Endo

Question 1

Describe the signs and symptoms of menopause

Answer 1

change in menstrual cycle
vasomotor sxs (hot flashes, night sweats)
vulvovaginal sxs (dryness) => painful sex
sleep disturbances
weight gain - 5 lbs

Question 2

menopause

Answer 2

stop period

after 12 months without period

Question 3

perimenopause

Answer 3

1st signs of endocrine change
irregular period
ends 1 year after last period

Question 4

natural/spontaneous menopause

Answer 4

12 months after last period confirmed

Question 5

induced menopause

Answer 5

stopped periods manually

Question 6

peri-menopause - menopause transition

Answer 6

starts when you see sxs

ends 12 months after last period

Question 7

post-menopause

Answer 7

years after last period

Question 8

bioidentical hormone therapy (BHT)

Answer 8

v similar to hormones of the body

Question 9

estrogen therapy (ET)

Answer 9

unopposed estrogen for:

1. systemic use for women without uterus
2. local for women with dryness

Question 10

estrogen-progestogen (EPT)

Answer 10

progestogen added to ET

protect women with uterus from endometrial cancer (estrogen can cause cancer)

Question 11

FDA approved indications for HT

Answer 11

Vasomotor sxs
prevention of bone loss
premature estrogen loss
genitourinary sxs

Question 12

How can contraceptives help with perimenopause symptoms?

Answer 12

less hot flashes
more predictable period
less cramps
improve BMD
decrease risk cancer

Question 13

What is the physiological effect of PTH

Answer 13

Bone: increase expression and secretion of RANK ligand from osteoblasts
RANKL causes osteoclast formation => bone resorption
Kidney: decrease phosphate transporter => decrease phosphate uptake

Question 14

What is the physiological effect of calcitonin

Answer 14

increases cAMP to inhibit osteoclasts

Question 15

What is the physiological effect of vitamin D

Answer 15

Bone: osteoblasts have Vit D receptors. Cause blasts to make cytokines that activate clasts to resorb Ca which make blasts deposit Ca. BONE MOBILIZING ACTION
Kidney: increase Ca reabsorption
Intestine: Increase Ca absorption

Question 16

List the causes of primary osteoporosis

Answer 16

aging, menopause, andropause

Question 17

list the causes of secondary osteoporosis

Answer 17

endocrine, liver/kidney disease, malignancies, malnutrition, GI disease (no Ca abs), genetic disease

Question 18

name the drugs used in treatment of osteoporosis

Answer 18

bisphosphonates
denosumab (Prolia)
estrogen/progestins & SERMs
calcitonin
teriparatide
abaloparatide

Question 19

MOA of bisphosphonates

Answer 19

1. get deposited onto bone
2. gets eaten by clast
3. cause clast apoptosis

Question 20

MOA of Denosumab

Answer 20

decrease binding of RANKL to RANK so prevent clast formation and activation

Question 21

MOA of SERMs

Answer 21

Ex: raloxifene (Evista)

estrogen receptor agonist: decrease bone resorption

Question 22

MOA of calcitonin

Answer 22

activate G protein receptor on clasts
increase cAMP
inhibit clast

Question 23

MOA of estrogen/progestin

Answer 23

make less cytokines which activate clasts

estrogen bind to blast => decrease making RANKL => decrease clast activity

Question 24

MOA of teriparatide

Answer 24

low dose causes increase in blasts and bone formation

Question 25

MOA of abaloparatide

Answer 25

low dose causes increase in blasts and bone formation

Question 26

who should be tested for osteoporosis

Answer 26

women over 65
post menopause/perimenopause
men over 70
men 50-69 with risk factors
fracture after 50 years
condition/medication: glucocorticoids, RA

Question 27

Risk factors of osteoporosis

Answer 27

vit D deficient
hyperprolact
hyperPTH
Cushings
Diabetes

Question 28

Meds associated with osteoporosis

Answer 28

depo-medroxyprogesterone
thiazolidenediones
glucocorticoids
thyroid hormone

Question 29

T-scores

Answer 29

• 1 and up: normal
• 1 to -2.5: osteopenia
• 2.5 and less: osteoporosis
• 2.5 and less and hx of fracture: severe