Menopause Pharm: Segars

Question 1

what comorbidities are increased in prevalence during menopause

Answer 1

• bone effects

- cardiovascular effects

Question 2

what is the primary therapy for menopausal symptoms

Answer 2

-Estrogen

Question 3

what must be added to the treatment of a menopausal woman with an intact uterus

Answer 3

progestin

Question 4

What are the available estrogenic forms of therapy

Answer 4

• Estradiol
• CE: conjugated estrogens
• EE: esterified estrogens
• Estropipate

Question 5

what are the available progestinic menopausal therapies

Answer 5

• Medroxyprogesterone (MPA)
• Methyltestosterone
• Pregesterone

Question 6

what are the effects of estrogen only hormone therapy

Answer 6

• endometrial proliferation
• Decreased: cholesterol, antithrombin III, osteoclastic activity
• Increased: triglycerides, clotting, platelet aggregation, sodium/fluid retention, TBG

Question 7

Harms of Estrogen and progestin therapy

Answer 7

• stroke
• DVT
• PE
• invasive breast cancer
• Dementia
• Gall bladder
• Self reported urinary incontinent

Question 8

Harms of estrogen only therapy

Answer 8

• Stroke
• DVT
• Gallbladder disease
• self reported urinary incontinence

Question 9

what are the 5 major reasons to give MHT (menopausal hormone therapy)

Answer 9

• younger women (up to 59 or within 10 years of menopause)
• women with vaginal symptoms only (low doses of topical estrogen)
• women with a uterus: add progestin
• women at risk for blood clots/stoke . . but this risk is less in 50-59 year olds
• women at risk for breast cancer: don’t have to give therapy continuously . . increased risk with 3-5 years of therapy

Question 10

what is the goal of Selective estrogen receptor modulators (SERMs)

Answer 10

beneficial pro-estrogenic (agonist) actions in select tissues with beneficial anti estrogenic in others
-Bone, Brain, Breast, Endometrium

Question 11

What is the goat of Tissue selective estrogenic complexes? (TSECs)

Answer 11

combines the unique elements of a SERM with an estrogen compound

Question 12

what is the one SERM

Answer 12

Ospemifene

Question 13

what is the one TSEC

Answer 13

Bazedoxifene (used in combo with a CE)

Question 14

what is Ospemifene used for

Answer 14

treatment of moderate to severe Dyspareunia (painful intercourse)

Question 15

what is the MOA of Ospemifene

Answer 15

-functions as an estrogen agonist by binding to ER’s in vagina, but also anti-estrogenic on breast

Question 16

side effects of Ospemifene

Answer 16

• worsening or increase in hot flashes/sweating
• similar estrogenic effects on coagulation
• endometral thickening and hyperplasia

Question 17

contraindications for Ospemifene

Answer 17

• same as all estrogens

- coagulation, abnormal bleeding, neoplasia

Question 18

what is the indication for Bazedoxifene

Answer 18

• women with a uterus
• moderate to severe vasomotor symptoms associated with menopause in women with a uterus
• prevention of post menopausal osteoporosis in women with a uterus

Question 19

MOA of Bazedoxifene

Answer 19

-Antagonistic activity in endometrium and breast tissue but also estrogenic physiologic effects especially in bone

Question 20

Side effects of Basedoxifene

Answer 20

• all estrogen side effects

- potential to worsen hot flashes/sweating