Sweatman: Drugs to Treat Menopause Flashcards Preview

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Flashcards in Sweatman: Drugs to Treat Menopause Deck (39):
1

symptoms of menopause are brought about via

loss of endogenous production of estrogen

2

what is no longer being used to treat symptoms of menopause

HRT--> too many CV bone dz., and Cancer risks
*though this treatment is very effective

3

CEE + MPA increases risks for

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

4

CEE and MPA decrease the risk for

>hip fractures
>Diabetes
>Vasomotor Syptoms

5

CEE alone shows what

more balanced risks vs benefits
>Dec risk of breast cancer

6

Side effects after therapy stopped
*neither regimine affected all cause mortality

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

7

absolute risks of adverse affects are much lower in

younger women as opposed to odler women
*time since menopause influences absolute risk

8

guidelines for HRT

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

9

deciding if patient should get HT

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)

10

E and oteoprosis

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

11

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

low dose, vaginal estrogen

12

women on HT follow up

reassess each steo every 6-12 months

13

never give woman HT if

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

14

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

women who have been post menopausal for over 10 years

15

Vasomotor symptoms most common in

Africn Americans
--> peaking in the late perimenopause

16

before treatment of perimenopausal VMS explore

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

17

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

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

18

pharmicological treatment of VMS
*all others are off label

Paroxetine
fluoxetine
escitalopram
venlafaxine
clonidine
gabapentin

19

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

N, HA, Insomnia, Possible Sexual Dysfunction

20

SE's of Venlafaxine

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

21

Clonidine SE's

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

22

SE's for gabapentin

dizziness
unsteadiness
drowsiness

23

qualifications of the drigs to treat VMS

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

24

MOA for clonidine

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

25

Name the oral estrogens approved for treatment of Menopause

>17 beta estradiol
>ethinyl estradiol
>conjugated estrogen

26

name the oral progesterones available to treat menopausal symptoms

Medoxyprogesterone actate
Norethindrone acetate
Drospirenone
micronized progesterone

27

transdermal estrogen treatment in Menopausal symptoms

estradiol patch/gel/spray/emulsion

28

vaginal estrogen treatment in menopausal

estradiol cream/tablet/ring

29

transdermal progesterones

norethindrone acetate
levonorgestril

30

the most effective treatment regimine for V

Estrogem +/- progesterone

31

relief of treatment with E+/- P occurs within

one month

32

Side effects of HT (dose related)

breast tenderness and uterine bleeding
(less commonly: Vomiting, headaches, weight change, rash pruritis, cholecystitis)

33

route of administration preferred

transdermal --> no first pass metabolism

34

benefit of transdermal route

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

35

name the conjugated estrogen

Bazedoxifene

36

Bazedoxifene makeup and MOA

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

37

help prevent endometrial overgrowth in Post menopausal women taking estrogens

bazedoxifene (e + SERM)

38

risk of VWS recurring when drug is stopped

50%
*independent of duration of sue

39

what happens with VMS is stopped

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