Hormonal Replacement Therapy Flashcards Preview

Pharmacology II > Hormonal Replacement Therapy > Flashcards

Flashcards in Hormonal Replacement Therapy Deck (23):
1

When does menopause officially begin?

12 months after the last menstrual period

2

What happens to FSH and LH in menopause?

INCREASE

3

What are the 4 indications approved by the FDA for hormone replacement?

1. Vasomotor symptoms**
2. Preventing bone loss
3. Hypoestrogenism caused by hypogonadism, castration, or primary ovarian insufficiency
4. Genitourinary symptoms*

4

What is the difference in hormone therapy if your patient has a uterus or not?

Uterus - combination of estrogen + progesterone

(this is for endometrial protection)

No uterus - unopposed estrogen

5

Risk of breast cancer with menopause hormone therapy is associated with which hormone?

progesterone with estrogen

(estrogen alone doesn't increase risk)

6

When can you consider using HRT (systemic estrogen therapy) in a recent postmenopausal patient at increased risk of bone fracture?

If alternative therapies are contraindicated or cause excessive ADE

7

Which two types of symptoms is Hormone replacement therapy best for?

1. Vasomotor symptoms

2. Genitourinary symptoms

8

Describe how time after menopause effects risk with HRT?

-If <10 years after menopause, pros out weight the cons

-If >10 years after menopause, don't initiate therapy because more risk for coronary heart disease, stroke, venous thromboembolism, and dementia

9

Absolute contraindications for HRT?

1. Abnormal genital bleeding
2. Breast cancer (hx, known, suspected)
3. Estrogen/Progesterone dependent neoplasia
4. VTE (stroke, MI)
5. Liver dysfunction

10

If a menopausal patient has vasomotor symptoms but has a contraindication to HRT what is the therapy of choice?

-SNRI
-SSRI
-Clonidine
-Gabapentin

11

Vasomotor symptoms: Non-pharmacologic treatment

-wearing layered clothing
-lowering room temperature
-decreasing hot spicy foods, caffeine, and hot beverages
-exercise

12

If a patient has liver function problems what type of estrogen should they receive?

NOT oral

-patch
-topical
-transdermal spray
-vaginal
-implantable pellet

13

What is important to educate your patient about their use of HRT?

HRT doesn't provide adequate contraception

14

Alternative medications to Estrogen for the treatment of hot flushes

1. Venlafaxine (SNRI) [Effexor]
2. Desvenlafaxine (SNRI) [Pristiq]
3. Paroxetine* -only one that is not considered off-label
4. Megestrol acetate
5. Clonidine
6. Gabapentin

15

Gabapentin: ADEs

-Somnolence
-Dizziness
-Ataxia

**increase dose gradually

16

Androgen insufficiency: Signs and symptoms

-diminished sense of well being
-Persistent fatigue
-Decreased libido

17

Food sources of estrogen

-soybean
-cereals
-flaxseed
-alfalfa sprouts

18

Black Cohosh: overview

-herbal supplement
-possible benefit for vasomotor symptoms
-ADE: hepatotoxicity

19

How long should HRT last?

Shortest time possible (2-3 years typically)

(breast cancer risk increases after 5 years of combined hormone therapy)

20

After starting a patient on HRT, when do they follow up?

6 weeks

21

If a patient is having breast tenderness how should you adjust the estrogen dose?

-decrease
-switch to transdermal

22

What should you look out for with a patient on Progestogen?

-bloating
-pre-menstrual symptoms (PMS)

Solution: switch to another progestogen

23

Should you use bioidentical hormones?

NO