CE Quiz

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Managing the Spectrum of Premenstrual Symptoms

Pharmacy Times

Continuing Pharmacy Education Accreditation /Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-000-05-022-H01.

Instructions

After reading "Managing the Spectrum of Premenstrual Symptoms," complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program.

1. Identify which statement is NOT CORRECT in the following list of statements.

• As many as 3% to 8% of women in the reproductive years may have the most severe premenstrual symptoms consistent with premenstrual dysphoric disorder (PMDD).
• Because symptoms may vary and there is no endocrine test to diagnose premenstrual syndrome (PMS) and PMDD, the condition may be underrecognized, underdiagnosed, and undertreated.

2. Work-productivity loss associated with PMS, in a study conducted over 2 menstrual cycles, indicated:

• Nearly 1 in 3 experience more than 5 days per month of 50% reduction in work productivity.
• Women with PMS are one third as likely to find satisfaction in their work as women who don't experience PMS.

3. An estimated 2 million to 5 million reproductive-age women in the United States have symptoms of sufficient severity to be classified as PMDD. Applying population averages for years of reproductive life and numbers of pregnancies, this extrapolates to a lifetime total of roughly _______ years of severe symptoms.

• 4
• 8

4. According to the criteria established for PMDD by the American Psychiatric Association, reported in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR), a woman must experience at least 5 of 11 listed symptoms, including one or more of 4 "core" or "essential" symptoms. Which of the following is NOT among the essential symptoms?

• Marked anxiety, tension, feelings of being "keyed up" or "on edge"
• Marked affective lability–feeling suddenly sad or tearful, or increased sensitivity to rejection

5. Which of the following self-assessment tools is NOT among those used to assess PMS and/or PMDD?

• Visual analogue scale (to quantify subjective factors)
• Goldberg Depression Inventory

6. PMDD symptoms must be present during most of the last week of the luteal phase in most, if not all, of the woman's menstrual cycles during the previous year. Which one of the following statements is NOT CORRECT?

• The symptoms must not recur during the week following menses.
• PMDD can affect a woman at any stage of her reproductive life.

7. Which of the following is true?

• A study of more than 400 evaluable women indicated that calcium supplementation appears to reduce premenstrual symptoms in some women.
• All of the above are true.

8. Current US Food and Drug Administration (FDA)-approved treatment options for PMDD are limited to:

• Estrogen-dominant oral contraceptives (OCs)
• All SSRIs and OCs

9. Although the SSRIs that have FDA indications for PMDD have demonstrated efficacy for several PMDD symptoms, a frequency of 10% or more has been reported for the following side effect(s) with SSRIs:

• Weight gain
• a and c

10. In a study of compliance in taking prescribed antidepressant agents for PMS, 148 women started but 91 (61.5%) had discontinued the antidepressant by the end of 2 years. Among the primary reasons (³ 15%) were all of the following EXCEPT:

• Aim to deal with symptoms "naturally"
• Bad publicity of antidepressant drugs in media

11. Gonadotropin-releasing hormone (GnRH) agonists can be used to suppress ovulation and effectively alleviate premenstrual symptoms. However, using GnRH agonists:

• Is recommended only for long-term use
• Leads to dependency

12. Another hormonally mediated drug, the synthetic androgen danazol, suppresses ovulation, but its use is limited by adverse effects, including:

• Decreased high-density lipoprotein cholesterol
• All of the above

13. In early studies, OCs have had mixed results in reducing premenstrual symptoms. However, more recent research indicates greater promise for low-dose formulations. Which of the following statements best reflects the results shown by recent studies?

• Low-dose OCs show greater inhibition of ovulation and greater overall efficacy with shorter, 3- or 4-day hormone-free intervals than with 7-day intervals.
• Affective, or emotional, premenstrual symptoms are reduced by almost all OC types, dosages, and regimens.

14. In the female reproductive system, the degree of follicular activity during OC use is dependent on:

• Individual metabolic responsiveness to the OC prescribed
• All of the above

15. Current trends in the use of low-dose OCs, including the use of newer progestins in extended regimens, are being followed in pursuit of these potential benefits:

• The possibility of lessening bleeding, anemia, and functional ovarian cysts
• All of the above

16. All but one of the progestins being used in OCs in the United States are derived from 19-nortestosterone. The exception, which has a pharmacologic profile closely resembling natural progesterone, is:

• Gestodene
• Desogestrel

17. Drospirenone, unlike progestins used in most OCs:

• Has no effect on sodium retention
• Has substantial androgenic activity

18. During the preextension phase of a current study, women taking a variety of 19-nortestosterone-based progestins were switched to an OC containing ethinyl estradiol (EE) 30 µg plus drospirenone 3 mg for 2 cycles. As measured by DSR-17 (Daily Symptom Report) scores, the mean scores for cycles in which EE/drospirenone were taken:

• Were somewhat worse than for those of other OCs during the hormone-free interval
• Showed improvement over other OCs on both cycles, especially on the second

19. Several recent studies that assess the efficacy of a new, low-dose OC (EE 20 µg, drospirenone 3 mg) on several somatic and affective scales have indicated the following.

• The efficacy of the low-dose OC had lower efficacy than EE 30 µg, drospirenone 3 mg, in approximate proportion to their relative doses of EE.
• EE 20 µg, drospirenone 3 mg showed significant efficacy over placebo on the affective scales, but not on the somatic scales.

20. A double-blind, placebo-controlled, parallel-group study of EE 20 µg, drospirenone 3 mg, using a 24/4 regimen in women with PMDD symptoms, was conducted over 3 treatment cycles. It showed improvements for the active drug in all groupings of the DRSP scale, beginning with the ____ treatment cycle, and the improvements continued for ____ cycle(s).

• Second/the following
• First/no further

For Pharmacists

ANSWER CARD INSTRUCTIONS

Testing and Grading Procedures

• Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CE credits earned. This form should be safeguarded and may be used as documentation of credits earned.
• All answers should be recorded on the answer form. Please print clearly to ensure receipt of CE credit.

Pharmacy Times,

• Take the test online for FREE at www.pharmacytimes.com and receive immediate grading and CE credits, and download your CE statement of credit.

Please photocopy the test form for additional test takers.

Pharmacy Times

/Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-000-05-022-H01. The program is available for CE credit through December 1, 2006.

Answer card and evaluation form for Pharmacists follow on page S502.

GOAL

To provide participants with an overview of premenstrual disorders and the diagnostic and therapeutic strategies for managing their symptoms.

TARGET AUDIENCE

This activity is intended for pharmacists, pharmacy directors, primary care physicians, gynecologists, medical directors, and other managed care decision makers.

LEARNING OBJECTIVES

After participating in this activity, participants should be better able to:

• Describe the epidemiology and disease burden of premenstrual disorders
• Identify new treatment approaches for managing premenstrual disorders

CONTINUING PHARMACY EDUCATION ACCREDITATION

Pharmacy Times

/Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-000-05-022-H01. Release Date: December 1, 2005. Expiration Date: December 1, 2006.

FUNDING

This program is supported by an educational grant from Berlex Pharmaceuticals.

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The contents of this supplement may include information regarding the use of products that may be inconsistent outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

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