Women Health by Pharmacy Survivor https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh en-us 2023-02-23 11:25:53 UTC 2023-02-23 12:03:25 UTC hello@padlet.com DRPS https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421240
  • Nancy is experiencing symptoms of dysmenorrhea, hot flashes, sleep disturbances and irritability for the past 3 months and dyspareunia recently despite the use of lubricants confirming the diagnosis of menopause requiring pharmacological and non-pharmacological interventions to control these symptoms.

    • ]]>     2023-02-23 11:27:23 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421240     Goals of therapy https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421510 Reduce hot flashes within 3 months
    Reduce symptoms associated with osteoporosis and increase bone density. 
    Reduce risk of falls.
    Improve the quality of life.
    Minimize adverse effects associated with therapy.]]>     2023-02-23 11:27:42 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421510     Alternatives https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421917 Non- pharmacological:
    • Wears layering clothes that can be removed
    • Avoid spicy food, coffee and hot beverages
    • stay in cool environment 
    • Cranberry for UTIs
    • Psychological support
    Pharmacological:
    • SSRIs
    • SNRIs
    • Dyspareunia: prasterone

    ]]>     2023-02-23 11:28:08 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492421917     Recommendations https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492422061 Paroxetine 7.5 mg per day
    Prasterone
    Non pharm: Cranberry supplements for UTI

    ]]>     2023-02-23 11:28:16 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492422061     Justification https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492424785
    • The clinical response is more rapid (days) in menopause than the typical response to SSRIs for depression (weeks).
    • SSRIs/ SNRIs appear to be equally effective in women with breast cancer and in women with surgical or natural menopause 
    • Although no head-to-head trials have been performed, indirect comparisons suggest that Venlafaxine, Desvenlafaxine, Paroxetine, Citalopram, and Escitalopram have a similar modest benefit for hot flashes. 
    •  Several studies suggest against the use of Sertraline and Fluoxetine, because neither has a clinically important effect on hot flashes. In three trials, sertraline was no more effective than placebo.
    • Although Venlafaxine is well studied, it has more acute toxicity (nausea and vomiting) and can have significant withdrawal symptoms in occasional patients. 
    • Prasterone - vaginal atrophy
      Better than estradiol - can't give estradiol/estrogen bc of prev breast cancer.

    ]]>     2023-02-23 11:31:02 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492424785     Safety https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492424919 2023-02-23 11:31:13 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492424919 Efficacy https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492425027 Reduced vasomtor symptoms like hot flashes.
    Reduced symptoms of dyspareunia.
    Increased bone density.

    ]]>     2023-02-23 11:31:21 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492425027     DRP https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492432300 DRP
    Patient is experiencing symptoms of menopause like dysmenorrhea, hot flashes at night  and dyspareunia recently despite the use of lubricants requiring pharmacological and non-pharmacological management .]]>     2023-02-23 11:39:17 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492432300     DRP https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492433561 1- Nancy is experiencing symptoms of menopause (vasomotor symptoms) requiring initiation of therapy ]]> 2023-02-23 11:40:41 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492433561 GoT https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492433810 Treat menopause sx (hot flashes usually at night, dysmenorrhea, irritability, dyspariunia not relieved by lubricants)]]> 2023-02-23 11:40:55 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492433810 GOT https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435428
    1- treat vasomotor symptoms   
    2- prevent complications 
    3- treat dyspareunia 
    4- minimize side effects of drug
    5- improve quality of life 
    6- educate patient about pharmacological and non pharmacological treatment strategy ]]>     2023-02-23 11:42:33 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435428     DRP amiraamohammed0 https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435825
  • Ms Nancy is experiencing vasomotor symptoms (Hot flashes, sleep disturbance) Dyspareunia, dysmenorrhea.
    • ]]>     2023-02-23 11:43:00 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435825     Recommendation https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435937 Gabapentin Oral: Initial: 300 to 400 mg once daily at bedtime; some experts use an initial dose of 100 mg once daily to avoid adverse effects (Ref); increase gradually (eg, over 3 to 12 days) based on response and tolerability up to 600 mg to 2.4 g/day in 2 to 3 divided doses (Ref). Some experts suggest gabapentin for women whose symptoms occur primarily at night and favor a maximum dose of 900 mg to 1.2 g, given as one dose at bedtime (Ref).]]> 2023-02-23 11:43:06 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492435937 Drp https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492437047 Nancy is experiencing symptoms of menopause (vasomotor symptoms such as hot flashes, sleep disturbances, vulvovaginal symptoms such as dysparenia requiring initiation    of therapy]]> 2023-02-23 11:44:19 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492437047 non-pharm amiraamohammed0 https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492437102 For hot flushes and night sweats: 

    ·       Wear layered clothes that be removed or added as necessary 
    ·       Turn the AC to lower room temperature 
    ·       Spend time in open air 
    ·       reduce amount of spicy food intake, caffeine, hot beverages 

    • Vaginal Lubricant
    ]]>     2023-02-23 11:44:23 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492437102     Nonpharm https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492438262 AC 
    Light clothes
    Avoid spicy food

    ]]>     2023-02-23 11:45:38 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492438262     alternatives https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492439355 non-hormonal therapy:
    SNRI: venlafaxine
    SSRI: paroxetine
    clonidine
    gabapentin

    AND

    vaginal moisturizer or lubricants]]>     2023-02-23 11:46:39 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492439355     pharm amiraamohammed0 https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492439944 Paroxetine
    Clonidine
    Gabapentin
    Tibolone
    SNRI
    MPA
    Megestrol acetate


    ]]>     2023-02-23 11:47:14 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492439944     Alternatives https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492441391 SSRIs/ SNRIs
    Clonidine 
    Paroxetine
    Venlafaxine
    Citalopram
    Ecitaloprem

    ]]>     2023-02-23 11:48:51 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492441391     GoT https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492441410 1. Releive symptoms (vasomotor symptoms)
    2. Minimize side effect of drug
    3. Resolve pain and irritable dyspareunia
    4. Improve quality of life 
    5. Educate about non pharmacological options 

    ]]>     2023-02-23 11:48:52 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492441410     Recommendation https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492443635 Pharmacological 
    1-Paroxetine 7.5 mg orally per day 
    2- Vaginal Lubricant Gel -KY- apply liberal so that your vulva and vagina are sufficiently wet as needed

    Non-Pharmacological 
    1- For Vasomotor symptoms
    Wear layered clothes that be removed or added as necessary 
    Turn the AC to lower room temperature
    Spend time in the open air 
    Reduce the amount of spicy food intake, caffeine, and hot beverages 
    ]]>     2023-02-23 11:51:20 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492443635     Alternative https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492444046 Pharm
    1. SSRI (paroxetine, sertraline) SNRI (venlafaxine, duloxtine, desvenlafaxine)
    2. clonidine
    3. Gapapentin
    4. Vaginal mositurizing

    Non-pharm
    1.Wearing layered clothing that can be removed or added as necessary 
    2. Lowering room temperature 
    3. Decreasing intake of hot spicy foods, caffeine, and
    hot beverages 
    4.Exercise

    ]]>     2023-02-23 11:51:46 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492444046     monitoring (safety) amiraamohammed0 https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492446237 side effects: 
    nausea, somnolence, insomnia, headache]]>     2023-02-23 11:54:07 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492446237     Justification https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492446568 Comparisons of gabapentin and placebo revealed reductions of 20% to 30% in the frequency and severity of hot flashes with gabapentin
    A randomized, double-blind, placebo-controlled trial concluded that Gabapentin at 900 mg/day is an effective and well-tolerated treatment for hot flashes in women treated for breast cancer.



    ]]>     2023-02-23 11:54:31 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492446568     Recommendation https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492447854 Paroxetine 7.5 mg/day ]]> 2023-02-23 11:56:02 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492447854 Recommendation https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492450919 Pharm:
    1. Paroxetine 7.5mg per day
    2. Non estrogen mostorizing cream 

    Non-pharm
    1.Wearing layered clothing that can be removed or added as necessary 
    2.Lowering room temperature 
    3. Decreasing intake of hot spicy foods, caffeine, and
    hot beverages 

    ]]>     2023-02-23 11:59:26 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492450919     Justification https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492454321 2023-02-23 12:03:19 UTC https://padlet.com/pharmaiscool/bwvgc6tm0d9ev3zh/wish/2492454321