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Flashcards in Treatments 6 Deck (94)
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1

Central precocious puberty

Continuous GnRH

2

Pseudoprecocious puberty

Remove tumor, cortisol replacement for CAH

3

Pros of HRT for menopause

Control symptoms
Reduced risk of osteoporosis
Reduced risk of colorectal cancer
May decrease coronary calcification if taken age 50-59 (unknown correlation w/ cardiac disease)

4

Cons of HRT for menopause

Increases risk of invasive breast cancer, endometrial cancer (NO estrogen w/o progesterone if woman still has uterus)
Increases risk of stroke, heart disease, hypercoagulability, biliary disease

5

Non-HRT options for hot flashes

Desvenlafaxine, venlafaxine
Clonidine
Gabapentin
Time

6

Menopause treatment

Vaginal lubricants (dyspareunia)
Calcium, vitamin D, bisphosphonates, weight bearing exercise (osteoporosis risk)
SERMs (tamoxifen, raloxifene) (osteoporosis risk)

7

Emergency contraception

High dose OCPs (lots of AE)
Levonorgestrel (Plan B, just progesterone)
Copper IUD (insertion w/i 4-5 days of intercourse)
Mifepristone (RU 486) (low dose, high dose for abortion)

8

Pros of OCPs

Reliable
Reduce risk of endometrial and ovarian cancer
Decreased incidence of ectopic pregnancy
Menses lighter, more regular, less painful

9

C/I for OCPs

Pregnancy
History of DVT/PE/hypercoagulability disorder
History of estrogen-dependent tumor
History of stroke or CAD
Poorly controlled HTN
Smokers >35 yo
Hepatic disease or neoplasm
Abnormal vaginal bleeding of unknown etiology
Migraine w/ aura, neuro sx or vascular involvement

10

Amenorrhea, behavioral

Behavior modification (eating, exercise)

11

Amenorrhea, anatomic

Surgical correction

12

Amenorrhea, HPO dysfunction

Leuprolide (GnRH agonist), pulsatile

13

Amenorrhea, prolactinoma

Dopamine agonists (bromocriptine, cabergoline)

14

Dysmenorrhea

NSAIDs, OCPs

15

PMS, PMDD

NSAIDs, OCPs
Vitamin B6, SSRI +/- alprazolam, exercise, progestins

16

Endometriosis

OCPs, progestins, GnRH, NSAIDs, (danazol)
Laparoscopy
Definitive = hysterectomy + b/l salpingo-oopherectomy

17

Abnormal uterine bleeding

Treat cause
NSAIDs, OCPs
Endometrial ablation / hysterectomy

18

When to get endometrial biopsy w/ abnormal uterine bleeding

Patient >45
Patient w/ multiple risk factors for endometrial cancer
Patient w/ persistent AUB >6 months

19

PCOS

Exercise, weight loss
OCPs (or at least progesterone by itself)
Spironolactone
Metformin
Consider statin, acne meds as needed

20

PCOS if patient wants to get pregnant

Clomiphene (antiestrogen, acts at hippocampus)

21

Pelvic prolapse

Mild - pelvic floor exercises
Moderate - pessary
Severe - surgery

22

Uterine fibroids (leiomyomas)

Asymptomatic - observation
GnRH agonists (temporary), OCP/IUD (for bleeding)
Myomectomy, hysterectomy, UAE

23

Endometrial cancer

TAH w/ bilateral salpingo-oopherectomy and LN sampling
Progestins to maintain fertility then surgery after finished
Add chemo/radiation for mets

24

Cervical cancer

Microscopic (<5 mm): TAH or conization
Visibly invasive: radical hysterectomy + lymphadenectomy
Major invasion/mets: radiation + chemo

25

SCC of the vagina

Radiation

26

Lichen sclerosis

Punch biopsy to r/o SCC
Steroids (clobetasol)

27

Benign ovarian tumors

Observation for functional cysts
Cysectomy or oopherectomy if malignant potential
TAH-BSO for postmenopausal

28

Ovarian cancer

Epithelial - TAH-BSO w/ pelvic wall sampling, abdominal omentum resection, LN resection w/ adjuvant chemo
Germ cell - oopherectomy +/- debulking w/ chemo

29

Fibrocystic changes

Observation
Caffeine and dietary fat reduction, OCPs

30

Breast abscess

I&D, antibiotics (dicloxacillin, cephalexin, amoxicillin-clavulanate, TMP-SMX for MRSA, metronidazole for anaerobes), continue breastfeeding