Hormones

Question 1

Indications of estrogen use

Answer 1

1. Prevention of pregnancy
2. Menopausal hormone replacement
3. Endometriosis
4. Dysfunctional uterine bleeding
5. Urogenital atrophy
6. Infertility
7. PCOS

Question 2

Contraindications of Estrogen Use

Answer 2

1. Liver disease - can worsen disease
2. Hypercoagulable states - impact the clotting cascade and increases risk of DVT or PE
3. Cancers with increased growth in response to estrogen - breast, ovarian, uterine, endometrial
4. Strong risk factors for atherosclerosis - HTN, DM, High cholesterol, Strong Family Hx

Question 3

MOA Estrogen

Answer 3

Modulates the pituitary secretion of LH and FSH

Question 4

Side Effects Estrogen

Answer 4

Migraine headaches, water retention (abdominal bloating, weight gain), stimulation of reproductive organs (vaginal bleeding or spotting - growth of endometrial tissue), enlarged fibroids, breast tenderness, gallbladder disease (associated with long term use), nausea, thrombosis, skin rashes, increased triglycerides

Question 5

In post-menopausal woman what do you need to administer with estrogen and why?

Answer 5

Progesterone. Estrogen stimulates endometrial growth and can stimulate cancers of reproductive tissues.

Only applies if the patient has a uterus. If patient has hysterectomy, then can just give estrogen only.

Question 6

What role does estrogen play with blood clotting and delivery?

Answer 6

Right after birth, estrogen is high and aids in preventing hemorrhage after birth. However, it increases her risk of DVT and PE in the long term recovery process of delivery.

Question 7

Indications of Progestins

Answer 7

1. prevention of pregnancy
2. menopausal HTR
3. decrease endometrial hyperplasia
4. treatment of secondary amenorrhea
5. Emergency contraception: high dose only
6. Dysfunctional uterine bleeding - aids in excessive bleeding for pt

Question 8

Contraindications Progestins

Answer 8

1. Risks for DVT and PE (less than estrogen though)
2. Unexplained vaginal bleeding
3. Breast cancer
4. Active liver disease
5. Conditions of concern for hypoestrogenic effects and reduce HDL levels, can increase CVD risk - HTN with vascular disease, ischemic heart disease, Hx stroke
6. DM for over 20 years or with neuropathy, retinopathy, neuropathy, or vascular disease

Question 9

MOA progestin

Answer 9

inhibits the pituitary GnRH, prevents follicular maturation, transforms proliferative endometrium into secretory endometrium, Inhibits spontaneous uterine contractions

Question 10

What generation of progestins is most androgenic?

Answer 10

second generation

Question 11

The more androgenic progestin, what happens for the patient?

Answer 11

creates more testosterone like side effects

Question 12

What progestin is the most androgenic?

Answer 12

Levonorgesterol

Question 13

Side Effects Progestins

Answer 13

1. Androgenic activity - acne, hirsutism, increased LDL, increased insulin resistance
2. DVT
3. Vaginal bleeding - common with progesterone only OC
4. Weight gain

Question 14

What patient education do you need to include with progesterone only OC?

Answer 14

Must take it at the same time every day (at least within the same 30-60 mins)

Question 15

Drospirenone (a progestin) is structurally similar to what medication? And who can this medication be good for?

Answer 15

Spironolactone, a woman for woman who complains about fluid retention with menstrual cycle/bloating

Question 16

Route of Delivery Progestin

Answer 16

Oral, IUDs, subcutaneous rods, IM

Question 17

Route of Delivery Estrogen

Answer 17

Oral, transdermal patch, vaginal ring, vaginal cream

Question 18

Route of Delivery Combination Estrogen/Progestin

Answer 18

oral, transdermal patch, vaginal ring