RxPrep Osteoporosis, Menopause, & Testosterone Use Part 2: Focus on Menopause & Testosterone Applications

12 months

Menopause is reached when the last menstrual period was over ________ ago.

decrease; estrogen, progesterone

A(n) (decrease/increase) in ________ and ________ causes an increase in FSH.

follicle stimulating hormone

What does FSH stand for?

vasomotor symptoms

What does in increase in FSH cause?

perimenopause

menopause transition period

perimenopause

When do many women experience vasomotor symptoms?

hot flashes, night sweats

Vasomotor symptoms are often described as ________ and ________.

burning, painful intercourse, vaginal dryness

What are the 3 genitourinary symptoms of menopause?

estrogen

What's the most effective treatment for vasomotor symptoms?

LH; temperature

Estrogen causes a decrease in ________ and more stable ________ control.

luteinizing hormone

What does LH stand for?

progesterone; endometrial cancer

Women with a uterus should use estrogen in combination with a form of ________ when treating vasomotor symptoms since unopposed estrogen increases the risk of ________.

progestin

What is an example of a form of progesterone used in combination with estrogen to treat vasomotor symptoms?

drospirenone, levonorgestrel, norethindrone

What 3 progestins are commonly used in a combination pill with estrogen to treat vasomotor symptoms?

medroxyprogesterone

What progestin is commonly used as a separate tablet with estrogen to treat vasomotor symptoms?

mood disturbances

Progestins can cause ________.

spotting

What can occur if progestins are taken intermittently to treat vasomotor symptoms?

micronized

(Micronized/Synthetic) progestins are considered to be safer.

medroxyprogesterone

What's an example of a synthetic progestin?

≤60 years old, healthy, no contraindications, symptomatic, within 10 years of menopause

What are 5 criteria that must be met in order to use hormone therapy to treat vasomotor symptoms?

patient has osteoporosis

What is a situation where hormone therapy treatment for vasomotor symptoms may be extended beyond age 60?

age, blood clot risk, breast cancer, heart disease, stroke, time since menopause

What are 6 risk factors that indicate a patient should use non-hormonal treatment for vasomotor symptoms?

gabapentin, pregabalin, SNRI, SSRI

What are 4 non-hormonal treatments for vasomotor symptoms?

local (topical), low-dose oral, transdermal

What 3 estrogen formulations are associated with a lower risk of VTE and stroke than standard doses of oral estrogen?

topical

________ estrogen formulations bypass first-pass metabolism, allowing lower doses to be used.

local

________ estrogen products are preferred for patients who have vaginal symptoms only.

dyspareunia

painful intercourse

Astroglide

lubricant specifically marketed for dyspareunia

conjugated equine estrogens, 17-beta-estradiol

What are 2 local hormone therapies used to treat menopause symptoms?

Estrace

What's the brand name for the 17-beta-estradiol vaginal cream?

Estring

What's the brand name for the 17-beta-estradiol vaginal ring?

Vagifem

What's the brand name for the 17-beta-estradiol vaginal tablet?

Premarin

What's the brand name for the conjugated equine estrogen vaginal cream?

17-beta-estradiol, conjugated equine estrogens, conjugated equine estrogens/medroxyprogesterone, estradiol, medroxyprogesterone, micronized progesterone

What are 6 systemic hormone therapies used to treat menopause symptoms?

Alora, Climara, Vivelle-Dot

What are 3 brand names for the estradiol transdermal patch?

Premarin

What's the brand name for the conjugated equine estrogen oral tablet?

Premarin

What's the brand name for the conjugated equine estrogen injection?

Provera

What's the brand name for the medroxyprogesterone oral tablets?

breast cancer, dementia, endometrial cancer, increased risk of stroke, increased risk of VTE

What are 5 boxed warnings associated with systemic hormone therapies for menopause?

breast cancer, pregnancy, uterine bleeding, VTE

What are 4 contraindications for estrogen-containing systemic hormone therapies for menopause?

increased risk of breast cancer

What's a warning associated with systemic hormone therapies for menopause?

twice weekly

How often are Vivelle-Dot patches applied when treating menopause symptoms?

once weekly

How often are Climara patches applied when treating menopause symptoms?

black cohosh, evening primrose oil, red clover, soy

What are 4 natural products used for vasomotor symptoms?

paroxetine

What SSRI is used as a non-hormonal treatment for moderate-severe vasomotor symptoms associated with menopause?

2D6; inhibitor

Paroxetine is a CYP________ (inducer/inhibitor).

tamoxifen

Paroxetine can block the effectiveness of ________.

bleeding; warfarin

SSRIs can increase the risk of ________ in patients using ________.

desvenlafaxine

What SNRI is used to treat vasomotor symptoms related to menopause?

true

True or False: Although desvenlafaxine has shown effectiveness for treating vasomotor symptoms associated with menopause, it is not FDA-approved for this indication.

ospemifene

oral estrogen agonist/antagonist indicated for dyspareunia and moderate-severe vaginal dryness

false (not indicated for mild symptoms)

True or False: Ospemifene is indicated for mild, moderate, and severe menopause symptoms.

Paxil

What's the brand name for paroxetine for depression and panic disorder?

chemotherapy drugs, cimetidine, methadone, spironolactone

What are 4 drugs that can lower testosterone?

CV; low testosterone levels

FDA has released a warning about the ________ risks associated with testosterone use, and they recommend treatment only in men with ________.

hematocrit; clotting

Testosterone increases ________ which can increase the risk for ________.

prostate; severe BPH

Testosterone can cause noncancerous ________ growth and use is restricted in men with ________.

acne, baldness, gynecomastia

What are 3 common side effects of testosterone?

abuse potential, serious adverse events

Testosterone and anabolic androgenic steroids carry a warning for ________ and ________.

IM injection, SC injection

What are 2 common formulations used for tesosterone?

true

True or False: Testosterone injections are painful.

upper body

Where is AndroGel applied?

Fortesta, Natesto

What 2 topical testosterone formulations reduce accidental exposure risk?

III

Testosterone products are C-________ scheduled drugs.

AndroGel

What's a brand name for testosterone gel?

cypionate

Testosterone ________ is a common injection formulation.

early virilization in children due to secondary exposure

What's a boxed warning associated with testosterone products?

acne, edema, hepatotoxicity, increased appetite, reduced sperm count

What are 5 side effects of testosterone products?

nasal irritation

What's a side effect of Natesto (testosterone nasal gel)?

same time each morning

When should testosterone gel be applied?