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Reproduction Final > Pharmacotherapy of Menopause > Flashcards

Pharmacotherapy of Menopause Flashcards

1
Q

Define Menopause

A

Life Event
Loss of ovarian function and hormonal deficiency
Amenorrhea for 12 months
FSH>40

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2
Q

Define Perimenopause

A

Period before menopause and 1 year after
Vasomotor and psycho symptoms
FSH fluctuates

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3
Q

What are you checking in the complete medical history

A

FH of CVD, breast cancer and personal history of thromboembolism

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4
Q

What are you looking at in the physical exam

A

CV, thyroid, breast and pelvic, mamogram and lipid panel

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5
Q

HRT Indications

A

Moderate to severe vasomotor symptoms
Vulvovaginal atrophy
Prevention of postmenopausal osteopororsis

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6
Q

Contraindication to HT

A 
Active or history of thromboembolism
Coronary heart disease
Stroke or transient ischemic attack
History of breast cancer
Pregnancy
Active liver disease
Un-diagnosed vaginal bleeding
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7
Q

Estrogen dose

A

Lowest effective dose for the shortest amount of time

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8
Q

Non-pharmacologic treatment

A 
Smoking cessation
Limited alcohol and caffeine
Limit hot beverages and spicy food
Dress in layers
Reduce stress
Increase exercise
Water based lubricants
Kegel exercise
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9
Q

Intact uterus needs

A

Progestogen to prevent endometrial hyperplasia and cancer

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10
Q

Continuous Cyclic HRT

A

Estrogen daily
Progestogen for 12-14 days
Withdrawal bleeding shorter and lighter

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11
Q

Continuous Combined HRT

A

Estrogen and progesterone DAILY
No withdrawal bleeding
Breakthrough bleeding for 6-12 months so best for postmeno of 2 years

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12
Q

Continuous Long Cycle HT

A

Estogen daily
Progestogen every other month for 12-14 days
6 periods per year that are longer and heavier

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13
Q

Intermittent Combined HT

A

Estrogen alone for 3 days then combo for 3 days, repeat

Lower bleeding and better tolerated

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14
Q

Premarin

A

Estrogen

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15
Q

Cenestin

A

Estrogen

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16
Q

Menest

A

Estrogen

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17
Q

Estrace or Femtrace

A

Estradial

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18
Q

Ogen

A

Estropipate

19
Q

Provera

A

MPA progesterone

20
Q

Prometrium

A

Progesterone

21
Q

Aygestin

A

NETA

22
Q

Prempro

A

CEE + MPA

23
Q

Angeliq

A

Estradial + drospirenone

24
Q

FemHRT

A

Estradiol + Norethindrone

25
Q

Activella

A

Estradiol + norethindrone

26
Q

Ortho-prefest

A

Estradiol + Norgestimate

27
Q

Low dose hormone therapy

A

Decrease hot flashes, improved vulvovaginal atrophy, increase bone mineral density and endometrial protection

28
Q

Androgen indication

A

Vasomotor symptom treatment

Not first line

29
Q

Estrogen Adverse Effects

A 
Nausea
Headache
Bloating 
Breast tenderness
Bleeding
CHD
Stroke
VTE
Cancer
30
Q

Progesterone Adverse Effects

A 
Nausea
Headache 
Weight gain
Bleeding
Irritability
Depression
VTE
Decreased bone mineral density
31
Q

Manage AEs

A

Reduce dose
Change preparation
Change method of administration

32
Q

When do you begin transdermal patches?

A

1 week after last day of oral HT

33
Q

1 Patch weekly

A

Climara
Menostar
Climarapro (combo)

34
Q

1 patch twice weekly

A

Alora
Estraderm
Vivelle-Dot
CombiPatch

35
Q

Divigel

A

Topical Gel
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing
FLAMMABLE

36
Q

Estrogel

A

Topical gel pump
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing (5 minutes)
FLAMMABLE

37
Q

Elestrin

A 
Topical gel pump
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing
FLAMMABLE
DO NOT APPLY SUNSCREEN FOR AT LEAST 25 MINUTES OR 7 DAYS IN A ROW
38
Q

Estrasorb

A 
Skin Emulsion
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing
Do not apply sunscreen at same time
Left over onto butt
39
Q

Evamist

A

Topical Spray on FOREARM
Allow to completely dry before dressing (2 min)
FLAMMABLE
Wash with soap and water if a person comes into contact

40
Q

Estring

A

Vaginal Ring
Replace after 90 days
Systemic absorption

41
Q

Vagifem

A

Vaginal tablet
New applicator each day
1 tablet daily for 2 weeks, 1 tablet twice weekly

42
Q

Estrace

A

Vaginal Cream

Squeeze to expel amount and put inside you

43
Q

Discontinuation

A

Vasomotor symptoms resolve in 4 years-ish

Reassess need for HRT and TAPER after 1 yr

44
Q

Bioidentical Hormone Therapy

A

Custom made HRT compound

Dose determined by salivary hormones

Reproduction Final (6 decks)

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