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Therapeutics Humber > Menopause > Flashcards

Menopause Flashcards

1
Q

What are some vasomotor sx’s of Menopause?
H,N,W,C

-These can be spontaneous OR ___
-Lasts __ to ___
-Most pronounced in ___
-How many times daily ?
-Generally ___

A

Hot flashes, night sweats, warmth, chills

-triggered by alcohol, caffeine, smoking, spicy foods

-seconds to hrs

-first 2 yrs
-4-5 daily, up to 20 hot flashes a day

  • improve over time
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2
Q

Genitourinary Syndrome of Menopause (GSM) : Includes which side effects? (v, B, I, S,D,D,U,R)

-These usually progress without therapy!

A

-Vaginal dryness
-burning,
-irritation
-sexual dysfunction
-dysuria
-dyspareunia
-urinary urgency
-recurrent UTI’s

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3
Q

Psychological Sx’s :
M
D
A
I
F
P
F

A

-Mood swings
-depression
-anxiety
-insomnia
-fatigue
-poor concentration
-forgetfullness

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4
Q

Sexual Sx’s :
L
D
G
V
D

A

Loss of libido
decr energy
genitourinary atrophy
vaginal dryness
dyspareunia

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5
Q

Other Sx’s of Menopause :
S, A, A

A

Sleep disturbances
arthalgia
abnormal uterine bleeding

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6
Q

Kim, print tx overview sheet

A

Sheet

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7
Q

Lifestyle Mods :

  1. avoid __
  2. Layered __, lower ___
  3. ___ may help with vasomotor and physical sx’s
    -weight bearing exercise prevents __?
  4. __ and __ supplementation
  5. ____ cessation
    -reduces risk of ?
A
  1. triggers (caffeine, alc)
  2. clothing, room temp
  3. exercise
    -osteoporosis
  4. calcium, vitamin D
  5. Smoking
    -osteoporosis, fracture, CV disease
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8
Q

What can help with vaginal dryness? (2)

A
  1. Topical lubricants
    -Water soluble products r preferred
    -can be applied internally and externally
    -generous dosing as often as needed
    -Avoid petroleum type products bc it damages latex rubber in condoms or diaphragms
  2. Vaginal moisturizers
    -longer lasting
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9
Q
  1. What can estrogen relieve sx’s of?
  2. Most effective tx of __
  3. Reverses ___
  4. Decreases LDL and t cholesterol but increases __ and __
  5. Increases ___
  6. Common adr’s? (4) **
  7. Serious ADRs such as ? (5)***
A
  1. Estrogen deficiency
  2. hot flashes
  3. genitourinary epithelial atrophy
  4. HDL, TG’s
  5. Bone mineral density
  6. nausea, ha, breast tenderness, heavy bleeding
  7. CHD risk, stroke, VTE, breast cancer, gallbladder disease
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10
Q

Initiate Estrogen dosing at ____ !

SOME EXAMPLES OF LOW DOSE ESTROGEN REGIMENS :

  1. ___ conjugated estrogens
  2. ___ micronized 17B Estradiol
  3. ___ TD 17B estradiol patch
A

Lowest effective dose for sx’s control

  1. 0.3 mg
  2. 0.5 mg
  3. 0.014 to 0.0375 mg
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11
Q

Vaginal estrogens :

  1. Improves ___ sx’s and ___ appearance, decreases vaginal ___ and reduces ___ and ____ sx’s
  2. Adverse rxns? (4)
  3. Kim, see chart for diff products and dosing
A
  1. atrophic , vaginal mucosal, pH, recurrent UTIs , lower urinary tract sx’s
  2. Vaginal discharge, vulvovaginal candidiasis, vaginal bleeding, nausea
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12
Q

Oral Estrogens : For each, state brand name and daily dose

  1. Conjugated equine estrogens CEE
  2. Esterified estrogens
  3. Estradiol (Micronized )
A
  1. Premarin (0.3mg or 0.45mg)
  2. Menest (0.3mg)
  3. Estrace, Generic (1mg or 2mg )
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13
Q

Non-Oral Estrogens :
1. Able to bypass ____ Which means more ?
2. Same effects on ___ as oral, but less likely to incr ___
3. Less likely to cause ___ or ___
4. Less risk of __ and possibly of ____

See Chart for Non-oral dosing and products

A
  1. first pass liver metabolism , more estradiol available than estrone (which is less potent)
  2. lipid metabolism , TG’s
  3. gallbladder disease, pancreatitis
  4. VTE, Stroke/CAD
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14
Q

Progestogen :

  1. effective for ___ does not incr ___
  2. ADR’s : I,V, B,W,I,B,A,H
  3. See chart for diff Progestogen Products
A
  1. vasomotor sx’s, VTE
  2. Irritability, vaginal bleeding, bloating, weight gain , incr appetite, breast tenderness, acne, headaches
  3. See chart
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15
Q

Combined MHT (E+P) :

  1. Cyclic (AKA sequential)
    -When do u receive estrogen, and when do u get progestogen?
  2. 1-2 days after last progestogen dose, what can occur?
  3. Any unexpected bleeding needs?
  4. Product is preferred in ?

B. Continuous
-When do u get estrogen and progestin ?
-Endometrial atrophy and ____
-During 6-12 months, expect ___
-Has less ____
-best for pt’s ___

See Chart for Product Selection!

A
  1. Daily, only on 12-14 days of 28 day cycle
  2. Withdrawal bleeding
  3. Endometrial biopsy
  4. Late menopausal transition and early postmenopause

B.
-Daily
-no vaginal bleeding
-initial spotting
-Endometrial cancer risk
-at least 2 yrs postmenopausal

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16
Q

SERMS : 3rd gen

  1. Bazedoxifene /CEE 0.45/20 mg PO daily
    -FDA approved for mod to severe ?
  2. Bazedoxifene ADR’s?
    M,N,D,D,U,O,D,N
  3. Ospemifene 60 mg PO daily with food
    -What is it FDA approved for?
  4. What are the ADR’s?
A
  1. vasomotor sx’s and prevention of osteoporosis
  2. muscle spams
    -nausea, diarrhea,
    -dyspepsia
    -upper abd pain
    -Oropharyngeal pain
    -Dizziness
    -neck pain
  3. mod to severe dyspareunia and vag dryness from menopausal vulvar and vag atrophy
  4. Hot flashes
    -vaginal discharge
    -muscle spasm
    -HA
    -Vaginal hemorrhage
    -Hyperhidrosis
17
Q

Risks of Systemic MHT :
1. CardioVasc Disease (CAD, stroke, PVD)
-Whats the risk amongst pt’s using E+P vs placebo and estrogen alone?
-Incr CHD risk if initiated MHT how long after meno pause?

  1. VTE
    -How much of an incr risk ?
    -Whats associated with decr VTE risk?
    -Oral v TD?
  2. Diabetes?
  3. breast cancer?
    -Estrogen alone vs E+P
    -Incr risk with Incr?
  4. Endometrial Cancer
    -What must ALWAYS be used for endometrial protection?
    -If ur at higher endometr cancer risk what should be used?
  5. Ovarian Cancer ?
  6. Lung cancer?
  7. Osteoporosis ?
  8. Mood, Cognition, dementia
  9. Gallbladder disease ?
  10. Body weight
A
  1. incr chd risk when using E+P vs estrogen alone
  • 10+ yrs after menopause vs within 10 yrs
  1. twofold incr risk
    -lower estrogen dose
    -Oral incr risk
  2. beneficial effect on fasting glucose levels
  3. Breast cancer risk associated with E+P
    -estrogen alone does NOT incr breast cancer risk
    -Duration
  4. ESTrogen with progestogen
    -prefer non hormone methods
  5. MHT does not incr risk of ovarian cancer
  6. Combined MHT didnt incr lung cancer incidence
  7. MHT reduces risk of fractures at hip , spine, and wrist
  8. Improved mental health, fewer depress episodes
    -If ur older >65 , incr dementia risk
  9. Incr risk in estrogen alone + combo product
    -If high risk, use TD estrogen
  10. No effect
18
Q

MHT CI :

  1. Absolute CI’s
    -Undiagnosed __
    -History of ___
    -Estrogen or progesterone dependent __
    -ACtive ___ __ or history of __
    -Active or recent (past year) ___
    -__ dysfunction or disease
  2. Relative
    -Elevated ___
    -Hyper ___
    -Impaired ____ or past history of ___
    -HYPO____
    -__ retention
    -Severe ____
    -__ cancer
    -____ exacerbation
    -Exacerbation of ?
A
  1. Abnormal genital bleeding
    -breast cancer
    -neoplasia
    -DVT, PE, VTE
    -arterial thromboembolic disease (MI or stroke)
    -Liver
  2. BP
    -triglyceridemia
    -liver function , cholestatic jaundice
    -thyroidism
    -fluid
    -hypocalcemia
    -ovarian
    -endometriosis
    - asthma, DM, migraine, SLE, epilepsy, porphyria, or hepatic hemangioma
19
Q

Non-Hormonal Alt’s : SSRI’s
1. Name 3

  1. What are the DDI’s?
  2. ADR’s? (3)
A
  1. Paroxetine 7.5 po daily
    - citalopram 10 mg po daily
    -lexapro 10 mg PO daily
  2. May reduce tamoxifen efficacy
  3. Anorgasmia, and loss of libido with lexapro, QT prolongation (citalopram)
20
Q

Non-Hormonal Alt’s : SNRis

  1. Name 2
  2. ADR’s?
A
  1. Venlafaxine 37.5 mg po daily
    -desvenlafaxine 50 mg PO daily
  2. N, HA, Somnolence, insomnia, dizziness, nervous, anorexia, constipation , diaphoresis, weakness, HTN (venlafax)
21
Q

Non-Hormonal Alt’s : GABAPENTINOIDS

  1. name 2 drugs
  2. decr intensity, duration and freq of ___
  3. onset of action?
  4. ADR’s?
A
  1. gabapentin 300 mg QHS
    -Pregab 50 mg PO daily
  2. hot flashes
  3. 4 wks
  4. Dizziness, somnolence, rash, edema, dry mouth, edema, blurred vision, weight gain, impaired concentration
22
Q

Non-Hormonal Alt’s : Clonidine

  1. Oral Tab dose
  2. TD patch Dose
  3. Less effective than ___
  4. ADR’s? (5)
A
  1. 0.05 mg PO BID or 1 mg PO qHS
  2. 0.1 mg/24 hrs once weekly
  3. MHT
  4. Drowsy, dizzy, constipation, dry mouth, orthostatic hypotension
22
Q

Androgen Therapy :
1. Use is ___, no ___
2. Consider only if ____ causes signif distress and weigh risks and benefits

  1. CI in ?
  2. Avoid in ?
  3. ADR”s?
  4. WHats fda approved for mod to severe dyspareunia?
A
  1. Controversial, FDA approved testos products
  2. hypoactive sexual desire disorder
  3. Preg, lactation, testost sensitive cancer
  4. severe acne, hirsutism, or androgen-induced alopecia
  5. Virilization, hirsutism, acne, fluid retention and androgenic alopecia
  6. Intrarosa (prasterone 6.5 mg vag inserts)

Therapeutics Humber (14 decks)

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