many-paws Flashcards
changes in menses occur when
-3a (late reproductive stage)
inc in FSH when
-1 late menopausal stage
amenorrhea can last >60 days
-1 late menopause
perimenopause spans
-2 to +1
early menopausal transition to early menopause
decline in fecundity is a hallmark
-3a
late reproductive years
indications for HRT
moderate to severe VMS
prevention of osteoporosis
premature hypoestrogenic state (such as POI or post BSO)
GUSM
baseline labs for menopause
height/weight/BMI
abd circumference
breast exam
pelvic exam
papsmear
TV-UTZ
digital mammogram starting 40
TSH (q5 at 35 then q1 at 60)
FBS, lipid profile
Crea, BUN, UA
LFT
colonoscopy at 50 then q10
STI screen
immunization record
dexa q2 yrs after 65 unless with symptoms
vices
transdermal if
at risk for vte
hyper-TGL
obese with metabolic syndrome
diabetic and hypertensive
smokers
hyposexual/dec libido
vaccines required for elderly
HPV
influenza annual
shingles/zoster
pneumococcal PPSV23 annual
TDAP q10 yrs
low dose estrogen
0.3 - 0.45 CEE
E2V 0.5
Estrogel 0.5mg (1/3 of ruler ~0.5mg)
17B estradiol 0.5-1mg
transdermal 25-37.5 mcg
for GUSM (vaginal)
3 - vagifem, ovestin, estring
1- DHEAS
1 - oral
vagifem tab/estradiol hemihydrate 10mcg/tab 1 tab daily x 2 weeks then 1 tab 2x/week
ovestin cream (estriol) 0.5g cream = 0.5mg estriol
1 applicator for 1st 2-3 weeks max 4 weeks
ESTRING: silicone ring with 2 mg estradiol (7.5 μg/day for 90 days)
Prasterone 0.5% 6.5mg intravaginal gel
Ospemifene 60mg OD
transdermal example
estradiol hemihydrate gel
oestrogel 48mg/80g tube
transdermal estradiol patch
climara 75mcg/patch
moderate dose estrogen
0.625mg CEE
E2V 1mg
Estrogel 1 mg (2/3 of ruler ~1mg)
17B estradiol 1.5-2mg
transdermal E2 50mcg/day
high dose estrogen
1.25 CEE
E2V 2
Estrogel 1.5mg
17B estradiol 2mg
transdermal 75-100 mcg
low dose progesterone
Dydrogesterone 5mg
Micronized progesterone 100mg
MPA 5mg (if cont 2.5mg)
NETA 1.25mg (0.5-1mg if cont)
LNG-IUS 52mgc(20mcg daily)
high dose progesterone
Dydrogesterone 10mg
Micronized progesterone 200mg
MPA 5-10mg (if cont 2.5-5mg)
NETA 1.25mg-2.5 (1-2.5mg if cont)
LNG-IUS 52mg
SERMs
Raloxifene 60mg (high risk for VTE)
Ospemifene 60mg
Bazedoxifene 20mg + CEE
*no effect for hip and wrist fractures but decreased vertebral fracture
STEAR
selective tissue estrogenic activity regulator
tibolone 2.5 mg
bisphosphonates prevention
Alendronate 35mg PO 1x/week
Zolendronic Acid 5mg IV
bisphosphonates tx
Alendronate 70mg PO 1x/week
Zolendronic Acid 5mg IV
bisphosphonates side effects
ulcer
gi upset
takes 10 years to clear out of system –> will manifest as pain
osteonecrosis of the jaw (slow bone turnover so osteomyelitis with necrosis)
MOA bisphosphonates
inhibits bone resorption
increase osteoclast apoptosis
reserve for older menses
monoclonal antibody to rankL
denosumab
Teriparitide 20mg SQ
PTH inc bone formation
tx for osteoporosis
TSEC
tissue selective estrogen complex
bazedoxefine
calcium and vit D
1000-1200IU ca
600 IU ca
bone losing meds
glucocorticoids
hyperthyroid
SSRI
proton pump inhibiting drugs like omep (inc PTH, dec Ca absorption)
aromatase inhibitors
thiazolidinediones
contraindications to HRT
breast CA (estrogen dependent cancers)
VTE
undiagnosed vaginal bleeding
active liver disease
CHD
Stroke
MI
SSRI
Citalopram Celexa 20mg
Fluoxetine Prozac 20mg
Setraline Zoloft 50-100mg
Paroxetine Paxil 12.5-25mg
SNRI
Venlaxafine Effexor 37.5/75/150mg
Desvenlaxafine Pristiq 100mg
Non hormonal
Gabapentin 900mg
Pregabalin Lyrica 150mg
