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Women's health > Week 6 Menopause, Breast Changes, & Osteoporosis > Flashcards

Week 6 Menopause, Breast Changes, & Osteoporosis Flashcards

1
Q

In postmenopausal women, estrogen levels increase with decreasing weight. True or False?

A

False

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2
Q

Which of these is NOT listed as a recommended dosing option for estrogen/progesterone therapy? Continuous Monophasic Sequential

A

Monophasic

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3
Q

Provera is an option for transdermal hormone therapy. True or false

A

False

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4
Q

Alendronate (Fosamax) and riserdronate (Actonel) are examples of calcitonin. True or false

A

false

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5
Q

Galactorrhea can persist for months or years after breastfeeding. True or False

A

True

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6
Q

Which of these procedures allows clinicians to distinguish between invasive and noninvasive cancer?

A

core needle biopsy

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7
Q

Mammograms help differentiate among malignant, benign, or cystic fibroids. true or false

A

false

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8
Q

Which of these screening procedures is reserved for those at very high risk for cancer?

A

MRI

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9
Q

Women with a parent, sibling. or child with BRCA-1 or BRCA-2 mutation should have an MRI and a mammogram every other year. True or false

A

false

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10
Q

Bisphosphonates

  • Aldronate (Fosamax)
  • Risedronate (Actonel, Atelvia)
  • Ibandronate (Boniva)

Indication

MOA

Contraindication

A

1st line osteoporosis

MOA: inhibit bone resorption by reducing osteoclast #

Contraindication

  • Upper GI disease
  • Hypocalcemia
  • Renal disease
  • MUST TAKE WITH WATER
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11
Q

Zoledronic acid (Reclast)

Indication

Contraindication

A

osteoporisis

IV

Contraindication: Hypocalcemia

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12
Q

Raloxifine (Evista)

Indication

MOA

side effect

Contraindication

A

Indication: Osteoporosis (spine)

MOA: selective estrogen receptor modulator (SERM)

Side Effect

  • Hot flashes

Contraindication:

  • not recommended if on estrogen therapy or EPT
  • Hx VTE
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13
Q

Calcitonin

Indication

Caution

Contraindication

A

Indication

  • Not first line for osteoporosis
  • Analgesic effect on osteoporotic fractures

Caution:

  • Consider malignancy risk
  • admin = nasal spray
  • Use <6 months

Contraindication

  • Allergy to calcitonin- salmon
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14
Q

What increases a patient’s modifiable risks for osteoporosis?

A
  • BMI <21
  • Hypogonadal states (anorexia, turner & kleinfelters)
  • Nulliparity
  • Lifestyle (smoking, sedentary)
  • Medications (thyroid, steroids, PPIs, SSRI)
  • Chronic disease
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15
Q

What are the non modifiable risk factors for developing osteoporosis?

A
  • Age
  • Female
  • Race (white)
  • Family history
  • history fracture as adult
  • 1st degree relative
  • Genetic disease
  • Hematologic disorder
  • Autoimmune
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16
Q

What are the diagnostic criteria for osteoporosis?

A

Bone mineral density score

T score -2.5 or higher = osteoporosis

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17
Q

What are the physiological changes that occur with menopause? What questions should you be asking your patients?

A

Follicles less responsive to FSH

Ovaries produce less estradiol, progesterone, and androgens

18
Q

Describe

Estradiol (E2)

Estriol (E3)

Estrone (E1)

A

Estradiol (E2)

  • most potent
  • Main estrogen in reproductive years
  • low post menopausal

Estriol (E3)

  • by product of estradiol and estrone

Estrone (E1)

  • Weak
  • Primary estrogen in post menopausal women
  • Produced by adipose
19
Q
A
20
Q

What are non hormonal treatment options for vasomotor symptoms? 3 and their side effects

A

Clonidine: weekly patch

  • Side Effect dizzy, dry mouth

Gabapentin:

  • Side Effect: anorgasmia

SSRI (Venlafaxine or Fluoxetine)

  • SE: sexual dysfunction
21
Q

What are the only FDA approved prescription for treating hot flashes in women with high risk breast cancer or people who have had breast cancer?

A

Paroxetine

22
Q

When will vasomotor symptoms resolve within _____ after initiation of hormone therapy but return in _____ % of women

A

2 to 6 weeks

50%

23
Q

how long do vasomotor symptoms last?

A

up to five years and sometimes up to 10 years

24
Q

What is the diagnostic criteria for Female Sexual Arousal Disorder

A

Complete lack or reduction in sexual interest/arousal associated with 3+ below for 6 months

Absence or reduction in

  • interest
  • erotic thoughts
  • desire to initiate sex
  • sense of excitemnt during sex
  • response to sexual cues
  • decreased sensation during sex
25
Q

Medications for sexual arousal disorder

A

Flibanserin

Bremelanotide

Brupopion

Testoserone

26
Q

Flibanserin

MOA

Side effect

A

For sexual arousal disorder

MOA: dopamine activation “female viagra”

Side Effect: Syncope esp with ETOH

27
Q

Bremelanotide

Side Effect

A

Sexual arousal disorder PRN autoinjector

Side Effect: Nausea

28
Q

What is the breast cancer screening recommendations for the average women without risk factors?

A

45 to 74

29
Q

What is the USPSTF screening recommendations for average risk women breast cancer?

A

Mammography Q 2 years

Ages 50 to 74

30
Q

What does the american cancer society recommend for breast cancer screening for women with high risk

A

MRI and mammogram yearly starting at 30

31
Q

What does the ACOG recommend for higher risk breast cancer individuals

A

MRI yearly starting at 25

Mammogram yearly starting at 30

32
Q

When would you order an ultrasound?

Benefits of US

A
  • When radiation is to be avoided if aged <30
  • pregnant
  • Dense breasts
  • palpable breast lumps

As an adjunct to mammography!!!

Benefits

  • Differentiate cysts v solid mass
  • guide fine needle aspiration of breast cysts

**cannot differentiate between malignant or benign solid masses

33
Q

Management for breast lump <30

>30

A

<30 = Ultrasound alone

>30 = US & Mammogram

34
Q

Causes of galactorrhea

A
  • Hyperprolactinemia
  • Pituitary prolactin secreting tumors - adenoma
  • Medications (COC, antidepressant)
  • Hypothyroidism
  • Neurologic disorder
  • Stress
35
Q

What diagnostics do you check for galactorrhea?

A

Pregnancy

Prolactin in AM before breast stimulation ( + = CT pituitary)

TSH

Mammogram if >30

US

36
Q

What are the screening recommendations for osteoporosis?

A

All women >65 years

Women <65 with risk factors

Men >70

Men <50 if previous broken bone

37
Q

How do you screen for osteoporosis?

A

DEXA scan Q2 years

osteoporosis = T score of -2.5 SD or lower

Osteopenia = t shore -1.1 to -2.4 SD

Z-score -2 or less

38
Q

What is the FRAX tool?

A

determines 10 year risk for fracture

39
Q

What are the benefits of Raloxifene (Evista)

Disadvantages?

A

Selective Estrogen Receptor Modulator (SERM)

  • Decreases bone resorption
  • Increases BMD at spine only/reduce risk vertebral fx
  • Protection against breast cancer

Disadvantages

  • May cause hot flashes
  • Increased risk DVT
  • Lose bone immediately after stopping
40
Q

When would you stop Bisphosphonates after 5 years?

When would you continue meds over 5 years?

A
  • No fracture hx or low risk for fracture
  • hip BMD >-2.5 = drug holiday reassess in 2 to 3 years

Continue if

  • Hx fracture before or during treatment
  • BMD is -2.5 or less or at high risk fracture

Reassess every 2 to 3 years

41
Q

Raloxifene (Evista)

Who is this for?

BBW

A

Who: Postmenopausal women at risk for breast cancer; people with bisphosphonate contraindications

BBW:

DVT, endometrial/uterine cancer, increased risk of stroke death

Women's health (10 decks)

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