Other Hormone Meds

Question 1

MC complaint women have during menopause is?

Answer 1

Hot flashes

Question 2

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…

Answer 2

Estrogen, can use estrogen vaginal products too

Question 3

AEs/Risk in estrogen therapy?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Cyclic = mimics female cycle

Continuous refers to progesterone

Intermittent is the progesterone 3 days on, 3 days off

Question 8

Vaginal estrogen products are indicated just for what?

Answer 8

Vaginal atrophy, no systemic effects except the femring

Question 9

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?

Answer 9

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

Question 10

Duavee has what adverse reactions and preg category?

Answer 10

CV disorders, hypertriglyceridemia, malignant neoplasms, gallbladder disease

Preg cat X

Question 11

Non-hormonal options for menopause include what drug classes?

Answer 11

Vaginal lubricants

Selective Estrogen Receptor Modulators (SERMs - raloxifene)

SSRIs (Paroxetine mesylate)

SNRIs (venlafaxine)

Clonidine, gabapentin, methyldopa

Question 12

Herbals/phytoestrogens for menopause?

Answer 12

Red clover, soy isoflavones, black cohosh, other

Question 13

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

Answer 13

Ospemifene
Tamoxifen
Raloxifene

Question 14

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

Answer 14

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

Question 15

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

Answer 15

Ospemifene

Some CYP DIs

Question 16

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

Answer 16

Tamoxifen

Question 17

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

Answer 17

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

Question 18

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.

Answer 18

Clomiphene (Clomid) PO

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

Question 19

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

Answer 19

Aromatase inhibitors like Letrozole, Anastrozole, Exemestane

Question 20

Two progesterone antagonists are? What do they do?

Answer 20

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

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

Question 21

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

Answer 21

First pass effect

Question 22

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

Answer 22

Senile osteoporosis and anemia

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

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

Question 23

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

Answer 23

Anabolic steroid control acts of 1990 and 2004

Question 24

AEs of androgens?

Answer 24

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

Females get masculinized

Question 25

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

Answer 25

Long: IM/SQ Short: transdermal

Question 26

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

Answer 26

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)

Question 27

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

Answer 27

Danazol (Danocrine) PO

Question 28

Clinical uses for anti-androgens and androgen antagonists?

Answer 28

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

Question 29

For BPH we use what drugs?

Answer 29

A-blockers (zosins)...tamsulosin and alfuzosin are only for BPH Also 5a Reductase inhibitor: Finasteride

Question 30

What is the main indication for using Finasteride?

Answer 30

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

Question 31

AEs with Finasteride?

Answer 31

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

Question 32

Main causes of ED?

Answer 32

Med, Arteriosclerosis, smoking and diabetes are big factors too

Question 33

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?

Answer 33

ED, pulmonary arterial HTN, BPH Vardenafil/Sildenafil lasts for 4 hours Tadalafil lasts 36 hours

Question 34

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

Answer 34

Reduced dose in renal/hepatic impairment for viagra Levitra, don’t use with severe liver impairment or on hemodialysis

Question 35

Tadalafil has two other indications, which are?

Answer 35

Adcirca brand: pulmonary arterial HTN Cialis: BPH

Question 36

AEs of PDE5-Is?

Answer 36

Upset stomach, nasal congestion, diarrhea, rash HA, flushing of skin, HoTN, priapsm, vision changes (PDE6 actually bust still effects it by blurring/color changes)

Question 37

DIs for PDE5-Is?

Answer 37

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

Question 38

Two FDA-approved androgens are? Non-FDA approve supplement for ED?

Answer 38

FDA: fluoxymesterone, methyl testosterone, testosterone enanthate, testosterone propionate Alprostadil Non-FDA: Yohimbine HCl

Question 39

This drug is an alternative to conventional treatment, particularly for ED due to neurogenic, vasculogenic, psychogenic, or mixed etiology? Not preferred

Answer 39

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

Question 40

In female sexual dysfunction, what works?

Answer 40

Non-pharm first Dopamine agonists in women with Parkinson’s FLIBANSERIN IS THE ONLY MED APPROVED FOR FEMALE SEXUAL DYSFUNCTION There are herbal supplements

Question 41

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

Answer 41

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