Hormone Replacement Therapy

Question 1

Human estrogen replacements

Answer 1

• estradiol
• estrone
• estriol

Question 2

synthetic estrogen replacements

Answer 2

• ethinyl estradiol
• mestranol
• conjugated estrogens
• diethylstilbestrol

Question 3

phytoestrogen replacements

Answer 3

• soy
• red clover
• flax
• alfalfa
• black cohosh
• dong quai

Question 4

Oral estrogens:

Answer 4

• conjugated estrogens
• Esterified estrogens
• Estropipate
• Mocronized estradiol

Question 5

Progestogens:

Answer 5

• Dydrogesterone
• medroxyprogesterone
• micronized progesterone
• Norethindrone
• norgestrel
• levonorgestrel

Question 6

how is estradiol metabolized

Answer 6

3A4

Question 7

Estrogen Indic.

Answer 7

-relief of vasomotor symptoms

Question 8

Estrogen ADRs:

Answer 8

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

Question 9

estrogen warning

Answer 9

• increased risk of stroke
• dementia
• CHD

Question 10

why no unopposed estrogen in pt with uterus?

Answer 10

endometrial cancer

Question 11

phytoestrogen risks:

Answer 11

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

Question 12

phytoestrogens may help with what part of menopause?

Answer 12

hot flashes

Question 13

how does red clover interact with warfarin?

Answer 13

may increase bleeding

Question 14

warning for black cohosh?

Answer 14

liver damage

Question 15

wild yam ADRs:

Answer 15

vomitting

Question 16

Flibanserin indications:

Answer 16

premenopausal hypoactive sexual desire disorder (HSDD)

Question 17

Flibanserin contra:

Answer 17

P450, 3A4 inhibitors, hepatic impairment

Question 18

flibanserin ADRs:

Answer 18

sedation, hypotension, syncope, cns depression,

REMS program: hypotension, syncope with EtOH use

Question 19

NAMS guidelines:

Answer 19

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

Question 20

compounded estrogen:

Answer 20

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

Question 21

breast cancer tx:

Answer 21

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

Question 22

SERMs:

Answer 22

• tamoxifen
• toremifene
• Raloxifene

Question 23

steroidal estrogen receptro antagonist

Answer 23

Fulvestrant

Question 24

Aromatase inhibitors:

Answer 24

• Anastrozole
• Exemestane
• Letrozole

Question 25

Tamoxifen uses:

Answer 25

- developed as OC - adjuvant therapy for breast ca - prevention in high risk women

Question 26

Tamoxifen warnings:

Answer 26

- hypercalcemia - uterine malignancies - endometrial hyperplasia and polyps - clots - liver abnormalities - ocular disorders

Question 27

how is tamoxifen metabolized?

Answer 27

p450

Question 28

tamoxifen adrs

Answer 28

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

Question 29

DI's from tamoxifen:

Answer 29

- Warfarin, anastrozole, letrozole, rifampin - paroxetine, fluoxetine, bupropion- causes death - prego category D

Question 30

Raloxifene uses:

Answer 30

-breast cancer prevention in high risk post menopausal its

Question 31

Tamoxifen vs. raloxifine:

Answer 31

Tamoxifene: better in preventing noninvasive breast ca, but higher incidence of clots raloxifine: fever cases of uterine ca, fewer clots, fewer cataracts

Question 32

Opemifene (SERM drug) Indic:

Answer 32

dyspareunia from vulvovaginal atrophy due to menopause

Question 33

Opemifene contra:

Answer 33

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

Question 34

Ospemifene ADRs:

Answer 34

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

Question 35

Toremifene indic.

Answer 35

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

Question 36

toremifene ADRs:

Answer 36

- hypercalcemia,prolonged QT, endometrial hyperplasia | - hotflashes, sweating, N, dizziness, edema, cataracts, clots, LFT elevation

Question 37

Toremifene DIs:

Answer 37

- p450, 3a4 | - thiazides

Question 38

Bazedoxifene/CE Indic:

Answer 38

moderate to severe vasomotor symptoms | -prevention of menopausal osteoporosis

Question 39

bazedoxifene black box:

Answer 39

- endometrial ca in women with uterus - CVD or dementia - CVA and DVT

Question 40

Aromatase inhibitors:

Answer 40

non-steroidal: anastrozole, letrozole | steroidal: exemestane

Question 41

aromatase inhibitor Indic.

Answer 41

-first-line adjuvant breast ca tx in postmenopausal

Question 42

aromatase inhibitors ADRs:

Answer 42

hot flashes, N, thin hair

Question 43

Fulvestrant indic.

Answer 43

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

Question 44

is fulvestrant good to use with p450 drugs?

Answer 44

yes

Question 45

fulvestrant ADRs:

Answer 45

-N, asthenia, hot flashes, HA