Pharmacology Of Abnormal Uterine Bleeding

Front 1

How does estrogen travel through the bloodstream?

Back 1

Bound to sex hormone binding globulins (SHBGs)

Front 2

Steroids are lipophilic/hydrophilic

Back 2

Lipophilic

Front 3

After steroids get through the cell membrane, what do they do next?

Back 3

Bind to the receptor, which then dimerizes

Front 4

What do dimerized steroid receptors activate in the nucleus?

Back 4

Steroid response element

Front 5

What enzyme is responsible for changing steroids released by the ovaries into estrone and estriol in the peripheral tissues?

Back 5

Aromatase

Front 6

This hormone not only has endometrial effects, but is responsible for female maturation.

Back 6

Estrogen

Front 7

What effect does estrogen have on skin and blood vessels?

Back 7

Maintenance of normal function

Front 8

What effect does estrogen have on bone?

Back 8

Decrease rate of bone resorption

Front 9

What effect does estrogen have on adipose tissue?

Back 9

Stimulate leptin production

Front 10

What does estrogen do to HDL and LDL levels?

Back 10

Raises HDL, slightly lowers LDL

Front 11

What does estrogen do to total plasma cholesterol?

Back 11

Lowers it

Front 12

What does estrogen do to triglycerides?

Back 12

Increases

Front 13

What effect does estrogen have on coagulation?

Back 13

Enhanced coagulatiblity

Front 14

What coagulation factors does estrogen increase?

Back 14

X, IX, VII, II

Front 15

What anticoagulant does estrogen decrease?

Back 15

Antithrombin III

Front 16

Estrogen induces synthesis of ___________ receptors.

Back 16

Progesterone

Front 17

What are six adverse effects of estrogen?

Back 17

Uterine bleeding in post-menopausal women

Nausea and breast tenderness

Increased frequency of migraine headaches

Cholestasis and gallbladder disease

Hypertension

Hyperpigmentation

Front 18

What are the five contraindications to estrogen use?

Back 18

Estrogen dependent neoplasms

Undiagnosed genital bleeding

Liver disease

History of thromboembolic disorders

Heavy smokers (more than 10 cigarettes a day)

Front 19

What is the name of the complex progesterone binds to in the nucleus, which activates gene transcription?

Back 19

Progesterone response element

Front 20

What does progesterone do to the breast?

Back 20

Causes further development of secretory apparatus

Front 21

What does progesterone do to the endometrium?

Back 21

Prepares endometrium for pregnancy

Front 22

Is estrogen or progesterone responsible for weight gain?

Back 22

Progesterone

Front 23

Stimulating lipoprotein release, increasing basal insulin levels/insulin response to glucose, promoting glycogen storage and promoting ketogenesis are properties of _____________.

Back 23

Progesterone

Front 24

Fluid retention associated with increased secretion of aldosterone is associated with this hormone.

Back 24

Progesterone

Front 25

What are two adverse effects of progesterone?

Back 25

May increase BP in some patients

Androgenic progestins may reduce HDL

Front 26

This treatment is effective for dysmenorrhea in women with heavy or prolonged uterine bleeding. It also prevents hyperplasia in anovulatory patients. Cyclical use will lead to withdrawal bleeding, while continuous use will lead to amenorrhea.

Back 26

Estrogen-progestin contraceptives

Front 27

This treatment uses local progestin concentrations to cause a thinning of the endometrium.

Back 27

Levonorgestrel IUD

Front 28

A levonorgestrel IUD may take up to _ months to reduce bleeding (which may increase initially), but most women will be amenorrheic by _ months.

Back 28

3, 6

Front 29

This long term treatment is good for women who have contraindications to estrogen therapy, such as smokers, estrogen dependent neoplasms, liver disease, increased risk of thrombotic events and undiagnosed bleeding.

Back 29

Levonorgestrel IUD

Front 30

Does levornorgestrel treat dysmenorrhea?

Back 30

No

Front 31

This oral or IM medication may be used for the prevention of excessive bleeding from endometrial hyperplasia, but is not as effective as the levornorgestrel IUD.

Back 31

Oral or parenteral Progestins

Front 32

Low dose luteal phase progestins are administered from cycle days __ to __, but are less effective than other therapies.

Back 32

15-26

Front 33

Naproxen, ibuprofen and mefanamic acid are examples of this drug class.

Back 33

NSAIDs

Front 34

Oral NSAIDs reduce the volume of menstrual blood loss by reducing the rate of synthesis of these two prostaglandins.

Back 34

PGE2, PGF2a

Front 35

NSAIDs reduce prostaglandin synthesis and decrease uterine bleeding by _____________.

Back 35

Vasoconstriction

Front 36

This class of drug is good for women with regular cycles and dysmenorrhea due to ovulatory DUB.

Back 36

NSAIDs

Front 37

Should NSAIDs be used daily to treat AUB?

Back 37

No. Only during the days of menses.

Front 38

Taranexamic acid and aminocaproic acid are examples of __________________.

Back 38

Antifibrinolytic agents

Front 39

This is an absolute contraindication for antifibrinolytic agents.

Back 39

Risk for thrombosis

Front 40

GI discomfort, leg cramps, dizziness, headaches and allergic reactions are associated with these agents.

Back 40

Antithrombolytic agents

Front 41

When should a woman with AUB take an antifibrinolytic agent?

Back 41

On the days of menses

Front 42

Goserelin, leuprolide and nafarelin are examples of this type of drug.

Back 42

Gonadotropin Releasing Hormone Agonists

Front 43

This class of drugs induces a menopausal state in premenopausal women (amenorrhea) that will return to normal upon discontinuation of the drug.

Back 43

Gonadotropin Releasing Hormone Agonists

Front 44

This drug isn't used as often as other treatments of AUB because of high cost, hot flashes and vaginal atrophy associated with the menopausal state it induces.

Back 44

Gonadotropin Releasing Hormone Agonists

Front 45

When using GnRH agonists, you must use ________________ for treatment lasting longer than 3 months to avoid osteopenia.

Back 45

Estrogen/progesin add-back therapy

Front 46

_____________ is an androgenic steroid that reduces bleeding from chronic menorrhagia through unclear MOAs.

Back 46

Danazol

Front 47

This drug can cause weight gain and acne and is not standard treatment for chronic heavy or prolonged uterine bleeding.

Back 47

Danazol

Front 48

This treatment causes rapid regrowth of endometrium over denuded or raw surfaces of the uterus in the case of acute uterine bleeding in a hemodynamically unstable woman.

Back 48

High dose estrogen

Front 49

The risks associated with high dose estrogen therapy include: (list two)

Back 49

PE

Thrombosis at other sites

Front 50

Women with anovulatory cycles should be treated with agents that decrease the risk of _____________.

Back 50

Endometrial cancer and hyperplasia

Front 51

Women with anovulatory cycles who desire amenorrhea should use:

Back 51

Levonorgestrel IUD

Front 52

What is the best treatment for women with anovulatory cycles?

Back 52

Estrogen/progestin contraceptives

Front 53

What symptoms would indicate a leiomyoma or adenomyosis?

Back 53

Heavy prolonged bleeding with pain/pressure

Front 54

What is the first option for treating a woman with AUB with adenomyosis as the cause?

Back 54

Estrogen progestin contraceptives

Front 55

What are second options for treating a woman with AUB with adenomyosis as the cause?

Back 55

Levonorgestrel IUD or NSAIDs

Front 56

What is the only guaranteed treatment for adenomyosis?

Back 56

Total hysterectomy

Front 57

What should be done to most effectively treat a leiomyoma associated with AUB?

Back 57

Reduce size or remove leiomyoma

Front 58

What is the pharmacological treatment for leiomyomas?

Back 58

GnRH agonists

Front 59

What treatment should not be used in women with AUB who want to get pregnant within 1 year?

Back 59

Levonorgestrel IUD (not cost effective)

Front 60

What is the best treatment option for women with AUB who are planning pregnancy?

Back 60

Oral progestin therapy (micronized progesterone)

Front 61

What is the second best treatment option for women with AUB who are planning pregnancy?

Back 61

NSAIDs discontinued upon conception

Front 62

What is the last resort treatment option for women with AUB who are planning pregnancy?

Back 62

Antifibrinolytic agents

Front 63

What is the best treatment option for women at risk for thrombosis?

Back 63

Non-estrogenic therapy

Front 64

What is the best therapy for a woman at risk for thrombosis with AUB?

Back 64

Levonorgestrel IUD