Hormone Replacement Therapy Flashcards
What THREE human estrogens are used in HRT?
Estradiol
Estrone
Estriol
What FOUR synthetic estrogens are used in HRT?
Ethinyl Estradiol
Mestranol
Conjugated Estrogens
Diethylstillbestrol
________ contain a phenolic ring that allows them bind to estrogen receptors
What are examples of these?
Phytoestrogens
Soy Red Clover Flaxseed Alfalfa Black Cohosh Dong Quai
What should you monitor when using black cohosh?
LFTs
What are FOUR oral Estrogens used in HRT?
Conjugated Estrogens (Premarin) Esterified Estrogens (Menest) Estropipate (Ogen) Micronized Estradiol (Estrace)
What are SIX progesterones used in HRT?
Dydrogesterone Medroxyprogesterone acetate Micronized progesterone Norethindrone Norgestrel Levonorgestrel
When are estrogens indicated in HRT?
For relief of vasomotor symptoms in menopause
What minor ADRs are associated with Estrogen use in HRT?
Major?
Minor:
Nausea
Headache
Breast Tenderness
Major:
CHD
CVA
VTE
Breast CA
What risks are associated with using Estrogen in HRT?
Increased risk of stroke/clotting (VTE)
Increased risk of developing endometrial cancer
Dementia
How should Estrogens used in HRT be managed with surgery?
What is this preventing?
They should be held 4-6 weeks prior to surgery to prevent venous thromboembolism
_______ is indicated for use in pre-menopausal women with acquired, generalized hypoactive sexual desire disorder.
Flibanserin
T/F: Flibanserin should be used in post-menopausual women
False
Should Flibanserin be used with alcohol or P450 Inhibitors?
No
What ADRs are associated with Flibanserin?
Sedation
Hypotension
Syncope
CNS Depression
What are FIVE Selective Estrogen Receptor Modulators (SERMs)?
- Tamoxifen
- Toremifene
- Raloxifene
- Ospemifene
- Bazedoxifene
What is a common indication for SERM use?
Metastatic Breast CA
What is a unique indication for Ospemifene use?
Dyspareunia (Due to vaginal atrophy)
What is a patient taking Tamoxifen at risk for?
- Hypercalcemia
- Uterine Malignancies / Hyperplasia / Polyps
- DVT / PE
- Liver Abnormalities
- Ocular disturbance
What ADRs are seen with Tamoxifen?
Vasomotor Symptoms Hair Loss Vaginal Atrophy Nausea Vomiting
T/F: Tamoxifen interacts with Warfarin
True
Also with Rifampin
Toremifene is indicated in women with metastatic breast cancer who are ____-menopausal and have ______-receptor positive tumors
Post-menopausal
Estrogen receptor positive tumors
What ADRs are seen with Toremifene?
Hot flashes Nausea Sweating Cataracts Clots Elevated LFTs
What cardiac ADR is seen with Toremifene?
Prolonged QT
Raloxifene is often used for breast cancer ______ in ____-menopausal women
Prevention
Post-menopausal
Should Ospemifene be used in patients with a history of DVT, PE, MI, CVA, or pregnancy?
No
Bazedoxifene is often used for the prevention of post-menopausal ________
Osteoporosis
Fulvestrant is a ______ _______ ________ _______ used in post-menopausal women with hormone receptor positive metastatic breast CA
Steroidal estrogen receptor antagonist
What are THREE Aromatase Inhibitors?
Are these Non-steroidal or steroidal?
Anastrozole (non-steroidal)
Exemestane (non-steroidal)
Letrozole (steroidal)
Which has a higher efficacy with advanced breast CA…
Aromatase Inhibitors or SERMs?
Aromatase Inhibitors
Do Aromatase Inhibitors work best in pre or post menopausal women?
Post-menopausal
