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Delivery Pharmaceutical care to patients > Women's health > Flashcards

Women's health Flashcards

1
Q

What are the list of conditions covered

A
  • Dysmenorrhoea
  • Menorrhagia
  • Endometriosis
  • FGM
  • The menopause
  • Vaginal dryness
  • Female cancer
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2
Q

What are the 7 stages of women and what are the signs

A

Reproduction
>Early: 12-18y/o- variable to regular periods and normal FSH
>Peak: 18-35 - regular periods and increasing FSH
>Late: 35-47- Regular periods and increasing FSH
Perimenopause
> Early: 45-49- variable periods <7 days
>Late 40-58 - more than 2 consecutive periods missed and amenorrhoea > 60days
Post menopause
>Early: 40 up/47-51 - 1 to 4 years of amenorrhoea
>Late: NO periods

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3
Q

Definition of endometriosis

A

A chronic oestrogen dependant condition.

Growth of endometrial tissue in sites other than the uterine cavity

The cells bleed monthly however there is no way for it to leave the body = inflammation, pain and scar tissue

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4
Q

Impact of endometriosis

A

Chronic pain, Fatigue, depression, problems with sex life, inability to conceive and difficulty fulfilling work.

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5
Q

Causes of endometriosis

A

Retrograde menstruation: back flow of endometrium through fallopian tubes into abdomen.
> tissue implants itself on organs

Genetic predisposition: suggestions that endometriosis can pass done from gen to gen through genes,

Lymphatic or circulatory spread: tissues travel round the body through lymphatic system and bloodstream

Immune dysfunction: Immune system can’t fight the endometriosis

Environmental causes: toxins in the environment such as dioxin can effect the body, immune and reproductive system.

Metaplasia: When once cell morphs into another to adapt to a change in environment

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6
Q

What is the differential diagnosis for endometriosis

A 
Pelvic inflammation disease
Ovarian Cyst 
Ectopic pregnancy
Appendicitis
IBS
Uterine fibrosis
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7
Q

What are the general symptoms of endometriosis

A 
Dysmenorrhoea 
Pain during intercourse(Dyspareunia)
cyclical/ pelvic pain
Subfertility 
Bloating, lethargy and constipation
Worsens during menstruation
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8
Q

Endometriosis and the bladder symptoms

A

Rare with unknown cause
Can be on surface or deeper

Symptoms: Alter menstrual cycle, bladder irritation, pain when bladder in full, loin pain in kidney area.

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9
Q

Endometriosis and the Bowel symptoms

A

can be superficial or deep

Similar symptoms to IBS

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10
Q

Treatment options for Endometriosis

A 
Hormone: 
-COC: Supresses ovulation. 
-Mirena coil: T shaped intra-urine device (PO)
-Progesterones
-GnRH
-Testosterone derivative
-Danazol (form of testosterone)
-Gestrinone (testosterone)
Pain relief:
-Heat/comfort
-NSAIDS/codeines and analgesia 
-Pain modifiers: Amitriptyline
-TENS(transcutaneous electrical nerve stimulators): Electrical pulses through the body 
Pain clinics.
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11
Q

Stages of FGM

A

Stage 1: Prepuce removed and/or partial closure of clitoris

Stage 2: Removal of clitoris and part or all of labia minera

Stage 3: Small hole for urine for menstruation and urine left

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12
Q

Causes of vaginal dryness

A

Lack of oestrogen causes thinning and reduces elasticity of vaginal walls.

Reduction in glands to produce lubricating mucus.

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13
Q

Factors linked to vaginal dryness

A

Hormone contraceptive, cigarette smoking, radiation therapy or chemo

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14
Q

Symptoms of vaginal dryness

A

Pain during intercourse
Inflamed valvula causing discomfort
Itch/scratch/inflammation cycle
Urinary problem due to thinning.

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15
Q

Treatment/management of vaginal dryness

A

OTC: lubricating gels (ReplensMD and sylk)- non hormone, drug free bio degradable

OTC: water based lubricant K-Y jelly

Avoid douching, perfumed soaps and bath products

HRT or hormone based vaginal gels

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16
Q

Types of female cancers

A

Breast

Endometrial

Ovarian

Cervical

17
Q

Risk factors for breast cancer

A

Age, ethic group, pervious history of breast cancer, FH, early menarche, menopause, HRT.

18
Q

Risk Risk factors of endometrial cancer

A

Age, obesity, high fat diet, not having children, menstrual disturbances, history of endometrial hyperplasia, PCOS, FH, tamoxifen and HRT

19
Q

Risk factors of ovarian cancer

A

FH, history of breast cancer, fertility drugs, HRT, being overweight, being tall, history of endometriosis and smoking

20
Q

risk of cervical cancer

A 
HPV infection, 
history of other STI, 
smoking, 
weakened immune system, 
contraceptive pills, 
personal hygiene, 
having kids young
21
Q

What is dysmenorrhoea

A

It is period pains which is located at the lower abdominal or pelvic pain that radiates to back and thighs,

there is primary and secondary dysmenorrhoea (refer for secondary)

22
Q

symptoms of primary dysmenorrhoea

A

Most sever pain from day before to 48 hrs after menstrual flows begins

pain, headache, constipation, nausea, vomiting, diarrhoea, dizziness

most common in young females`

23
Q

symptoms of secondary dysmenorrhoea

A

Late onset
pain throughout menstrual cycle
dyspareunia, intermenstrual bleeding.

24
Q

causes of secondary dysmenorrhoea

A 
Endometriosis
Fibroids
Pelvic inflammatory disease
Ovarian cysts/tumours
Copper IUD
25
Q

Treatment for Dysmenorrhoea

A

Analgesia
contraceptive
Age

Heat therapies
exercise
TENs
Lifestyle

26
Q

signs of Menorrhagia (heavy bleeding)

A

30-40ml of blood loss during period

9/10 women loss less than 80ml

Heavy loss = >60ml per cycle

27
Q

Causes of menorrhagia

A 
PCOS
fibroids
Pelvic inflammatory disease
Endometriosis
Hypothyroidism
Anti-coagulants
IUD
Bleeding after C-section
28
Q

Treatment of menorrhagia

A

1st line: Mirena coil
2nd line: NSAIDs
3rd line: Norethisterone 5mg daily

29
Q

What is Bacterial vaginosis

A

overgrowth if anaerobic organism in vagina: Lactobacilli (present in normal flora)

pH goes from 4.5 to 6

30
Q

Risk factors of BV

A
  • New sexual partner.
  • Other sexually transmitted infections (STIs).
  • Ethnicity (more common in women of Afro-Caribbean descent).
  • Presence of a copper intrauterine contraceptive device (IUCD).
  • Vaginal douching.
  • Bubble baths.
  • Receptive oral sex.
  • Smoking.
31
Q

Protective factors from BV

A
  • Combined oral contraceptive pill (oestrogen encourages lactobacilli).
  • Condoms.
  • Circumcised partner
32
Q

Presentation of BV

A

Offensive, fishy-smelling vaginal discharge without soreness or irritation.
Approximately half of all women infected are asymptomatic.
On examination there is usually a thin layer of white discharge covering the vaginal wall.

33
Q

Treatment for BV

A

Antibiotics. Metronidazole is the most common and preferred antibiotic treatment for BV.

Further treatment. For some women, the first course of treatment doesn’t treat BV effectively.

Vaginal pH correction treatments.

Referral to a specialist.

34
Q

Definition and properties of osteoporosis

A

loss in bone density, increased bone fragility, high risk of fracture.

osteoporosis is asymptomatic and the condition usually presents only after first bone fracture

Bone mass density can decline during menopause due to lack of oestrogen

35
Q

Osteoporosis management and advice

A

Ask a set of questions when deciding on the various treatment options for a patient with Osteoporosis:
-Is bone sparing treatment required?
>Bisphosphate, raloxifene, strontium ranelate

-Is calcium intake adequate?
>700mg/day

-Is the patient male of female?
>Alendronate is only licenced to be used in men

-Is the patient in premature menopause?
>HRT can be considered

-Lifestyle
> Balanced diet,
>stop smoking,

36
Q

Treatment for osteoporosis

A
  1. Bisphosphonates e.g. alendronate, risedronate-
    >Can’t be sucked or chewed due to oropharyngeal ulceration risk
    >Sit and remain up right for half an hour
    >Take between meals (2 hours between or first thing)
    -Work by slowing osteoclasts and the build up of osteoblasts
  2. HRT
  3. Raloxifene: Selective oestrogen receptor modulator which reproduce effect of oestrogen without side effects on breast and endometrium
  4. Tibolone (hormone therapy): Selective tissue oestrogenic activity modulator, reduces bone turnover and increase bone mineral density.
  5. Calcium & Vitamin D: Excreted through the kidney
    > 700mg/Day

Delivery Pharmaceutical care to patients (6 decks)

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