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Pharmacotherapy 4271 > Menopause (Final) > Flashcards

Menopause (Final) Flashcards

1
Q

this is the cessation of menses for at least 12 consecutive months. there a loss of ovarian follicles and production of sex hormones. can be natural or due to the removal of ovaries

A

menopause

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2
Q

the average age of menopause is

A

51 (40 to 58)

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3
Q

this is known as menopause transition. begins with an alteration in menstrual cycle length and/or flow and ends with natural menopause

A

perimenopause

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4
Q

the average duration of perimenopause is

A

4 years

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5
Q

true or false: the fertility rate in perimenopasue is zero therefore there is no chance of pregnancy

A

false - fertility rate is low but not zero

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6
Q

what are some signs and symptoms of menopause

A

vasomotor sxs: hot flashes, night sweats

genitourinary: atrophy, dryness, vaginitis, dyspareunia, recurrent UTI, urgency

  • insomnia
  • decreased libido and sexual function
  • h/a
  • joint pain
  • mood swings, anxiety, depression
  • worsening memory and brain fog
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7
Q

these symptoms result from a disruption of temperature regulation by the hypothalamus due to low estrogen levels after prior estrogen priming

A

vasomotor

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8
Q

when to vasomotor symptoms usually start with regards to the last menstrual period

A

2 years before

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9
Q

how long do vasomotor symptoms usually last and when are they the most intense

A

usually last 7-8 years, most intense 2 years after the last menses

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10
Q

this treatment is the most effective for VMS with approx 75% reduction in frequency and severity.

A

hormone replacement therapy (estrogen +/- progesterone)

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11
Q

who is a candidate for HRT

A
  • patients < 60 y/o or <10 years post menopause
  • those not at a high CV risk
  • those with no absolute contraindication to hormone therapy
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12
Q

this type of hormonal therapy is used when a patient has NO uterus therefore needs to endometrial protection

A

estrogen only

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13
Q

this type of hormone therapy is used when a patient has a contraindication or is unwilling to take estrogen

A

progesterone only

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14
Q

this type of hormone therapy is used when a patient has an intact uterus

A

E + P

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15
Q

what types of estrogens are used in oral products used for VMS

A

synthetic (derived from horse urine) and bioidentical (derived from plant sources)

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16
Q

what types of estrogens are used in transdermal produces used for VMS

A

bioidentical (derived from plant sources)

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17
Q

this transdermal estrogen product used for VMS is timed released, and is applied 1-2 times per week; can be applied to hips, buttocks, or abdomen

A

patch

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18
Q

this transdermal estrogen product used for VMS is applied once daily

A

gel

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19
Q

what are some advantages of transdermal estrogen

A
  • avoids first pass metabolism
  • less effect on TG, SHBG and thrombosis markers
  • may have less risk of VTE, possibly stroke but not MI
  • lower dosing of estrogen
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20
Q

what patients is transdermal estrogen preferred in

A
  • high TG (because has less effect on TG)
  • hypertension
  • migraines
  • sexual dysfunction
  • hx of smoking
  • higher risk of VTE
  • malabsorption syndrome
  • BMI > 30
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21
Q

what are contraindications for systemic estrogen

A
  • known or suspected estrogen-dependant malignant neoplasia (endometrial cancer) or known or history of breast cancer
  • undiagnosed vaginal bleeding
  • history or present VTE or arterial thromboembolic disease (stroke, MI, CHD)
  • liver dysfunction/disease
  • starting treatment > 60 y/o or after 10 years of menopause
  • pregnancy
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22
Q

when should the patient see an improvement in their VMS symptoms if using a standard dose of estrogen

A

4 weeks

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23
Q

when should the patient see an improvement in their VMS symptoms if using a lower dose of estrogen

A

8-12 weeks

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24
Q

this is an oral dosage form of progestin; it has a less effect on TG. can cause sedation therefore dosing at HS may have a benefit for sleeping if pt has trouble sleeping due to VMS. usually used in conjunction with estrogen

A

micronized progesterone

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25
Q

this is an oral dosage form of progestin; only used for VMS if the patient is unwilling or unable to taken estrogen. usually used alone!
has more s/e

A

MPA (medroxyprogesterone acetate)

26
Q

this is better tolerated than MPA. usually an option in perimenopause if need contraception and/or control of irregular or heavy bleeding

A

levonorgestrol (IUD)

27
Q

this is an oral dosage form of progestin; usually seen in perimenopause if need contraception and/or control of heavy/irregular bleeding

A

norethindrone

28
Q

what are contraindications for systemic progesterone

A
  • known or suspected carcinoma of the breast
  • undiagnosed vaginal bleeding
  • pregnancy
29
Q

true or false: progesterone cream may be used with estrogen for endometrial protection

A

false - cream does not prevent endometrial hyperplasia

30
Q

true or false: progestin can be taken cyclically or continuously for VMS

A

true

31
Q

what are some s/e of estrogen

A
  • breakthrough bleeding/spotting
  • nausea
  • headache
  • bloating/water retention
  • breast tenderness
32
Q

what are some s/e for ORAL estrogen only

A
  • increase TGs
  • increase in liver enzymes
  • increase in CRP
  • irratibility and anxiety
33
Q

what are some s/e of progesterone

A
  • alterations in modd/irratibilty
  • breast tenderness
  • bloating
  • h/a
  • fluid retention
  • break through bleeding
34
Q

this medication can be used for treatment of moderate to severe VMS; it is a combination of conjugated estrogen and bazedoxifene (SERM)

A

tissue selective estrogen complex (TSEC)

35
Q

true or false: progesterone should be used with TSEC

A

false

36
Q

true or false: there is an increased risk of VTE with TSEC

A

true

37
Q

this medication can be used for short term treatment of VMS, it is a synthetic steroid analogue of norethynodrel with 3 active metabolites

A

tibolone

38
Q

true or false: progesterone should be used with tibolone

A

false

39
Q

true or false: if a patient has a contraindication to estrogen, tibolone is an alternative

A

false

40
Q

what are the main s.e of TSEC

A

breakthrough bleeding/sptting and cholasma

41
Q

what the main s/e of tibolone

A

GI upset, fatigue and increased appetite

42
Q

this drug class is a non-hormonal treatment option for VMS. may provide mild to moderate reduction in frequency and severity of VMS. used as first line if also experiencing mood and anxiety

A

antidepressants (SNRI and SSRI)
escitalopram, citalopram, venlafaxine and desvenlafaxine

43
Q

this drug class is a non-hormonal treatment option for VMS. it is off label but may be a good option if night swears and fragmented sleep are main complaints

A

GABA derivatives
- gabapentin

44
Q

this drug class in a non-hormonal treatment option for VMS. it is a centrally acting antihypertensive and is APPROVED for treating VMS.

A

clonidine (alpha 2 adrenergic agonist)

45
Q

this is a non-hormonal treatment option for VMS. less well studied, poorly tolerated, and caution should be used in patients with renal impairment (do not recommend this on test!)

A

oxybutynin (anticholinergics)

46
Q

this is a natural health product that may be used for VMS. it has a risk of liver injury and is a CYP 2D6 inhibitor therefore has DI’s

A

black cohosh

47
Q

this is a natural health product that may be used for VMS. it should be avopided in women with estrogen recpeptor + cancer

A

soy

48
Q

what are some non-pharm options for managing VMS

A
  • weight management and reg exercise
  • smoking cessation
  • avoiding triggers (e.g. spicy foods, hot drinks, alcohol)
  • cooling techniques
49
Q

these type of symptoms are known as changes to the vulva, vagina, urinary tract and sexual functioning due to lower estrogen. such as:
- vaginal dryness
- dyspareunia
- valvular pruritis
- burning or pain of the vulva
- incontinence
- UTIs

A

genitourinary syndrome of menopause (GSM)

50
Q

this is the most effective therapy for GSM. improves local blood supply and restores local flora. less side effects than oral estrogen.

A

vaginal estrogen

51
Q

what are the 3 different vaginal estrogens used to treat GSM

A

cream, ring and PV tabs

52
Q

what is the most common side effect with vaginal estrogens

A

vaginal discharge

53
Q

true or false: progestin is not required if vaginal estrogen is used for less than one year

A

true

54
Q

this is a treatment options shown to help with moderate to severes dyspareuria and dryness. it is a natural steroid compound converted to E and P in the vaginal cells

A

intravaginal DHEA

55
Q

what is the most common s/e of intravaginal DHEA

A

vaginal discharge

56
Q

true or false: progestin therapy is needed if a patient is using intravaginal DHEA

A

false

57
Q

this is used for moderate to severe dyspareunia and dryness. it is a specific estrogen receptor agonist that acts on the receptors in the vagina nad on the bones and is a partial estrogen receptor agonist in the uterus.

A

oral SERM (ospemifeneoral)

58
Q

what are s/e of oral SERM (ospemifeneoral)

A

hot flashes, increased sweating and vaginal discharge

59
Q

true or false: if a patient is taking oral SERM (ospemifeneoral), progestin is needed

A

false

60
Q

this is a non-hormonal tx option used to treat GSM. may be water, silicone or oil based. useful for rapid, short term relief of dyspareunia by reducing friction

A

vaginal lubricant

61
Q

this is a non-hormonal tx option used to treat GSM. reduces friction and changes fluid content of the epithelium and reduces pH. useful for dyspareunia and dryness. has a longer duration of action (2-3 days)

A

vaginal moisturizers

62
Q

this is a non-hormonal tx option used to treat GSm. has some anti-inflammatory properties and helps with sxs by changing and lowering vaginal pH. used for vaginal dryness and dyspareunia. used daily for 5-7 days then weekly. do not use with latex condoms

A

hyaluronic acid

Pharmacotherapy 4271 (29 decks)

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