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Pharmacology > Hormones KC > Flashcards

Hormones KC Flashcards

1
Q

Indications for estrogen

A
  1. contraception
  2. menopausal hormone replacement
  3. endometriosis
  4. dysfunctional uterine bleeding
  5. urogenital atrophy
  6. infertility
  7. PCOS (w/ progesterone)
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2
Q

Estrogen CIs

A
  1. Liver disease
  2. hypercoagulable states
  3. cancer - breast, ovarian, uterine, endometrial
  4. Strong risk factors for atherosclerosis (HTN, DM, high cholesterol, strong FMHx of stroke, MI)
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3
Q

Estrogen MOA

A

helps modulate the pituitary secretion of gonadotropins, LH and FSH

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4
Q

Estrogen S/E

A
  1. migraines
  2. water retention, bloating
  3. weight gain
  4. stimulates reproductive organ tissues - vaginal bleeding/spotting, enlarge fibroids (pelvic cramping), breast tenderness
  5. gallbladder disease
  6. nausea
  7. thrombosis
  8. skin rashes
  9. increased triglycerides
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5
Q

special consideration for postmenopausal woman with uterus who is initiating estrogen therapy

A

must coadminister progesterone - interrupts proliferative process of endometrium and decreases risk of endometrial cancer

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6
Q

Indications for progestins

A
  1. contraception
  2. menopausal hormone therapy replacement
  3. decrease endometrial hyperplasia
  4. treatment for secondary amenorrhea
  5. emergency contraception (high dose)
  6. dysfunctional uterine bleeding
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7
Q

Progestin CI

A
  1. risks for DVT, PE
  2. unexplained vaginal bleeding
  3. breast cancer
  4. active liver disease
  5. conditions of concern for hypoestrogenic effects and reduced HDL (HTN, hx of ischemic heart disease, hx of stroke)
  6. diabetes >20 years or w/ neuropathy, retinopathy, nephropathy, or vascular disease
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8
Q

Progestin MOA

A
  1. inhibits pituitary gonadotropin release
  2. prevents follicular maturation
  3. transforms proliferative endometrium into secretory endometrium
  4. inhibits spontaneous uterine contractions
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9
Q

Generations of progestin agents and what they mean

A

first, second, third, fourth

based on degree of affinity for estrogen, androgen, and progesterone receptors

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10
Q

most androgenic progestin and what this means

A

Levonorgesterol

acne, hirsutism are most common side effects

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11
Q

Progestin S/E

A
  1. androgenic activity - acne, hirsutism, insulin resistance, increased LDL
  2. DVT
  3. vaginal bleeding/spotting
  4. weight gain
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12
Q

progestin good for women who complain about fluid retention or bloating with menstrual cycle

A

drospirenone

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13
Q

Routes of delivery for estrogen

A
  1. oral
  2. transdermal patch
  3. vaginal ring
  4. vaginal cream
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14
Q

routes of delivery for progestin

A
  1. oral
  2. IUD
  3. subcutaneous rods
  4. IM
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15
Q

routes of delivery for combination estrogen and progesterone

A
  1. oral
  2. transdermal patch
  3. vaginal ring
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16
Q

Schedule for PO progestin for birth control

A

don’t take week off, continuously take progesterone

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17
Q

benefits of IUDs

A

good for pts who cannot take estrogen but cannot tolerate or remember progesterone only pill
less side effects compared to PO

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18
Q

frequency of IM injections of progestin

A

every 3 months

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19
Q

benefits of transdermal patch

A

good for pts w/ GI issues because consistent levels compared to PO pill

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20
Q

how long does estrogen vaginal ring last?

A

90 days

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21
Q

benefits of estrogen vaginal ring

A

good for vaginal atrophy, urinary incontinence, symptoms related to menopause

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22
Q

how to use combination vaginal ring

A

for birth control only, left in for 3 weeks then take out 4th week

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23
Q

hormone options for contraception

A
  1. combination estrogen and progesterone

2. progesterone only

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24
Q

hormone options for hormone replacement therapy

A
  1. estrogen only (women w/o uterus)
  2. combination estrogen and progesterone (women w/ uterus)
  3. NOT progesterone alone
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25
Q

contraceptive options for combination estrogen and progesterone

A
  1. pill - monophasic, biphasic, triphasic
  2. nuvaring
  3. combipatch
26
Q

contraceptive options for progesterone only

A
  1. depo provera injection
  2. IUD
  3. pill
  4. nexplanon, implanon
27
Q

estrogen in contraception

A

ethinyl estradiol

28
Q

types of progestin

A
  1. levonorgesterol
  2. norethindrone
  3. medroxyprogesterone
  4. norgestimate
  5. drospirenone
29
Q

monophasic pill

A

same amount of ethinyl estradiol and progesterone for week 1, 2, 3 then take 4th week off

30
Q

biphasic pill

A

same amount of ethinyl estradiol and progesterone for week 1, 2, 3 then 4th week has a little bit of estrogen

31
Q

triphasic pill

A

same steady amount of ethinyl estradiol but levels of progesterone changes each week - tries to mimic body’s natural response

32
Q

benefit of biphasic pills

A

prevent withdrawal - prevent headaches

33
Q

benefit of triphasic pills

A

good for acne

34
Q

typical dose of ethinyl estradiol you start someone at

A

10-25 mcg

35
Q

Hormone contraception

A
  1. smoking (relatively if <35, definitely if >35)
  2. previous hx of DVT or PE
  3. familial factor V leiden
  4. 2 or more risk factors for cardiovascular disease (ie smoking, HTN, DM)
36
Q

MOA hormone contraception

A
  1. suppress ovulation
    - estrogen: suppression of production of FSH –> prevents follicle maturation
    - progestin: prevent LH surge
  2. changes endometrium making implantation less likely
    - progestin makes lining inhospitable to implantation
    - no thickening or uterine lining
    - thickens cervical mucous
37
Q

Hormone Contraception S/E

A
  1. breakthrough bleeding when OCP is started
  2. estrogen side effects
  3. progestin s/e - acne, hirsutism
38
Q

what is extended cycle

A

continuous dosing, skipping placebo effect
monophasic pill
3 months of active pill, may have breakthrough bleeding so stop and have period then resume

39
Q

specific s/e of extended cycle, progestin only, depo provera, morning after pill (hormone contraception)

A

extended cycle –> breakthrough bleeding, acne
progestin only –> breakthrough bleeding
depo provera –> decreased bone density (limit to 2 yrs)
morning after –> nausea

40
Q

when OCPs are used properly, they prevent pregnancy ___% of the time

A

99

41
Q

failure rate of OCPs

A

2-3%

42
Q

Selective Estrogen Receptor Modulators examples

A

tamoxifen / Nalvadex

raloxifene / Evista

43
Q

estrogen receptor antagonist example

A

Clomid / Clomiphene

44
Q

SERM MOA

A
  1. estrogen agonist activity on bones and lipids
  2. estrogen antagonist effect on breast - block estrogen uptake in breast (tamoxifen)
  3. estrogen antagonist effect on breast and uterus (evista)
45
Q

Indications for SERMs

A
  1. estrogen receptor positive breast cancer (tamoxifen)
  2. Prevention and treatment of osteoporosis in post menopausal women
  3. prevention of breast cancer in high risk women (raloxifene)
46
Q

tamoxifen vs evista

A

tamoxifen does not block estrogen at uterus so can have stimulated endometrial growth and endometrial hyperplasia - requires endometrial screening

47
Q

how long to give SERM

A

if low risk 5 years

if high risk 10 years

48
Q

Clomid MOA

A

stimulates follicles to develop

49
Q

SERMs CIs

A

pregnancy and lactation

history of thromboembolic events

50
Q

SERMs S/E

A
  1. hot flashes
  2. nausea, vomiting
  3. menstrual irregularities
  4. endometrial effects (increased endometrial thickness, polyps, leiomyomas, cancer)
  5. thromboembolism
  6. stroke
51
Q

Aromatase Inhibitors examples

A

anastrozole / arimidex

Letrozole / femara

52
Q

Aromatase Inhibitors MOA

A

block the conversion of testosterone to estradiol and androstenedione into estrone (so no synthesis of estrogen)

53
Q

Aromatase Inhibitors indications

A
  1. hormone-sensitive breast cancers in POST MENOPAUSAL WOMEN
  2. first-line therapy for metastatic breast cancer
  3. advanced therapy if treatment with tamoxifen fails and disease progression continues
54
Q

Aromatase Inhibitors CIs

A
  1. pregnancy
  2. anastrozole not used in premenopausal women
  3. caution if renal insufficiency –> dose adjustment
55
Q

Aromatase Inhibitors treatment timeframe

A

5 years if lower risk

56
Q

Aromatase Inhibitors S/E

A
  1. reduced bone density and increased fractures
  2. hot flashes
  3. increased sweating
  4. nausea
  5. fatigue
  6. peripheral edema
  7. increased appetite
57
Q

AIs vs. SERMs

A

estrogen metabolites reduced with AIs but not SERMS

SERMs will block exogenous estrogen but AIs won’t

58
Q

oxytocin route of administration and half life

A

IV, SQ, 3 minutes

59
Q

Oxytocin Indications

A
  1. induction of labor
  2. augmentation of labor
  3. prevention and treatment of postpartum bleeding
60
Q

Oxytocin CIs

A

previous uterine rupture

anticipation of non-vaginal delivery

61
Q

Oxytocin S/E

A
  1. hypotension with rapid administration (mom & baby)
  2. abnormally high uterine tone (uterine rupture)
  3. tachycardia
  4. premature ventricular contractions

Pharmacology (27 decks)

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