Hormone therapy and menopause

Question 1

HT/ET CI

Answer 1

ABSOLUTE: sever liver dx
acute vascular dx (embolus/thrombus)
hypercoagulability (Factor V Leiden, etc)
severely elevated fasting triglycerides
undiagnosed abnormal vag bleeding
current brease CA
RELATIVE: migraine, past hx of VTE, past hx of breast CA, hx of CVD/stroke

Question 2

Estrogen SE

Answer 2

breast tenderness
n/v
most resolve within 2 months

Question 3

progestin related SE

Answer 3

breast tenderness, nausea/abdominal cramps

depression, anxiety, irritability

Question 4

transdermal estrogen

Answer 4

less favorable lipid effects
to avoid potential effects on hepatic protein production d/t lack of first pass metabolism
less GI SE

Question 5

vaginal estrogen with systemic absorption

Answer 5

creams and femring
NOT Estring
will need progestin if using consistently, maybe

Question 6

drug interaction

Answer 6

enzyme inducers may decrease estrogen activity
rifampin, barbiturates, carbamazepine, phenytoin
Estrogen may inc the effects of TCA, corticosteroids, theophylline

Question 7

non hormonal hot flash drug therapy

Answer 7

megestrol acetate, venlafaxine, fluoxetine, paroxetine, clonidine, gabapentin
efficacy <50%

Question 8

other causes of hot flashes

Answer 8

psychosomatic, stress, thyroid disease, pheochromocytoma, leukemia, cancer, TB