Estrogens - Progestins

Question 1

The release of GnRH from the hypothalamus triggers release of what from the ant. pituitary?

Answer 1

FSH and LH

Question 2

FSH and LH stimulate the ovarian follicle to release what?

Answer 2

Estrogen

Question 3

The corpus luteum release what hormones?

Answer 3

Estrogen and progesterone

Question 4

Estrogen at high levels provides positive feedback on production of?

Answer 4

FSH and LH

Question 5

COC have low levels of estradiol that causes ____ feedback for FSH and LH.

Answer 5

negative

Question 6

Estrogen effect on breast tissue?

Answer 6

growth

Question 7

Estrogen effect on endometrium?

Answer 7

Growth

Question 8

Estrogen effect on bone?

Answer 8

Decrease osteoclasts

Question 9

Estrogen effect on liver?

Answer 9

Increase HDL, decrease LDL, increase clotting factor synthesis

Question 10

Estrogen effect on hyp-pit?

Answer 10

decrease LH, FSH release

Question 11

Adverse effects of estrogen therapy include?

Answer 11

Increased risk of breast and endometrial cancer, increased VTE Risk.

Question 12

What is a SERM?

Answer 12

selective estrogen receptor modulator

Question 13

Give 3 examples of SERMs.

Answer 13

Tamoxifen
Raloxifene
Ospemifene

Question 14

T/F? SERMs have only agonist effects on ERs.

Answer 14

False - they are selective, so they have some agonist and some antagonist properties

Question 15

What are the antagonistic properties of SERMs?

Answer 15

Breast growth, vasomotor function(causing hot flashes), and endometrium growth (raloxifene only)

Question 16

Which SERM has greater risk of VTE? Tamoxifen or Raloxifene?

Answer 16

Tamoxifen

Question 17

Which SERM provides greater benefit in osteoporosis prevention?

Answer 17

Raloxifene

Question 18

What medication is added to MHT for patients with an intact uterus? Why?

Answer 18

Progesterone (medroxyprogesterone) to reduce endometrial cancer risk

Question 19

When is topical estradiol used?

Answer 19

Urogenital symptoms for menopause (atrophic vaginitis)

Question 20

When is oral estradiol used?

Answer 20

For vasomotor and osteoporosis symptoms of menopause

Question 21

What SERM has been approved as an oral alternative to vaginal estrogens?

Answer 21

Ospemifene

Question 22

What medication is the only approved medication for mod-severe hot flashes?

Answer 22

Low dose paroxetine

Question 23

List adverse reactions to MHT.

Answer 23

Post menopausal bleeding
Nausea
Breast tenderness
Anorexia
Vomiting and diarrhea
HTN
Migraines
Gallstones

Question 24

List contraindications to MHT.

Answer 24

Hx of breast or endometrial cancer
Vaginal bleeding
Liver dz
Active thrombosis
Heart disease
Hypertriglyceridemia

Question 25

List a 1st, 2nd, and 3rd generation synthetic progestin.

Answer 25

1st - norethindrone 2nd - Levonorgestrel 3rd - Desogestrel

Question 26

Which synthetic progestins have the highest VTE risk?

Answer 26

Desogestrel and Drospirenone

Question 27

What is the clinical use of progestin without estrogen?

Answer 27

Contraception

Question 28

List adverse reactions to progestins

Answer 28

``` CNS depression headache somnolence Breast enlargement and tenderness Nausea HTN Edema Weight gain ```

Question 29

What medication is an oral progestin only?

Answer 29

Norethindrone

Question 30

What medication is an IUD progestin only?

Answer 30

Levonorgestrel

Question 31

What medication is an IM progestin only?

Answer 31

Medroxyprogesterone

Question 32

What medication is a subdermal progestin only?

Answer 32

etonogestrel