NU 665D Exam 1
1. Hormone replacement therapy: Indications?: -Bothersome Vasomotor symp-toms
-Prevention of bone loss ( remember lack of estrogen increases a womens risk forosteoporosis)
-Hypoestrogenism caused by hypogonadism, castration, or POI
-Genitourinary symptoms
2. Hormone replacement therapy: Contraindications: -Undiagnosed vaginalbleeding
-Known or suspected pregnancy
-Vascular thromboembolic episodes (CVA,MI, DVT, Thrombophlebitis)
-Abrnormal mammogram ( Brst CA?)
-Active liver disease acute or chronic
-Known or suspected cancer of the breast or reproductive tract
3. Hormone replacement therapy: Precaution with these type of pt:: -Type IDM
-Active gallbladder disease
-> 1ppd smoker
-Obesity
-FMH breast cancer
-Fibroid uterus
-HX of peripheral vascular episode
-Migraines
-Elevated triglycerides
4. Hormone replacement therapy: Ideal candidates: -Newly menopausal (within5 years)
-Good health
-No risk factors for heart disease or breast CA (no first degree relative and neg fmxfor BRCA1
or 2)
-Non smoker
-Non-obese
-Normal Blood sugar and blood pressure
-Moderate to severe vasomotor s/s or menopausal s/s
5. Hormone replacement therapy: Increase risk for...: -Blood Clots
-Gallbladder Disease
, -Breast Cancer: Use for < 4yr, no increase
-Breast Cancer: Use for 4-10 years, risk is questionable
-Breast Cancer: Use for > 10 years, increased risk
-Increased cardiac events in 1st year use with patient with prior heart disease -HERS II
6. Hormone replacement therapy: Side Effects: -withdrawal bleeding
-Progesterone: breast tenderness, fluid retention, wgt gain, depression, irritability
-Increase fibroids
-Allergic reaction to patch
-Virilization with testosterone products
7. Non-hormonal alternative Meds for Menopausal vasomotor s/s:: -Brisdelle
7.5 mg QHS (paroxetine)
-Venlafexine- venlafaxine ER 37.5 qd x 1 week then 75mg once a day or Immediaterelease
37.5mg qd x 1 week then 37.5 mg bid
-Gabapentin- 600mg q hs or 300mg TID depending on when the flashes take place(Hot flashes
or night sweats)
Clonidine - 50-75 mcg/day
-SSRI some effect+/-: Paroxetine 25mg qdFluoxetine 10-20mg qdSertraline 50mgqd
8. Menopause: Alternatives to insomnia issues: --Melatonin
-Gabapentin - 300mg 1-2 hours before bedtime, some patients may need 600mg
-Lunesta - 2mg qhs
-Ambien - 5mg qhs (no longer 10mg)
9. Menopause: Complimentary Methods: -May be effective - Estroven, BlackCohash, Soy,
Vitamin E
-No evidence - Dong quai, acupuncture, yoga, Evening primrose, Ginseng, Kava,Red Clover,
Flaxseed
10. Estrogen Replacement Therapy: -Conjugated estrogen - Premarin
(0.3/0.45/0.625,0.9,1.25mg/d)
-Esterified estrogen - Menest (0.3/0.625,1.25,2.5mg/d)
-Transdermal estrogen - Vivelle dot, Vivelle, Estraderm, Alora, Climara, Esclim,Menostar,
FemPatch
**avoids liver effects and less effect on triglycerides and lipids compared to oralformulations.
-Micronized estrogen - Estradiol 1.0mg/d
1. Hormone replacement therapy: Indications?: -Bothersome Vasomotor symp-toms
-Prevention of bone loss ( remember lack of estrogen increases a womens risk forosteoporosis)
-Hypoestrogenism caused by hypogonadism, castration, or POI
-Genitourinary symptoms
2. Hormone replacement therapy: Contraindications: -Undiagnosed vaginalbleeding
-Known or suspected pregnancy
-Vascular thromboembolic episodes (CVA,MI, DVT, Thrombophlebitis)
-Abrnormal mammogram ( Brst CA?)
-Active liver disease acute or chronic
-Known or suspected cancer of the breast or reproductive tract
3. Hormone replacement therapy: Precaution with these type of pt:: -Type IDM
-Active gallbladder disease
-> 1ppd smoker
-Obesity
-FMH breast cancer
-Fibroid uterus
-HX of peripheral vascular episode
-Migraines
-Elevated triglycerides
4. Hormone replacement therapy: Ideal candidates: -Newly menopausal (within5 years)
-Good health
-No risk factors for heart disease or breast CA (no first degree relative and neg fmxfor BRCA1
or 2)
-Non smoker
-Non-obese
-Normal Blood sugar and blood pressure
-Moderate to severe vasomotor s/s or menopausal s/s
5. Hormone replacement therapy: Increase risk for...: -Blood Clots
-Gallbladder Disease
, -Breast Cancer: Use for < 4yr, no increase
-Breast Cancer: Use for 4-10 years, risk is questionable
-Breast Cancer: Use for > 10 years, increased risk
-Increased cardiac events in 1st year use with patient with prior heart disease -HERS II
6. Hormone replacement therapy: Side Effects: -withdrawal bleeding
-Progesterone: breast tenderness, fluid retention, wgt gain, depression, irritability
-Increase fibroids
-Allergic reaction to patch
-Virilization with testosterone products
7. Non-hormonal alternative Meds for Menopausal vasomotor s/s:: -Brisdelle
7.5 mg QHS (paroxetine)
-Venlafexine- venlafaxine ER 37.5 qd x 1 week then 75mg once a day or Immediaterelease
37.5mg qd x 1 week then 37.5 mg bid
-Gabapentin- 600mg q hs or 300mg TID depending on when the flashes take place(Hot flashes
or night sweats)
Clonidine - 50-75 mcg/day
-SSRI some effect+/-: Paroxetine 25mg qdFluoxetine 10-20mg qdSertraline 50mgqd
8. Menopause: Alternatives to insomnia issues: --Melatonin
-Gabapentin - 300mg 1-2 hours before bedtime, some patients may need 600mg
-Lunesta - 2mg qhs
-Ambien - 5mg qhs (no longer 10mg)
9. Menopause: Complimentary Methods: -May be effective - Estroven, BlackCohash, Soy,
Vitamin E
-No evidence - Dong quai, acupuncture, yoga, Evening primrose, Ginseng, Kava,Red Clover,
Flaxseed
10. Estrogen Replacement Therapy: -Conjugated estrogen - Premarin
(0.3/0.45/0.625,0.9,1.25mg/d)
-Esterified estrogen - Menest (0.3/0.625,1.25,2.5mg/d)
-Transdermal estrogen - Vivelle dot, Vivelle, Estraderm, Alora, Climara, Esclim,Menostar,
FemPatch
**avoids liver effects and less effect on triglycerides and lipids compared to oralformulations.
-Micronized estrogen - Estradiol 1.0mg/d
