Sweatman: Drugs to Treat Menopause

Question 1

symptoms of menopause are brought about via

Answer 1

loss of endogenous production of estrogen

Question 2

what is no longer being used to treat symptoms of menopause

Answer 2

HRT–> too many CV bone dz., and Cancer risks

*though this treatment is very effective

Question 3

CEE + MPA increases risks for

Answer 3

>Coronary Heart Dz
>Invasive Breast cancer
>stroke
>PE
>gall bladder dz
>Dememtnia
>urinary incontinence

Question 4

CEE and MPA decrease the risk for

Answer 4

> hip fractures
Diabetes
Vasomotor Syptoms

Question 5

CEE alone shows what

Answer 5

more balanced risks vs benefits

>Dec risk of breast cancer

Question 6

Side effects after therapy stopped

*neither regimine affected all cause mortality

Answer 6

except for risk of breast cancer..the other side effects do away

Question 7

absolute risks of adverse affects are much lower in

Answer 7

younger women as opposed to odler women

*time since menopause influences absolute risk

Question 8

guidelines for HRT

Answer 8

currently remains the appropriate management for moderate to severe menopausal symptoms–> but not rcommended E +P of E alone for long term management of chronic disease prevention

Question 9

deciding if patient should get HT

Answer 9

1. determine if they have mod-severe menopausal symptoms
2. determine if contraindications to HT and h/o CHD, CVA, TIA
3. assess CHD risk and years since last menstrual period
   ( OK: 6-10 no unless VL risk: >10 years AVOID)

Question 10

E and oteoprosis

Answer 10

recommended to treat women at HIGH risk for fracture who cannot tolerate alternative OP therapies

Question 11

Women with genitourianry symptoms in the absence of vasomotor symptoms should receive

Answer 11

low dose, vaginal estrogen

Question 12

women on HT follow up

Answer 12

reassess each steo every 6-12 months

Question 13

never give woman HT if

Answer 13

unexplained vaginal bleeding, liver disease, DVT hx, clotting disorder, breast or endometrial cancer,

Question 14

who is not a good cancidate overall (regqrdless of CHD risk score)

Answer 14

women who have been post menopausal for over 10 years

Question 15

Vasomotor symptoms most common in

Answer 15

Africn Americans

–> peaking in the late perimenopause

Question 16

before treatment of perimenopausal VMS explore

Answer 16

secondary causes of flushing_carcinoid, hyperthyroidism, alchohol, emotional flushoing, CCB;, pheochromocytoma

Question 17

non-pharm tx of VMS (small-moderate improvement of symptoms)

Answer 17

aerobic exercise, avoid smoking, moderate etoh, dressing in layers, low ambient temperature, consuming cool drinks, paced respiration (requires training), clinical hypnosis, cognitive behavioral therapy

Question 18

pharmicological treatment of VMS

*all others are off label

Answer 18

Paroxetine
fluoxetine
escitalopram
venlafaxine
clonidine
gabapentin

Question 19

SE’s of Paroxetine, Fluoxetine, and Escitalopram (all the same)

Answer 19

N, HA, Insomnia, Possible Sexual Dysfunction

Question 20

SE’s of Venlafaxine

Answer 20

Nausea OR Vomiting, Dry mouth, anorexia, possible sexual dysfunction

Question 21

Clonidine SE’s

Answer 21

dry mouth, insomnia, drowsiness, skin reactions to transdermal patch

Question 22

SE’s for gabapentin

Answer 22

dizziness
unsteadiness
drowsiness

Question 23

qualifications of the drigs to treat VMS

Answer 23

• MOA unknown
• lower doses than for depression/pain
• affects are more rapid in onset

Question 24

MOA for clonidine

Answer 24

raises sweating threshold in thermoregulatory center and in the periphery it lowers vascular reactivity

Question 25

Name the oral estrogens approved for treatment of Menopause

Answer 25

> 17 beta estradiol
ethinyl estradiol
conjugated estrogen

Question 26

name the oral progesterones available to treat menopausal symptoms

Answer 26

Medoxyprogesterone actate
Norethindrone acetate
Drospirenone
micronized progesterone

Question 27

transdermal estrogen treatment in Menopausal symptoms

Answer 27

estradiol patch/gel/spray/emulsion

Question 28

vaginal estrogen treatment in menopausal

Answer 28

estradiol cream/tablet/ring

Question 29

transdermal progesterones

Answer 29

norethindrone acetate

levonorgestril

Question 30

the most effective treatment regimine for V<A and Urogenital atrophy

Answer 30

Estrogem +/- progesterone

Question 31

relief of treatment with E+/- P occurs within

Answer 31

one month

Question 32

Side effects of HT (dose related)

Answer 32

breast tenderness and uterine bleeding

less commonly: Vomiting, headaches, weight change, rash pruritis, cholecystitis

Question 33

route of administration preferred

Answer 33

transdermal –> no first pass metabolism

Question 34

benefit of transdermal route

Answer 34

first pass metabolism (transdermal avoids)–> promotes prothrombotic hemostatic changes oin factor IX, activated protein C resistance and TPA

Question 35

name the conjugated estrogen

Answer 35

Bazedoxifene

Question 36

Bazedoxifene makeup and MOA

Answer 36

combo of Estrogens and a SERM–>agonist in some E-sensitive tissues and an antagonist is others
–> in OM women it helps prevent endometrial overgrowth

Question 37

help prevent endometrial overgrowth in Post menopausal women taking estrogens

Answer 37

bazedoxifene (e + SERM)

Question 38

risk of VWS recurring when drug is stopped

Answer 38

50%

*independent of duration of sue

Question 39

what happens with VMS is stopped

Answer 39

• ->VMS recurs in 50%
• ->bone resoprtion worsens, –>vulvovaginal atrophy recurs
• ->other risks and benefits return to baseline rather quickly with exception of breast cancer