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Phar 508 > Menopause > Flashcards

Menopause Flashcards

1
Q

What is perimenopause, menopause, and postmenopause

A

Perimenopoouase: 2-8 year period proir to menopause AND the 1 year following menopause
Menopuase: The last menstrual period
Postmenopause: Time after the last menses

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2
Q

When dose menopuase usually occur in women

A

Ages 40-60 years old ( Average in America = 51)

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3
Q

What is the most common vasomotor symptom of menopause, how is characterized, when dose it usually begin, rhythm and length of episode

A

Hot flashes, sudden feeling of warmth with increased sweating/flushing, years before last menstrual period, episodes last 5-12 minutes while mostly occurring at night

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4
Q

T/F: The average duration of hot flashes in menopause is 7.5 years

A

True

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5
Q

What is the vaginal symptom of menopause, characteristics

A

Vaginal Dryness/ irritation, discomfort, painful sex

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6
Q

T/F: Just like hot flashes, vaginal atrophy decreases with time since menopause

A

False: Vaginal atrophy does NOT wane with time since menopause

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7
Q

T/F: Women with menopause can have breast atrophy as well

A

True

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8
Q

What are risks that women with menopause must now be aware of

A

Osteoprorisis and Cardivascular disease

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9
Q

What hormone is increased during menopause

A

FSH ( Greater than 40 pg/mcl)

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10
Q

What are possible triggers for hot flashes in menopausle women

A

Hot beverages, spicy foods, alcohol, warm environment, emotional stress

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11
Q

What type of exercises can be done for menopausle women and what would they help these women with

A

Aeorbic exercise (cardiovascular protection), weight-bearing (bone protection)

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12
Q

What are diet suggestions in menopausle women

A

adequate dietary calcium intake, adequate vitamin D, heart healthy diet

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13
Q

What are the hormone therapy options to give menopausle women

A

Estrogen +/- progestin, Tissue selective estrogen complex (TSEC), SERM

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14
Q

What are non hormone therapy options to give menopausle women

A

Seritonergic agents, antiepileptic drugs, antihypertensives, local (vaginal) therapies, herbals

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15
Q

What are the types of estrogen only hormone therapies

A

Systemic estrogen (oral, transdermal, high dose vaginal), localized estrogen (low-dose vaginal)

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16
Q

T/F: Estrogen plus Progesterone can be given oral, transdermal or high-dose vaginal

A

True

17
Q

What is SYSTEMIC estrogen monotherapy indicated for , what is the most important rule and why

A

Vasomotor symptoms, ONLY used in women with NO UTERUS, could increase risk of endometrial cancer in women with a uterus

18
Q

What hormone therapy can be used for vasomotor symptoms in women who still have a uterus

A

SYSTEMIC estrogen/PROGESTIN therapy

19
Q

What TSEC is used in menopausle women, what is the indication, what women should avoid this drug

A

Estrogen plus Bazedoxifene (Duavee)/ moderate to severe vasomotor symptoms, prevention of postemenopausal osteoporosis/ those with renal or hepatic disease

20
Q

T/F: Women who Duavee are still at high risk of endometrial cancer

A

False: Estrogen plus Bazedoxifene has estrogenic effects on bone BUT antiestrogenic effects on the uterus/breast

21
Q

What hormone therapy would be used for vaginal atrophy, changes if they have a uterus

A

Low dose vaginal estrogen, Can be used in women who have uterus because the estrogen does not have significant systemic absorption

22
Q

What is the most effective therapies for vasomotor symptoms, vaginal atrophy

A

Both estrogen AND estrogen/progestin therapies, systemic and vaginal routes

23
Q

What are the estrablished benefits of using hormone therapy

A

Controlled vasomotor symptoms, less osteoporisis, less vaginal atrophy

24
Q

What are the established risks of hormone therapy

A

Thromboembolic disease, breast cancer. cardiovascular disease, endometrial cancer, ischemic stroke. gallbladder disease, hypertriglyceridemia

25
Q

What are the ABSOLUTE CONTRAINDICATIONS of using hormone therapy

A

Undiagnosed vaginal bleeding, severe active liver disease, active venous thrombosis, history of hormone related thrombosis, history of ischemic stroke and/or TIA, history of dementia, migraine WITH aura, pregnancy, current tobacco use, histroy of estrogen dependent cancer

26
Q

What are the RELATIVE CONTRAINDICATIONS of using hormone therapy

A

Enometriosis, gallbladder or moderate liver disease, hypertriglyceridemia, Migraine WITHOUT aura, uncontrolled DM or HTN, obese, strong family history of breast cancer

27
Q

Why would a transdermal patch be preffered over an oral route

A

Patient has a high risk of thromboembolic disease, gallbladder disease, HTN, hypertriglycerdiemia

28
Q

Side effects from using hormone therapy

A

nausea, breast tenderness, headaches, increased blood pressure, leg crams, decreased libido, skin irritation (transdemal)`

29
Q

What are key concepts for using hormone therapy

A

Use lowest effective dose, use less than 5 years, can use vaginval ET long term as long as it isn’t systemic

30
Q

What serotonergic antidepressant is also FDA approved for menopause (vasomotor), other antidepressants

A

Paroxetine mesylate, citalopram, duloxetine,fluoxetine, sertraline,mitrazapine,venalfaxine

31
Q

What AED and NSAID can be used for vasomotor symptoms of menopause, hypertension med

A

Gabapentin (900mg/day), pregablin, clonidine

32
Q

What vaginal lubricant can be used extended relief of symptoms

A

Vaginal moistrurizer (Replens)

33
Q

What SERM therapy is okay for vaginal symptoms and ok for bone, contraindications

A

Osphena (estrogenic in vaginal mucosa/bone while agonist in uterus) 60 QD/ active or history of thromboembolic disease, breast cancer

34
Q

What are adverse effects of ospemifene

A

hot flashes, muscle cramps, vaginal discharge, sweating, concurrent use of CYP3A4 and/or 2C9 inhibitors/induces

35
Q

What intravaginal DHEA is indicated for pain during sex

A

Prasterone

Phar 508 (21 decks)

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