!
Treatment early VIN by local cauterization (cryo, electro, laser)
Higher grade VIN wide local excision with or without laser
Sometimes simple vulvectomy
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|
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| Fiery red lesions with white hyperkeratotic areas - what disease? | PAGET DISEASE - *PAGENT WAS RED AND WHITE – THINK THIS
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|
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| Paget Disease - higher incidence of what? Age group? Tx? | Higher incidence of underlying carcinoma, esp colon and breast
Age group over 65
Treatment wide local excision or vulvectomy (wide margins)
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|
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| sx of endometriosis | pain with period, dyspareunia
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|
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| long term result of endometriosis | infertility
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|
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| estrogen increases when | middle of menstrual cycle
🗑
|
||||
| menopausal women have X levels of X | high FSH
🗑
|
||||
| Clearance rate of HPV for women under 30 is X%. | 90
🗑
|
||||
| what counsel people with HPV on | smoking - stop b/c can't clear
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|
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| 14 days from period starting, not on birth control, fullness is detected on right or left side – most likely X | functional cyst
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|
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| risks for PID | Sex during menses
>1 male partner last 30 days
Parity >0
Lack of BCM
Current smoking
19 years or younger
Cocaine use (especially crack)
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|
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| PID - treat partners or no? | YES
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|
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| Textbooks say bilateral but may be unilateral Often require surgery Rupture and septic shock that ensues life threatening | Tubo-ovarian abcssess - a complication of PID
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|
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| May be caused by GC or chlamydia “Violin string” adhesions between liver and parietal peritoneum RUQ pain may be prominent symptom, especially in young women | Fitz-Hugh—Curtis syndrome (perihepatitis)
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|
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| Fitz Hugh Curtis aka | perihepatitis
🗑
|
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| complications of PID | Fitz Hugh Curtis, Tubo-ovarian abcess
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|
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| incidence of ovulation when taking OCPs | 10%
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|
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| MOA of progesterone | MAIN: Promotes endometrium atrophy
Thickens cervical mucus
Slows ovum transport
Inhibits fertilization
Inhibits ovulation
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|
||||
| MOA of estrogen | MAIN: Inhibits ovulation
Inhibits GnRH release from hypothalamus
Inhibits implantation
Accelerates ovum transport
Breaks down corpus luteum
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|
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| Progestins - androgenicity - increasing to decreasing - pneumonic (if not very androgenic, what is it)? | LEVATATE TO TOP, DROP TO BOTTOM
Levonorgestrel
Norgestrel
Norethindrone
Ethynodiol
Norgestimate
Desogestrel
Drosperinone - ANTI MINERALCORTICOID ACTIVITY
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|
||||
| Drosperinone - brand name and what is different about it | think Drop weight on Yasmin - anti mineralcorticoid activity (LOWEST ANDROGENICITY of all); Analogue of spironolactone (antimineralocorticoid)
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|
||||
| Androgen excess causes | Increased appetite
Noncyclic weight gain
Hirsutism
Acne
Oily skin
Increased libido
Pruritis
THINK EVERYTHING A MAN HAS INCLUDING ITCHING AND ACNE
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|
||||
| ALL THESE SX ARE FOR ESTROGEN OR PROGESTERONE - INCREASE OR DECREASE? nausea bloating cervical mucorrhea polyposis melasma hypertension migraine headache breast fullness or tenderness edema | Estrogen increase
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|
||||
| ALL THESE SX ARE FOR ESTROGEN OR PROGESTERONE - increase or decrease? appetite weight gain tiredness fatigue hypomenorrhea acne oily scalp hair loss hirsutism depression monilial vaginitis breast regression | Progesterone increase
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|
||||
| ALL THESE SX ARE FOR ESTROGEN OR PROGESTERONE - INCREASE OR DECREASE? early or mid-cycle breakthrough bleeding increased spotting hypomenorrhea | Estrogen deficiency
🗑
|
||||
| ALL THESE SX ARE FOR ESTROGEN OR PROGESTERONE - INCREASE OR DECREASE? Late breakthrough bleeding Amenorrhea Hypermenorrhea | Progesterone deficiency
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|
||||
| Lybrel | 365 days continuous hormones
🗑
|
||||
| Ortho-Micronor | Progestin only "minipill"
🗑
|
||||
| Progestin only "minipill" - ovulation inhibited in X% of cases | 50
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|
||||
| Progestin only "minipill" - same dose every day or different? lower or higher or same dose as in combined OCPs? Similar effectiveness or not? | SAME; Lower progestin dose than in combined
Less effective than combined OCP’s
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|
||||
| Progestin only "minipill" | Disadvantages: irregular menses, BTB, spotting, ectopic pregnancy risk, need for STRICT compliance
🗑
|
||||
| Progestin minipill - If > X hours late patient should be advised to use backup method for X hours. | 3, 48
🗑
|
||||
| advantages of progestin minipill | Scanty menses or no menses
Decreased menstrual cramps & pain
Suppression of pain associated with ovulation
Management of pain with endometriosis
Can use while lactating
🗑
|
||||
| patch falls off for <1 day | <1 day: Reapply to same place or replace it with new patch immediately. No back-up contraception is needed.
🗑
|
||||
| patch falls off for >1 day | >1 day: Stop the current contraceptive cycle and start a new cycle immediately by applying new patch. Now a new 'day 1' and a new 'patch change day.‘ Back-up contraception must be used for 1st week of new cycle.
🗑
|
||||
| FDA issued warning of higher estrogen exposure | OrthoEvra
🗑
|
||||
| Less effective for patients weighing more than 90 kg | OrthoEvra
🗑
|
||||
| Given within 5 days after the beginning of menses or after a negative pregnancy test | DepoProvera
🗑
|
||||
| DepoProvera SE | Menstrual irregularities/ Amenorrhea
Weight gain, increased appetite (average 5.4 # in first year)
HA, bloating, breast tenderness
Bone density loss
Depression
Decrease in HDL
🗑
|
||||
| No demonstrated drug interactions, except with Cytadren (used to suppress adrenal function) | DepoProvera
🗑
|
||||
| Excellent short-term protection for women following rubella immunization, on Accutane, awaiting sterilization or vasectomy in partner | DepoProvera
🗑
|
||||
| DepoProvera may prevent | PID, candida vulvovaginitis, ectopic pregnancy, endometrial & ovarian CA
🗑
|
||||
| Return to fertility can be delayed | DepoProvera
🗑
|
||||
| main SE of implanon | intermenstrual bleeding
🗑
|
||||
| levonorgestrel | Plan B
🗑
|
||||
| Plan B - pills and when take | 1 white pill within 72 hours after unprotected sex and 1 more white pill 12 hours later
🗑
|
||||
| Preven Emergency Contraception - pills and when take | 2 blue pills within 72 hours after unprotected sex and 2 more blue pills 12 hours later
🗑
|
||||
| Norgestrel or Levonorgestrel | Emergency contraception - ges for gestation
🗑
|
||||
| Emergency contraception - for pharm, what does it say in slide about timeframe for reporting? | Must be administered within 72 hours after unprotected intercourse
🗑
|
||||
| timing of emergency contraception | Old: Efficacy unaffected by timing if within 72 hours. Obstet Gynecol 1996;88:150-154
New: WHO study found that efficacy declines significantly with delay between unprotected intercourse and initial treatment
🗑
|
||||
| effectiveness of emergency contraceptives | Combined ECP reduces risk of pregnancy by 75%
Progestin only ECP reduces risk by 88%
🗑
|
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