Hormones 3 Flashcards
What are the pharmacological uses of estrogen and progesterone?
- contraceptives
- OP
- hypogonadism
- failure of ovarian development
- menstrual irregularities
- endometriosis
- carcinoma
Pharmacology: contraceptives
Alter control between pituitary and ovarian hormones
Pharmacology: OP
Estrogen replacement
Pharmacology: hypogonadism
Combo of estrogen and progesterone
Pharmacology: hypogonadism
Combo of estrogen and progesterone to address
- low ovarian function
- bleeding abnormalities
Pharmacology: failure of ovarian development may be the result of
Hypopituitarism
Pharmacology: failure of ovarian development
estrogens given at time of puberty to encourage development of secondary sex characteristics
Pharmacology: menstrual irregularities
- amenorrhea
- dysmenorrhea
Pharmacology: endometriosis
- progesterone and estrogen/progesterone combos
- to help shrink growths
What is endometriosis?
- deposits of uterine tissue that develop in other regions
- scar tissue
- difficulty getting pregnant
Pharmacology: carcinoma
- metastatic BC treated by estrogen for men and postmenopausal women
- progesterone for treating uterine cancer and other metastases
HRT: benefits
- improves bone mineralization
- may improve plasma lipid profile » reduce the risk of CVD in postmenopausal women
HRT: no bueno stuff
Increased risk of
- stroke
- thromboembolism
- altered blood clotting
- PE
- some cancers
- nausea
- LE swelling
HRT: timing of tx
start HRT when women are ≤ 60 and within 10 years of reaching menopause
HRT: cognitive benefits?
- no benefit in protecting cognitive decline of Alzheimer’s
- mixed results in other cognitive studies
How might HRT impact normal menstrual function?
- altered normal menstrual function with prolonged use
- unpredictable changes in bleeding pattern
HRT: increased risk for certain cancers
- can’t use estrogen with estrogen-sensitive BC
- importance of screening for women on contraceptives
HRT: nausea
Usually transient
SERM =
Selective
Estrogen
Receptor
Modulator
What do SERMs do?
- bind to and activate estrogen receptors on certain tissues
- block the effects on other tissues
Why might SERMs be a beneficial tx in cancer?
- can reduce carcinogenic effects of estrogen on breast and uterine tissue
- produce favorable effects on bone mineralization and cardiovascular function
Examples of SERMs
- Tamoxifen
- Raloxifene
Raloxifene is primarily used to treat
OP
Side effects of Raloxifene
- hot flashes
- bone/joint pain
- GI issues
- “flu-like” sx
What do anti-estrogens do?
block effects of estrogen by occupying the receptor
What are the examples of anti-estrogens?
- Clomiphene
- Fulvestrant
Clomiphene
- treats infertility by promoting ovulation
- mechanism is complex, but related to negative feedback loop
Fulvestrant
Antiestrogen used to treat estrogen-sensitive BC
What are antiprogestins used for?
termination of pregnancy and tx of
- uterine fibroids
- endometriosis
- Cushing syndrome
What do antiprogestins block?
Glucocorticoid receptors
example of antiprogestin
Mifepristone
What does Mifepristone do?
- terminates pregnancy
- must be taken within first 7 weeks of pregnancy
Korlym
- Tx of hyperglycemia due to increased cortisol in Cushing syndrome
- antiprogestin
Hormonal contraceptive components
Varying levels of estrogen/progesterone combos
What is inhibited with hormonal contraceptives?
- LH
- FSH
No ovulation!
Adverse effects of hormonal contraceptives have decreased with newer drugs due to
- less estrogen
- better forms of progestins
Risks of hormonal contraceptives
- thromboembolism
- cardiovascular events (usu associated with risk factors of smoking, HTN, hyperlipidemia)
Hormonal contraceptives may protect against
- endometrial/ovarian cancers
- relationship to BC more complicated
