REI Flashcards

Question

What is mechanism of letrozole? What is dosing?

Answer 1

Aromatase inhibitor - blocks synthesis of estrogen which reduces feedback at pituitary and increases FSH. - 1st line for oligo-ovulatory w/ PCOS. - SE: hot flashes, fatigue, dizziness - benefits: higher rate mono follicular development (less multiples), no direct anti-estrogen effects on endometrium. - dose 2.5mg/d for 5d on day 3 of cycle, increase at 2.5mg increments.

Answer 2

FSH or combination of FSH and LH - acts on fSH receptors to stimulate follicular growth - use LH w/ hypothalamic amenorerhea

Answer 3

GnRH agonist produces CONTINUOUS exposure (not pulsatile) of GnRH -> reduces FSH. Indications: - tx endometriosis or CPP, shrink fibroids pre-surgery, increase blood count pre surgery, precocious puberty to switch off stimulation, thin out endometrium prior to ablation. - SE: osteoporosis if use >6 mo, vasomotor sx, vaginal dryness.

Answer 4

competitively and reversibly bind GnRH-R in pituitary, block FSH and LH. - SE: hypoestrogenic sx -Indications: endometriosis, fibroids, infertility for SUBQ injection

Answer 5

Copper: 10yrs, inhibits sperm migration, +emergency contraception Progesterone: Levonorgestrel 52mg, use for 8 years. SE: hormonal (breast tenderness, nausea, depression). inhibits sperm migration, alters cervical mucus, suppresses endometrium. -- decreases HMB, dysmenorrhea, anemia, endometriosis pain, risk of PID, risk of endometrial cancer, treats endometrial hyperplasia. CONTRAINDICATIONS: pregnancy, PID, undiagnosed vaginal bleeding, genital tract malignancy, uterine anomalies, copper allergy, any of this in past 3 months (PP endometritis, septic AB, PID).

Answer 6

regular menses less blood loss esp w/ fibroids decr IDA decr PID decr dysmenorrhea decr endometrial and ovarian cancer decr functional ovarian cysts and benign breast disease tx for endometriosis tx for hyperandrogenism

Answer 7

OK to use to age 50-55 if no contraindications - HTN: not if >160/100 or vascular disease. POPs ok. - lipid disorder: low dose (<35mcg ) ok if well controlled. monitor lipids frequently. oral estrogen incr TG - DM acceptable unless microvascular disease. avoid depo - migraine w/ aura: stroke risk increased. use pOP or IUD - fHx breast cancer: okay! doesn't incr risk for BRCA 1 and 2.

Answer 8

- breast cancer - any estrogen sensitive tumor - pregnancy - unexplained vaginal bleeding - known inherited thrombophilia. - thrombosis - smoker age 35+ - liver disease - CHD - first 21days postpartum - migraines w/ aura - severe HTN - DM w/ vascular dz or disease <20yr duration - SLE w/ APL Ab

Answer 9

ovarian reserve is decreased, decreases ability to respond to ovarian stimulation.

Answer 10

rule out genetic causes: karyotype, FMR1 premutation, adrenal Ab - Pelvic US If Turner's, pregnancy contraindicated 2/2 high cardiac risks. Donor egg IVF best option or adoption.

Answer 11

H&P Confirm normal vagina, cervix, uterus (US or MRI) 1. If blind vagina, obtain karyotype and testosterone (Mullein agenesis vs androgen insensitivity 2. If normal outflow tract: hormonal eval (HCG, TSH, FSH, PRL) 3. If hyperandrogenism: testosterone, DHEA-S, 17-OHP 4. If normal/low FSH: central hypothalamic or pituitary process: consider cranial MRI 5. If high FSH: karyotype for Turner's, FMR1 permutation and adrenal Ab for POI Treatment: - remove gonads if Y chromosome 2/2 cancer risk - correct outflow tract obstruction (transverse vaginal septum) - hormone replacement for gonadal dysgenesis - correct underlying abnormality: TSH, PRL.

Answer 12

Pregnancy, PID, fibroids, TOA, ectopic pregnancy. GI: diverticulitis, post-op ileus, constipation, IBS.

Answer 13

Concern for ovarian hyperstimulation syndrome. Shift of serum from intravascular space to abdominal cavity 2/2 follicular stimulation If mild: CBC, BMP, US. abdominal distension, mild N/V, diarrhea. Tx=tylenol, AVOID NSAIDS Mod: US w/ ascites. Monitor weight and urine uOP Severe: Hct>55, Cr>1.6, severe abdominal pain, N/V, rapid weight gain, VTE, oliguria. VTE prophylaxis. Resolves in 10-14d, longer if pregnant. Can cause stroke, loss of perfusion to extremities. anticoagulation, correct electrolyte abnormalities. Inform their REI.

Answer 14

PCOS, prior episode, AMH>3, antral follicle count >8, high # oocytes retrieved, pregnancy, high estradiol level,

Answer 15

1-2 million. Declining number as we age. At menopause: thousands. 12% 51%

Answer 16

1. Ovarian factor: prior chemo/RT 2. Uterine factor: Prior pelvic surgery, Asherman’s (hysteroscopic resection then place foley to maintain cavity + vaginal estrogen to prevent adhesions), Mullerian abnormality , Leiomyoma, Endometriosis, Pelvic infection 3. Tubal factor: PID 4. Male factor - know specifics on semen analysis Sperm count: 39 million is minimum for normal 5. Female factor: age, Smoking, obesity, meds, Fragile X

Answer 17

HDP, DM, SAB, fetal anomalies, CD Changes in meiotic spindle predispose to non-disjunction

Answer 18

- Hyperandrogenism - ovulatory dysfunction - polycystic ovaries (in one or both ovaries, either 12+ follicles measuring 2-9mm or increased ovarian volume (greater than 10cm3)

Answer 19

Arcuate: A minor irregularity in the shape of the uterus, causing a small dent in the top. Septate: The uterus is divided by a band of muscle or tissue creating two separate cavities within the uterus. Bicornate: Similar to a septate uterus, a bicornate uterus also known as “heart-shaped,” has two cavities created by a wall of tissue, but also has an external fundal indentation of more than 1cm. Didelphys: Additionally known as a “double uterus”, women with this rare abnormality have two separate uteruses with smaller cavities than a normal uterus. Each uterus has its own cervix, fallopian tube, and ovary. Unicornuate: This abnormality is classified by only one half of the uterus developing, resulting in only one fallopian tube Pregnancy risks: SAB, PTL, malpresentation, CD

Answer 20

>2 spontaneous pregnancy loss incidence: 5% baseline incidence of SAB: 10% Causes: - Uterine anomalies: congenital (septate=worst), acquired (fibroids, polyps) - genetic (balanced translocation, robertsonian translocation, mosaicism) - Hormonal (thyroid, DM) - Environmental (smoking, drugs, obesity) - APLS - unexplained: in 50% cases. Workup: - history (family pedigree, maternal hx, exposures) - physical (inspect placenta, autopsy of fetus) - Labs: a1c, TSH, APLS labs, karyotype of parents and fetus, sono-hysterogram/US

REI Flashcards

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