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Therapeutics 1 > Menopause > Flashcards

Menopause Flashcards

1
Q

What are vasomotor symptoms of menopause?

A

hot flashes, night sweats

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2
Q

What is the first line pharmacological treatment for vasomotor symptoms of menopause?

A

systemic hormone therapy (menopause hormone therapy)

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3
Q

What is menopause hormone therapy (MHT)?

A

estrogen + progestin (NEEDED if woman has intact uterus!!)

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4
Q

Describe: transdermal estrogen

A

-bypass first pass metabolism
-lower VTE risk
-no impact on triglycerides
-lower stroke risk

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5
Q

Describe: Oral Estrogen

A

-higher VTE risk
-decrease libido
-increase triglycerides

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6
Q

Describe: Estradiol

A

lower risk of thrombosis, lower risk of MI

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7
Q

Dosing: Estrogen only

A

-in use in those WITHOUT a uterus
-oral prep taken daily
-patch

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8
Q

Dosing: Continuous-Cyclical Combined

A

-use in patients with uterus
-estrogen taken daily
-progesterone is taken 10-14 days a month (withdrawal bleeding can occur due to absence of progesterone)

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9
Q

Dosing: Continuous-Combined

A

-use in patients with a uterus
-estrogen + progestin used continuously
-unpredictable bleeding may occur

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10
Q

Indications: Conjugated equine estrogens/Medroxyprogesterone (Prempro)

A

-moderate to severe vasomotor symptoms due to menopause
-moderate to severe symptoms of vulvar and vaginal atrophy due to menopause (use topical therapies for sole treatment of vulvar and vaginal atrophy)
-osteoporosis treatment

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11
Q

Adverse Reactions: Prempro

A

headache, abdominal pain, nausea, mastalgia, dysmenorrhea, diarrhea

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12
Q

What is Duavee?

A

conjugated equine estrogen (CEE) + selective estrogen receptor modulator (SERM)

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13
Q

Indication: Duavee

A

postmenopausal women WITH a uterus for vasomotor symptoms (suggested to use in women who are at risk for breast cancer), osteoporosis prevention

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14
Q

Adverse effects: Duavee

A

diarrhea, muscle spasms, nausea, may increase risk of stroke and DVT

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15
Q

Contraindications to Hormone Therapy in postmenopausal women?

A

-unexplained vaginal bleeding
-liver disease
-prior estrogen- sensitive cancer (breast cancer)
-prior coronary heart disease, stroke, or MI
-prior venous thromboembolism
-personal history or inherited risk of thromboembolic disease

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16
Q

FDA Boxed Warning: Estrogen + Progestin

A

-do NOT use for prevention of cardiovascular disease or dementia
-increased risk of stroke, DVT, PE, MI
-increased risk of invasive breast cancer
-increased risk of probable dementia among women 65 and older

17
Q

FDA Boxed Warning: Estrogen-only products

A

-do NOT use for prevention of CVD or dementia
-increased risk of endometrial cancer in those with a uterus taking unopposed estrogen
-increased risk of stroke/DVT
-increased risk of probable dementia among women 65 and older

18
Q

When is it safe to begin HT for Menopause?

A

pt with no contraindications who are within 10 years of menopause and/or <60 yo

19
Q

What are the non-pharmacological treatment options for menopause?

A

-cognitive behavioral therapy
-clinical hypnosis
-temperature control
-yoga
-avoid spicy food
-exercise
-acupuncture
-paced respiration

20
Q

What herbal therapies can be used for menopause?

A

isoflavones/phytoestrogens (no evidence, avoid in breast cancer pt), black cohosh

21
Q

Describe: SSRI for Menopause

A

unknown MOA for menopause
-escitalopram
-paroxetine 7.5mg= approved for vasomotor symptoms, side effects: N/V, HA, fatigue, AVOID IN breast cancer pt on TAMOXIFEN
-fluoxetine (not as effective)= avoid in pt on tamoxifen

22
Q

Describe: SNRI for Menopause

A

-venlafaxine (most common)= side effects: GI upset, sleep disturbances, blood pressure increase
-desvenlafaxine (inconsistent results)
-duloxetine

23
Q

MOA: Fezolinetant (Veozah)

A

neurokinin-3 receptor antagonist

24
Q

Adverse Effects: Fezolinetant

A

headache, nausea, UTI, diarrhea, URI, fatigue, cough, may increase hepatic transaminases

25
Q

Monitoring: Fezolinetant

A

-baseline tests to assess liver damage
-AST, ALT (liver tests) every 3 months for first 9 months

26
Q

Max dose of gabapentin for menopause?

A

900 mg/day in divided doses

27
Q

What is the non-pharmacological first line treatment for vaginal symptoms of menopause?

A

vaginal moisturizer or lubricant= Replense (polycarbophil bioadhesive polymer)

28
Q

What other products can be used to treat vaginal symptoms of menopause?

A

-vaginal estrogen
-prasterone (Intrarosa)
-ospemifene (Osphena)

29
Q

Describe: prasterone (Intrarose)

A

DHEA that is converted to androgens and estrogens in a vaginal insert that restores vaginal tissue

30
Q

Describe: Ospemifene (Osphena)

A

-FDA approved for dyspareunia (painful sex)
-MOA: SERM
-may result in hot flashes

Therapeutics 1 (16 decks)

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