Hormone replacement Flashcards
When are estrogens used?
OCP, hormone replacement therapy for menopause, gender tranisitioning
When are the progestins used?
OCP, with estrogen in HRT for menopause and with estrogen for gender transitioning
What is estrogen in the drug world?
Estradiol
What are the progestins in the drug world?
Promethrin, Norethindrone, Depo
Can women with an intact uterus receive estrogen only therapy?
No, it poses a large risk of endometrial cancer.
What are the adverse effects of estrogens?
blood clots, HTN, acne, endometrial CA, weight gain
What are the adverse effects of progestins?
acne, irregular menstrual bleeding, osteoporosis, amenorrhea, weight gain
What are the absolute contraindications for estrogen-only replacement therapy?
intact uterus
What are the absolute contraindications for OCP use?
clotting disorders, family history of thrombophilia, CVA, CAD, cancer, liver disease, pregnancy, undiagnosed vaginal bleeding
What are the relative contraindications for OCP use?
smokers, HTN, DVT, diabetes, migraines, lactation, obesity, gall bladder disease, pt > 50y/o, SCC, HLD
What are the SERMs?
raloxifene (evista), tamoxifen, toremifene, bazedoxifene
What is the mechanism of action of the SERMs?
selectively modulate estrogen by antagonizing some receptors and agonizing others
What is the indication for SERMs use?
breast cancer, osteoporosis, post menopausal therapy
What are the adverse effects of SERMs?
fatigue, hot flashes, mood swings, night sweats, vaginal discharge
What is the first line progestin choice of HRT?
Micronized progesterone
Who can be prescribed HRT?
Post-menopausal women needing symptom management
Should HRT be prescribed to prevent CAD, CVA, osteoporosis?
Not the current recommended guidelines
Which HRT can be used for osteoporosis?
Evista, topical
When should HRT be cautioned/strongly avoided?
Thrombophilia, gall bladder disease, hypertriglyceridemia, transdermal with patients with migraines with aura
Who is HRT absolutely contraindicated with?
Hx of breast CA, CHD, stroke/thrombus, undiagnosed vaginal bleeding, endometrial cancer, TIA
What must be assessed prior to starting OCP?
Pregnancy and family history for contraindications
What is the PATH acrynomn for OCP intiation?
Assess: Pregnancy Attitudes, Timing, How important is prevention
If a patient misses a pill, what is the next step?
Take the missed pill as soon as it is noted even if that means 2 in a day
What is recommended if a patient misses 2 or more pills?
Use a backup method of contraception, take the remaining pills at the normal time.
When is Depo given?
Every 12 weeks
Who cannot get prometherin?
Patients with peanut allergies
When is osteoporosis treatment indicated?
T-score of -2.5
Hx of fragility fractures
Hx of T-score of -2.5 - -1.0
FRAX 3%
What medications are indicated for osteoporosis treatment?
Vitamin D and Calcium supplements Biphosphonates Prolia PTH analougues Estrogen replacement (women), testosterone replacement (men)
What is the MOA of Biphosphonates (Fosamax)?
They inhibit osteoclasts to promote bone structure stablility
When should Fosamax be taken?
In the morning with 8oz of water, 40 minutes prior to food or others medications
How long can a patient be on Fosamax?
3-5 years
What is the mechanism of action of Denosumab (Prolia)
It inhibits proliferation and maturation of preosteoclast to prevent them from maturing to osteoclasts
How is Prolia administered?
IV (it’s a monoclonal antibody)
How long can a patient be on Prolia?
3-5 years
What is the mechanism of action of the PTH analougues?
They stimulate the production of new collagenous bone matrix
What is a PTH analougue medciation?
Forteo
How long can Forteo be administered for?
2 years
What is the adverse effects of Forteo?
nausea, headaches, arthrlagias, back pain, leg cramps, ortho hypotension, dizziness
What is the BBW for Forteo?
Increased risk of osteoscarcoma
What are the adverse effects of Prolia?
back pain, extremity pain, musculoskeletal pain, HLD, UTI
What are the adverse effects of Fosamax?
esophagitis, musculoskeletal pain, ocular inflammation, atypical femur fractures, osteonecrosis of the jaw
What are non-pharmacological treatment modalities for osteoporosis?
Sufficient calcium and Vitamin D intake
Weight bearing exercises
Avoid excessive alcohol consumption
Smoking cessation
How do OCP prevent pregnancy?
Inhibits ovulation, thickens cervical mucus, thins endometrium
How does estrogen prevent pregnancy?
It prevents FSH and LH excretion thus preventing ovulation
How does progestin prevent pregnancy?
Prevent LH production to prevent egg release, changes uterine lining to prevent implantation, blocks sperms ability to fertilize egg, thickens cervical mucus to hinder sperms ability to travel
When should OCP be stopped?
Around 50-51 (onset of menopause)
What medication effects OCP effectiveness?
Rifampin
How are vaginal ring OCP used?
Every week in the vagina, 3 weeks a month with a one week ‘bleeding’ week
What is the weight limit for vaginal ring use as an OCP option?
198lbs
How does the implant work?
Placed under the skin, in place for up to three years
What are the adverse effects of the implant?
It can move, irregular bleeding, mood swings, weight gain, depression, headache, acne, breast pain
How is the implant removed?
Surgically
How long to IUDs last?
3-12 years depending on the IUD
How long do the IUDs need to stay in place?
They can be pulled up to 1 year into placement
What are complications of the IUD?
irregular bleeding, implantation into the uterine wall, infections with placement, rejection by body (‘falls out’), cramping
How long can a patient be on Depo shots?
2 years d/t BBW for bone demineralization with extended use
