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Nurs 5229 Clinical Pharmacotherapeutics > HRT > Flashcards

HRT Flashcards

1
Q

Perimenopausal cycles are associated with

A

Elevated and irregular follicle-stimulating hormone
Decreased inhibin
Normal luteinizing hormone
Slightly elevated estradiol levels

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2
Q

Menopause is considered to have occurred when there is no menses for

A

12 months

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3
Q

The average age of menopause is

A

51 years of age (95% between ages of 45 and 55 years).

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4
Q

Vasomotor symptoms are caused by

A

fluctuations in estrogen levels

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5
Q

Vaginal changes are caused by

A

low estrogen levels

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6
Q

Primary goal of MHT

A

relieve hot flashes but can help with sleep disturbances, mood lability/depression, and in some cases, joint aches and pains

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7
Q

Hot flashes require

A

systemic estrogen, GU syndrome of menopause (GSM) – treat with low-dose vaginal estrogen

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8
Q

Exogenous estrogens work like endogenous estrogens - Examples

A

Estradiol
Equine estrogen
Esterified and micronized estrogen

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9
Q

Exogenous progestins work like endogenous progestins - Examples

A

Medroxyprogesterone
Norethindrome
Micronized progesterone

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10
Q

HRT: Goals of Treatment

A 
Provide relief from symptoms associated with menopause. 
Prevent or reduce vasomotor symptoms.
Prevent or reduce vaginal atrophy.
Reduce risk for osteoporosis.
Ensure benefits of HRT outweigh risks.
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11
Q

Guidelines for indvidual approach

A

Based upon calculating women’s baseline CV and baseline risk prior to initializing therapy

Menopausal hormonal therapy (MHT) indicated for management of menopausal symptoms but not the prevention of CVD, osteoporosis, or dementia

Benefits outweigh risk for most symptomatic women who are either under age 60 y.o. or less than 10 years from menopause

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12
Q

Cardiac disease:

A

HRT not recommended

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13
Q

Breast cancer:

A

HRT may promote it; inconclusive evidence in younger women, but definite in older adults

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14
Q

Colon cancer:

A

HRT decreases risk

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15
Q

Osteoporosis:

A

HRT reduces risk but is not primary reason

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16
Q

Vasomotor symptoms and vaginal atrophy

A

HRT improves symptoms

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17
Q

Cognitive performance, sleep disturbances, and skin changes - HRT

A

inconsistent data

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18
Q

HRT: Rational Drug Selection

A

Use lowest dose that relieves symptoms for shortest time (up to 5 years in menopause; longer with surgical menopause).

Extended use of MHT should be individualized and not based solely on age (North American Menopause Society and the American college of Obstetrics and Gynecology).

Individualize the drug choice and dose based on patient’s risk profile.

Monitor patient annually.
Tapering versus abrupt stopping

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19
Q

Estrogen Therapy - Relief of

A

Relief of peri-menopausal/post-menopausal symptoms

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20
Q

Estrogen Therapy all types of

A

All types of estrogen are effective for relieving hot flashes

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21
Q

Estrogen Therapy - Route

A

Route – oral, transdermal, topical gels and lotions, and vaginal rings

22
Q

Estrogen Therapy started on

A

Started on lowest dose (typically oral or transdermal).
Lower doses are associated with less vaginal bleeding, breast tenderness, fewer effects on coagulation and inflammatory markers, and a possible lower risk of stroke and VTE than standard-dose therapy

23
Q

Estrogen Therapy NO

A

NO unopposed estrogen to women with intact uterus

24
Q

Estrogen Therapy avoid in women with

A

Avoid in women with hypertriglyceridemia, active gallbladder disease, or known thrombophilia

25
Q

Estrogen Therapy transdermanl

A

Transdermal estrogen preferred in women with migraine headaches with auras.

26
Q

Estrogen Therapy symptoms start

A

Symptoms start to improve in 2 weeks, reach maximal effect in 8 weeks

27
Q

Estrogen Therapy phytoestrongens

A

Phytoestrogens

Red clover, soy, and black cohosh have inconsistent results.

28
Q

Estrogen Therapy Botanicals/herbals

A

Botanicals/herbals

Black cohosh and chaste tree fruit have inconsistent results.

29
Q

Estrogen Therapy can be used to treat

A

Vulvovaginal atrophy and dryness

Low-dose estrogen (0.3 to 0.625 mg daily) alleviates symptoms.

Vaginal application of estrogen (ring or cream form) can improve symptoms in as little as 2 weeks.

Topical application is preferred because of lower overall estrogen dose and no systemic effect.

30
Q

Estrogen Therapy - Increased risk for

A

Increased risk for endometrial cancer with unopposed oral estrogen

31
Q

Estrogen Therapy increase in risk for coronary heart disease with

A

Increase in risk for coronary heart disease risk with combination HRT
May be related to onset and length of therapy

32
Q

Estrogen Therapy increased risk of strok and

A

Increased risk of stroke and thromboembolic events

33
Q

Progestin Therapy - All women with an

A

intact uterus need a progestin to be added to their estrogen to prevent endometrial hyperplasia, which can occur after as little as six months of unopposed estrogen (KNOW)

34
Q

Progestin-alone is used for

A

contraception or menorrhagia

35
Q

Progestin Combined with estrogen

A

to treat perimenopausal or postmenopausal women

36
Q

Combined Estrogen/Progestin Therapy options

A

Multiple combinations are available.

Cyclical or sequential therapy is used if breakthrough bleeding is a problem.

Estrogen is taken daily.
Medroxyprogesterone is taken for part of the cycle (10 to 12 days, 14 days, or Monday through Friday).

Estrogen is started at low dose (0.3 mg) every other day for 2 months and then daily for 2 months before increasing dose.

37
Q

Testosterone Therapy

A

If hot flashes do not improve with HRT/estrogen therapy, then adding testosterone may help

38
Q

Testosterone Therapy is combined with

A

is combined with estrogen

39
Q

Testosterone Therapy alone may cause

A

Testosterone-alone may cause masculinizing.

40
Q

Testosterone Therapy - what is an issue

A

Acne is an issue.

41
Q

Menopausal Hormone Therapy Risks

A 
Cardiovascular events: Myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis
Endometrial cancer
Breast cancer
Ovarian cancer
Gallbladder disease
Dementia
Urinary incontinence
42
Q

HRT - Use for Approved Indications

A

Treatment of moderate to severe vasomotor symptoms associated with menopause

Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause

Prevention of postmenopausal osteoporosis

43
Q

IMPORTANT note when Treating Menopause with Hormones - Check

A

Check lab work along with pt. history and exam to verify pt. IS in menopause
Hormone levels consistent with menopause
Menopausal symptoms – sleep disturbances, hot flashes, mood swings, headaches in combination
Amenorrhea for greater than 12 months or menstrual irregularity with periods of amenorrhea (peri-menopause)

44
Q

IMPORTANT note when Treating Menopause with Hormones - if patient has

A

HAS uterus - use combined estrogens for treatment

This protects against endometrial hyperplasia and cancer

45
Q

IMPORTANT note when Treating Menopause with Hormones - if patient does not have

A

DOES NOT have a uterus – estrogen alone therapy is recommended hormone treatment

46
Q

IMPORTANT note when Treating Menopause with Hormones - KEE in mind

A

we can also treat menopause symptoms with NON-hormonal therapies such as antidepressants, herbals and other alternative therapies if pts choose to treat menopause without hormones.

47
Q

HRT Monitoring - Annual complete

A

history and physical, including pelvic examination (Papanicolaou test per other guidelines)

48
Q

HRT Monitoring - Annual

A

Annual mammography

49
Q

HRT Monitoring - Liver

A

Liver function tests at baseline

50
Q

HRT Monitoring Lipid

A

Lipid profile at baseline

51
Q

HRT Monitoring women older than 45

A

Women older than age 45 years should be screened for type 2 diabetes mellitus.

52
Q

HRT Monitoring - Abnormal uterine

A

bleeding requires uterine biopsy.

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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