MHT/SERM/TSEC Pharm

Question 1

Estrogen Forms Used in MHT (4)

Answer 1

Estradiol (acetate and cypionate forms)

Conjugated Estrogens

Esterified Estrogens (mostly Na+ estrone sulfate)

Estropitate (estrone with piperazine)

Question 2

Progestins

Examples (3), Effect and Indication with Explanation

Answer 2

Medroxyprogesterone
Methyltestosterone
Progesterone

Progestins oppose the actions of estrogen

Used for women on MHT therapy that still have uterus
Decreases risk of endometrial cancer

Question 3

Estrogen Effects (8)

Answer 3

Endometrial Proliferation**

Decreases: Cholesterol, Anti-Thrombin III, Osteoclast Activity

Increases: Triglycerides, Clotting Factors, Platelet Aggregation, Fluid Retention, TBG

Question 4

Menopausal Hormone Therapy

Indication and Contraindications (3)

Answer 4

Moderate to severe vasomotor symptoms and vaginal changes

Unusual vaginal bleeding
Thromboembolic diseases
Estrogen-related neoplasias (breast, ovary, uterus)

Question 5

Ospemifene

Drug Class, Indication, Mechanisms of Action (5)

Answer 5

Selective Estrogen Receptor Modulator

Dyspareunia (painful intercourse)

Vaginal estrogen Agonist
Increase cell growth and Secretions
Decrease pH and pain during intercourse
Breast estrogen Antagonist

Question 6

Ospemifene
Side Effects (3) and Contraindications (3)

Answer 6

Worsening hot flashes
Increased risk of clotting
Endometrial Thickening/Hyperplasia

Unusual vaginal bleeding
Thromboembolic diseases
Estrogen-related neoplasias (breast, ovary, uterus)

Question 7

Bazedoxifine
Drug Class (2), Indications (2), Mechanisms of Action (4)

Answer 7

Tissue Selective Estrogen Complex
Used in combination with Conjugated Estrogens

Moderate to severe menopausal symptoms in women with uterus
Prevention of post-menopausal osteoporosis i women with uterus

Breast and Endometrial estrogen antagonist
Bone estrogen agonist
Destroys HER2 malignant cells

Question 8

Bazedoxifine
Side Effects (2) and Contraindications (3)

Answer 8

Estrogen-related side effects (due to CE combo)
Worsens hot flashes/sweating

Unusual vaginal bleeding
Thromboembolic diseases
Estrogen-related neoplasias (breast, ovary, uterus)

Question 9

Clomiphene

Drug Class, Indications (3), Mechanisms of Action (3)

Answer 9

Selective Estrogen Receptor Modulator

Infertility in women with:
PCOS
Amenorrhea
Dysfunctional bleeding with anovulatory cycles

Blocks estrogen inhibition at hypothalamus (purely anti-estrogenic)
Increases GnRH which increases FSH/LH
Stimulates ooctye development and ovulation

Question 10

Clomiphene
Side Effects (5)

Answer 10

Multiple births (mostly twins)
Ovarian cysts 
Ovarian cancer with prolonged use (limit to 3 cycles)
Hot flashes
Luteal Phase Dysfunction (inadequate progesterone)

Question 11

Combined Estrogen and Progestin Therapy

Harms (7) and Benefits (3)

Answer 11

Harms:
Breast cancer
Coronary Heart Disease
Stroke
Venous Thromboembolism
Dementia
Gallbladder Disease 
Urinary Incontinence

Benefits:
Diabetes maintenance
Decreased Fractures
Decreased colorectal cancer

Question 12

Estrogen Therapy

Harms (5) and Benefits (3)

Answer 12

Harms:
Stroke
Venous Thromboembolism 
Dementia
Gallbladder Disease
Urinary Incontinence

Benefits:
Decreased Breast cancer
Decreased Fractures
Diabetes Maintenance

Question 13

Menopause Symptoms (6)

Answer 13

Hot flashes
Night sweats
Dyspareunia
Sleep disturbances
Mood issues
Urinary incontinence