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Therapeutics > Exam 4- Women's Health > Flashcards

Exam 4- Women's Health Flashcards

1
Q

What hormone is released from the hypothalamus to help regulate the menstrual cycle?

A

gonadotropin releasing hormone

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2
Q

When does gonadotropin releasing hormone reach it’s peak?

A

right before ovulation

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3
Q

What are the two gonadotropic hormones that regulate the menstrual cycle?

A

FSH and LH

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4
Q

When do FSH and LH peak?

A

ovulation ( ~ day 14)

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5
Q

What are the ovarian hormones?

A

progesterone and estrogen

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6
Q

When does estrogen peak?

A

Ovulation

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7
Q

When does progesterone peak?

A

in the luteal phase- it’s function is to maintain the endometrium

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8
Q

Where are FSH and LH released from?

A

the anterior pituitary

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9
Q

In which phase of the menstrual cycle is the release of estrogen stimulated?

A

the follicular phase

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10
Q

In which phase of the menstrual cycle is the release of progesterone stimulated?

A

the luteal phase

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11
Q

What function does estrogen play in the HPO axis?

A

estrogen stimulates GnRH secretion and produces the LH surge

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12
Q

What function does inhibin play in the HPO axis?

A

inhibin inhibits the secretion of FSh

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13
Q

What function does progesterone play in the HPO axis?

A

negative feedback for GnRH

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14
Q

What is the effect of estrogen during puberty?

A

stimulate breast development, fat deposition, and increase growth hormone and height.

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15
Q

What is the effect of estrogen throughout the reproductive years?

A

maintain female sexual physical characteristics, behaviors, and reproductive organs. Stimulate cyclic uterine lining growth and repair.

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16
Q

contraindications to estrogens

A
  • abnormal vaginal bleeding
  • DVT or PE (blood clots)
  • active or history of stroke or heart attack
  • breast cancer
  • hypercoagulable disorder
  • pregnancy
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17
Q

estrogen uses

A
  • breast cancer palliation
  • uremic bleeding
  • prevention of post-menopausal osteoporosis
  • vasomotor symptoms of menopause
  • vulvar and vaginal atrophy
  • female hypogonadism
  • ovarian failure
  • abnormal uterine bleeding
  • contraception
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18
Q

what is progesterone produced by?

A

ovary and corpus luteum

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19
Q

what is the target of progesterone?

A

uterus

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20
Q

what is the target of estrogen

A

many systemic targets

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21
Q

what is the role of progesterone in pregnancy?

A
  • prepare endometrium for pregnancy
  • inhibits contraction of the uterus
  • inhibits development of a new follicle
  • maintaining the endometrial lining
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22
Q

what are the available forms of medroxyprogesterone?

A

Depo-Provera (injection) and Provera (tablet)

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23
Q

What are contraindications of medroxyprogesterone?

A
  • history or current VTE
  • severe hepatic dysfunction
  • breast cancer
  • undiagnosed vaginal bleeding
  • use for more than 2 years: may result in loss of bone mineral density
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24
Q

What is the role of medroxyprogesterone?

A
  • reduce risk of endometrial cancer with unopposed estrogen treatment
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25
Q

What are the therapeutic uses of progestins?

A
  • long-term pregnancy prevention
  • treatment of heavy menstrual bleeding
  • emergency contraception
  • amenorrhea
  • endometriosis
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26
Q

What drugs are GnRH agonists?

A

Leuprolide, buserelin, nafarelin, goserelin, triptorelin

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27
Q

What is the mechanism for GnRH agonists?

A

Creating a pseudomenopausal state

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28
Q

What are side effects of GnRH agonists?

A

hot flashes, vaginal dryness, insomnia, osteoporosis

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29
Q

What are the therapeutic uses of GnRH agonists?

A

Menorrhagia, endometriosis, and premenstrual dysphoric disorder

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30
Q

What is menopause?

A
  • marks the end of fertility
  • inability of ovaries to produce estrogen
  • diagnosis is confirmed after 12 consecutive months of amenorrhea
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31
Q

What is premenopause?

A
  • The time period of endocrine changes before cessation of menstruation
  • most symptoms occur during this period
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32
Q

What is perimenopause?

A

the period of endocrine changes surrounding menopause, marked by irregular periods.

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33
Q

What is postmenopause?

A

the time period of endocrine changes after cessation of menstruation

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34
Q

When is menopause most likely?

A

Median age of onset is 51 years

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35
Q

What is premature menopause?

A
  • occurs before age 40
  • normally due to hysterectomy, radiation therapy, or chemotherapy
  • increased risk of mortality and morbidity
  • worst symptoms first 1-2 years due to estrogen deficiency
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36
Q

What are the causes of menopause?

A
  • physiologic (deterioration of follicular cells and ova with aging. Decreased estrogen and progesterone levels and increased FSH and LH levels)
  • surgery- removal of ovaries or full hysterectomy
  • chemotherapy
  • radiation therapy
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37
Q

What are vasomotor symptoms of menopause?

A

Hot flashes and night sweats

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38
Q

What happens to vasomotor symptoms over time?

A

they get better long-term and become less severe

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39
Q

What are genitourinary symptoms of menopause?

A

irregular menses, amenorrhea, sleep disturbances, mood changes, fatigue, vulvovaginal atrophy, urinary tract dysfunction, sexual dysfunction, urinary frequency and urgency

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40
Q

What are long-term consequences of menopause?

A

cardiovascular disease, bone loss, osteoarthritis, body composition changes, skin changes, balance issues

41
Q

What are the options for treatment of menopausal symptoms?

A

nonpharmacologic therapy, menopausal hormone therapy, and nonhormonal alternatives

42
Q

What are nonpharmacologic therapies for treatment of menopause symptoms?

A
  • smoking cessation
  • limit alcohol and caffeine use
  • limit hot beverages
  • limit spicy foods
  • weight loss
  • keep cool; dress in layers
  • others
43
Q

what are indications for menopausal hormone therapy?

A

vasomotor symptoms, vulvovaginal atrophy, osteoporosis prevention

44
Q

absolute contraindications to MHT

A
  • unexplained vaginal bleeding
  • pregnancy
  • endometrial or breast cancer
  • stroke
  • active or history of thromboembolic disorders
  • active liver disease
45
Q

relative contraindications to MHT (needs monitored)

A
  • uterine leiomyoma
  • migraine headaches
  • seizure disorders
  • diabetes
  • hypertriglyceridemia
  • active gallbladder disease
  • high risk for heart disease
  • family history of breast cancer
46
Q

When can estrogen monotherapy be used?

A

When a woman does not have a uterus

47
Q

What is the risk of estrogen monotherapy in women with a uterus?

A

risk for endometrial cancer/hyperplasia

48
Q

Oral estrogen monotherapy options

A
  • premarin (conjugated estrogens)
  • menest (esterifies estrogen)
  • estrace generics (micronized estradiol)
49
Q

What are side effects or key points of oral estrogen products?

A
  • undergo hepatic first-pass metabolism
  • systemic effects –> more side effects
  • effective for hot flashes
50
Q

Transdermal estrogen monotherapy options

A
  • alora
  • climara
  • menostar
  • minivelle
  • vivelle
  • vivelle-dot
51
Q

Key points for transdermal estrogen therapy

A
  • continuous rate of hormone release
  • less side effects and risk of stroke
52
Q

topical estrogen therapy products

A
  • topical gels
  • topical sprays
53
Q

topical estrogen therapy key points

A
  • variable absorption
54
Q

IM injections for estrogen therapy products

A
  • estradiol cypionate (depo-estradiol)
  • estradiol valerate (delestrogen)
55
Q

Intravaginal estrogen products

A

Vaginal cream (estrace; premarin)
Vaginal insert (Imvexxy)
Vaginal tablet (vagifem, yuvafem)
Vaginal ring (estring, femring)

56
Q

intravaginal estrogen product key notes

A
  • are put on a localized area = minimal systemic absorption
  • patient can use even if they have an intact uterus
  • femring has systemic absorption; can help with vasomotor symptoms but a progesterone is needed
57
Q

When should topical vaginal products be prescribed?

A

exclusively for women experiencing vulvovaginal atrophy

58
Q

When should progestin be used

A

in women with an intact uterus in addition to estrogen to decrease the risk of endometrial hyperplasia and endometrial cancer.

59
Q

When should MHT be started?

A
  • ideally in women under age 60, within 10 years of menopause
  • lowest risk of coronary heart disease
60
Q

what is continuous cyclic therapy?

A
  • estrogen is administered daily and progesterone is administered 12 to 14 days of a 28 day cycle.
  • mimics the menstrual cycle
  • includes scheduled withdrawal bleeding
  • preferred in perimenopausal women and recently menopausal women
61
Q

continuous cyclic therapy drug options

A

premphase (oral)- conjugated estrogens and medroxyprogesterone acetate
combipatch (transdermal)- estradiol and norethindrone acetate

62
Q

What is continuous long cycle hormone therapy?

A
  • estrogen administered daily
  • progesterone co-administered 12 to 14 days every other month
  • 6 scheduled bleeds (longer and heavier withdrawal bleeds)
  • not as much endometrial protection
  • not used as often
63
Q

What is continuous combined hormone therapy?

A
  • daily estrogen and progesterone
  • endometrial atrophy and absence of vaginal bleeding
  • initial unpredictable spotting or bleeding (should resolve within 6-12 months)
  • drug free period of 1-2 weeks may help stop bleeding
  • recommended for women >2 years post menopause
  • best long-term endometrial protection
64
Q

continuous combined hormone therapy options

A
  • many different oral options
  • climapro and combipatch are transdermal options
    -climapro is preferred due to low risk of side effects.
65
Q

what is intermittent combined hormone therapy?

A
  • continuous pulsed estrogen and progesterone
  • 3 days of estrogen + progesterone
  • pulsing prevents bleeding
  • long-term endometrial protection is unknown
66
Q

What is the best oral progestin for endometrial protection?

A
  • micronized progestin (prometrium)
  • no increased cardiovascular risk; closest to biological progesterone
67
Q

What can combination therapy of estrogen and SERMs be used for?

A

treats menopausal symptoms and prevents bone loss in women with an intact uterus
- decreases risk of endometrial cancer (antagonist to breast and uterus)
- higher risk of hyperplasia and stroke in overweight women

68
Q

What is the most commonly used estrogen/SERM therapy

A

Duavee

69
Q

Estrogen + SERM side effects

A

GI track disorders, muscle spasms, neck pain, dizziness, oropharyngeal pain

70
Q

What are alternatives for vasomotor symptoms?

A
  • phytoestrogens, black cohosh, dong quai, gabapentin/pregabalin, and clonidine
71
Q

When are SSRIs and SNRIs used for hot flashes?

A

Drug of choice if estrogen treatment is contraindicated

72
Q

What are the drugs of choice and key points for use of SSRIs?

A

Paroxetine, citalopram, and escitalopram
- help with vasomotor symptoms and mood

73
Q

What are the drugs if choice and key points for use of SNRIs to treat post-menopausal symptoms

A

venlafaxine, desvenlafaxine, duloxetine
- should not stop abruptly (need to taper)
- side effects: mouth dryness, anorexia, nausea, constipation

74
Q

What is bioidentical hormone replacement therapy?

A
  • compounds with a unique mix of estradiol, estrone, estriol, and progestone
  • not usually covered by insurance
  • only FDA approved is Bijuva
  • questionable safety, efficacy, and potency
75
Q

what is the first-line treatment for genitourinary symptoms of menopause?

A
  • non-hormonal lubricants and vaginal moisturizers
76
Q

What is the second-line treatment for genitourinary symptoms of menopause?

A
  • estrogen topical creams, tablets, and rings
  • low dose oral contraceptives
  • low dose vaginal estrogen does not require progestin
77
Q

What medication is used for the treatment of moderate to severe dyspareunia?

A

ospemifene

78
Q

What is ospemifene?

A
  • SERM
  • black box warning for endometrial cancer, stroke, and VTE
  • used in post-menopausal women for painful sexual intercourse
  • may cause hot flashes
79
Q

What is prasterone (intrarosa)? Indication, side effects, etc.

A
  • inactive DHEA converted to active estrogens and androgens
  • intravaginal inserts; used for post-menopausal women only
  • only contraindication is undiagnosed vaginal bleeding and avoid if history of breast cancer
80
Q

What are the two main thyroid hormones?

A

Thyroxine (T4) and triiodothyronine (T3)
- T4: concentration is 10x higher than T3; converted to T3 by enzymes
- T3: most potent

81
Q

What are the physiologic effects of thyroid hormones?

A

Growth and development (absent T3= cretinism), metabolic effects (increases BMR and oxygen consumption; starvation lowers T3 hormone and thyroid receptor), thermogenesis (increase resting heat production), cardiovascular effects including catecholamine sensitivity (epinephrine/norepinephrine)

82
Q

How are thyroid hormones synthesized?

A

using dietary iodine (I2)

83
Q

What catalyzes iodide organification?

A
  • thyroid peroxidases
84
Q

What hormone is released from the hypothalamus to control thyroid hormone synthesis?

A

TRH (thyrotropin releasing hormone)

85
Q

What hormone is released from the anterior pituitary to control thyroid hormone synthesis?

A

TSH (thyrotropin)

86
Q

What is released from the thyroid gland?

A

T4 and T3

87
Q

What stimulates production of T4 and T3 from the thyroid gland?

A

thyrotropin (released by the anterior pituitary)

88
Q

What is iodine used for?

A
  • used in synthesis of thyroid hormones
89
Q

What does iodine deficiency cause?

A
  • nontoxic goiter
  • enlargement of the thyroid gland due to rise in TSH but lack of T4
90
Q

How are thyroid hormones transported in the body?

A
  • transported in plasma by thyroxine-binding globulin
  • transport proteins have greatest affinity to T4
  • T4 has a longer-half life than T3; but T3 has a more rapid onset due to less binding affinity
91
Q

how is T3 made?

A

T4 converted to T3 by deiodinase

92
Q

What are symptoms of hypothyroidism

A

decrease in metabolic rate (fatigue, lethargy, attention deficit)
- defective thermoregulation (cold)
- may occur with thyroid enlargement (non-toxic goiter)
- causes dwarfism and cretinism in children
- myxoedema coma if left untreated (water intoication, shock, and death)

93
Q

what are causes of hypothyroidism

A

hashimotos thyroiditis- an autoimmune disease that destroys the thyroid gland
- secondary causes include TSH deficiency

94
Q

hyperthyroidism symptoms

A
  • excessive metabolism
  • poor thermoregulation (hot)
  • weight loss
  • increased heart rate and cardiac output
95
Q

Hyperthyroidism causes

A

grave’s disease- an autoimmune disease; thyroid-stimulating antibodies (enlargement of the thyroid gland– toxic goiter)
- thyroiditis– infection; release of thyroid hormones

96
Q

What are characteristics of a toxic goiter

A

excess T3

97
Q

What is hyperglycemia caused by?

A

hyperthyroidism

98
Q

What is hypoglycemia caused by?

A

hypothyroidism

99
Q

thyroid hormone replacement therapy

A

levothyroxine (t4)
levothyronine (t3)

Therapeutics (7 decks)

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