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Pharm 359 > Menopause > Flashcards

Menopause Flashcards

1
Q

What is natural menopause?

A

> 1 year of permanent no menses

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2
Q

What is perimenopause?

A

prior to pause where cycle becomes irregular

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3
Q

What is premature menopause?

A

<40

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4
Q

What is the difference between primary ovarian insufficiency and premature menopause?

A

POI= <40 but can still have irregular cycles

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5
Q

How do we treat premature menopause or POI? What is dose?

A

restore estrogen levels until menopause
may need higher doses
give calcium and vitamin D

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6
Q

What can predispose people to earlier menopause?

A

smoking, chemo, toxins

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7
Q

What happens to ovaries as a woman ages?

A

less eggs and poorer quality= estrogen production stops and progesterone is not needed to antagonize estrogen

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8
Q

What hormones increase in menopause?

A

FSH and LH

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9
Q

Why can perimenopause take so long?

A

ovaries stop producing estrogen but periphery able to convert androgens to estrogen

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10
Q

What is the primary estrogen after menopause? What is it’s potency and where is it made?

A

estrone
1/3
in adipose

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11
Q

What are the VMS of menopause?

A

hot flashes, sweating, redness, anxiety, palpitations

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12
Q

Why do hot flashes happen in menopause?

A

narrowing of thermoregulatory system due to low E

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13
Q

Non pharm for hot flashes?

A

cooling methods, avoid triggers, exercise, lose weight, stop smoking

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14
Q

Is CBT good for hotflashed?

A

yes and for sleep :)

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15
Q

When is estrogen therapy alone fine for menopause?

A

hysterectomy

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16
Q

What is the most effective treatment for VMS?

A

E and P

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17
Q

Why must progesterone be onboard if on estrogen as well?

A

risk of cancer if P is on risk is no higher than normal women

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18
Q

Dosing of adding P to estrogen?

A

> 12-14 days a month and match dose to E

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19
Q

True or false: E and P patch is better than oral?

A

no more effective
all are equal

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20
Q

Issue with patches for MHT?

A

anecdotal increase in VTE

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21
Q

What progesterone product may have an issues with peanut or sunflower allergy?

A

Micronized progesterone
peanut= Tea
sunflower= PMS

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22
Q

Benefit of transdermal estrogen?

A

less nausea, headache, and effect on TG

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23
Q

What is a weird s/e of micronized progesterone when taken with food?

A

drowsy

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24
Q

Pro of micronized progesterone?

A

less ate and breast cancer

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25
How does bazedoxifene work?
SERM, antagonist at endometrium and agonist at bone
26
Do you need progesterone if on a SERM? Benefits of bazedoxifene?
NO Pros= no progesterone s/e such as boob soreness and bleeding
27
What is Bijuva?
combo of E and P for MHT
28
What is tibolone for? what hormone does it have?
- for VMS SHORT TERM NO hormone
29
MOA of tibolone?
steroid analogue that is converted to a weak form of E and P
30
Which is better EPT or tibolone?
EPT
31
If contraception In perimenopause what are options?
Low dose CHC estrogen + LNG-IUS MHT- barrier non-hormonal +POP
32
Why can't we use contraception for menopausal sx?
E dose is WAYYYYY too high
33
When. can you stop OC in menopause?
>50 stop and use non hormonal until no period for >1 year >58 stop and ur fine
34
Is compounded BHT worth it?
hormone testing unreliable so no point can be under or overdosed easily lack of safety and efficacy
35
Pros of continuous E and P? CONS?
easy no withdrawal bleeding least risk of cancer CONS: irregular bleeding seen initial 6 months
35
CI of MHT?
active liver dx Estrogen cancer pregnant active thombolic untreated/uncontrolled CVD`
35
Pros of Continuous E and cyclic P?Cons?
Pros: less pills, no breakthrough bleeding Cons: withdrawal bleeding
35
Typical E s/e?
nausea, headache, bloating boob sore
36
Typical P s/e?
irritable, boob sore, bloat, PMS
37
When to go with non oral E options of MHT?
migraine, CBD, DM, old
38
What did the women's health initiative find?
if >60, and way past menopause end= risk>>>>>>> benefits
39
What is another GOOD option for VMS?
SSRI/SNRI
40
Which is more effective SSRI or hormones?
hormones
41
What AD is good for VMS?
Paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine
42
When to see effect of AD for VMS?
2-4 weeks
43
Is Veozah worth it?
for VMS but bad s/e of headache, LFTs, insomnia, and gi issues
44
What are the only herbal options with SOME evidence for VMS?
black cohosh, isoflavanoes= estrogen like effects
45
Other 3rd line options for VMS but s/e bad?
clonidine, oxybutinin, gabapentin, pregabalin
46
Are hormones indicated for osteoporosis treatment?
NOOOOO- only preventative
47
How does E effects lipids?
Lowers LDL and increases HDL increases TG
48
Who is at most risk of CVD event of MHT?
>60 and longer times from menopause
49
Is the cancer risk high with MHT?
slight increase risk than general population, if had before= AVOID
50
Would estrogen replace AD for mood sx in menopausal women?
no but if other sx use MHT
51
Is MHT recommended to prevent cognitive decline?
No if >65 may even worsen
52
GSM sx in menopause?
itchy, dry, burning, painful sex, UTI
53
1st line for GSM?
lubricants- sex moisturizers 2-3 x a week
54
2nd line for GSM?
if OTC fail vaginal estrogen
55
Do you need P if vaginal estrogen for GSM?
NO
56
Are you at increased risk of E s/e if vaginal E for GSM?
NO
57
Dosing for Premarin?
0.5-2 g pv HS f2w then 1-3 x a week
58
s/e of vaginal estrogen?
irritation, burning, leakage
59
If CI to estrogen for GSM what is an option? What is weird with formulation?
Prasterone- in hard fat
60
If treatment of VMS with MHT, will it also help GSM?
YES
61
How does Ospemifene work? S/e?
SERM for GSM hot flashes= do not administer with E
62
Is weight gain attributed to meds or menopause?
menopause
63
When should Abnormal uterine bleeding be investigated?
if ALOT, or happens 12 months after amenorrhea OR >6 months after hormonal treatment
64
Treatment for abnormal uterine bleeding?
low dose OCP (20 mcg EE), progestin

Pharm 359 (16 decks)

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