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Pharmacotherapeutics Theory 2 > HRT, BPH, ED > Flashcards

HRT, BPH, ED Flashcards

1
Q

What are the Stages of Menopause?

A
  • Perimenopause
  • Menopause
  • Post Menopause
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2
Q

Stages of Menopause:

Perimenopause

  • When?
  • What?
A
  • Few years before last period
  • 1-2 years of fluctuating hormones and irregular cyclez
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3
Q

Stages of Menopause:

Menopause

  • When?
  • Causes?
A
  • Date of last period
  • Causes
    • Natural depletion of eggs
    • Surgical menopause
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4
Q

Stages of Menopause:

Post Menopause

  • When?
  • What?
A
  • 12 months after last period
  • No more bleeding
  • Effects of lack of estrogen in body
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5
Q

What are the Effects of Low Levels of Oestrogen?

A
  • Headaches and hot flushes and night sweats
  • Increased risk of CVD
  • Incontinence
  • Mood Swings
  • Aches and pains
  • Vaginal dryness, itching and shrinking
  • Bone loss
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6
Q

Effects of Low Levels of Oestrogen: Increased risk of CVD

  • What are Oestrogen’s known effects?
  • What happens in menopause?
A
  • Oestrogen’s known effects:
    • Increases HDL
    • Decreases LDL
    • Promotes blood clot formation
    • Relaxes, smooths and dilates blood vessels so blood flow increases
  • In menopause:
    • Changes in the walls of the blood vessels, making it more likely for plaque and blood clots to form
    • Changes in the level of lipids in the blood
    • Increase in fibrinogen – increase risk of heart disease and stroke
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7
Q

Effects of Low Levels of Oestrogen: Bone loss

  • What does oestrogen inhibit?
  • What is the role of osteoclasts and what happens in menopause?
A
  • IL-6 - Stimulator for bone resorption
    • In menopause, decreased oestrogen levels
    • IL-6 starts being active and starts to actively resorb bone
  • Osteoclasts – Eats away at bone
    • In menopause, decreased oestrogen levels
      • Osteoclasts live longer and therefore active in bone resorption
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8
Q

What are Preventive Measures in Post-Menopausal Women?

What should be screened?

For CVD what should be evaluated?

A
  • Avoid or quit smoking
  • Lose weight
  • Exercise for 30-40 mins 3-5 days per week
  • Follow a diet low in saturated fat, low in trans-fat and high in fibre, fish and folate rich foods
  • Treat and control comorbidities e.g. diabetes, HTN, dyslipidaemia
  • Avoid alcohol
  • Screen for Breast, colon, ovary and uterus cancer
  • Evaluate bone mass
  • For CVD
    • Family hx
    • Risk factors: BP, Smoking, Diabetes, Cholesterol
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9
Q

What is HRT used for?

How is it initiated?

Does it provide contraceptive cover?

A
  • Used to reduce frequency and severity of hot flushes
  • Initiated at a low or ultra-low dose to reduce the incidence of adverse effects of oestrogen such as breast tenderness and nausea
  • DOES NOT provide contraceptive cover
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10
Q

What are symptoms of Progestin Intolerance?

A
  • Bloating and flatus
  • Irritability
  • Depression
  • Breast tenderness
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11
Q

What are the Management Options for Progestin Intolerance?

A
  • Alternative oral progestin
  • Reducing progestin dose (keep in mind the need for endometrial protection)
  • Trying a different route of administration e.g. transdermal
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12
Q

What are the Indications for Non-Oral Route in HRT?

A
  • Patient preference
  • Poor symptom control with oral treatment
  • Adverse effects
  • History of, or risk of VTE
  • Poorly controlled HTN
  • Hypertriglyceridemia
  • Current hepatic enzyme inducing agent
  • Poor absorption of oral therapy
  • History of migraine
  • History of gall stones
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13
Q

What are the Goals of Therapy in HRT?

A
  • Trying to treat 3 main symptoms
    • Vasomotor symptoms
    • Psychological symptoms
    • Urogenital atrophy
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14
Q

Goals of HRT:

What are the Treatment options for Vasomotor Symptoms?

A
  • FIRST LINE: HRT
  • 2nd Line: SSRIs, SNRIs and clonidine
    • Venlafaxine = no HTN effects
    • Paroxetine = avoid in women taking tamoxifen
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15
Q

Goals of HRT:

What are the Treatment options for Psychological Symptoms?

A

Consider HRT, CBT to alleviate low mood/anxiety

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16
Q

Goals of HRT:

What are the Treatment options for Urogenital Atrophy?

A
  • Vaginal oestrogen
  • PLUS vaginal moisturisers and lubricants
17
Q

What are the Benefits of HRT?

A
  • Controls vasomotor symptoms
  • Reduces risk of Osteoporosis by protecting BMD
  • Protects and stops symptoms of vaginal atrophy
18
Q

What are the risks of HRT?

A
  • Thromboembolitic disease
    • Oral HRT > transdermal
    • Consider transdermal for those with risk of VTE
  • Breast Cancer
    • Risk is high in both women on oestrogen alone and women on oestrogen and progestogen
  • Endometrial cancer
  • Cardiovascular disease
    • Increased risk of MI
    • Oral HRT associated with small increase in risk of stroke
  • Hypertriglyceridemia
    • Oestrogen alone increases triglycerides
19
Q

What are Contraindications to HRT?

A
  • History of hormone-dependent cancer or active hormone-dependent cancer → Explore other options in these individuals
  • History of thromboembolic disease for oral HRT → Safer to use transdermal oestrogen
  • Patients with CV and cerebrovascular disease
20
Q

HRT in Older Women (10 years post menopause)

How is it treated?

Are there any adverse effects?

A
  • Ultra-low dose of oestrogen that’s slowly increased as adverse effects (breast pain and tenderness) resolve or are tolerated
  • Initiating, but not continuing, combined HRT in older women is associated with an increase in CV events
  • If an older women needs HRT, other CV risks should be addressed concurrently
21
Q

Cessation of HRT

  • Is HRT abruptly ceased?
  • What is suggested?
A
  • An abrupt cessation is more likely to be followed by a return of symptoms, especially in women who had severe symptoms before treatment
  • Suggest gradual tapering of the HRT dose
    • Over 6 weeks (for mild symptoms)
    • 6 months (for severe symptoms)
  • Unless for medical reasons it has to be stopped abruptly e.g. breast cancer
22
Q

Are Alternative Therapies good for HRT?

A

Little evidence to support the use of alternative therapies

23
Q

What are essential for BPH?

A

Normally functional testes are essential for BPH

24
Q

What 3 components contribute to symptoms of BPH?

A
  • Mechanical obstruction by the enlarged prostate
  • Dynamic obstruction caused by the tone of the prostatic smooth muscle
  • Reaction of the bladder to the obstruction
25
Q

What are the 2 Groups of Symptoms in BPH?

What are the Symptoms of Each?

A
  • Voiding symptoms
    • Hesitancy
    • Straining
    • Weak or intermittent flow
    • Sensation of incomplete emptying
  • Bladder storage symptoms
    • Urgency
    • Frequency
    • Nocturia
26
Q

Before Starting Treatment for BPH, what is done?

A
  • Assess symptom severity using IPSS
  • Assess prostate size
  • Look for aggravating factors (constipation, diuretics, drugs with anticholinergic effects)
  • Non-Pharmacological
    • Reduce caffeine and alcohol intake
    • Bladder training
    • Reducing fluid intake at times when urinary frequency is inconvenient
27
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Decreases prostate size?

A
  • Alpha adrenergic antagonists: No
  • 5-alpha reductase inhibitors: Yes
28
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Halts Disease Progression?

A
  • Alpha adrenergic antagonists: No
  • 5-alpha reductase inhibitors: Yes
29
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Peak Onset?

A
  • Alpha adrenergic antagonists: 1-6 Weeks
  • 5-alpha reductase inhibitors: 3-6 Months
30
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Efficacy?

A
  • Alpha adrenergic antagonists: ++
  • 5-alpha reductase inhibitors: ++ (enlarged prostate)
31
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Dosing Frequency?

A
  • Alpha adrenergic antagonists: Once Daily
  • 5-alpha reductase inhibitors: Once Daily
32
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Decreases PSA?

A
  • Alpha adrenergic antagonists: No
  • 5-alpha reductase inhibitors: Yes
33
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

Sexual Dysfunction?

A
  • Alpha adrenergic antagonists: +
  • 5-alpha reductase inhibitors: ++
34
Q

Compare and contrast the indications and effects of Alpha adrenergic antagonists and 5-alpha reductase inhibitors

CVS adverse effects?

A
  • Alpha adrenergic antagonists: Yes
  • 5-alpha reductase inhibitors: No
35
Q

What is Erectile Dysfunction?

A
  • Consistent or recurrent inability of a man to attain and/or maintain a penile erection adequate for sexual intercourse
36
Q

What are the Causes of Erectile Dysfunction?

A
  • Psychogenic (mind)
  • Organic
    • Neurogenic
    • Hormonal
    • Vasculogenic
    • Drug-induced
37
Q

What drugs and medical conditions can be associated with ED?

A
  • Diabetes
  • HTN
  • Depression
  • Hyperlipidaemia
  • Erectile dysfunction is a risk marker for CVD

Pharmacotherapeutics Theory 2 (17 decks)

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