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Repro 2 > MHT and SERMs - Segars > Flashcards

MHT and SERMs - Segars Flashcards

1
Q

In Menopause, you simply must resupply _____

A

The hormones that she is now deficient in

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2
Q

Menopause symptoms

A

Hot flashes, night sweats, vaginal dryness, painful intercourse, sexual dysfunction, sleep disturbances, mood/cognition issues, urinary incontinence, reduced quality of life

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3
Q

Menopause causes increased prevalence of what diseases/issues?

A

Osteopenia/osteoporosis/fractures

ACS/MI/CVD

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4
Q

Primary therapy for menopause symptoms

***When must Progestin ALSO be given w/ estrogen? Why?

A

Estrogen

IF intact uterus – estrogen alone will cause endometrial hyperplasia and cancer

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5
Q

6 forms of post-menopause estrogens

A 
Estradiol (+/- acetate, etc.)
Conjugated estrogens (CEE)
Synthetic conjugated estrogens - A
Synthetic conjugated estrogens - B
Esterified estrogens (EE)
Estropipate (w/ piperazine)
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6
Q

3 forms of post-menopause progesterone (ONLY FOR THIS)

A

Medroxyprogesterone
Methyltestosterone
Progesterone

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7
Q

Which post-menopause progesterone can come with estrogen? Which one?

A

Medroxyprogesterone + CEE

Methyltestosterone + EE

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8
Q

Can progestins from HCs also be used in post-menopause?

A

YES - some of them

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9
Q

Are there non-oral forms of estrogen-only therapy?

Can they be used in all post-menopausal women?

A

YES - many

NO - only if uterus has been removed

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10
Q

***Estrogen-only therapy will DECREASE what lab values or physiologic processes?

These are the SAME as what?

A

Cholesterol (TC, LDL)
AT3
Osteoclastic activity

HC estrogens

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11
Q

***Estrogen-only therapy will INCREASE what lab values or physiologic processes?

These are the SAME as what?

A 
TGs, HDL
Clotting factors
Platelet aggregation
Na/H20 retention (wt gain)
TBG levels

HC estrogens

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12
Q

***ANY women on estrogen-only therapy (HC or HRT) have increased risk of what serious side effects?

Estrogen-only therapy in ANY woman (HC or HRT) is contraindicated in who?

A

DVT/PE/MI etc.

PMHx of vascular disease or event

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13
Q

A woman has a FHx of osteoporosis and wants to take HRT to prevent it. She has a Hx of a previous MI. Should you prescribe the HRT?

A

NO

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14
Q

Should MHT be used to prevent CVD and dementia in post-menopausal women?

Should MHT be used to prevent/treat osteoporosis or colon cancer?

A

NO - worsens risk

NO - CV risks outweigh benefits

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15
Q

***When can MHT be used to treat moderate/severe menopausal symptoms (more than just vaginal symptoms)?

A

Younger than 60 or within 10 years of menopause start

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16
Q

***How can MHTs be used to treat vaginal symptoms ONLY post-menopause?

A

Topical

17
Q

***Describe breast cancer risk with MHT

A

Increases w/ 3-5 years of continuous treatment, but returns to normal over time after stopping treatment

18
Q

A post-menopausal woman free of breast/uterine cancers or CV disease has been taking HRT for hot flashes, night sweats, vaginal issues, etc. She has been taking it for 3-5 years now. What should be discussed?

A

Potentially cutting dose or trying to stop therapy and re-assess symptoms. SHOULD NOT BE TAKEN INDEFINITELY

19
Q

MHT should ONLY be used for what?

Should NOT be used primarily for what?

A

Reducing hot flashes/night sweats/vaginal issues in post-menopausal women

NOT for bone disease, heart disease, or w/ concurrent cancers

20
Q

Goal of SERMs

A

Estrogenic (agonist) effects in some tissues w/ anti-estrogenic effects (antagonist) in other tissues

21
Q

Raloxifene, Tamoxifen, and Toremifene can be used for what? (NOT FOR HIS QUESTIONS)

A

Treating ER+ breast cancers, and potentially for osteoporosis too

22
Q

Ospemifene - what is it used for (ONLY)?

What is this caused by?

A

SERM - used for ORAL therapy for moderate to severe dyspareunia (painful intercourse)

Vulvar/vaginal atrophy and dryness

23
Q

Ospemifene - MoA

Specifically does what to the vagina?

A

ER agonist in vagina, ER antagonist in breast

Increases vagiinal superficial cell growth, increases vaginal secretions, decreases vaginal pH, and reduces vaginal pain/discomfort

24
Q

Ospemifene - side effects

A

Increased hot flashes/sweating, vaginal discharge, pro-coagulation, endometrial hyperplasia

25
Q

Ospemifene - contraindications

A

Vaginal bleeding, thromboembolic diseases, estrogen-related neoplasia (SAME AS ALL ESTROGENS)

26
Q

Bazedoxifene - ingredients

Has what effect?

A

SERM w/ CEE (estrogen)

PROGESTIN replacement (without being

27
Q

Bazedoxifine - MoA

A

Antagonist in endometrium (like progesterone) + estrogen agonist in bone (b/c CEE)

28
Q

Bazedoxifene - uses

A
  • Treat moderate/severe vasomotor symptoms of menopause (WITH UTERUS)
  • Prevent post-menopausal osteoporosis
29
Q

How does Bazedoxifene differ from other SERMs in terms of side effects?

How does Bazedoxifene differ than CEE + progestin?

A

No endometrial proliferation or worsened vasomotor symptoms

Less vaginal bleeding/spotting

30
Q

Bazedoxifene - side effects

A

Estrogen-related effects:

- Hot flashes, sweating, etc.

31
Q

Bazedoxifene - contraindications

A

Anything where estrogen is contraindicated

Repro 2 (28 decks)

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