PCOS Dysmenorrhea by mikeholy


									                                                       Exam 1 Answers

1. Pregnant women with nausea, what’s the cause?                 11. Which pills have less risk for VTE?
A: Estriol – made by placenta (nausea from estrogen)             A. Ortho 1/35
Estradiol made from follicles in ovary                           Want 2nd generation agent
Progesterone doesn’t cause nausea                                Not Ovral since has large amt of estrogen
Prolactin not high in pregnancy

2. Menopause, what’s her blood work show?                        12. CI for ECP?
A:  FSH & LH and decreased estradiol                            A. Missed menstrual period b/c they could be pregnant
In menopause, FSH & LH are trying to get ovary to                which is the CI for ECP
produce estradiol, so increase, no egg, no estradiol

3. 33 day cycle, what’s day 1?                                   13. Suppose to take 2nd ECP at 7am, but now 9:45am, what
A: 1st day of menstruation                                       do you tell pt? (2 hr 45min)
                                                                 A. since within 3 hours, tell pt to take the dose
                                                                 Have to know if pt is on Ovral (2 pills) or Plan B (1 pill)
4.S/E of depot injection?                                        14. Breastfeeding mom and doesn’t want to get pregnant
A: will induce menopause and get amenorrhea                      A. Wait 6 wks for established milk prod’n , then go on
                                                                 Progestin-only can be used right away, don’t have to wait
5. What will induce abortion during 1st trimester?               15. Getting  libido, wants to change, what do you give?
A: Prostaglandin – cause uterine contraction, causes painful     A. Brevicon (increase libido) like ortho 1/35
contractions in dysmenorrhea, can induce abortion                Not Diane-35 since low androgen
Bromocriptine has no effect on uterine contraction               Ortho-cept is 3rd generation – low androgen
Oxytocin –affects uterine contraction only around term, but      Need to watch for 2nd generation the amt of progestin, high
can use it for miscarriage since body thinks it’s at term, but   p = anti-estrogen leads to lower SHBG,  T
not for inducing abortion                                        low p = estrogen
6. How to decrease libido?                                       16.Women wants to get pregnant in 1 yr, but can’t take
A: decrease LH                                                   estrogen, what does she take?
If  SHBG,  testosterone                                        A: Progestin-only
If  E, will  SHBG                                              Depo takes too long to reverse
7. Girl wants OC, and friends on Marvelon, which OC?             17. Took ECP & vomited 1.5 hrs ago, what do you say?
A: Marvelon, since her friends are on it and knows its good      A. give gravol with 2nd dose at usual time
and will work                                                    Rule: vomit >1 hr ago, then don’t need to repeat the dose
Can use any one except Ovral…triphasic has no advantage
over mono-phasic, pick pill pt will like
8. Using pill for Acne (no sex) and she misses, what should      18.Girl starting OC on Wednesday and sees BF only on
she do?                                                          weekends, when should she start the pill?
A: Skip pills and continue on                                    A. start on Sunday
As long as she’s not having sex, then don’t need to double       Give pill within 5 days for immediate protection, and start
up since not using if for birth control, acne won’t “flare” up   Sunday so she doesn’t have periods on weekend
just b/c she missed pills
9. Was on triphasil for 1 mth and got spotting near end of       19.MD gave piroxicam for dysmenorrhea, no use now what
cycle then switched to ortho 1/35 and still spotting, what do    do you try?
you do?                                                          A. change to Naproxen
A. Pt was on it only for 2 mths, not supposed to switch until    Piroxicam is not appropriate
after 3 months – stay on ortho 1/35                              Don’t need to add or change to OC yet since didn’t try
If pt was spotting near the end of cycle on 4th mth, then        NSAID yet
switch to lo-estrin since it has higher progestin

10. How to manipulate period using OC?                           20.What’s an indication for ECP?
A: take back to back                                             A. 2 missed pills in 2nd week of OC pack
Don’t want to stop taking pill after 1st wk b/c may not have     Indication: if Depo-provera given after 13 wks, diaphragm
contraceptive care                                               <6hrs, if using rhythm method, that’s what they’re willing
                                                                 to use and not reason for ECP
21. What’s pregnancy rate for ECP?                             31.Breakthru bleeding with Depo-Provera, what’s been
A. 1-2%                                                        shown to help?
                                                               A. give injection every 8 wks

22. What info to give to pt about PlanB ?                      32. Woman on progestin-only, and missed pill in 2nd wk of
A. spotting                                                    pack and is sexually active
Will not get breast tenderness, since caused by estrogen,      A. use ECP
Plan B is progestin only, dose is only 1 pill and Plan B has   In trouble if missed dose > 3 hrs
lower rate of nausea and vomiting than ovral
23. Pt was on BCP, but forgot to take them, MD prescribed      33. Where is progesterone produced during pregnancy?
ECP, when should she start her pills again?                    A. placenta
A. start new pack next days after ECP and use back up for
7 days
Don’t need to worry about preg since she was on the pill,
she’ll know not pregnant in 3 wks
24. What’s the most potent estrogen?                           34.Which cancer increases with OC use?
A. Estradiol                                                   A. breast cancer
25.Wants to get pregnant and has 34 day cycle, when in her     35.Had sex 4 days ago, wants to know about ECP
cycle will she ovulate?                                        A. check if candidate for IUD
A. Day 20 (34-14) Count 14 days after the cycle, corpus
luteum lasts for 14 days
26. What is a symptom of dysmenorrhea?                         36.Has dysmenorrhea & recommended to take NSAID,
A. Diarrhea                                                    what do you tell her
                                                               A. no loading dose required
                                                               Don’t take 2 days prior to period since no cramps yet, no
                                                               release of prostaglandins
27. Pt with dysmenorrhea has tried all OTCs for treatment      37. Which combination of OC to give for ECP, has ortho77,
for 3 mths, what is the next step?                             ortho1/35, orthocept, minovral
A. Mefenamic acid – since Rx NSAID                             A. 4 Ortho 1/35 and rpt in 12 hours or give 3 ortho 777
First treat with OTC NSAID, then Rx NSAID, then OC             (two answers for this) usu give 4 low doses and 5 alesse
28.Woman wants OC, has family history of breast cancer,        38. Which doesn’t interact with OC?
CVD, has 23 and has mild dysmenorrhea, which OC?               A. ampicillin
A. Marvelon
Not triphasics, since not good for dysmenorrhea
3rd generation decreased risk for CVD
29.Getting migraine-like headaches, but is happy on            39. Got ECP 2 wks ago, and period is late, what do you tell
ortho777, h/a start around period                              her?
A. add daily premarin on days off the pill                     A. period may be delayed b/c of ECP
Giving back to back pills, not best option, may still get      Should expect period in 3 wks after ECP
breakthrough spotting, eventually have to take her off
30. What’s S/E of Depo-provera?                                40. Contraindication for OC?
A. Bone loss
Get increase appetite, no breast tenderness (from estrogen),   A. Undiagnosed vaginal bleeding
VTE not S/E as stated in CP

To top