Pharmacotherapy 4271 > Menopause (Final) > Flashcards

Menopause (Final) Flashcards

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1
Q

this is the cessation of menses for at least 12 consecutive months. there a loss of ovarian follicles and production of sex hormones. can be natural or due to the removal of ovaries

A

menopause

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2
Q

the average age of menopause is

A

51 (40 to 58)

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3
Q

this is known as menopause transition. begins with an alteration in menstrual cycle length and/or flow and ends with natural menopause

A

perimenopause

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4
Q

the average duration of perimenopause is

A

4 years

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5
Q

true or false: the fertility rate in perimenopasue is zero therefore there is no chance of pregnancy

A

false - fertility rate is low but not zero

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6
Q

what are some signs and symptoms of menopause

A

vasomotor sxs: hot flashes, night sweats

genitourinary: atrophy, dryness, vaginitis, dyspareunia, recurrent UTI, urgency

  • insomnia
  • decreased libido and sexual function
  • h/a
  • joint pain
  • mood swings, anxiety, depression
  • worsening memory and brain fog
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7
Q

these symptoms result from a disruption of temperature regulation by the hypothalamus due to low estrogen levels after prior estrogen priming

A

vasomotor

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8
Q

when to vasomotor symptoms usually start with regards to the last menstrual period

A

2 years before

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9
Q

how long do vasomotor symptoms usually last and when are they the most intense

A

usually last 7-8 years, most intense 2 years after the last menses

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10
Q

this treatment is the most effective for VMS with approx 75% reduction in frequency and severity.

A

hormone replacement therapy (estrogen +/- progesterone)

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11
Q

who is a candidate for HRT

A
  • patients < 60 y/o or <10 years post menopause
  • those not at a high CV risk
  • those with no absolute contraindication to hormone therapy
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12
Q

this type of hormonal therapy is used when a patient has NO uterus therefore needs to endometrial protection

A

estrogen only

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13
Q

this type of hormone therapy is used when a patient has a contraindication or is unwilling to take estrogen

A

progesterone only

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14
Q

this type of hormone therapy is used when a patient has an intact uterus

A

E + P

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15
Q

what types of estrogens are used in oral products used for VMS

A

synthetic (derived from horse urine) and bioidentical (derived from plant sources)

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16
Q

what types of estrogens are used in transdermal produces used for VMS

A

bioidentical (derived from plant sources)

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17
Q

this transdermal estrogen product used for VMS is timed released, and is applied 1-2 times per week; can be applied to hips, buttocks, or abdomen

A

patch

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18
Q

this transdermal estrogen product used for VMS is applied once daily

A

gel

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19
Q

what are some advantages of transdermal estrogen

A
  • avoids first pass metabolism
  • less effect on TG, SHBG and thrombosis markers
  • may have less risk of VTE, possibly stroke but not MI
  • lower dosing of estrogen
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20
Q

what patients is transdermal estrogen preferred in

A
  • high TG (because has less effect on TG)
  • hypertension
  • migraines
  • sexual dysfunction
  • hx of smoking
  • higher risk of VTE
  • malabsorption syndrome
  • BMI > 30
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21
Q

what are contraindications for systemic estrogen

A
  • known or suspected estrogen-dependant malignant neoplasia (endometrial cancer) or known or history of breast cancer
  • undiagnosed vaginal bleeding
  • history or present VTE or arterial thromboembolic disease (stroke, MI, CHD)
  • liver dysfunction/disease
  • starting treatment > 60 y/o or after 10 years of menopause
  • pregnancy
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22
Q

when should the patient see an improvement in their VMS symptoms if using a standard dose of estrogen

A

4 weeks

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23
Q

when should the patient see an improvement in their VMS symptoms if using a lower dose of estrogen

A

8-12 weeks

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24
Q

this is an oral dosage form of progestin; it has a less effect on TG. can cause sedation therefore dosing at HS may have a benefit for sleeping if pt has trouble sleeping due to VMS. usually used in conjunction with estrogen

A

micronized progesterone

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25
this is an oral dosage form of progestin; only used for VMS if the patient is unwilling or unable to taken estrogen. usually used alone! has more s/e
MPA (medroxyprogesterone acetate)
26
this is better tolerated than MPA. usually an option in perimenopause if need contraception and/or control of irregular or heavy bleeding
levonorgestrol (IUD)
27
this is an oral dosage form of progestin; usually seen in perimenopause if need contraception and/or control of heavy/irregular bleeding
norethindrone
28
what are contraindications for systemic progesterone
- known or suspected carcinoma of the breast - undiagnosed vaginal bleeding - pregnancy
29
true or false: progesterone cream may be used with estrogen for endometrial protection
false - cream does not prevent endometrial hyperplasia
30
true or false: progestin can be taken cyclically or continuously for VMS
true
31
what are some s/e of estrogen
- breakthrough bleeding/spotting - nausea - headache - bloating/water retention - breast tenderness
32
what are some s/e for ORAL estrogen only
- increase TGs - increase in liver enzymes - increase in CRP - irratibility and anxiety
33
what are some s/e of progesterone
- alterations in modd/irratibilty - breast tenderness - bloating - h/a - fluid retention - break through bleeding
34
this medication can be used for treatment of moderate to severe VMS; it is a combination of conjugated estrogen and bazedoxifene (SERM)
tissue selective estrogen complex (TSEC)
35
true or false: progesterone should be used with TSEC
false
36
true or false: there is an increased risk of VTE with TSEC
true
37
this medication can be used for short term treatment of VMS, it is a synthetic steroid analogue of norethynodrel with 3 active metabolites
tibolone
38
true or false: progesterone should be used with tibolone
false
39
true or false: if a patient has a contraindication to estrogen, tibolone is an alternative
false
40
what are the main s.e of TSEC
breakthrough bleeding/sptting and cholasma
41
what the main s/e of tibolone
GI upset, fatigue and increased appetite
42
this drug class is a non-hormonal treatment option for VMS. may provide mild to moderate reduction in frequency and severity of VMS. used as first line if also experiencing mood and anxiety
antidepressants (SNRI and SSRI) escitalopram, citalopram, venlafaxine and desvenlafaxine
43
this drug class is a non-hormonal treatment option for VMS. it is off label but may be a good option if night swears and fragmented sleep are main complaints
GABA derivatives - gabapentin
44
this drug class in a non-hormonal treatment option for VMS. it is a centrally acting antihypertensive and is APPROVED for treating VMS.
clonidine (alpha 2 adrenergic agonist)
45
this is a non-hormonal treatment option for VMS. less well studied, poorly tolerated, and caution should be used in patients with renal impairment (do not recommend this on test!)
oxybutynin (anticholinergics)
46
this is a natural health product that may be used for VMS. it has a risk of liver injury and is a CYP 2D6 inhibitor therefore has DI's
black cohosh
47
this is a natural health product that may be used for VMS. it should be avopided in women with estrogen recpeptor + cancer
soy
48
what are some non-pharm options for managing VMS
- weight management and reg exercise - smoking cessation - avoiding triggers (e.g. spicy foods, hot drinks, alcohol) - cooling techniques
49
these type of symptoms are known as changes to the vulva, vagina, urinary tract and sexual functioning due to lower estrogen. such as: - vaginal dryness - dyspareunia - valvular pruritis - burning or pain of the vulva - incontinence - UTIs
genitourinary syndrome of menopause (GSM)
50
this is the most effective therapy for GSM. improves local blood supply and restores local flora. less side effects than oral estrogen.
vaginal estrogen
51
what are the 3 different vaginal estrogens used to treat GSM
cream, ring and PV tabs
52
what is the most common side effect with vaginal estrogens
vaginal discharge
53
true or false: progestin is not required if vaginal estrogen is used for less than one year
true
54
this is a treatment options shown to help with moderate to severes dyspareuria and dryness. it is a natural steroid compound converted to E and P in the vaginal cells
intravaginal DHEA
55
what is the most common s/e of intravaginal DHEA
vaginal discharge
56
true or false: progestin therapy is needed if a patient is using intravaginal DHEA
false
57
this is used for moderate to severe dyspareunia and dryness. it is a specific estrogen receptor agonist that acts on the receptors in the vagina nad on the bones and is a partial estrogen receptor agonist in the uterus.
oral SERM (ospemifeneoral)
58
what are s/e of oral SERM (ospemifeneoral)
hot flashes, increased sweating and vaginal discharge
59
true or false: if a patient is taking oral SERM (ospemifeneoral), progestin is needed
false
60
this is a non-hormonal tx option used to treat GSM. may be water, silicone or oil based. useful for rapid, short term relief of dyspareunia by reducing friction
vaginal lubricant
61
this is a non-hormonal tx option used to treat GSM. reduces friction and changes fluid content of the epithelium and reduces pH. useful for dyspareunia and dryness. has a longer duration of action (2-3 days)
vaginal moisturizers
62
this is a non-hormonal tx option used to treat GSm. has some anti-inflammatory properties and helps with sxs by changing and lowering vaginal pH. used for vaginal dryness and dyspareunia. used daily for 5-7 days then weekly. do not use with latex condoms
hyaluronic acid
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