Estrogens and Antiestrogens

Question 1

positive feedback loop.

Answer 1

hypothalamus produces GnRH.

this stimulates the anterior pituitary to produce FSH and LH.

This stimulates the ovary to produce estrogen and progesterone

those work on uterus

Question 2

estrogen forms in contraceptives

Answer 2

pill, transdermal, vaginal ring

Question 3

estrogen in oral contraception : Ethinyl estradiol

Answer 3

20-35 mcg.
metabolized by the liver.
start with the lowest dose.
can increase dose if breakthrough bleeding occurs.

Question 4

monophasic

Answer 4

pill dosing stays the same for 28 days

Question 5

biphasic

Answer 5

pill dosage changed after 14 days

Question 6

triphasic

Answer 6

pill dosage changes every 7 days.

Question 7

caution and contraindications of estrogen as a contraceptive

Answer 7

over 35 y/o and smoker,
uncontrolled HTN,
venous thromboembolism,
breast cancer,
hx of stroke,
cirrhosis,
migrane with aura,
ischemic heart disease

Question 8

advantages of oral contraceptives

Answer 8

highl effective ,
rapidly reversible,
regulate menstrual bleeding,
improve dysmenorrhea,
decrease blood loss,
reduces risk of ovarian and endometrial cancer

Question 9

drug interactions with oral contraceptives

Answer 9

anticonvulsants (increase in microsomal enzyme activity),

rifampin is the only abx that can reduce serum estrogen and progestin levels.

griseofulvin, antifungal, associated with HF.

Question 10

estrogen in menopause indications

Answer 10

vasomotor symptoms, genitourinary symptoms, vaginal dryness, burning, UTI.

benefits outweighs the risk in women younger than 60 and those within 10 years of menopause.

Question 11

estrogen in menopause formulations

Answer 11

oral, transdermal, gels, emulsions, lotions, intravaginal creams

Question 12

estrogen systemic treatment

Answer 12

oral or transdermal formulations. oral formulation has great effect on liver dueto first pass effect. (will increase tryglicerides, HDL, sex hormone binding globulin.

transdermal form is associated with lower risk of venous thrombosis and stroke. and has less effect on lipids than oral dosing.

Question 13

Conjugated Equine Estrogens CEE (premorin)

Answer 13

derived from pregnant mares urine. comprised of estrone. synthetic version is plant based (Soy and Yams)
0.625 mg

Question 14

micronized 17 beta estradiol

Answer 14

structurally identical to the main product of premenopausal ovary

1mg

Question 15

esterified estrogens

Answer 15

comparable serum estrone/ estradiol levels to conjugated estrogen.

Question 16

ethinyl estradol (estrase)

Answer 16

more potent than others for Menopausal Hormone Therapy, used in low doses.. 5 mcg.

Question 17

vaginal dosing of estrogen

Answer 17

use lowest doses for vaginal atrophy. vasomotor symptoms can be treated in higher doses.

Question 18

adverse effects of estrogen in menopause hormone therapy.

Answer 18

breast soreness, headaches, HTN, exacerbation of diabetes, cholestasis, thromboembolic events, endometrial hyperplasia

Question 19

contraindications of estrogen in Meopause Hormone Therapy

Answer 19

hx of breast cancer, CAD, venous thromboembolic event, stroke/TIA, active liver disease, vaginal bleeding, high risk of endometrial cancer

Question 20

estogen in bone health

Answer 20

transdermal is effective.
1. raloxifine (Evista): selective estrogen receptor modulator.

2. Bazedoxifene (Duavee): combination estrogen derivative with selective estrogen receptor modulator.

Question 21

spironolactone

Answer 21

selective estrogen receptor modulator.
estrogen agonist in bone prevents bone loss, improves bone mineral density, decreases rx for fracture.

increase in thromboembolism and hot flashes.

no effect on heart disease or endometrium.

Question 22

Ospemifene (Osphena)

Answer 22

Selective estrogen receptor modulator.

increases thickness and moisture of vaginal mucosa..

Indication: dysparenunia in postmenopausal females. vaginal dryness in postmenopausal females.

estrogen agonist effect in endometrium.

potential risk for endometrial cancer if uterus is intact. increased risk for DVT and stroke.

60 mg daily is typical dose.

Question 23

Which adverse reaction is common with menopausal estrogens?

Answer 23

elevation of systemic blood pressure

Question 24

Patients treated with androgen therapy should be instructed to seek emergent evaluation if which adverse reaction occurs?

Answer 24

priapism (sustained erection)

Question 25

Which is an effect of estrogen?

Answer 25

maintenance of bone density by decreasing the rate of bone reabsorption