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Course 10814
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A 29-year-old woman presents with severe cyclic pelvic pain, , and dyspareunia for the past 2 years. Pain worsens during menstruation and partially improves afterward and the patient described her pain as severe. She is not planning pregnancy for the next few years and is seeking both pain relief and contraception. She previously used ibuprofen during menses with only mild relief. Physical examination and clinical history suggest . The physician decides to start pharmacological management.
Past Medical History: Cancer at the age of 20 years, Perforated gastric ulcer
1. What is the best treatment regimen for the treatment of pain? (1 points)
Which hormonal therapy is the best to be prescribed (along with the type of use) and which one should be avoided? (3 points)
If the patient does not respond to COCs, why are GnRH agonists and Danazol considered second-line rather than first-line therapy? (3 points)
If the patient's is unresponsive to first-line therapies, a GnRH agonist such as Nafarelin might be considered. Looking at the medicinal chemistry of natural GnRH, what specific structural modification is made to create Nafarelin, and how does this chemical change improve its therapeutic viability? (4 marks)
Describe the pharmacological management of endometriosis , including all first-line and alternative treatment options. In your answer, discuss how the choice of therapy is influenced by patient factors such as desire for contraception, contraindications to estrogen, and comorbidities. (4 marks)
Q2f. The patient previously discontinued a Combined Oral Contraceptive (COC) due to nausea and breakthrough bleeding. The estrogenic component of most COCs is Ethinyl Estradiol (EE) or Mestranol (shown below). Why are these synthetic estrogens used in oral contraceptives instead of natural 17β-estradiol, and how do they differ chemically from one another? (2 marks)
Q2g. If this patient, who is non-compliant with daily oral medications, opted for an intramuscular (IM) injection instead of an IUD, she might receive Depo-Provera (Medroxyprogesterone acetate) or Lunelle (Estradiol cypionate + Medroxyprogesterone acetate) . Chemically, how is estradiol modified to allow for a prolonged duration of action (14 to 28 days) when given as an IM injection? (2 Marks)
Q2d. What are the serious warning signs that should be explained to any patient starting COCs?
Q2e. If this patient had unprotected intercourse and presents , what are the two appropriate emergency contraception options?
A 32-year-old woman visits the pharmacy seeking advice on contraception. She has and wants for at least 5 years. She reports . Her medical history reveals . She is non-compliant with daily medications and prefers a method that does not require daily attention. She previously used a but stopped because of when she occasionally missed pills. (13 Marks)
Q2a. Which contraceptive method is most appropriate for this patient based on her condition and preferences?