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PHARM 443 : Sex Ed/MSK > Lecture 9/10 > Flashcards

Lecture 9/10 Flashcards

Menopause

1
Q

What is the average age to start menopause ?

A

45-55 yo

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2
Q

When do we say that a women entered menopause ?

A

backwards diagnosis
1 year since the period has stopped

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3
Q

What is the period range of perimenopause ?

A

when the pt has the symptoms to one year after the period stopped

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4
Q

What is the MAIN difference between early menopause and premature menopause ?

A

early –> < 45yo
premature < 40 yo

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5
Q

What are the effect of menopause on ovarian function ?

A

decrease in number and function of the follicles
reduced release of FSH and LH

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6
Q

what are the effect of menopause on menstrual cycles?

A

menstrual irregularity

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7
Q

What is the main process of estrogen levels in menopause ?

A

Ovaries or adrnal glands –> Androstenedione –> body Fat –> E1 ( estrone) –> Estradiol E2

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8
Q

What is the ratio of estradiol to estrone before menopause ?

A

Estradiol : Estrone (4:1)

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9
Q

What type of estrogen receptors found on uterus and breast ?

A

Alpha

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10
Q

What are the estrogen receptors on blood vessels, lungs and heart ?

A

Beta

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11
Q

What happens to hormones in menopause ?

A

Post menopause
Low estrogen ( greatest drop) + progesterone
High FSH/LH

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12
Q

Where are testosterone made from ?

A

25% ovaries
25% adrenals
50% conversion from androstenedione

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13
Q

What is the main cause of testosterone decline in menopause ?

A

Aging and less due to menopause

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14
Q

What is the androgen production ?

A

Andrenal gland –> DHEAS –> etc..
Ovaries –> DHEA –> etc

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15
Q

Why can we not use FSH levels to diagnose in perimenopause ?

A

FSH fluctuate all the time

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16
Q

What is the main cause of low libido in menopause ?

A

reduction of testosterone

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17
Q

What is the symptoms for menopause ?

A

Vasomotor Symptoms
Mood Symptoms
Insomnia
Concentration
Ureogenital Ageing
muscle/joint pain
breast tenderness
dry skin
low libido

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18
Q

What are the long term potential of hot flushes ?

A

cardiovascular outcomes
brain health

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19
Q

What are the symptoms of vasomotor symptoms ?

A

Hot flash : heat in the upper , anxiety, high heart rate , palpitations
Night sweats

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20
Q

What is the MOA that causes the vasomotor symptoms ?

A

low endocrines in the hypothalamus
Low 5HT and high NE
narrow thermoregulatory zone

Also Low estrogen to inhibit KNDy receptors

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21
Q

What are the symptoms of GSM ?

A

Vaginal atrophy ( painful intercourse, dry, irritation)
UTI
sexual function

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22
Q

What are the MOA of GSM ?

A

less collagen, mooth muscle
less vaginal blood flow and secretion
less glycogen –> pH increase –> more bacteria –> UTI

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23
Q

What are the effects of estrogen in cardiovascular system ?

A

Estrogen helps in artery intimal layer and reduces atherosclerosis, vascular injury

24
Q

What are the effects of estrogen on cognitive system ?

A

Affects the NTs –> ( 5HT, NE, dopamine)
loss of concentration, memory

25
Q

What are examples of NHP for menopause ?

A

black cohosh, femarelle

26
Q

What should we watchout for black cohosh ?

A

liver damage

27
Q

What are the CI of MHT ?

A

abnormal vaginal bleeding
hx of breast cancer
CAD
hx or current VTE , Stroke
thrombophilia
activer liver disease
pregnancy

28
Q

What are the benefits for EPT based on the WHI ?

A

decrease the hip fractures, colorectal cancer

29
Q

What are the risks of EPT based on the WHI ?

A

increase the risks of stroke, MI, VTE, Breast cancer
Not significant for breast and stroke ( cross the line)

30
Q

What is the risk for ET study arm in WHI ?

A

only the stroke

31
Q

Does ET increase breast cancer ?

A

NO basedon WHI

32
Q

When is MTH beneficial * age, conditions ?

A

<60 yo
<10 years since the last mentrual period

CV: best in 45-60 years

33
Q

What is the effect of MHT and VTE ?

A

estrogen increase VTE ( ET and EPT)
Greast risk in first year, fmhx thrombophilia

less risk with transdermal

34
Q

What is the effect of MHT and CVD ?

A

avoid high risks ( obesity, HTN, diabetes, smoking)
moderate can sue transdermal

35
Q

What is the effect of MHT and breast cancer ?

A

WHI mentions an increases –> relative small

ET does not increase breast cance WHI

increase breast cancer : synthetic progestin > progesterone

36
Q

What type of CHC can you give to a pt in perimenopause ?

A

low dose of EE
CHC
estrogen + LNG-IUS

37
Q

What are types of estrogen in MHT >

A

Conjugated Estrogen
17B estradiol
estrone

38
Q

If you have an allergy to sunflower oil, peanut allergy ; which MHT to avoid ?

A

Prometrium –< with micronized progesterone

39
Q

What is the effect of low SHGB from estrogen ?

A

less free testosterone –> low libido

40
Q

When is best to use of transdermal MHT estrogens ?

A

Less fluctuation and no first-pass effect
Good for smokers, previous VTE/CV, migraines, malabsorption problems

41
Q

What is the equivalence dose for MHT estrogen ?

A

0.5 mg to 1 mg of 17b estradiol

42
Q

What are the symptoms of micronized progesterone ?

A

sleepy and nightmare

43
Q

How long can BTB remains in MHT ?

A

6-9 months and needs to see the doctor > 12 months

44
Q

What is the MOA of tibolone ?

A

STEAR
synthetic analog progestin

45
Q

tibilone with help in menopause symptoms?

A

Libido low

46
Q

What are the benefits and risks of tibolone ?

A

benefits : less BTB

risks : same as progestin

47
Q

What is the MOA of bazedoxifene ?

A

SERM –> inhibits endometrial

48
Q

What is TSEC?

A

SERM + estrogen

49
Q

What is the breast cancer for TSECs ?

A

no increase in breast density
no risk for cancer

50
Q

What is the dose of micronized progesterone in VSM ?

A

high dose of micronized progesterone

51
Q

When should a pt stop a MHT ?

A

no benefit

51
Q

What are BHT ?

A

Bioidentical hormonal therapy
- comes soy and mexican yam

52
Q

What is the DDI : tamoxifen + paroxetine/fluoxetine ?

A

blocks the active conversion of tamoxifen

53
Q

What is the menopause indication for gabapentinoids and SNRI/SSRI ?

A

VSM

54
Q

what is ospemifene ?

A

SERM used for GSM
oral tablet
best for breast cancer pts / not taking estrogen

55
Q

What is prasterone ?

A

intravaginal DHEA
Gives precursors of estrogen + androgenic → LOCAL effect for GSM

56
Q
A

PHARM 443 : Sex Ed/MSK (10 decks)

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