HRT

Question 1

estrogen indication

Answer 1

relieve vasomotor sx

Question 2

common estrogen HRT adr

Answer 2

HA, breast tenderness, bleeding, nausea

Question 3

serious possible estrogen complications

Answer 3

CHD, CVA, VTE, breast cancer, gallbladder dz

Question 4

do we worry about breast cancer?

Answer 4

yes but not as much with this age group? as compared to concerns with OCP

Question 5

what estrogen formulation has lower breast cancer risk and why?

Answer 5

transdermal due to less systemic absorption

Question 6

how to dose estrogen hrt?

Answer 6

based on form and sx relief needed

Question 7

which formulations don’t have first pass effect 3

Answer 7

gels, sprays, emulsions

Question 8

when would intravaginal forms be useful?

Answer 8

vaginal atrophy - large systemic absorption

Question 9

tables and rings have lower estrogen absorption than ___

Answer 9

creams

Question 10

rings give a sustained release of estradiol in ___

Answer 10

liquid polymer matrix

Question 11

estrogen for HRT increases risk for

Answer 11

stroke
VTE
(both above increase with age anyway but estrogen amplifies risk)

Question 12

when if ever should you discontinue HRT estrogens?

Answer 12

at least 4-6 wks prior to surgeries due to clot risk

lifestyle med - so can take off when needed to reduce risks

Question 13

if a women still has her uterus and wants HRT..

Answer 13

MUST GIVE HER PROGESTROGEN WITH ESTROGEN ….NEVER GIVE ESTROGEN ALONE

why> endometrial cancer risk

Question 14

women with uterus and persistent or recurrent bleeding on HRT must

Answer 14

rule out endometrial cancer with biopsy

Question 15

____is an absolute contraindication for HRT

Answer 15

pt with a breast cancer history

Question 16

t or f estrogen only HRT treatment has higher risk of dementia

Answer 16

false - estrogen with progesterone is much higher risk for dementia as well as breast cancer and DVT

Question 17

which therapy option has highest risk of stroke?

Answer 17

estrogen only

Question 18

isoflavones ex

Answer 18

soy, garbanzos, red clover, lentils, beans

Question 19

lignans ex

Answer 19

flaxseed

fruits, lentils, grains, beans, veggies

Question 20

coumestans

Answer 20

more like estrogens 
red clover 
sunflower seeds 
sprouts  
can act like estrogen antagonists or agonists depending on tissue type

Question 21

phytoestrogens are similar to

Answer 21

endogenous estrogen

Question 22

women with __ _should avoid phytoestrogens

Answer 22

history of breast cancer, or family history avoid it all

Question 23

natural products for hot flashes

Answer 23

soy
flaxseed
black cohash

Question 24

t/f black cohosh is as effective as low dose Estraderm patch

Answer 24

true

Question 25

warnings of black cohosh

Answer 25

hepatotoxic contaminant
LFT
newer formulation better

Question 26

what phytoestrogens to avoid

Answer 26

dong quai, chasteberry, ginseng, kudzu, alfalfa, hops, licorice

Question 27

wild yam is from what species

Answer 27

discorea sp.

Question 28

wild yam is a natural form of __

Answer 28

progesterone

Question 29

flibaserin is for__

Answer 29

hypoactive sexual desire disorder (HSDD)

Question 30

fibaserin ADR

Answer 30

like opioids

sedation, syncope, CNS depression

Question 31

flibanserin with alcohol =

Answer 31

syncope

Question 32

flibanserin in 2C19 poor metabolizers

Answer 32

increased half life Cmax

Question 33

what are 3 contraindicaitons for flibanserin

Answer 33

alcohol, 3A4 inhibitors, hepatic impairment

Question 34

what are good HRT options for breast cancer pts

Answer 34

non hormonal options such as clonidine, SSRI, gabapentin

Question 35

women with increased clot risk areadly..

Answer 35

should not take estrogen containing therapy

Question 36

biest is a

Answer 36

estrogen compound

80% estriol and 20% estradioil

Question 37

triest is a

Answer 37

estrogen compound

10% estradiol, 10% estrone, 80% estriol