Menopause Flashcards
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 ___
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
Genitourinary Syndrome of Menopause (GSM) : Includes which side effects? (v, B, I, S,D,D,U,R)
-These usually progress without therapy!
-Vaginal dryness
-burning,
-irritation
-sexual dysfunction
-dysuria
-dyspareunia
-urinary urgency
-recurrent UTI’s
Psychological Sx’s :
M
D
A
I
F
P
F
-Mood swings
-depression
-anxiety
-insomnia
-fatigue
-poor concentration
-forgetfullness
Sexual Sx’s :
L
D
G
V
D
Loss of libido
decr energy
genitourinary atrophy
vaginal dryness
dyspareunia
Other Sx’s of Menopause :
S, A, A
Sleep disturbances
arthalgia
abnormal uterine bleeding
Kim, print tx overview sheet
Sheet
Lifestyle Mods :
- avoid __
- Layered __, lower ___
- ___ may help with vasomotor and physical sx’s
-weight bearing exercise prevents __? - __ and __ supplementation
- ____ cessation
-reduces risk of ?
- triggers (caffeine, alc)
- clothing, room temp
- exercise
-osteoporosis - calcium, vitamin D
- Smoking
-osteoporosis, fracture, CV disease
What can help with vaginal dryness? (2)
- 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 - Vaginal moisturizers
-longer lasting
- What can estrogen relieve sx’s of?
- Most effective tx of __
- Reverses ___
- Decreases LDL and t cholesterol but increases __ and __
- Increases ___
- Common adr’s? (4) **
- Serious ADRs such as ? (5)***
- Estrogen deficiency
- hot flashes
- genitourinary epithelial atrophy
- HDL, TG’s
- Bone mineral density
- nausea, ha, breast tenderness, heavy bleeding
- CHD risk, stroke, VTE, breast cancer, gallbladder disease
Initiate Estrogen dosing at ____ !
SOME EXAMPLES OF LOW DOSE ESTROGEN REGIMENS :
- ___ conjugated estrogens
- ___ micronized 17B Estradiol
- ___ TD 17B estradiol patch
Lowest effective dose for sx’s control
- 0.3 mg
- 0.5 mg
- 0.014 to 0.0375 mg
Vaginal estrogens :
- Improves ___ sx’s and ___ appearance, decreases vaginal ___ and reduces ___ and ____ sx’s
- Adverse rxns? (4)
- Kim, see chart for diff products and dosing
- atrophic , vaginal mucosal, pH, recurrent UTIs , lower urinary tract sx’s
- Vaginal discharge, vulvovaginal candidiasis, vaginal bleeding, nausea
Oral Estrogens : For each, state brand name and daily dose
- Conjugated equine estrogens CEE
- Esterified estrogens
- Estradiol (Micronized )
- Premarin (0.3mg or 0.45mg)
- Menest (0.3mg)
- Estrace, Generic (1mg or 2mg )
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
- first pass liver metabolism , more estradiol available than estrone (which is less potent)
- lipid metabolism , TG’s
- gallbladder disease, pancreatitis
- VTE, Stroke/CAD
Progestogen :
- effective for ___ does not incr ___
- ADR’s : I,V, B,W,I,B,A,H
- See chart for diff Progestogen Products
- vasomotor sx’s, VTE
- Irritability, vaginal bleeding, bloating, weight gain , incr appetite, breast tenderness, acne, headaches
- See chart
Combined MHT (E+P) :
- Cyclic (AKA sequential)
-When do u receive estrogen, and when do u get progestogen? - 1-2 days after last progestogen dose, what can occur?
- Any unexpected bleeding needs?
- 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!
- Daily, only on 12-14 days of 28 day cycle
- Withdrawal bleeding
- Endometrial biopsy
- Late menopausal transition and early postmenopause
B.
-Daily
-no vaginal bleeding
-initial spotting
-Endometrial cancer risk
-at least 2 yrs postmenopausal
SERMS : 3rd gen
- Bazedoxifene /CEE 0.45/20 mg PO daily
-FDA approved for mod to severe ? - Bazedoxifene ADR’s?
M,N,D,D,U,O,D,N - Ospemifene 60 mg PO daily with food
-What is it FDA approved for? - What are the ADR’s?
- vasomotor sx’s and prevention of osteoporosis
- muscle spams
-nausea, diarrhea,
-dyspepsia
-upper abd pain
-Oropharyngeal pain
-Dizziness
-neck pain - mod to severe dyspareunia and vag dryness from menopausal vulvar and vag atrophy
- Hot flashes
-vaginal discharge
-muscle spasm
-HA
-Vaginal hemorrhage
-Hyperhidrosis
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?
- VTE
-How much of an incr risk ?
-Whats associated with decr VTE risk?
-Oral v TD? - Diabetes?
- breast cancer?
-Estrogen alone vs E+P
-Incr risk with Incr? - Endometrial Cancer
-What must ALWAYS be used for endometrial protection?
-If ur at higher endometr cancer risk what should be used? - Ovarian Cancer ?
- Lung cancer?
- Osteoporosis ?
- Mood, Cognition, dementia
- Gallbladder disease ?
- Body weight
- incr chd risk when using E+P vs estrogen alone
- 10+ yrs after menopause vs within 10 yrs
- twofold incr risk
-lower estrogen dose
-Oral incr risk - beneficial effect on fasting glucose levels
- Breast cancer risk associated with E+P
-estrogen alone does NOT incr breast cancer risk
-Duration - ESTrogen with progestogen
-prefer non hormone methods - MHT does not incr risk of ovarian cancer
- Combined MHT didnt incr lung cancer incidence
- MHT reduces risk of fractures at hip , spine, and wrist
- Improved mental health, fewer depress episodes
-If ur older >65 , incr dementia risk - Incr risk in estrogen alone + combo product
-If high risk, use TD estrogen - No effect
MHT CI :
- Absolute CI’s
-Undiagnosed __
-History of ___
-Estrogen or progesterone dependent __
-ACtive ___ __ or history of __
-Active or recent (past year) ___
-__ dysfunction or disease - Relative
-Elevated ___
-Hyper ___
-Impaired ____ or past history of ___
-HYPO____
-__ retention
-Severe ____
-__ cancer
-____ exacerbation
-Exacerbation of ?
- Abnormal genital bleeding
-breast cancer
-neoplasia
-DVT, PE, VTE
-arterial thromboembolic disease (MI or stroke)
-Liver - BP
-triglyceridemia
-liver function , cholestatic jaundice
-thyroidism
-fluid
-hypocalcemia
-ovarian
-endometriosis
- asthma, DM, migraine, SLE, epilepsy, porphyria, or hepatic hemangioma
Non-Hormonal Alt’s : SSRI’s
1. Name 3
- What are the DDI’s?
- ADR’s? (3)
- Paroxetine 7.5 po daily
- citalopram 10 mg po daily
-lexapro 10 mg PO daily - May reduce tamoxifen efficacy
- Anorgasmia, and loss of libido with lexapro, QT prolongation (citalopram)
Non-Hormonal Alt’s : SNRis
- Name 2
- ADR’s?
- Venlafaxine 37.5 mg po daily
-desvenlafaxine 50 mg PO daily - N, HA, Somnolence, insomnia, dizziness, nervous, anorexia, constipation , diaphoresis, weakness, HTN (venlafax)
Non-Hormonal Alt’s : GABAPENTINOIDS
- name 2 drugs
- decr intensity, duration and freq of ___
- onset of action?
- ADR’s?
- gabapentin 300 mg QHS
-Pregab 50 mg PO daily - hot flashes
- 4 wks
- Dizziness, somnolence, rash, edema, dry mouth, edema, blurred vision, weight gain, impaired concentration
Non-Hormonal Alt’s : Clonidine
- Oral Tab dose
- TD patch Dose
- Less effective than ___
- ADR’s? (5)
- 0.05 mg PO BID or 1 mg PO qHS
- 0.1 mg/24 hrs once weekly
- MHT
- Drowsy, dizzy, constipation, dry mouth, orthostatic hypotension
Androgen Therapy :
1. Use is ___, no ___
2. Consider only if ____ causes signif distress and weigh risks and benefits
- CI in ?
- Avoid in ?
- ADR”s?
- WHats fda approved for mod to severe dyspareunia?
- Controversial, FDA approved testos products
- hypoactive sexual desire disorder
- Preg, lactation, testost sensitive cancer
- severe acne, hirsutism, or androgen-induced alopecia
- Virilization, hirsutism, acne, fluid retention and androgenic alopecia
- Intrarosa (prasterone 6.5 mg vag inserts)
