Menopause + MS Flashcards

1
Q

Dx of menopause in pt with hysterectomy

A

High FSH and low estradiol

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2
Q

Dx of menopause generally, when it is premature + when it is early

A

12mo after final period
Premature if <40
Early if <45

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3
Q

Sx menopause

A

Sx:
Hot flashes
Libido change
Vaginal dryness
Dysuria
Incontinence
Sleep disturbance
Thinning skin + hair
Depression
Forgetfulness
Headache
Wt gain

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4
Q

RF for early menopause

A

smoking, surgery, chemo, RT

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5
Q

Lifestyle management of menopause

A

Diet (fruit, veg, grains, calcium)
Maintain healthy weight
Exercise
Stop smoking
BP control
Reduce alcohol

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6
Q

HRT - when to give, CI, what to give if uterus vs no uterus

A

Recommended if <60, <10 yrs past menopause
CI: abn vaginal bleeding, breast/ ovarian/ endometrial cancer, CAD, CVA, VTE, liver disease
If uterus intact, progestin + estrogen
If uterus absent, only estrogen

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7
Q

Oral vs transdermal HRT names

A

Oral:
Estrogen only: premarin or estrace
Progestin only: micronized progesterone, provera
Combined: activelle or angelique
Tissue selective estrogen complex + tibolone = progesterone free options for vasomotor sx
Transdermal (lower risk of VTE):
Estrogen only: Climara or Estradot patch or Estrogel
Combined: Estalis

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8
Q

Rx For breast cancer pts

A

venlafaxine, gabapentin, clonidine, CBT

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9
Q

Rx for Genitourinary sx

A

ospemifene (estrogen)
prasterone (steroid)
both topical

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10
Q

Rx for Hyposexual desire

A

Flibanserin or transdermal testosterone

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11
Q

Rx for hot flashes

A

Black Cohosh, Primrose Oil, SSRI/SNRIs (Venlafaxine), Clonidine, Gabapentin, Hormone Replacement Therapy

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12
Q

Sx of MS

A

loss of vision in one eye
painful eye movements
diplopia
ascending sensory disturbance
weakness
imbalance
altered sensation down back
bladder + bowel dysfunction
sexual dysfunction

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13
Q

patterns of MS

A

Relapsing remitting (periods of remission followed by exacerbations)
Secondary progressive (gradual accumulation of disability)
Primary progressive (sx gradually worsen over time)
Progressive relapsing (progressive w/ occasional attacks)

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14
Q

What dx criteria to use for MS + what Ix to order

A

Dx:
McDonald criteria
Ix:
MRI
CBC, LFTs, Cr, lutes, Calcium, glucose, TSH, B12

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15
Q

Management of MS: non-pharm

A

Education
MDT approach (neurologist, MS nurse, PT, OT, SLP, psychologist, RD)
Lifestyle
Exercise
Smoking cessation

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16
Q

Annual review for MS - what to cover

A

Mobility, balance, falls
Spasticity, stiffness, tremors
Bladder, speech, swallowing, vision
Sensory sx + pain
Cognitive sx, depression, fatigue, sleep
Resp function
Weight, smoking, alcohol, SU, exercise

17
Q

what is Lhermitte’s sign?

A

electric shock sensation travelling down spine

18
Q

What is Uhthoff’s phenomenon?

A

Heat will precipitate a worsening of symptoms

19
Q

What meds for MS for:
a) relapse
b) maintenance

A

Relapse: methylprednisolone 0.5mg daily x 5/7
DMARDs

20
Q

Sx management for MS:
Fatigue
Spasticity
Emotional lability

A

Fatigue: amantadine, CBT
Spasticity: baclofen or gabapentin
Emotional lability: amitriptyline

21
Q

When do you test FSH for ?menopause?

A

Never!

22
Q

5 ways to rx menopause w/o meds

A

stop smoking, quit alcohol, stop caffeine, start exercise, weight loss

23
Q

When can you prescribe HRT safely?

A

Within 10 yrs of LMP, <60, safe for 5 years

24
Q

5 ways to rx vasomotor sx of menopause w/o meds

A

fan, layers, cool environment, no hot drinks, optimize sleep

25
Q

Rx for psych/ sex sx of menopause

A

treat sleep, relationship issues, genitourinary sx, SSRI

26
Q

Consequences of multimorbidity

A

increased mortality, complex critical care, polypharmacy