HRT Flashcards
estrogen indication
relieve vasomotor sx
common estrogen HRT adr
HA, breast tenderness, bleeding, nausea
serious possible estrogen complications
CHD, CVA, VTE, breast cancer, gallbladder dz
do we worry about breast cancer?
yes but not as much with this age group? as compared to concerns with OCP
what estrogen formulation has lower breast cancer risk and why?
transdermal due to less systemic absorption
how to dose estrogen hrt?
based on form and sx relief needed
which formulations don’t have first pass effect 3
gels, sprays, emulsions
when would intravaginal forms be useful?
vaginal atrophy - large systemic absorption
tables and rings have lower estrogen absorption than ___
creams
rings give a sustained release of estradiol in ___
liquid polymer matrix
estrogen for HRT increases risk for
stroke
VTE
(both above increase with age anyway but estrogen amplifies risk)
when if ever should you discontinue HRT estrogens?
at least 4-6 wks prior to surgeries due to clot risk
lifestyle med - so can take off when needed to reduce risks
if a women still has her uterus and wants HRT..
MUST GIVE HER PROGESTROGEN WITH ESTROGEN ….NEVER GIVE ESTROGEN ALONE
why> endometrial cancer risk
women with uterus and persistent or recurrent bleeding on HRT must
rule out endometrial cancer with biopsy
____is an absolute contraindication for HRT
pt with a breast cancer history
t or f estrogen only HRT treatment has higher risk of dementia
false - estrogen with progesterone is much higher risk for dementia as well as breast cancer and DVT
which therapy option has highest risk of stroke?
estrogen only
isoflavones ex
soy, garbanzos, red clover, lentils, beans
lignans ex
flaxseed
fruits, lentils, grains, beans, veggies
coumestans
more like estrogens red clover sunflower seeds sprouts can act like estrogen antagonists or agonists depending on tissue type
phytoestrogens are similar to
endogenous estrogen
women with __ _should avoid phytoestrogens
history of breast cancer, or family history avoid it all
natural products for hot flashes
soy
flaxseed
black cohash
t/f black cohosh is as effective as low dose Estraderm patch
true
warnings of black cohosh
hepatotoxic contaminant
LFT
newer formulation better
what phytoestrogens to avoid
dong quai, chasteberry, ginseng, kudzu, alfalfa, hops, licorice
wild yam is from what species
discorea sp.
wild yam is a natural form of __
progesterone
flibaserin is for__
hypoactive sexual desire disorder (HSDD)
fibaserin ADR
like opioids
sedation, syncope, CNS depression
flibanserin with alcohol =
syncope
flibanserin in 2C19 poor metabolizers
increased half life Cmax
what are 3 contraindicaitons for flibanserin
alcohol, 3A4 inhibitors, hepatic impairment
what are good HRT options for breast cancer pts
non hormonal options such as clonidine, SSRI, gabapentin
women with increased clot risk areadly..
should not take estrogen containing therapy
biest is a
estrogen compound
80% estriol and 20% estradioil
triest is a
estrogen compound
10% estradiol, 10% estrone, 80% estriol