CLPH 471 Final

  1. Strains included in Gardasil shot
    6, 11, 16, 18 (Not the only strains out there though)
  2. ADRs: Gardasil
    Injection Site reaction, Fever, Nausea, HA
  3. Menopause (def)
    permanent cessation of menses following the loss of ovarian follicular activity. Diagnosed after 12 months amenorrheic
  4. Perimenopause (def)
    period immediately prior to menopause and the first year after menopause
  5. Characterisitcs of Perimenopause
    Menstrual cycle irregularity, vasomotor symptoms, psychological symptoms, and disturbances of sexuality
  6. Clinical Presentations: (FSH Lab Values)
    Perimenopause: 10-12 IU/L, Menopause: >40 IU/L (FSH surge because no estrogen to shut off negative feedback on the pituitary) **normal levels: 3-20 IU/L
  7. Slowing Bone loss (Non-pharm)
    Weight bearing exercise (Avoid: smoking, excessive alcohol and caffeine intake)
  8. Slowing Bone loss (Pharm)
    • Calcium and Vitamin:
    • Women >50 1200mg/day
    • <50 1000/mg/day
    • **no more than 500mg at a time ??
  9. Slowing Bone loss (Pharm--RX)
    Bisphosphonates, Raloxifine, Calcitonin, Teriparatide
  10. What is not a treatment for PREVENTION of osteoporosis?
    Estrogen therapy
  11. Indications for MHT (menopausal hormone therapy)
    • vasomotor symptoms, vulvovaginal atrophy
    • EXCEPTION: any women who is obese. These women have high amounts of estrogen already due to high amounts of adipose tissue (could result in potential excess estrogen)
  12. Contraindications of MHT (absolute)
    • undiagnosed vaginal bleeding
    • pregnancy
    • estrogen-dependent malignancies (Endometrial cancer, Breast cancer)
    • Active thromboembolic disorders
    • Active liver disease
  13. Contraindications MHT (risk versus benefit)
    • uterine leiomyoma
    • migraine HAs
    • seizure disorders
  14. ADRs of MHT
    Nausea, hypertriglyceridemia, edema, breast tenderness, mood swings, acne
  15. Estrogen Monotherapy Contraindication
    any women with a uterus (i.e. still have one NOT the therapy for you)
  16. Oral Estrogen ONLY products
    • premarin
    • estrace
    • enjuvia
  17. Transdermal Estrogen ONLY products
    • estrogel
    • elestrin
    • alora
    • climara
    • vivelle-dot
  18. Misc. Estrogen ONLY products
    • Vagifem (vaginal tablet)
    • Femring (vaginal ring)
  19. Combination Therapy: Estrogen and Progestin (3 types)
    • Continuous cycle (Scheduled withdrawal of bleeding)
    • Continuous combined (no scheduled bleeding)
    • Intermittent combined (continuous pulsed): 3 days estrogen only, 3 days combined
  20. Continuous Cycle
    • Premphase (conjugated estrogens/medroxyprogesterone acetate)
    • **Progestin administed for 12 to 14 days of 28 day cycle
  21. Continous Combined
    • Prempro, Activella patch, Angeliq, ClimaraPro, Combipatch
    • Results in edometrial atrophy and absence of vaginal bleeding
    • Recommended for women 2 years postmenopause due to higher risk of unpredictable bleeding in those with recent menopause
  22. Intermittent Combined
    • Prefest (estradiol/norgestimate)
    • *better tolerated because of lower progesterone=decreased SE
  23. First line therapy for patients who can't take hormones
    SSRIs (Paroxetine, fluoxetine) and SNRI (venlafaxine)
  24. Endometriosis
    bengin growth of endometrial tissue occurring outside the uterine cavity
  25. Symptoms of Endometriosis
    • severe recurring pain due to nerve stimulation
    • dysmenorrhea
    • heavy menstrual periods
    • infertility or sub-fertility
  26. Treatment of Endometriosis (ALL)
    • Cure: complete hysterectomy
    • Non-pharm: exercise and relaxation techniques, conservative surgery
    • Pharm: OCs, NSAIDs
  27. Dose Endometriosis: Medroxyprogesterone acetate/norethindrone (Progestins)
    150 IM every 3 months OR 15 mg po daily
  28. GnRH analogues: Leuprolide, Nafarelin
    11.25 mg IM every 3 months (Lupron) and 1 spray intranasally BID (Nafarelin)
  29. Gn Inhibitors Danazol
    600-800mg po daily for 2 divided doses
  30. Aromatase Inhibitors: Letrozole, Anastrozole
    2.5mg daily, 1mg daily
  31. Presentation PCOS
    • Normal FSH
    • Increased LH
    • Overgrowth of ovarian follicles
Card Set
CLPH 471 Final
P2 Second Semester Final