Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EndoRepro 2 Exam 1 > Pharm MHT/SERM - Segars > Flashcards

Pharm MHT/SERM - Segars Flashcards

1
Q

what do you see an increase in prevalence of during menopause?

A
  1. bone effects: osteopenia/osteoporosis/fractures

2. CV effects: ACS/MI/CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the primary therapy for menopausal symptoms?

A

estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

women with an intact uterus must also be on what??

A

PROGESTIN

- due to increased risk of endometrial hyperplasia/carcinoma from unopposed tissue proliferation with prolonged duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the two most popular estrogenic forms of menopausal hormone therapy (MHT)?

A
  1. estradiol (tablet/vaginal ring)

2. conjugated estrogens (CE) - blend of 6 estrogen derivatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does progestin do?

A

it opposes estrogen’s effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the 3 available progestinic MHT compounds?

A
  • medroxyprogesterone (MPA)
  • methyl testosterone (alone) or Covaryx (with EE)
  • progesterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the effects of estrogen?

A

endometrial proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does estrogen decrease the production of?

A
  • cholesterol (TC.LDL-C)
  • anti-thrombin III
  • osteoclastic activity (bone turnover)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does estrogen increase the production of?

A
  • tryglycerides and HDL-C
  • clotting factors
  • platelet aggregation
  • sodium/fluid retention
  • thyroid binding globulin (TBG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what were the objectives of hormone trial of Women’s Health Initiative (WHI) study?

A

examine MHT’s purported beneficial or preventative effects on heart disease, osteoporosis-related fractures, and risk of various cancers (breast, endometrial, and colon cancers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what did the WHI study identify as harms of combined estrogen and progestin treatment? INCREASED risk of: (7)

A
  • breast cancer
  • CAD
  • dementia
  • gallbladder disease
  • stroke
  • venous thromboembolism
  • urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what did the WHI study identify as benefits of combined estrogen and progestin treatment? DECREASED incidence of:

A
  • colorectal cancer
  • diabetes
  • all fractures (decrease in osteoclastic activity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what did the WHI study identify as harms of estrogen only treatment? INCREASED risk of: (5)

A
  • dementia
  • gallbladder disease
  • stroke
  • venous thromboembolism
  • urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what did the WHI study identify as benefits of estrogen only treatment? DECREASED incidence of: (3)

A
  • breast cancer
  • diabetes
  • all fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the summary message from the WHI findings?

A

MHT very effectively minimizes/treats vasomotor symptoms and vaginal changes (and their associated complications)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MHT is an acceptable option for treating moderate to severe menopausal symptoms for who?

A

relatively young (up to age 59 or within 10 years of menopause) and healthy women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when is low dose vaginal estrogen (topical) the preferred treatment?

A

for women with vaginal symptoms only

18
Q

women who still have a uterus need to take what?

A

progestin along with estrogen to prevent uterine cancer

19
Q

women who have had their uterus surgically removed are able to take what?

A

estrogen alone

20
Q

both estrogen alone and combination therapy increase the risk of what?

A

blood clots

21
Q

an increased risk of what, is seen within 3-5 years of continuous estrogen with progestin therapy?

A

breast cancer

22
Q

if therapy is needed for moderate-severe vasomotor symptoms, what is the dose and duration?

A
  • lowest dose possible to control sx

- treat for the shortest duration possible, and re-evaluate at least yearly

23
Q

these drugs have beneficial pro-estrogenic (agonist) actions in select tissues with beneficial (or non-harmful) anti-estrogenic (antagonist) actions in other tissues

A

selective estrogen receptor modulators (SERM)

24
Q

these drugs combine the unique elements of a SERM with an estrogen compound

A

tissue selective estrogen complex (TSEC)

25
Q

ospemifene, clomiphene

A

SERMs

26
Q

Bazedoxifene

A

TSEC

- currently only used as combo with CE

27
Q

this drug is used to treat moderate-severe dyspareunia

- a sx of vulvar and vaginal atrophy (VVA) of menopause

A

osemifene

  • topical estrogen cream
  • or oral product tailored to more beneficial estrogen-like effects
28
Q

this drug functions as estrogen agonist by binding to ER’s in vagina, but also anti-estrogenic on breast
- increases superficial cell growth (on vaginal smear), increases vaginal secretions, decreases vaginal pH, reduces pain/discomfort during intercourse

A

ospemifene

29
Q

what are the side effects of ospemifene? (3)

A
  • worsening hot flashes/sweating
  • estrogenic-similar effects of coagulation (stroke/VTE demonstrated)
  • endometrial thickening (proliferation)
30
Q

what are the contraindications for ospemifene?

A
  • unusual/abnormal vaginal bleeding
  • thromboembolic disease (CVA, MI, VTE, PE, DVT)
  • estrogen-related neoplasia (uterine, ovarian, breast)
31
Q

this drug is used to treat:

  1. moderate-severe vasomotor symptoms associated with menopause in women with a uterus
  2. prevention of post-menopausal osteoporosis (along with Ca and vitD) in women with a uterus
A

Bazedoxifene (with CE)

32
Q

antagonistic activity in endometrium (replaces progestin-concept in women with an intact uterus) and in breast tissue; but also estrogenic (agonist)

A

Bazedoxifene MOA

33
Q

how is Bazedoxifene different than 1st generation SERMs?

A
  • does not stimulate endometrial proliferation
  • has been shown to destroy HER2 malignant cells (SERDs), including cells resistant to Tamoxifen, similar to anti-estrogen drug Fulvestrant
34
Q

what is the main Bazedoxifene-specific side effect (other than estrogen-related effects)?

A

it has the potential of worsening hot flashes/sweating (similar to Tamoxifen, Raloxifene and Ospemifene)

35
Q

what situation is Bazedoxifene contraindicated?

A

in all situations that estrogens are contraindicated (due to CE component)
- NOTE: Bazedoxifene is ONLY available as a complex in the US

36
Q

Clomiphene

A

anti-estrogen

37
Q

what is the indication for clomiphene?

A

infertility in anovulatory women

  • used to stimulate ovulation
  • dose orally between cycle-days 5-9
38
Q

what is the MOA of clomiphene?

A

most significant effect on induction of ovulation in women with amenorrhea, PCOS, and dysfunctional bleeding with anovulatory cycles

39
Q

what does Segars especially want us to know about the MOA of clomiphene?

A

it primarily blocks inhibitory actions of estrogen on hypothalamus GnRH and pituitary gonadotropin release
- increases gonadotropin secretion thereby stimulating the ovaries to develop oocyte follicles

40
Q

what are the side effects of clomiphene?

A
  • multiple births
  • ovarian cytst (ovarian cancer with prolonged use)
  • hot flashes
  • luteal-phase dysfunction

EndoRepro 2 Exam 1 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions