WEEK 5
1. How does hormone therapy aid osteoporosis?
a. Estrogen slows down bone resorption
2. When should progestin be used for hormone replacement therapy?
a. For menopausal women with INTACT UTERUS
i. Required to prevent estrogen-associated endometrial hyperplasia
3. When should progestin NOT be used for hormone replacement therapy?
a. Women with HYSTERECTOMY
4. When should local estrogen be used?
a. Intravaginal—vaginal and vulvar atrophy (LESS ADR)
b. Vaginal ring (Estring)—vaginal and vulvar atrophy
5. When should systemic estrogen be used?
a. IV—acute emergency control of heavy uterine bleeding
b. Vaginal ring (Femring)—systemic hot flashes/night sweats)
6. What is the purpose of peri-menopausal estrogen therapy?
a. Most effective treatment option for menopausal symptoms and structural
changes
i. ET (estrogen alone)
ii. EPT (estrogen-progestin)
7. Which form of estrogen therapy has fewer ADR?
a. Transdermal—bypasses liver
i. Less N/V
ii. Estrogen levels fluctuate less
iii. Lower risk for DVT, PE, STROKE
1. Emulsion (Estrasorb)
2. Spray (Evamist)
3. Gels (EstroGel) (Elestrin) (Divigel)
4. Patches (Alora) (Climara) (Estraderm) (Menostar) (Vivelle-
Dot) (Oesclim)
8. What medication is used for osteoporosis, osteopenia, and HRT?
a. SERM—Bazedoxifene
9. How to change pt from one OC to another?
a. Start new brand
b. Skip placebo week of old OC OR use condoms until 7 pills taken of new brand
, 10. When is the best time in cycle to start new OC?
a. On day ONE of period
i. Use condoms for 7 days
11. Patient teaching with new OC?
a. Take at same time daily
b. Higher weight = less effective
c. Report: leg tenderness/redness, SOB, headache, chest pain, visual changes
12. What to do if you mess up OC?
a. More than 3 hr late—take 1 ASAP and condom x 2 days
b. 1+ pills missed in FIRST WEEK—take 1 ASAP continue pack condoms x
7 days
c. 1-2 pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP
placebo week
d. 3+ pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week AND condoms x 7 days
13. What baseline info is needed for OC?
a. HTN
b. DM
c. Thromboembolism
d. CV disease
e. Breast CA
f. Pregnancy test
14. What are CI for OC?
a. ABSOLUTE CI:
i. Thrombophlebitis / thrombotic disorders
ii. Cerebrovascular disease
iii. Coronary occlusion
iv. Liver dysfunction
v. Breast CA
vi. Abnormal vaginal bleeding
vii. Pregnant
viii. Smoker 35+
b. RELATIVE CI:
i. HTN
ii. CV disease
iii. DM
iv. Cholestatic jaundice (pregnancy)
v. Gallbladder disease
vi. Uterine leiomyoma
1. How does hormone therapy aid osteoporosis?
a. Estrogen slows down bone resorption
2. When should progestin be used for hormone replacement therapy?
a. For menopausal women with INTACT UTERUS
i. Required to prevent estrogen-associated endometrial hyperplasia
3. When should progestin NOT be used for hormone replacement therapy?
a. Women with HYSTERECTOMY
4. When should local estrogen be used?
a. Intravaginal—vaginal and vulvar atrophy (LESS ADR)
b. Vaginal ring (Estring)—vaginal and vulvar atrophy
5. When should systemic estrogen be used?
a. IV—acute emergency control of heavy uterine bleeding
b. Vaginal ring (Femring)—systemic hot flashes/night sweats)
6. What is the purpose of peri-menopausal estrogen therapy?
a. Most effective treatment option for menopausal symptoms and structural
changes
i. ET (estrogen alone)
ii. EPT (estrogen-progestin)
7. Which form of estrogen therapy has fewer ADR?
a. Transdermal—bypasses liver
i. Less N/V
ii. Estrogen levels fluctuate less
iii. Lower risk for DVT, PE, STROKE
1. Emulsion (Estrasorb)
2. Spray (Evamist)
3. Gels (EstroGel) (Elestrin) (Divigel)
4. Patches (Alora) (Climara) (Estraderm) (Menostar) (Vivelle-
Dot) (Oesclim)
8. What medication is used for osteoporosis, osteopenia, and HRT?
a. SERM—Bazedoxifene
9. How to change pt from one OC to another?
a. Start new brand
b. Skip placebo week of old OC OR use condoms until 7 pills taken of new brand
, 10. When is the best time in cycle to start new OC?
a. On day ONE of period
i. Use condoms for 7 days
11. Patient teaching with new OC?
a. Take at same time daily
b. Higher weight = less effective
c. Report: leg tenderness/redness, SOB, headache, chest pain, visual changes
12. What to do if you mess up OC?
a. More than 3 hr late—take 1 ASAP and condom x 2 days
b. 1+ pills missed in FIRST WEEK—take 1 ASAP continue pack condoms x
7 days
c. 1-2 pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP
placebo week
d. 3+ pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week AND condoms x 7 days
13. What baseline info is needed for OC?
a. HTN
b. DM
c. Thromboembolism
d. CV disease
e. Breast CA
f. Pregnancy test
14. What are CI for OC?
a. ABSOLUTE CI:
i. Thrombophlebitis / thrombotic disorders
ii. Cerebrovascular disease
iii. Coronary occlusion
iv. Liver dysfunction
v. Breast CA
vi. Abnormal vaginal bleeding
vii. Pregnant
viii. Smoker 35+
b. RELATIVE CI:
i. HTN
ii. CV disease
iii. DM
iv. Cholestatic jaundice (pregnancy)
v. Gallbladder disease
vi. Uterine leiomyoma
