Estrogens and Progestins (Exam 1) Flashcards
Three pharmacotheraputic applications of hormones
Hypofunction: menopausal hormone therapy
Hyperfunction: suppression of production, cancer
Alteration of normal endocrine states: combined oral contraceptives
Women who take combination oral contraceptives:
A. Have a higher risk of ovarian cancer
B. Have a higher risk of endometrial cancer
C. Have a reduced risk of both ovarian and endometrial cancer
D. Have a higher incidence of benign breast disease
C
SERMs (tamoxifen and Raloxifene) have anatagonistic actions of what functions/ tissues?
Breast
Vasomotor
Endometrium - raloxifene only
- A 70-year-old woman is being treated with raloxifene for
osteoporosis. Which of the following is a concern with this
therapy?
A. Breast cancer
B. Endometrial cancer
C. Hot flashes
D. Hypercholesterolemia
C
SERMs and Estrogen have a adverse effect of ________ because of increasing clotting factors
VTE
Estrgoen _______ LDL and _______ HDL
decreases, increases
SERMs have an adverse effect of _______ because of the antagonistic effect of vasomotor function
hot flashes
Medications used for MHT:
Ethinyl estradiol (conjugated estrogens), estradiol (topical), progesterone- medroxyprogesterone (for pts with intact uterus)
. A thin, dry vaginal lining and thin urethral mucosa can
cause:
A. Vaginal and vulvar burning and irritation
B. Pain during intercourse
C. An increased risk of urinary tract infections
D. All of the above
D
An oral alternative to vaginal estradiol for vaginal symtptoms of menopause
Ospemifene - SERM
Adverse rxns of ospemifene
endometrial hyperplasia, VTE risk, hot flashes
non hormonal drug that is FDA approved for hot flashes
paroxetine
. The most effective treatment for vasomotor symptoms of menopause is: A. Systemic estrogen B. A low-dose vaginal estrogen C. Ospemifene D. Paroxetine
A
Which of the following is recommended for women
with genitourinary syndrome of menopause without
vasomotor symptoms?
A. An oral estrogen
B. A low-dose vaginal estrogen
C. An oral progestogen
D. Low-dose paroxetine
B
Which of the following would be appropriate for
treatment of a 52-year-old menopausal woman with an
intact uterus and a history of venous thromboembolism
who is complaining of severe hot flashes that are
keeping her awake at night?
A. A transdermal estrogen/progestin
B. Ospemifene (a SERM)
C. Conjugated estrogens/bazedoxifene (a SERM)
D. Low-dose paroxetine
A
A 54-year-old woman with severe hot flashes asks for
advice about choosing treatment for menopausal
vasomotor symptoms. You could tell her that:
A. Oral, transdermal, and vaginal formulations are all equally
effective
B. Transdermal estrogens are probably as effective as oral
estrogens
C. Vaginal estrogen products are as effective as transdermal
products
D. All of the above are true
B
Compounded personalized doses of bioidentical hormones
are:
A. More effective than conjugated or fully synthetic hormones
B. Safer than conjugated or fully synthetic hormones
C. Not regulated by the FDA
D. All of the above
C
Contraindications for MHT with hormonal therapy
Hx of breast or endometrial cancer vaginal bleeding liver disease active thromosis coronary heart disease Hypertriglycerides
Adverse reactions of estrogen use
Post menopausal bleeding Nausea Breast tenderness anorexia, vomitting, diarrhea HTN Increased migraines Gallstones
0.You are planning to prescribe an oral estrogen for a 56-
year-old woman with menopausal vasomotor symptoms
and an intact uterus and are considering whether to add
a progestin. Which of the following statements about use
of these hormones in this patient is true?
A. Taking an oral estrogen alone increases the risk of
uterine cancer
B. Adding a progestin to oral estrogen decreases the risk of
uterine cancer
C. Adding a progestin to oral estrogen may increase the
risk of invasive breast cancer
D. All of the above
D
Progestin oral contraceptives and their ADRs
Norethindrone (prog only)
Levonorgestrel : decreased VTE risk, but increase antoandrgen actions (prog only)
Desogestrel - lower antiandrogen but increase VTE risk (combo)
Drospirenone- antiandrogenic and antimineralocorticoid- increased VTE risk (combo)
Hyperkalemia is a possible side effect of: A. Levonorgestrel B. Medroxyprogesterone acetate C. Desogestrel D. Drospirenone
D
main clinical uses of progestins
contraception and MHT (with estrogen)
Progestins will have what effect on menses
anovulation and amenorrhea , this is good for individuals with dysmenorrhea, endmetriosis, and those with bleeding disorders
Adverse drug reactions of progestins
Depression, somnolence, headache
breast enlargement, tenderness
nausea
elevated b/p, edema, weight gain
Progestin only contraception
Oral: norethindrone
IUD: levonorgestrol
IM: medroxyprogesterone
Subdermal: etonogestrel
.Implants and intrauterine devices both:
A. Require no patient compliance
B. Provide long-term protection against pregnancy
C. Permit rapid return of fertility after removal
D. All of the above
D
.Which of the following women should NOT take a
combination oral contraceptive?
A. A 44-year-old with a history of breast cancer
B. A 37-year-old who smokes
C. A 30-year-old with a history of VTE
D. All of the above
D
Mechanism of action for estrogen in OCs
suppresion of FSH and follicle development
Mechanism of action for progestin in OCs
prevention of the ovulatory surge og LH
A 26-year-old female is using injectable medroxyprogesterone
acetate as a method of contraception. An adverse effect of
concern with long-term use of this therapy is:
A. Hyperkalemia
B. Male pattern baldness
C. Osteoporosis
D. Weight loss
C
Medroxyprogesterone acetate:
A. Is injected once monthly
B. Commonly causes amenorrhea-irregular bleeding
C. Permits rapid return of fertility after the last injection
D. Causes irreversible bone loss in most women
B
Which of the following would be the most appropriate
oral contraceptive for a patient with moderate acne?
A. Ethinyl estradiol - levonorgestrel
B. Ethinyl estradiol - norethindrone
C. Ethinyl estradiol - desogestrel
D. Medroxyprogesterone
E. Uliprista
A,B, C
combined oral contraceptives have what effects on the skin
Increased pigmentation: chloasma
can cause acne or decrease it
drugs that interact with COCs
rifampin, anticonvulsants, griseofulvin
-not an issue with prostin only
The most effective method of emergency contraception is:
A. A progestin-only emergency contraception pill
B. Ullipristal acetate (Ella)
C. A copper intrauterine device
D. Two doses 12 hours apart of a combination oral
contraceptive
C
