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PHARM II TEST 2 > Other Hormone Meds > Flashcards

Other Hormone Meds Flashcards

1
Q

MC complaint women have during menopause is?

A

Hot flashes

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2
Q

We give this during menopause to relieve GU atrophy; reduce pain w/sex, relieves vasomotor instability (hot flashes), improve sleep, reduce bone resorption in osteoporosis, stabilize mood swings…

A

Estrogen, can use estrogen vaginal products too

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3
Q

AEs/Risk in estrogen therapy?

A

CV risk, cancer, thrombosis…esp. endometrial cancer and BREAST CANCER (so we need a good Hx)

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4
Q

If a pt has a uterus, what do you need to use with the estrogen?

A

Progestin…if they’re had a hysterectomy, then you don’t need to add progestin

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5
Q

We use medroxyprogesterone for progestin therapy in menopause, what’s the good and the bad for that?

A

Benefits: lowers risk of irregular bleeding, endometrial hyperplasia, carcinoma, protection against breast carcinoma, enhancement of estrogen prophylaxis of osteoporosis

AEs: bloating, weight gain, irritability, depression, unpredictable endometrial bleeding

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6
Q

The women’s health initiate study looked at long term risks of hormone replacement therapy

A

Lung cancer, breast cancer, endometrial cancer, ovarian cancer (estrogen)

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7
Q

Estrogen + Cyclic progesterone, estrogen + continuous progesterone, intermittent are the three therapy regimens, explain.

A

Cyclic = mimics female cycle

Continuous refers to progesterone

Intermittent is the progesterone 3 days on, 3 days off

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8
Q

Vaginal estrogen products are indicated just for what?

A

Vaginal atrophy, no systemic effects except the femring

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9
Q

Bazedoxifene w/ conjugated estrogens (Duavee)…the B is a selective estrogen receptor modulator (agonist/antagonist) so it acts as an agonist of estrogen receptors in some estrogen sensitive tissues and antagonist in others (uterus)…reduces risk of endometrial hyperplasia, what is it used for?

A

Moderate to severe vasomotor symptoms from menopause and preventions of postmenopausal osteoporosis

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10
Q

Duavee has what adverse reactions and preg category?

A

CV disorders, hypertriglyceridemia, malignant neoplasms, gallbladder disease

Preg cat X

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11
Q

Non-hormonal options for menopause include what drug classes?

A

Vaginal lubricants

Selective Estrogen Receptor Modulators (SERMs - raloxifene)

SSRIs (Paroxetine mesylate)

SNRIs (venlafaxine)

Clonidine, gabapentin, methyldopa

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12
Q

Herbals/phytoestrogens for menopause?

A

Red clover, soy isoflavones, black cohosh, other

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13
Q

What are the three selective estrogen receptor modulators (SERMs) we talk about?

A

Ospemifene
Tamoxifen
Raloxifene

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14
Q

SERMs are agonists where we want them and antagonists mostly to reduce cancer risk, but might cause hot flashes, what are the other AEs?

A

CV risk, stroke, DVT, PE, endometrial cancer risk

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15
Q

This drug is used for treatment of moderate to severe dyspareunia caused by valvular and vaginal atrophy (menopause) but is NOT approved for osteoporosis

A

Ospemifene

Some CYP DIs

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16
Q

This drug is not really used for much outside of breast cancer and prevention of breast cancer in high risk women…again NOT for osteoporosis

A

Tamoxifen

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17
Q

This drug can be used to prevent/treat osteoporosis in postmenopasual women…not for premenopausal women (teratogen)

A

Raloxifene PO…DIs include bile acid resins, warfarin, thyroid hormones

18
Q

Drug that mediates ovulation through increased output of pituitary gonadotropins and estrogens by inhibiting the action of stronger estrogens on the body’s negative feedback system…basically it’s to treat ovulation failure, help her get pregnant, nom ore than 3 courses recommended.

A

Clomiphene (Clomid) PO

AEs look like menopause (b/c increased LH/FSH)…also increases possibility of multiple fetuses

19
Q

Drug class that inhibits production of estrogen by blocking _________, a cytochrome p450 enzyme that distinguishes estrogen from progesterone

A

Aromatase inhibitors like Letrozole, Anastrozole, Exemestane

20
Q

Two progesterone antagonists are? What do they do?

A

Mifepristone (Mifeprex): termination of intrauterine pregnancy up to 70 days of gestation

Mifepristone (Korlym): treat hyperglycemia in pts with Cushing syndrome

21
Q

Anabolic actions of androgens stimulate the production of RBCs in pts w/refractory anemia (renal disease)…testosterone is inactivated when administered orally why?

A

First pass effect

22
Q

Clinical use of androgens (testosterone) in men and women?

A

Senile osteoporosis and anemia

Men: replacement therapy with testosterone deficiency; testicular insufficiency, impotence, primary hypogonadism

Women: hypopituitarism (w/estrogen), metastatic breast cancer and endometriosis

23
Q

This act declared anabolic androgens and prohormones as schedule III drugs b/c high potential for abuse/misuse?

A

Anabolic steroid control acts of 1990 and 2004

24
Q

AEs of androgens?

A

Adult males: azoospermia, oligospermia, priapism, impotence, gynecomastia, PREMATURE CLOSURE OF BONE EPIPHYSES IN PRE-PUBERTAL MALES (GROWTH STUNTED)

Females get masculinized

25
Q

Androgens that are long-acting come in what form, what about short acting?

A

Long: IM/SQ

Short: transdermal

26
Q

There are also oral androgens and anabolic androgens, used for what?

A

Oral: replacement, carcinoma of breast, post-pubertal cryptorchidism

Anabolic: weight gain where protein breakdown is at fault…anemia’s form deficient RBC production

(See drug chart)

27
Q

Androgen derivative used to treat endometriosis and fibrocytic breast disease, orally active synthetic androgen that supremes pituitary ovarian axis?

A

Danazol (Danocrine) PO

28
Q

Clinical uses for anti-androgens and androgen antagonists?

A

Prostate cancer, endometriosis, advanced breast cancer, female hirsutism, alopecia, acne, precocious puberty in males, BPH

29
Q

For BPH we use what drugs?

A

A-blockers (zosins)…tamsulosin and alfuzosin are only for BPH

Also 5a Reductase inhibitor: Finasteride

30
Q

What is the main indication for using Finasteride?

A

BPH: halts BPH profession and reduces prostate size and symptoms over time, also can be used for male pattern baldness

31
Q

AEs with Finasteride?

A

Decreased libido, ED…

Preg cat X: women have to not come into any contact w/crushed or broken tablets, semen from a male partner exposed to Finasteride also bad

32
Q

Main causes of ED?

A

Med, Arteriosclerosis, smoking and diabetes are big factors too

33
Q

PDE5 is responsible for degradation of cGMP in the corpus cavernosum, so inhibiting it increases blood flow there…no effect in the absence of sexual stimulation** so used for what?

A

ED, pulmonary arterial HTN, BPH

Vardenafil/Sildenafil lasts for 4 hours
Tadalafil lasts 36 hours

34
Q

What do you have to keep in mind when giving sildenafil (Viagra)?

What about Vardenafil (levitra)?

A

Reduced dose in renal/hepatic impairment for viagra

Levitra, don’t use with severe liver impairment or on hemodialysis

35
Q

Tadalafil has two other indications, which are?

A

Adcirca brand: pulmonary arterial HTN

Cialis: BPH

36
Q

AEs of PDE5-Is?

A

Upset stomach, nasal congestion, diarrhea, rash

HA, flushing of skin, HoTN, priapsm, vision changes (PDE6 actually bust still effects it by blurring/color changes)

37
Q

DIs for PDE5-Is?

A

Nitrates and a-blockers

Nitrates are CI, a-blockers it’s just a caution, maybe don’t use with pt who already has low HoTN

A-blockers for BPH: use tamsulosin b/c it’s selective for that, less HoTN

38
Q

Two FDA-approved androgens are?

Non-FDA approve supplement for ED?

A

FDA: fluoxymesterone, methyl testosterone, testosterone enanthate, testosterone propionate

Alprostadil

Non-FDA: Yohimbine HCl

39
Q

This drug is an alternative to conventional treatment, particularly for ED due to neurogenic, vasculogenic, psychogenic, or mixed etiology?

Not preferred

A

Alprostadil

There’s also injectable and urethral pellet options

CI in men w/conditions that predispose them to priapism or ED in men with fibrotic conditions of the penis

40
Q

In female sexual dysfunction, what works?

A

Non-pharm first

Dopamine agonists in women with Parkinson’s

FLIBANSERIN IS THE ONLY MED APPROVED FOR FEMALE SEXUAL DYSFUNCTION

There are herbal supplements

41
Q

The MoA of this drug exhibits sertonergic and dopaminergic activity that treats premenopausal women with acquired generalized hypactive secual desire disorder (HSDD)

A

Flibanserin (Addyi)

Don’t use with co-existing psych condition, problems in relationship, post-menopause, or to enhance performance

AEs: look out for dizzy, drowsiness, HoTN, syncope…alcohol makes that worse, take these at bedtime

PHARM II TEST 2 (7 decks)

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