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101 Cards in this Set
- Front
- Back
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For menopause treatment using an estrogen replacement, which route of administration is best for having the least amount of AE's?
1. oral 2. topical 3. transdermal |
3. transdermal (has the least amount of side effects because of less systemic absorption, topical estrogens have variable drug absorption)
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If a menopausal women complains of only of urogenital problems (vaginal dryness), what do you recommend to treat it?
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intravaginal estrogen ring, cream or tablet
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When treating vaginal dryness, is oral or intravaginal estrogen replacement better to avoid systemic effects?
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intravaginally
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Is gallbladder disease a complication from estrogen use or progestin use?
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estrogen use, less risk with transdermal formulations
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Which is not a CI of estrogen therapy:
1. history of DVT, PE, stroke or MI 2. active liver disease 3. undiagnosed abnormal vaginal bleeding 4. history of ovarian cancer 5. history of endometrial cancer |
4. history of ovarian cancer
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If a menopausal women has not had a hysterectomy, is it ok to treat her with just estrogen replacement?
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No, since she has an intact uterus still, she has an increased risk of endometrial cancer with estrogen only replacement (she may take OCs with both progestin and estrogen)
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Conjugated equine estrogens are derived from urine of a pregnant cow? T or F?
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F, urine of a pregnant horse
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Oral estrogens vs. non-oral estrogens have what undesirable effects?
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1. stimulate synthesis of sex hormone-binding globulin
2. increase TG production |
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Which one, oral estrogens or non-oral estrogens produce a more physiologic estradiol to estrone ration?
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non-oral ( i think from bypassing the 1st pass metabolism)
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What is the maintenance dose of vaginal creams for urogenital problems?
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1 gram daily
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How long can you leave a vaginal ring(Femring) in for estrogen replacement?
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90 days
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When a menopausal woman has her uterus still, and is using intravaginal replacement of estrogen, how many days out of every 12 weeks should she also use oral progestins?
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10 days for every 12 weeks of intravaginal estrogen replacement
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For progestin replacement of menopausal women, what are the most commonly used?
1. medroxyprogesterone 2. norethindrone 3. norgestrel 4. desogesterel 5. micronized progesterone |
1 (medroxyprogesterone)
2 (norethindrone 5 (micronized progesterone) |
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Which one below is best for women post-menopausal for 2 years?
1. Continuous Cyclic estrogen-progestogen Tx 2. Continuous Combine Estrogen-progestin Tx 3. Continuous Long-cycle estrogen-progestin Tx 4. intermittent combine estrogen-progestin Tx |
2. Continuous Combine Estrogen-progestin Tx
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Which one below is best mimics the natural hormone cycle?
1. Continuous Cyclic estrogen-progestogen Tx 2. Continuous Combine Estrogen-progestin Tx 3. Continuous Long-cycle estrogen-progestin Tx |
1. Continuous Cyclic estro-progestin Tx
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Which one below is estrogen and progestogen given daily?
1. Continuous Cyclic estrogen-progestogen Tx 2. Continuous Combine Estrogen-progestin Tx 3. Continuous Long-cycle estrogen-progestin Tx |
2. Continuous Combined estrogen-progestin Tx
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Which one below is endometrial protection unclear or undetermined with this regimen?
1. Continuous Cyclic estrogen-progestogen Tx 2. Continuous Combine Estrogen-progestin Tx 3. Continuous Long-cycle estrogen-progestin Tx |
3. Continuous Long-cycle
4. Intermittent Combined |
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Does the FDA recommend the use of bioidentical or natural hormone for menopause?
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recommends against the use of natural hormones because of lack of evidence for efficacy and safety
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What is the big statement to take away from menopausal HRT?
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use the shortest effective dose for the shortest duration of time, preferrable less than 5 years because of the risk for many adverse outcomes
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Treatment of HRT for menopause is not recommended for women that are how many years past menopause?
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10+ years
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vasomotor symptoms are aka as?
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hot flashes or flushes
(other places in the notes included night sweats) |
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Vasomotor symptoms prevalance is highest during the first how many years of menopause?
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2 years
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Treatment of hot flashes
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1. non-pharmacologic (avoid triggers, regular exercise, wt. control, diet, stress reduction)
2. estrogen replacement 3. (if not a HRT candidate) Venlafaxine, paroxetine, clonidine, gabapentin 4. Others: phytoestrogens (soy, flaxseed or alfalfa sprouts), black cohosh, dong quai, red clover leaf, kava |
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Does the american endocrine society recommend diagnosing women with androgen deficiency?
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recommends against it
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absolute CI with androgen replacement
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pregnancy, lactation, known androgen dependent cancer
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Generalized use of testosterone is currently recommended? T or F
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False
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2 symptoms associated with premenstrual molimina
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bloating and breast tenderness
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2 symptoms associated with dysmenorrhea
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back pain and painful cramps
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Does PMDD affect the daily functioning of the patient?
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yes, very much so as it is a more severe form of PMS
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Why is premenstrual pain painful? basically what inflammatory process occurs that leads to uterine and GI smooth muscle contraction and ischemia?
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shedding of uterine lining releases arachidonate and sitmulates PG release
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What is one of the leading theories or PMDD?
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central serotonergic system dysfunction
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Are increased melatonin levels associated with PMDD?
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no, reduced levels
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rates of PMDD are increased with monozygotic or dizygotic twins?
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monozygotic twins
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Do women with PMDD have higher rates of SAD and post-partum depression?
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yes
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To confirm dx of PMDD, how many cycles using standardized prostspective instruments are necessary?
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2 cycles
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how many symptoms must occur prementsrually to dx PMDD?
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5 symptoms
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In order to diagnose PMDD, one of the 5 symptoms must be:
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markedly depressed mood, anxiety, irritability or affective lability(quickly changing emotions)
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Treatment of PMS and PMDD:
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1. non-pharmacologic
(reduce bad intake of things, regular condition and increase workout time by 30 min during the week before menses, good diet, maybe bright white light in the morning in premenstrual period, rest, relaxation, group therapy) 2. SSRIs(PMDD), NSAIDS (PMS), spironolactone, OCs(monophasics better), GNRH agonists(leuprolide, busereline, gosereline), dopamine agonists(bromocriptine), antianxiety agents(buspar) herbals(ST. johns wort, dong quai, chasteberry, black cohosh |
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When do you give spironolactone for PMS or PMDD?
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days 12-16 of the menstrual cycle until onset of menses
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GNRH agonists should never be used for over how many months?
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6 months (run the risk of osteoporosis form hypoestrogenic state)
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Bromocriptine is used to treat what symptoms of PMS or PMDD?
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mastodynia, this drug decreases plasma prolactin
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NSAIDS for PMS should be started when?
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7-10 days prior to menses and continued during the first few days of bleeding
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Avoid benzodiazepeines in what kind of patients?
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dependency prone
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When are antianxiety agents used for PMS?
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not given continuously, given on days 16-28 of the cycle
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What 3 drugs can be given to Tx insomnia in PMS?
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temazepam, zolpidem, trazadone
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Endometriosis is thought to be transplanted via what kind of menstrual flow?
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retrograde
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What 4 symptoms especially should you suspect endometriosis?
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1. dysmenorrhea
2. dyspareunia 3. pelvic pain (chronic) 4. subfertility |
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Is laparoscopic visualization the Gold Standard for biopsy of endometriosis?
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yes
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Red Flame lesions are characteristic of advanced stage of endometriosis? T or F
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False, early disease
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Chocolate cysts are characteristic of advanced stage of endometriosis? T of F
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True
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White lesions of endometriosis are characteristic of what?
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healed or inactive disease
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1st line therapy for endometriosis treatment (patient cannot immediately get pregnant)
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NSAIDS, OCs (recommended in adolescents over surgery)
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If patient has endometriosis, what surgical options does the patient have?
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laparoscopy(primary standard of care for endometriosis surgery), total abdominal hysterectomy, conservative surgery(though typically used for patients still desiring fertility and often used as primary surgical treatment for endometriosis associated infertility)
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Patients that undergo conservative surgery for endometriosis still have the chance of not being able to become pregnant after the procedure? T or F
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T, a lot of these women will not be able to get prego
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With conservative surgery, what other agents are used in combo?
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1. GnRH agonists
2. Danazol 3. Medroxprogesterone for 6 months |
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Is medroxyprogesterone a good option for patients who desire immediate future fertility for endometriosis?
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No, can cause prolonged amenorrhea and anovulation for up to 18 months after cessation of therapy
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If a patient uses a GnRH agonist for 3 months, should you use add back therapy?
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may use for the relief of vasomotor symptoms
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What regimens for add back therapy of GnRH agonists are available?
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NE alone
NE + CEE NE + etidronate (supplement calcium as well) |
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What drug was formerly the gold standard of endometriosis therapy?
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Danazol
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Danazol is probably best to avoid in patients who have what 2 conditions?
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liver disease or dyslipidemia
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Should a women desiring pregnancy at some point be put on Danazol for endometriosis?
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NO, it is teratogenic and requires a barrier method during therapy as well
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How long is treatment of Danazol
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6 months
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Success rate of counseling for sexual dysfunction is less than what percent?
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< 50%
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Are antidepressants a good option for treating sexual dysfunction?
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if the sexual dysfunction is related to depression, it may help
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cause of sexual aversion
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history of sexual or physical abuse
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treatment of sexual arousal disorder in women
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lubricants or topical estrogens for women
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What is the success rate of treating orgasmic disorders in women?
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75-90%
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How do you treat orgasmic disorders in women?
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1. sex therapy
2. masturbation |
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2 main treatments for painful intercourse in women
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1. surgery or medical treatment
2. counseling on sex positions |
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How do you treat vaginismus?
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dilators and relaxation techniques
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What is a possible future treatment option for women in sexual dysfunction?
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PDE-5 inhibitors (increase lubrication and clitoral stimulation)
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If a patient has both ED and premature ejaculation, which do you treat first?
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ED
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How do you treat ED?
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1st line: behavioral therapy
2. SSRIs 3. topical anesthetics |
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Does ED prevalence increase with age?
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Yes, significantly....at age 40 about 5% of men suffer from ED, at age 70 about 15% suffer from ED
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When trying to increase libido with testosterone, when is a time when you shouldn't give testosterone?
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when levels are normal
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ED is mostly associated with what 2 things?
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DM and smoking
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What is the independent risk factor for ED?
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smoking, it increases the risk of other risk factors
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D/C of vacuum restrictive devices for ED treatment most likely occurs in the first how many months of use?
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first 3 months of use
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Caverject and Edex are what kind of drugs for ED treatment
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intracavernosal injections work as synthetic PGE1 causing smooth muscle relaxation
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Muse is what kind of ED treatment
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intraurethral hollow stemmed tube containing a an Alprostadil pellet is inserted into the urethra, less effective than injections (less rigidity)
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Do the injections or intraurethral tube cause more hypotension and dizziness?
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the intraurethral tube(MUSE) because of systemic side effects
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CI of MUSE
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abnormal penile anatomy, predisposition to priapism, known allergy to alprostadil
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Which is historically considered an aphrodisiac?
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Yohimbe
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MOA of Yohimbe
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alpha-2-inhibitor
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Dose of Yohimbe
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5.4 mg TID taken daily
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Does Yohimbe cross the BBB
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yes and causes CNS effects
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Which agent is good for psychogenic ED?
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Yohimbe
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Yohimbe CI
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renal insufficiency
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What is 1st line therapy for ED?
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PDE-5 inhibitors
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MOA of PDE-5 inhibitors
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inhibit PDE-5, increases cGMP, opening of Calcium channels and causing smooth muscle relaxation and penile erection
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What PDE-5 inhibitor doesn't require renal adjustment
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Levitra (vardenafil)
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CI of al PDE-5 inhibitors
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Nitrates
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Which PDE-5 inhibitor is associated with visual disturbances?
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Viagra mostly, but also levitra (thought to be from inhibiting PDE-6)
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What PDE-5 inhibitor is associated with back pain/myalgia?
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Cialis (thought to be from inhibiting PDE-11)
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What PDE-5 inhibitor has the SE of rhinitis?
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Levitra
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What PDE-5 inhibitor is not affected fat/food?
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Cialis
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What are the doses of Viagra?
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starting dose is 25 mg daily, but also comes in 50 mg tabs, and 100 mg tabs
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What PDE-5 inhibitor has the longest duration of action?
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Cialis 36 hour duration
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What PDE-5 inhibitor is probably best to use with hepatic impairment?
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Viagra
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Is Cialis good to use in renal impairment?
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probably not since the duration of action is so long
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are alpha blockers CI with PDE-5 inhibitors?
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No, just dose adjust mostly
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