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pharm summer 1 > Hormone Replacement Therapy > Flashcards

Hormone Replacement Therapy Flashcards

1
Q

Human estrogen replacements

A
  • estradiol
  • estrone
  • estriol
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2
Q

synthetic estrogen replacements

A
  • ethinyl estradiol
  • mestranol
  • conjugated estrogens
  • diethylstilbestrol
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3
Q

phytoestrogen replacements

A
  • soy
  • red clover
  • flax
  • alfalfa
  • black cohosh
  • dong quai
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4
Q

Oral estrogens:

A
  • conjugated estrogens
  • Esterified estrogens
  • Estropipate
  • Mocronized estradiol
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5
Q

Progestogens:

A
  • Dydrogesterone
  • medroxyprogesterone
  • micronized progesterone
  • Norethindrone
  • norgestrel
  • levonorgestrel
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6
Q

how is estradiol metabolized

A

3A4

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7
Q

Estrogen Indic.

A

-relief of vasomotor symptoms

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8
Q

Estrogen ADRs:

A

-N, HA, breast tenderness, bleeding
Serious; CHD, CVA, VTE, breast ca, gallbladder disease
-less likely with transdermal

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9
Q

estrogen warning

A
  • increased risk of stroke
  • dementia
  • CHD
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10
Q

why no unopposed estrogen in pt with uterus?

A

endometrial cancer

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11
Q

phytoestrogen risks:

A
  • increased proliferation of breast tissue in vitro
  • may decrease risk of breast ca. in asians
  • women with breast cancer should avoid these
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12
Q

phytoestrogens may help with what part of menopause?

A

hot flashes

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13
Q

how does red clover interact with warfarin?

A

may increase bleeding

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14
Q

warning for black cohosh?

A

liver damage

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15
Q

wild yam ADRs:

A

vomitting

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16
Q

Flibanserin indications:

A

premenopausal hypoactive sexual desire disorder (HSDD)

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17
Q

Flibanserin contra:

A

P450, 3A4 inhibitors, hepatic impairment

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18
Q

flibanserin ADRs:

A

sedation, hypotension, syncope, cns depression,

REMS program: hypotension, syncope with EtOH use

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19
Q

NAMS guidelines:

A
  • lowest dose, shortest duration
  • estrogen most effective
  • avoid compounded hormones
20
Q

compounded estrogen:

A

biest: estradiol and estriol
Triest: estradiol, estrone, estriol

21
Q

breast cancer tx:

A

-Selective estrogen receptormodulator (SERMs)
-steroidal estrogen receptor antagonist
-aromatase inhibitors
all anti estrogens

22
Q

SERMs:

A
  • tamoxifen
  • toremifene
  • Raloxifene
23
Q

steroidal estrogen receptro antagonist

A

Fulvestrant

24
Q

Aromatase inhibitors:

A
  • Anastrozole
  • Exemestane
  • Letrozole
25
Q

Tamoxifen uses:

A
  • developed as OC
  • adjuvant therapy for breast ca
  • prevention in high risk women
26
Q

Tamoxifen warnings:

A
  • hypercalcemia
  • uterine malignancies
  • endometrial hyperplasia and polyps
  • clots
  • liver abnormalities
  • ocular disorders
27
Q

how is tamoxifen metabolized?

A

p450

28
Q

tamoxifen adrs

A

vasomotor symptoms, vaginal atrophy, hair loss, n/v, menstrual irregularities, inc risk of VTE, inc risk of endometrial ca, live damage, retinal deposits, cataracts

29
Q

DI’s from tamoxifen:

A
  • Warfarin, anastrozole, letrozole, rifampin
  • paroxetine, fluoxetine, bupropion- causes death
  • prego category D
30
Q

Raloxifene uses:

A

-breast cancer prevention in high risk post menopausal its

31
Q

Tamoxifen vs. raloxifine:

A

Tamoxifene: better in preventing noninvasive breast ca, but higher incidence of clots

raloxifine: fever cases of uterine ca, fewer clots, fewer cataracts

32
Q

Opemifene (SERM drug) Indic:

A

dyspareunia from vulvovaginal atrophy due to menopause

33
Q

Opemifene contra:

A

Clots, CVA, MI, prego, estrogen-dependent neoplasia, undx genital bleed

34
Q

Ospemifene ADRs:

A

Clots, hot flashes, vag discharge, muscle spasms, hyperhidrosis

35
Q

Toremifene indic.

A

tx of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or unknown tumors

36
Q

toremifene ADRs:

A
  • hypercalcemia,prolonged QT, endometrial hyperplasia

- hotflashes, sweating, N, dizziness, edema, cataracts, clots, LFT elevation

37
Q

Toremifene DIs:

A
  • p450, 3a4

- thiazides

38
Q

Bazedoxifene/CE Indic:

A

moderate to severe vasomotor symptoms

-prevention of menopausal osteoporosis

39
Q

bazedoxifene black box:

A
  • endometrial ca in women with uterus
  • CVD or dementia
  • CVA and DVT
40
Q

Aromatase inhibitors:

A

non-steroidal: anastrozole, letrozole

steroidal: exemestane

41
Q

aromatase inhibitor Indic.

A

-first-line adjuvant breast ca tx in postmenopausal

42
Q

aromatase inhibitors ADRs:

A

hot flashes, N, thin hair

43
Q

Fulvestrant indic.

A

-postmenopausal women with hormone receptor positive metastatic breast ca that has progressed on tamoxifen

44
Q

is fulvestrant good to use with p450 drugs?

A

yes

45
Q

fulvestrant ADRs:

A

-N, asthenia, hot flashes, HA

pharm summer 1 (4 decks)

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