Men's and Women's Health

Question 1

What are common ways to treat menopause?

Answer 1

Unopposed estrogen- ONLY if patient does not have uterus.

Estrogen + cyclic progestogen (progestin)

Estrogen + daily progestogen

Estrogen and intermittent progestogen

Question 2

How do you treat moderate to severe vasomotor symptoms in menopause?

Answer 2

Primary indication for HT, recommended lowest effective dose

Question 3

How to treat GSM in menopaue?

Answer 3

Moderate to severe vaginal symptoms and urinary health.

Recommended local ET vs systemic therapy if treating vaginal symptoms only.

Question 4

Is HT for sexual function in menopause?

Answer 4

NO

Question 5

Is HT indicated for osteoporosis associated with menopause?

Answer 5

YES for prevention, lowers osteoporotic fractures, only used when alternate therapies are not appropriate

Question 6

How to navigate risks in menopause?

Answer 6

High risk of VTE - use non oral route of HT at lowest effective dose if not CI’d.

High risk of breast cancer or history or CVD - non hormonal recommended

Moderate CVD risk - transdermal estradiol with appropriate use of progestogen

Question 7

What are alternatives for vasomotor symptoms?

Answer 7

Paroxetine (has FDA labeling for postmenopausal hot flashes), other SSRIs and SNRIs, clonidine, megestrol, gabapentin/pregablin, lifestyle changes, natural products, etc.

SERMS

Question 8

What are risk factors for osteoperosis?

Answer 8

Female, white, poor nutrition, early menopause (before 45) or prolonged amenorrhea, estrogen deficiency, low BMI, low calcium and vitamin D intake, cigarettes, alcohol, dementia, etc.

Drugs - glucocorticoids, long term heparin use, anticonvulsants, excessive levothyroxine, GnRH agonists, lithium, cancer drugs

Question 9

What is the BMD T-score cut off?

Answer 9

-1 - -2.5 is osteopenia. More than -2.5 it’s considered osteoporosis. Pharmacotherapy for anything -2.5 or lower and 1.0-2.5 with a 10% fracture risk.

Question 10

What is osteoperosis treatment?

Answer 10

1st line - bisphosphonates, denosumab

Alternates - ibandronate, SERMS

Fragility fractures or higher risk - Denosumab, teriparatide, zoledronic acid. Alternates are bisphosphonates (alendronate and risendronate)

Question 11

How to take bisphosphonates?

Answer 11

Taken on empty stomach and upright for 30 minutes. 60 minutes for ibandronate and risedronate sodium delayed release should be taken after breakfast

Question 12

What is zoledronic acid’s dosing for osteoperosis?

Answer 12

5 mg IV yearly. 4 mg is for cancer.

Question 13

Can Raloxifene be used for non-verterbral (hip) fractures?

Answer 13

NO

Question 14

How much folic acid do pregnant women need?

Answer 14

400 mcg daily

Question 15

How to treat N/V in pregnancy?

Answer 15

Vitamin B6, antihistamines, ondansetron, metoclopramide

Question 16

How to reat HA in pregnancy?

Answer 16

APAP

Question 17

How to treat coagulation disorders in pregnancy?

Answer 17

Heparin/LMWH preferred. Avoid warfarin

Question 18

How to treat diabetes in pregnancy?

Answer 18

Insulin preferred, sulfonylureas/metformin studied

Question 19

How to treat hypertension in pregnancy?

Answer 19

Labetalol, nifedipine oral extended are 1st line. DO NOT USE ACEI/ARBs or Atenolol

Question 20

What drugs are contraindicated in breastfeeding?

Answer 20

Amphetamines, antineoplastics, benzos, bromocriptine, cocaine, drugs of abuse, ergotamine, lithium, nicotine, pain meds (opioid ones, not APAP or Advil)