Hormone Replacement Therapy

Front 1

What were found to be an increased risk with CEE + MPA?

Back 1

Coronary heart disease

Invasive breast cancer

Stroke

Pulmonary embolism

Gallbladder disease

Dementia

Urinary incontinence

Front 2

What were found to be a decreased risk with CEE + MPA?

Back 2

Hip fracture

Diabetes

Vasomotor symptoms

Front 3

Were the risk vs. benefits more balanced for CEE alone?

Was there an increased risk of BC with CEE alone?

Did either regimen affected all cause mortality?

In all except what did most effects dissipate after treatment was discontinued?

What appeared to influence many of the finding as absolute risks of adverse events were much lower in younger women than in older women in both trials?

Back 3

Yes

No (decreased)

No

Breast cancer

Age and time since menopause

Front 4

What should HT be used for (time)?

Back 4

Management of moderate to severe MP symptoms in early MP

No use of either estrogen-progestin or estrogen alone for long term chronic diseases

Front 5

For women who have genitourinary symptoms in the absence of vasomotor symptoms, what can be used?

Back 5

Low dose vaginal estrogen

Front 6

Dementia
Gallbladder disease
Hypertriglyceridemia
Prior cholestatic jaundice
Hypothyroidism
Fluid retention plus cardiac or renal dysfunction Severe hypocalcemia
Prior endometriosis
Hepatic hemangiomas

Can estrogen be used in women with these conditions?

Back 6

Yes, with caution

Front 7

Undiagnosed abnormal genital bleeding
Known, suspected, or history of breast cancer
Known or suspected estrogen-dependent neoplasia
Active DVT, pulmonary embolism, or history of these conditions
Active or recent (e.g., within the past year) arterial thromboembolic disease (e.g., stroke or MI)
Liver dysfunction or disease
Known hypersensitivity to the ingredients of the estrogen preparation
Known or suspected pregnancy. There is no indication for estrogen in pregnancy. There appears to be little or no increased risk of birth defects in children born to women who have used estrogens and progestins from oral contraceptives inadvertently during early pregnancy

Can estrogen be used in women with these conditions?

Back 7

NO!

Front 8

What are some vasomotor symptoms that appear late perimenopause and early post menopause?

Back 8

Emotional flushing

Autonomic epilepsy

Hyperthyroidism

Medications (CCBs)

Alcohol related flushing

Pheochromocytoma

Carcinoid syndrome

Front 9

Avoiding smoking

Moderating alcohol consumption

Dressing in layers

Maintaining low ambient temperature

Consuming cool drinks

Aerobic exercise (indirect action via effects on mood, perceived stress, body image and body weight)

Paced respiration (a type of slow, deep breathing that requires training)

Clinical hypnosis

Cognitive behavioral therapy

What are all these strategies considered?

Back 9

Non-pharmacologic approaches = appropriate first step to manage the symptoms

Front 10

Paroxetine

Fluoxetine

Escitalopram

Non-hormonal medications for treatment of vasomotor symptoms.

What are the common side effects for all three?

Back 10

N/HA/Insomina

Sexual dysfunction

Front 11

Side effects of Venlafaxine?

Back 11

N/V

Dry mouth

Anorexia

Sexual dysfunction

Front 12

Side effects of clonidine?

What is the mechanism?

Back 12

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

Lowers peripheral vascular reactivity and raises sweating threshold (actions in thermoregulatory center)

Front 13

Side effects of gabapentin?

Back 13

Dizziness, unsteadiness, drowsiness

Front 14

What is the only non-hormonal drug approved by the FDA?

Back 14

Paroxetine

Front 15

What are the three oral estrogen drugs?

Back 15

17-B estradiol

Ethinyl estradiol

Conjugated estrogen

Front 16

What are the four oral progestogens?

Back 16

Medroxyprgosesterone acetate

Norethindrone acetate

Drospirenone

Micronized progestone

Front 17

What is the transdermal estrogen?

Back 17

17 B-estradiol patch/gel/spray/emulsion

Front 18

What is the vaginal estrogen?

Back 18

17 B-estradiol cream/tablet/ring

Front 19

What are the two transdermal estrogen drugs?

Back 19

Norethindrone acetate

Levonorgestril

Front 20

What is THE MOST EFFECTIVE TREATMENT for VMS and urogenital atrophy?

How long until relief occurs?

Back 20

Estrogen+/-progesterone

One month

Front 21

What are some common adverse effects?

Back 21

Breast tenderness/uterine bleeding

(vomiting, headaches, weight change, rash and pruritus, and cholecystitis)

Front 22

What type of estrogen is preferred since it avoids first-pass metabolism?

Back 22

Transdermal estrogen

Front 23

What does first past metabolism promote? (things that are bad...)

Back 23

Prothrombotic hemostatic changes in factor IX

Activated protein C resistance

Tissue-plasminogen activator

Front 24

What is bazedoxifene a combo of?

How does it act in tissues?

What does it help reduce in postmenopausal women?

Back 24

Estrogen and SERM

Agonist in some estrogen-sensitive tissues and an antagonist in others (uterus)

Reduce endometrial overgrowth

Front 25

What happens when post-menopausal drugs are stopped?

What happens to bone resorption?

What about the vagina?

Back 25

50% change of recurrence of VMS symptoms regardless of age and duration

Bone resorption accelerates when MHT discontinued

Vulvovaginal atrophy should be expected to return