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Repro > week seven > Flashcards

week seven Flashcards

1
Q

Pre/Peri-menopause sx

A

Cycle irregularity (shortening then lengthening)
Increasing menopausal sx
Can last 3-8 years

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2
Q

Cessation of menses for _____ = menopause

A

1 full year

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3
Q

Avg age menopause

A

51

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4
Q

Post-menopause is used to describe

A

All the time following 1 full year of cessation of menses

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5
Q

CC-EPT vs CS-EPT

A

CC-EPT - continuous combined EPT; daily dosing both estrogen and progestogen

CS-EPT - continuous/sequential EPT; daily estrogen and cyclic progestogen (14 days month or 3 days on 3 days off)

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6
Q

Bio-identical HT options

A

Compounding pharmacy: bi-est, micronized progesterone

Pharm company: estradiol (vivelle patch, estring, estrace), progesterone (prometrium)

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7
Q

Non-bioidentical hormone options

A

From natural substance: esterified estrogens (premarin)

Synthetic: progestins (provera)

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8
Q

Indications for use of HT

A

Decent option for women within 10 years of menopause (or younger than 60)

Benefits outweigh risks in women with no CI

BEST indication for use:
Vasomotor instability (hot flashes)
Vaginal dryness

It NOT used for disease prevention, except in the case of osteoporosis when a pt has failed bisphosphonates (given during osteopenia)

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9
Q

Goals of menopausal intervention

A

Sx relief/improve QOL
Minimal impact on inc risk of other disease

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10
Q

Why would a woman post hysterectomy not need an opposed progestin?

A

No uterus > no endometrial lining to protect from endometrial cancer

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11
Q

The most effective tx of menopause related vasomotor sx (diminished sleep, irritability, difficulty concentration) according to the 2017 NAMS statement is ___

A

ET with or without progestogen

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12
Q

The most effective tx of severe sx of vulvar and vaginal atrophy (dryness, dyspareunia, atrophic vaginitis) according to the 2017 NAMS statement is ___

A

ET

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13
Q

What is another way you can describe the vulvar and vaginal changes of menopause with more patient comfortable language?

A

Genitourinary syndrome of menopause

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14
Q

If there is only vaginal sx without systemic sx what is advised?

A

Local vaginal ET

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15
Q

Sexual function effects of ET

A

Improved lubrication, inc blood flow and sensation

NOT supported for interest, arousal, orgasmic response, libido, etc

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16
Q

ET effects urinary tract health

A

Local ET may benefit overactive bladder and reducing UTIs (estradiol ring equivalent to oxybutynin in overactive bladder)

Systemic HT may worsen/provoke stress incontinence

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17
Q

Advantages HT, specifically estrogen

A

Osteoporosis
Endocrine effects
Relief of perimenopausal major depression
Relief of GU sx
Relief of perimenopausia vasomotor instability
Protective against colon CA

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18
Q

Disadvantages HT, specifically estrogen

A

Inc risk coronary event first year
Inc CVA (stroke)
Inc cancer risk
Inc VTE risk
Can increase incontinence
Increase GB dz
If already inc TGs > can cause pancreatitis

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19
Q

Absolute CI TO HT

A

Hx breast cancer
CHD
Previous venous thromboembolic event or stroke
Known clotting disorder
Hx heart attack, angina, coronary bypass
Active liver disease undx vaginal bleeding
Pregnancy

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20
Q

Relative CI to HT

A

Chronic liver disease
Heart disease
Endometrial cancer
HTN
Familial hyperlipidemia
Seizure disorder
Migraine headaches
Hx thrombophlebitis
Endometriosis
Gallbladder dz

21
Q

Complete PE for HT intake

A

Height measurement
Wt measurement
Determination of obesity index
BP
Breast exam
Abdominal exam
Pelvic exam
Rectal exam

22
Q

What are some pre-treatment assessment tools to use before HT?

A

Fasting lipid profile
Blood glucose levels
Papanicolaou test
Mammography

Demography
UA
Electrocardiography
Ultrasonography for endometrial thickness and ovarian volume
ASCVD risk score
GAIL model

23
Q

3 most important factors for determining risk vs benefit for HT

A

Age at initiation (yrs since menopause)
Dose of estrogen
Route of administration

24
Q

Before selecting a tx plan for menopause, consider:

A

General health status and age
Severity of sx
Risk for developing other dz
Risks and benefits
Lifestyle
Pt view on tx options

25
Q

Levels of intervention menopause

A

Diet, exercise, stress management
Nutritional supplementation
Botanicals
HT (moderate sx)
Other pharm (SSRIs, fosamax, lipitor) (mod and severe sx)

26
Q

Examples of bioidentical hormones

A

17b estradiol
Estrone
Estriol
Progesterone
Testosterone
DHEA

27
Q

What type of hormones do NAMS, ACOG, and endocrine society advise against?

A

Custom compounded HT from compounding pharmacy

28
Q

Advantages oral HT capsules

A

Least expensive
Easy use
Storage
Beyond use date

29
Q

Disadvantages oral HT capsules

A

First pass metabolism
Subject drug to gastric pH
Gut requires active transport of molecule
Some pt may have trouble swallowing capsules
Low absorption

30
Q

E3

A

Estriol

31
Q

E2

A

Estradiol

32
Q

E1

A

Estrone

33
Q

Estriol:estradiol ratio

A

80% estriol / 20% estradiol

34
Q

Oral estradiol lipid effects

A

Dec LDL but inc atherogenicity (inc in oxidized LDL)
Inc HDL
Inc triglyceride
Inc Serum amyloid A (associated with inflammation)

35
Q

Oral estradiol CV risks

A

Increased CRP production in liver
Dec IGF1
Dec Activated protein C
Dec Antithrombin III

36
Q

Oral progesterone caps downsides

A

Rapid clearance and poor bioavailability

37
Q

Benefits oral testosterone

A

Sexual function
Inc energy
Improve memory
Improves mood
Improves concentration
Inc muscle strength

38
Q

Side effects and cautions oral testosterone

A

Acne
Hair thinning
Irritability
Raise LDL and TGs
Lowers HDL
Can convert to estrogen in body and have same risks

39
Q

Advantages sublingual/buccal dosing HT

A

Rapid absorption
Dec first pass metabolism
Bypasses gastric system
Removal of dosage form if needed

40
Q

Disadvantage sublingual/buccal dosing HT

A

Disadvantage sublingual/buccal dosing
Interference with saliva testing
Still will be oral administration from swallowing dose
Taste
Can’t confer endometrial protection with sublingual progesterone

41
Q

Transdermal HT advantages

A

Easy to use
Avoids first pass metabolism
Avoids gut metabolism
With patches, quick removal of patch removes therapy
Adjustable dosages

42
Q

Transdermal HT disadvantages

A

Dose variability
Compliance

43
Q

Dr Ashney’s most common rx ideas menopause

A

All women with uterus get estrogen AND a progesterone

Women with insurance - vivelle dot, and if she has uterus prometrium
Atrophic vaginitis or GSM - E3

44
Q

For premature menopause, when should you re-evaluate continued estrogen?

A

Age 51

45
Q

When should you consider stopping estrogen replacement with progesterone?

A

After 3-5 years of use

46
Q

When should you consider stopping estrogen replacement without progesterone?

A

After 7 years of use

47
Q

How should you discontinue HT?

A

Slow taper over 2-3 mo to reduce withdrawal effects

48
Q

Estrogen withdrawal effects

A

Irregular vaginal bleeding or spotting
Hot flushes

Repro (7 decks)

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