Estrogens and Progestins

Question 1

Benefits of Ethinyl group to Estrogen

Answer 1

Longer half life

Decreased first pass metabolism

Question 2

Conjugated Equine Estrogens used in

Answer 2

Hormone Replacement therapy (high doses)

Question 3

Estrogen for Hypogonadism

Answer 3

Promotes development of female sex organs

Induces development of ovaries, fallopian tubes, uterus, vagina, breasts

Question 4

Estrogen for HRT

Answer 4

maintain bone density, suppress hot flashes/urogenital atrophy
Acts of HPG axis, endometrium, bone, sex organ development

Question 5

Risks of HRT

Answer 5

Increased coronary heart disease, stroke, pulmonary embolism, breast cancer

Question 6

Benefits of HRT

Answer 6

decreased colorectal cancer and hip fracture

Question 7

When can you give estrogen alone?

Answer 7

If patient doesn’t have uterus - no concern for endometrial proliferation

Question 8

Estrogen for Contraception

Answer 8

Negative feedback on HPG axis

Block ovulation - repress LH surge

Question 9

Estrogen for Acne treatment

Answer 9

suppress steroidogenesis, increasing SHBG production by liver/decreased testosterone
Depress androstenedione + increase plasma protein = more bound inactive testosterone

Question 10

What causes acne

Answer 10

Progestrone

Question 11

AE Estrogen

Answer 11

breast tenderness, endometrial hyperplasia, increased blood coagulation

Question 12

Cancer with HRT combination therapy

Answer 12

invasive breast cancer (progestin)

Question 13

Cancer with HRT estrogen monotherapy

Answer 13

endometrial cancer

Question 14

Cancer with Contraceptive therapy

Answer 14

Reduced ovarian/endometrial

Potential for increased breast - History = do not prescribe

Question 15

Progestrone based drug

Answer 15

Medroxyprogesterone

Question 16

19-Nortestosterone based drugs

Answer 16

Norethindrone
Norgestrel
“NOR”

Question 17

Progestin Contraceptive

Answer 17

alone or in combination with estrogen

Feedback suppress ovulation/steroidogenesis and increase cervical mucous viscosity

Question 18

Progestin HRT

Answer 18

decreased endometrial hyperplasia by estrogens

Causes endometrial differentiation and decreases uterine contractions

Question 19

Progestin dysmenorrhea

Answer 19

decrease endometrial mass and prostaglandin production

Decrease proliferation in endometrium

Question 20

Progestin endometriosis

Answer 20

Inhibit endometrial proliferation; stimulate differentiation (ER regulation)

Question 21

AE Progestins

Answer 21

breakthrough bleeding, impaired glucose tolerance, lipid metabolism changes, acne, hirsuitsm

Question 22

Oral pill

Answer 22

estrogens/progestins (or progestin alone)

Question 23

Injectable

Answer 23

estrogens/progestins (or progestins alone)

Question 24

Implantable

Answer 24

progestins alone

Question 25

Intrauterine device

Answer 25

progestins + copper

Question 26

Transdermal

Answer 26

combination

Question 27

Vaginal ring

Answer 27

combination

Question 28

Mild Hormone Contraceptive AE

Answer 28

nausea, mastalgia, breakthrough bleeding (estrogen), edema, headache, withdrawal

Question 29

Moderate Hormone Contraceptive AE

Answer 29

breakthrough bleeding (progestin), WG, skin pigmentation, acne, hirsutism, infection amenorrhea

Question 30

Severe Hormone Contraceptive AE

Answer 30

thromboembolic disease, MI, cerebrovascular disease, GI disorder, depression, cancer

Question 31

Benefits of hormone contraceptive

Answer 31

``` reduced ovarian/endometrial cancer reduced dysmenorrhea/endometriosis decreased incidence of ectopic pregnancy/benign breast disease Increased Hb Suppress acne/hirsutism ```

Question 32

Contraindications of contraceptive

Answer 32

known/suspected breast cancer/female reproductive tract cancer Thromboembolic disorders Liver disease, history of CV disease smokers 35+

Question 33

Interactions of contraceptive

Answer 33

HIV agents, anticonvulsants, St. John's wort induce hormone metabolism Antibiotics lower contraceptive effectiveness