Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 825- menopausal hormone therapy > Menopausal hormone therapy > Flashcards

Menopausal hormone therapy Flashcards

1
Q

Define premenopausal

A

This is the time period where endocrine changes are occurring before the cessation of menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Perimenopausal

A

The time period of endocrine changes that surround the menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define postmenopausal

A

This is the time period of changes to the endocrine that happens after the cessation of mensuration and this would be described as when menopause actually hits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Evaluate a patients risk-benefit profile for hormonal treatment of menopausal symptoms

A

Treatment should be selected and tailored for each patient. It will depend for each patient based on their age, symptom severities, personal preferences, uterus intact or not, and risk/benefit profile which includes the list below -
osteoporosis fracture risk, cardiovascular disease risk, breast cancer risk, and thromboembolic risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Design an individualized treatment plan using pharmacologic options for menopausal symptoms

A

Start by assessing the symptoms of the patient GSM, Vasomotor, or both.
If just GSM - see if there is contraindication to estrogen - if Yes contraindication consider a vaginal lubricant/ moisturizer. If NO contraindications look into vaginal estrogen through creams, inserts, rings, or vaginal prasterone (DHEA), or ospemifene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Evaluate a treatment plan on the basis of a patients response to pharmacologic management of menopausal symptoms

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the circumstances under which non-hormonal therapies for menopausal symptoms should be considered

A

SSRIs/SNRIs for hot flashes in women who do not want to take hormonal products or when the patient has contraindications

SSRIs are recommended for patients that are experiencing strong vasomotor symptoms (hot flashes and night sweats) and lower mood disorder symptoms like depression

SNRIs are recommended for patients that are experiencing more mood disorders like strong depression and little or light vasomotor symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of menopause

A
  • physiologic - there is usually extensive deterioration of the follicular cells and ova with aging
  • Surgery - removing the ovaries
  • Chemotherapy- breat cancer chemotherapy
  • radiation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical presentation of menopause

A

Vasomotor symptoms
- Night sweats and hot flashes

Genitourinary syndrome of menopause
- sleep disturbance, irregular menses, episodic amenorrhea, mood changes, fatigue, vaginal dryness, urinary tract dysfunction, sexual dysfunction, urinary frequency and urgency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HOT SEAT
If hormones lost during menopause were replaced through drug therapy, women would be protected from both menopausal symptoms and chronic diseases that often follow after women experience menopause

TRUE
FALSE

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Estrogen mono-therapy products

A

These products are for those who DO not have uterus
Oral - These products undergo the first pass metabolism which results in more side effects because of this they are not preferred treatment option)
- Premarin ( conjugated estrogens)
- Menest (esterified estrogen)
- Estrace generics (micronized estradiol)

Topical - risk of secondary exposure so these are also not a preferred treatment option
- topical gel (estrogel, divigel, elestrin)
- topical spray (evamist)

Transdermal - Preferred line of therapy due to them all containing 17-b-estradiol and having less side effects. They also release at a constant rate
- Alora
- Climara
- Menostar
- Minivelle
- Vivelle
- Vivelle-dot

Intramuscular injections - have many side effets so are not a preferred treatment option
- Estradiol cypionate (Depo- estradiol)
- Estradiol valerate (Delestrogen)

Intravaginal - low dose and localized concentration of estrogen to vaginal area (for women with uterus intact) do not require additional progesterone therapy
- Vaginal cream (estrace, premarin)
- Vaginal insert (imvezzy)
Vaginal tablets (vagifem, Yuvafem)
Vaginal ring (estring, and Femring)
-EXCEPTIONS TO NO ADDITIONAL PROGESTERONE THERAPY= Estring - which is not absorbed systemically and therefore does not require additional progesterone therapy, and Femring - IS absorbed systemically and therefore requires additional progesterone therapy ( a ring is bigger than a string = systemically absorbed) (femring can not be given as monotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Estrogen therapy principles

A
  • Oral or transdermal estrogen products should be prescribed at the appropriate dose, duration, regimen and route that provides the most benefit with the least amount of risk
    also topical products should be prescribed exclusively for women experiencing vulvovaginal atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Progestin use principles

A

Women with an intact uterus should be prescribed a progestin in addition to estrogen in order to decrease the risk of endometrial hyperplasia and endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HOTSEAT
The women’s health initiative showed estrogen plus progestin increased the risk of all of the following except
A. Stroke
B. Fracture
C. Heart attack
D. Venous thromboembolism
E. Breast cancer

A

Fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HOTSEAT
The womens health initiative showed estrogen alone increased the risk of all of the following except: (pick 3)
A.Stroke
B. Fracture
C. Heart attack (age <60, within 10 years of menopause)
D. Venous thromboembolism
E. Breast cancer

A

Fracture, Heart attack, Breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

WHI: extended post-intervention

A

Time since menopause and age if initiation are two factors that increase or decrease the risk of hear disease and other side effects associated with MHT

17
Q

WHI estrogen only findings

A

-Women 50-59 and within 10 years of menopause had no evidence of CHD or stroke
-Women > 10 years of menopause, increase risk of CHD within first 2 years
-Women 70-79 years and > 20 years of menopause, highest risk of CHD and stroke
- Women with established CHD, no additional benefit

18
Q

WHI estrogen + progesterone findings

A

*Ages 50-59 years: Lowest risk of CHD and stroke
*Ages 60-69 years: Increasing risk of CHD and stroke
*Ages 70-79 years: Highest risk of CHD and stroke

19
Q

What are the methods of administrating combined estrogen and progestin

A

1- continuous cyclic therapy
2- continuous long cycle therapy
3- continuous combined therapy
4- intermittent combined therapy

20
Q

Estrogen and progestin - continuous cyclic therapy

A

Also known as = Sequential treatment
- estrogen is administered daily and progesterone administered at least 12-14 days of a 28 day cycle
- Preferred in recently menopausal women because it can regulate cycle

21
Q

Continuous cyclic therapy options

A

Premphase - oral - conjugated estrogens - medroxyprogesterone acetate
Combipatch - transdermal - estradiol - norethindrone acetate

22
Q

Estrogen and progestin - continuous long cycle (RARE)

A

Estrogen is administered daily but progesterone is co administered with estrogen for at least 12 to 14 days every other month (so bleeding only happens every other month)
-patient had 6 scheduled bleeding times per year

23
Q

Estrogen and progestin- continuous combination therapy

A

Daily estrogen + progesterone
results in endometrial atrophy and absence of vaginal bleeding
reccomended for women >2 years post-final menstrual period
Really great long term endometrial protection
Best for addressing vasomotor symptoms more preffered than continuous cyclic therapy and continuous long cycle therapy

24
Q

Estrogen and progestin - continuous combination therapy options

A
  • Prempro - oral - conjugated estrogens/ medroxyprogesterone acetate
  • Fyavolv, Jinteli - oral - ethinyl estradiol/ norethindrone acetate
  • angeliq - oral - estradiol/drospirenone
  • activella, amabelx, mimvey - oral - estradiol/norethindrone acetate
  • Bijuva - oral - estradiol/ levonorgestrel
  • climaraPro - transderal (low risk of SA) - estradiol/ levonorgestrel
  • Combipatch - transdermal - estradiol/ norethindrone acetate
25
Q

Estrogen and Progestin: Intermittent Combined

A
  • AKA “continuous-pulsed estrogen-progesterone” or “pulsed-progesterone”
  • 3 days of estrogen  3 days of estrogen + progesterone
  • Pulsing prevents downregulation of progesterone receptors
  • Preferred in women who are not tolerating long progesterone therapy
  • Long-term endometrial protection: unknown
26
Q

Estrogen and Progestin: Intermittent Combined options

A

Prefest - oral - estradiol/ norgestimate

27
Q

Estrogen and SERM

A
  • AKA “tissue-selective estrogen complex (TMEC)”
  • SERM (selective-estrogen receptor modulator)
    o Non-hormonal agent
    • Agonist: bone
    • Antagonist: breast, uterus
      o Decreased risk of endometrial cancer
      o VTE, DVT, stroke risks?
    • As a monotherapy, bazedoxifene has been shown to increase the risk of VTE, DVT, and stroke – theoretical risk when combining estrogen with bazedoxifene
      o Overweight women (BMI > 27 kg/m2)
    • Have a lower concentration of bazedoxifene and therefore receive less protection
  • To treat both menopausal symptoms and prevent bone loss in women with intact uterus (alternative for women who don’t want to take progesterone but still have uterus intact)
28
Q

Estrogen and SERM option

A

Duavee - oral - Conjugated estrogen 0.45mg/ Bazedoxifene 20mg

29
Q

HOTSEAT
which statement is true regarding MHT?

A. Conjugated estrogen (premarin) is an appropriate treatment option for a patient who has undergone a hysterectomy

B. Transdermal estrogen is associated with a higher increased risk of venous thromboembolism and stroke

C. Progestin should be added for protection in women without a uterus

D. Daily estrogen and progesterone therapy represents continuous cyclic therapy administration

A

A

30
Q

SSRIs and SNRIs (treatment options)

A

SSRIS
o Brisdelle (paroxetine) 7.5 mg qhs
o Paxil, Pexeva (paroxetine) 10-20 mg/day
o Paxil CR (paroxetine CR) 12.5 or 25 mg/day
o Celexa (citalopram) 20 mg/day
o Lexapro (escitalopram) 10-20 mg/day
SNRIs
o Effexor (venlafaxine) 75 mg/day
o Pristiq (desvenlafaxine) 100 mg/day
o Side effects: dry mouth, anorexia, nausea, constipation

31
Q

Menopausal Decision- support symptom management

A
  • Women within 10 years since menopause + low 10 year CVD (<5%) May use MHT (Oral or transdermal)
  • balance the potential benefits and risks of treatment for the patient
  • Women within 10 years since menopause + moderate 10 year CVD (5-10%) (avoid oral estrogen but prefer transdermal administration)
  • Women with high 1–year CVD risk (>10%) Should avoid systemic MHT and if genitourinary symptoms, may consider low dose vaginal estrogen or other treatment
32
Q

First line therapy of Genitourinary Syndrome of Menopause

A

*First line (non-hormonal)
o Lubricants
- Short duration of action
-Frequent applications needed
o Vaginal moisturizers
- 2-3 applications/week

33
Q

Second line therapy of Genitourinary Syndrome of Menopause

A

o Topical
- Cream*
- Tablet*
- Ring
o Low dose oral contraceptives
* low-does vaginal estrogen (minimal systemic exposure) do not require progestin for endometrial protection * Data limited to 1 year

34
Q

Treatment of Moderate-Severe Dyspareunia (painful intercourse)

A
  • Ospemifene (Osphena)
    o SERM (selective-estrogen receptor modulator)
     Agonist: vagina, uterus
  • Vaginal agonist will help with dyspareunia but uterine agonist MAY increase the risk of endometrial cancer (no data supporting the increased risk – still use caution)
    o Black Box Warning
    • Endometrial cancer
    • Stroke
    • VTE
      o 60 mg once daily in postmenopausal women
    • Taken with meals
      o Common side effects
    • Vaginal discharge
    • Endometrial hyperplasia
    • Hot flashes 7-12%
      o Similar precaution to estrogen therapies
  • Prasterone (Intrarosa)
    o Inactive DHEA converted to active estrogens and androgens
    o 6.5 mg qhs in postmenopausal women
    o No black box warning for VTE, endometrial hyperplasia
    o Contraindications: undiagnosed vaginal bleeding
    o Avoid: history of breast cancer
    o Common side effects
    • Vaginal discharge (5.7-14%)
      o Cost: $180/month
      o Do not rely on oral DHEA supplements
      *Estrogen-based regimen remains the first-line for moderate-severe symptoms of vulvovaginal atrophy

PHRM 825- menopausal hormone therapy (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions