MHT, SERM, TSEC Pharmacology

Question 1

MHT stands for?

Answer 1

Menopausal Hormone Therapy

Question 2

What are some symptoms of menopause?

Answer 2

Hot flashes/sweating
Vaginal dryness
Sleep disturbances
UI

Question 3

What are the general options for MHT?

Answer 3

Estrogen +/- Progestin

Question 4

Women with an intact uterus must also get what with MHT?

Answer 4

Estrogen + PROGESTIN

Question 5

With MHT, women with an intact uterus get?

Answer 5

ESTROGEN + PROGESTIN

Question 6

What does Progestin do?

Answer 6

Opposes the effects of Estrogen

Question 7

What are the 4 Estrogenic forms with MHT?

Answer 7

• Estradiol
• Conjugated Estrogens
• Esterified Estrogens
• Estropipate

Question 8

What are the 4 Estrogenic forms with MHT?

Answer 8

• Estradiol
• Conjugated Estrogens
• Esterified Estrogens
• Estropipate

Question 9

What are the 3 Progestin forms with MHT?

Answer 9

• Medroxyprogesterone
• Methyltestosterone
• Progesterone

Question 10

What are the 3 Progestin forms with MHT?

Answer 10

• Medroxyprogesterone
• Methyltestosterone
• Progesterone

Question 11

What 3 things can Estrogen DECREASE?

Answer 11

1. Cholesterol
2. Anti-thrombin III
3. Osteoclast activity

Question 12

What 5 things can Estrogen INCREASE?

Answer 12

1. Triglycerides (hdl-c)
2. Clotting factors
3. Platelet aggregation
4. Na+/fluid retention
5. TBG

Question 13

The Women’s Health Initiative Studies examined the beneficial/risks of MHT. What were the 2 trial groups?

Answer 13

1. With a uterus

2. Without a uterus

Question 14

With the WHIs, the women with an intact uterus received what therapy?

Answer 14

Estrogen + Progestin

Question 15

With the WHIs, the women without a uterus received what therapy?

Answer 15

Estrogen only

Question 16

Estrogen + Progestin… what are the HARMS?

Answer 16

Breast cancer
CAD
Gallbladder disease
Stroke/VTE
Dementia
UTI

Question 17

Estrogen + Progestin… what are the HARMS?

Answer 17

Breast cancer
CAD
Gallbladder disease
Stroke/VTE
Dementia 
UTI

Question 18

Estrogen + Progestin… what are the BENEFITS?

Answer 18

– decreases risk of:
Colorectal cancer
Fractures
Diabetes

Question 19

Estrogen + Progestin… what are the BENEFITS?

Answer 19

– decreases risk of:
Colorectal cancer
Fractures
Diabetes

Question 20

Estrogen only… what are the HARMS?

Answer 20

Gallbladder disease
Stroke/VTE
Dementia
UI

Question 21

Estrogen only… what are the BENEFITS?

Answer 21

– decreases risk of:
Breast cancer
Fractures
Diabetes

Question 22

What are 2 harms that are present with Estrogen + Progestin and NOT present with Estrogen only/

Answer 22

Breast cancer

CAD

Question 23

What is MHT best at treating?

Answer 23

Vasomotor symptoms

Vaginal dryness

Question 24

What is MHT best at treating?

Answer 24

Vasomotor symptoms

Vaginal dryness

Question 25

Why must women with an intact uterus also be on a Progestin?

Answer 25

It opposes Estrogens effects | -- stops the endometrial hyperplasia that is occurring with just estrogen

Question 26

If a menopausal woman presents with vaginal symptoms only, what is a better treatment option than MHT?

Answer 26

Topical estrogen cream

Question 27

What happens several years after MHT is stopped?

Answer 27

Risks and benefits are eliminated

Question 28

If you are going to use MHT, how should you use it?

Answer 28

Lowest dose for the shortest duration possible

Question 29

SERM stands for?

Answer 29

Selective Estrogen Receptor Modulator

Question 30

TSEC stands for?

Answer 30

Tissue Selective Estrogen Complexes

Question 31

Generally, what do SERMs and TSECs do?

Answer 31

Pro-estrogen on some tissues and Anti-estrogen on others

Question 32

What are the 2 SERMs?

Answer 32

Ospemifene | Clomiphene

Question 33

What are the 2 SERMs?

Answer 33

Ospemifene | Clomiphene

Question 34

What is 1 TSEC?

Answer 34

Bazedoxifene

Question 35

What is 1 TSEC?

Answer 35

Bazedoxifene

Question 36

SERMs are Anti-estrogen where?

Answer 36

Breast | Endometrium

Question 37

What are TSECs?

Answer 37

SERMS + Estrogen component

Question 38

What are 2 indications for the use of Ospemifene?

Answer 38

1. Dyspareunia (pain with sex) | 2. Vaginal dryness

Question 39

If a patient presents with dyspareunia and vaginal dryness, what SERM should you prescribe?

Answer 39

Ospemifene

Question 40

MOA for Ospemifene?

Answer 40

Pro-estrogen at vagina and endometrium

Question 41

What are 2 indications for the use of Bazedoxifene?

Answer 41

1. Vasomotor symptoms in a woman with a uterus | 2. Prevention of osteoporosis in a woman with a uterus

Question 42

Bazedoxifene should be used with a woman with or without a uterus?

Answer 42

WITH - vasomotor symptoms - prevention of osteoporosis

Question 43

MOA for Bazedoxifene?

Answer 43

Pro-estrogen physiologically and in bone

Question 44

Which drug can destroy HER2 cells?

Answer 44

Bazedoxifene

Question 45

What are 3 indications for the use of Clomiphene?

Answer 45

1. Infertility in anovulatory women 2. Irregular ovulation or luteal phase defects 3. PCOS

Question 46

What are 3 indications for the use of Clomiphene?

Answer 46

1. Infertility in anovulatory women 2. Irregular ovulation or luteal phase defects 3. PCOS

Question 47

MOA for Clomiphene?

Answer 47

Anti-estrogenic = blocks (-) feedback from estrogen on the hypothalamus --> increases release of gonadotropins

Question 48

Which drug blocks the negative feedback from estrogen on the hypothalamus in order to increase the release of gonadotropins? (anti-estrogenic)

Answer 48

Clomiphene

Question 49

A woman presents with infertility due to anovulation. What should she be treated with?

Answer 49

Clomiphene

Question 50

A woman with a uterus presents with vasomotor symptoms and wants to prevent osteoporosis. What should she be treated with?

Answer 50

Bazedoxifene