Pharm for dysmenorrhea

Question 1

Drugs used to treat dysmenorrhea (3)?

Answer 1

1. NSAIDs:
   - celecoxib (cox2 inhibitor)
   - ibuprofen + naproxen (non-selective)
2. CHC
3. Progestin-only: levonorgestrel IUS

Question 2

Indications of NSAIDs, CHC and progestin only pills for dysmenorrhea?

Answer 2

CHC = 1st line therapy
Progestin only (IUS) = heavy bleeding

NSAIDs= when contraception not desired

Question 3

Very common: dyspepsia, N/V

Common: nonspecific rash, pruritus, dizziness, headache

Nephrotoxic – caution w/ severe renal impairment

May  risk of cardiovascular events

Answer 3

NSAIDs

Question 4

Spotting, expelled (6%), failure rate 0.2%

CI:
Pregnancy, PID, cervicitis
Postpartum endometriosis
Undiagnosed AUB/ uterine anomaly
Uterine, cervical, hematologic malignancies
Acute liver disease
Hypersensitivity to components of system

Answer 4

Levonorgestrel IUS

Question 5

is acetaminophen or ASA indicated?

Answer 5

NO

Question 6

When are neuromodulators indicated? (amitriptyline/ gabapentin)

Answer 6

poorly controlled dysmenorrhea & overlapping chronic pain

Question 7

Drug classes used for endometriosis (7)?

Answer 7

1. NSAIDs
2. Opioids
3. CHC
4. Progestin only - medroxyprogesterone acetate OR levonorgestrel IUS
5. Androgen agonist (Danazol)
6. GnRH agents (Leuprolide + goserelin)
7. GnRH antagonists (Elagolix)

Question 8

Danazol drug class?

Answer 8

androgen agonist

Question 9

Leuprolide + goserelin drug class?

Answer 9

GnRH agonist

Question 10

Elagolix drug class?

Answer 10

GnRH antagonist

Question 11

1st line tx for mild endometrial pain?

Answer 11

NSAIDs

Question 12

Which drug is indicated to alleviate sx esp in early months and endometriomas < 1cm

Answer 12

Danazol (androgen agonist)

Question 13

Which drug is as effective as CHC but has more side effects thus not 1st line

Answer 13

GnRH agonists (Leuprolide + goserelin)

Question 14

Effect on BM may contribute to pelvic pain (constipation)
Addiction

Answer 14

Opioids

Question 15

Androgenic effects: voice depending (irreversible),  breast size,  weight, hirsutism,
 LDL +  HDL

May: vaginal dryness + hot flashes

*Effective contraception necessary

Answer 15

Androgen agonists (Danazol)

Question 16

Decrease bone mineral density (reversible upon cessation)

Vasomotor sx: hot flashes, vaginal dryness, insomnia, loss of libido, emotional lability

Temp increase in pain may occur at start

Answer 16

GnRH agonists
(Leuprolide + goserelin)

Question 17

Headache, nausea, hot flashes, altered mood, depressive sx

increase serum lipids, decrease BMD

If 2x / day higher rates of adverse effects

Answer 17

GnRH antagonists
(Elagolix)

Question 18

whats used to mitigate the perimenopausal sx + BMD loss that occur with GnRH agonists (& sometimes GnRH antagonists)?

Answer 18

Add back therapy
- estrogen + progesterone alone or in combo

Question 19

What drug is used for infertility in endometriosis?

Answer 19

Letrozole (aromatase inhibitor)

Question 20

Drugs used for AUB (5)?

Answer 20

1. CHC
2. Progestin-only
3. GnRH agonist/ antagonist
4. NSAIDs
5. Ani0fibronolytics (tranexamic acid)