Estrogens - Progestins Flashcards
The release of GnRH from the hypothalamus triggers release of what from the ant. pituitary?
FSH and LH
FSH and LH stimulate the ovarian follicle to release what?
Estrogen
The corpus luteum release what hormones?
Estrogen and progesterone
Estrogen at high levels provides positive feedback on production of?
FSH and LH
COC have low levels of estradiol that causes ____ feedback for FSH and LH.
negative
Estrogen effect on breast tissue?
growth
Estrogen effect on endometrium?
Growth
Estrogen effect on bone?
Decrease osteoclasts
Estrogen effect on liver?
Increase HDL, decrease LDL, increase clotting factor synthesis
Estrogen effect on hyp-pit?
decrease LH, FSH release
Adverse effects of estrogen therapy include?
Increased risk of breast and endometrial cancer, increased VTE Risk.
What is a SERM?
selective estrogen receptor modulator
Give 3 examples of SERMs.
Tamoxifen
Raloxifene
Ospemifene
T/F? SERMs have only agonist effects on ERs.
False - they are selective, so they have some agonist and some antagonist properties
What are the antagonistic properties of SERMs?
Breast growth, vasomotor function(causing hot flashes), and endometrium growth (raloxifene only)
Which SERM has greater risk of VTE? Tamoxifen or Raloxifene?
Tamoxifen
Which SERM provides greater benefit in osteoporosis prevention?
Raloxifene
What medication is added to MHT for patients with an intact uterus? Why?
Progesterone (medroxyprogesterone) to reduce endometrial cancer risk
When is topical estradiol used?
Urogenital symptoms for menopause (atrophic vaginitis)
When is oral estradiol used?
For vasomotor and osteoporosis symptoms of menopause
What SERM has been approved as an oral alternative to vaginal estrogens?
Ospemifene
What medication is the only approved medication for mod-severe hot flashes?
Low dose paroxetine
List adverse reactions to MHT.
Post menopausal bleeding Nausea Breast tenderness Anorexia Vomiting and diarrhea HTN Migraines Gallstones
List contraindications to MHT.
Hx of breast or endometrial cancer Vaginal bleeding Liver dz Active thrombosis Heart disease Hypertriglyceridemia
List a 1st, 2nd, and 3rd generation synthetic progestin.
1st - norethindrone
2nd - Levonorgestrel
3rd - Desogestrel
Which synthetic progestins have the highest VTE risk?
Desogestrel and Drospirenone
What is the clinical use of progestin without estrogen?
Contraception
List adverse reactions to progestins
CNS depression headache somnolence Breast enlargement and tenderness Nausea HTN Edema Weight gain
What medication is an oral progestin only?
Norethindrone
What medication is an IUD progestin only?
Levonorgestrel
What medication is an IM progestin only?
Medroxyprogesterone
What medication is a subdermal progestin only?
etonogestrel
