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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Sex hormones > Flashcards

Sex hormones Flashcards

1
Q

If long-term oestrogen therapy is required in women with a uterus, what other hormone should normally be added?

A

Progestogen

Reduce the risk of cystic hyperplasia of the endometrium and possible transformation to cancer

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2
Q

Why should a progestogen be added for women taking long-term oestrogen therapy who have a uterus?

A

Reduce the risk of cystic hyperplasia of the endometrium and possible transformation to cancer

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3
Q

Why are oestrogens NO LONGER used to suppress lactation?

A

Association with thromboembolism

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4
Q

What preparation can be used for menopausal atrophic vaginitis?

A

Topical vaginal oestrogen

Used for a few weeks and repeated if necessary

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5
Q

HRT may be used in women with early natural or surgical since they are at high risk of (?)

A

Osteoporosis

Early menopause is before age 45 years

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6
Q

If HRT is given to women for early menopause, at what age should they stop taking HRT?

A

Approximate age of natural menopause (i.e. until age 50 years)

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7
Q

What drug can be used in women who have vasomotor symptoms of menopause but cannot take an oestrogen?

A

Clonidine hydrochloride

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8
Q

What 5 conditions does HRT increase the risk of?

A 
Venous thromboembolism
Stroke
Endometrial cancer (reduced by a progestogen)
Breast cancer
Ovarian cancer
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9
Q

If a women starts the combined HRT more than 10 years after menopause, what disease are she at increased risk of?

A

Coronary heart disease

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10
Q

All types of systemic (oral or transdermal) HRT treatment increase the risk of breast cancer after (?) year(s) of use

A

1 year

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11
Q

Which HRT preparation has a higher risk of breast cancer:
Combined oestrogen-progestogen HRT
OR
Oestrogen-only HRT?

A

Combined oestrogen-progestogen HRT

Particularly continuous HRT preparations where both oestrogen and progestogen are taken throughout each month

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12
Q

Which of the following factors increase the risk of breast cancer in women taking HRT:
Age at which HRT is started
OR
Duration of HRT use?

A

Duration of HRT use

Longer duration of HRT use (but not age at which HRT is started) further increases risk

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13
Q

After a woman stops using HRT, how long does the increased risk of breast cancer continue?

A

More than 10 years

Although the risk of breast cancer is lower after stopping HRT than it is during current use, the excess risk persists for more than 10 years after stopping compared with women who have never used HRT.

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14
Q

Do vaginal preparations of HRT increase the risk of breast cancer?

A

NO

Vaginal preparations containing low doses of oestrogen to treat local symptoms are not thought to be associated with an effect on breast cancer risk.

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15
Q

Why is radiological detection of breast cancer harder in women who take HRT (especially oestrogen-progestogen combined HRT)?

A

Mammographic density can increase

BUT not the case with tibolone

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16
Q

Which HRT does NOT increase mammographic denisity, and therefore, does NOT make radiological detection of breast cancer more difficult?

A

Tibolone

Tibolone has also been associated with an increased risk of breast cancer during treatment, although the extent of risk and its persistence after stopping is currently inconclusive.

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17
Q

Which preparation of HRT increases the risk of endometrial cancer in women with a uterus?

A

Oestrogen-only HRT

In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously.

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18
Q

Which cancers are associated with an increased risk in women taking HRT? (3)

A
  1. Breast cancer
  2. Endometrial cancer (oestrogen-only HRT)
  3. Ovarian cancer
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19
Q

Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the (?) of use.

A

first year

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20
Q

Which conditions does HRT increase the risk of? (6)

A
  1. Breast cancer
  2. Endometrial cancer (oestrogen-only HRT)
  3. Ovarian cancer
  4. DVT/PE
  5. Stroke
  6. Coronary heart disease (in women who start HRT > 10 years after menopause)
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21
Q

How long before major surgery under general anaesthesia (including orthopaedic and vascular leg surgery), should HRT be stopped?

A

4-6 weeks before surgery

Restart only after full mobilisation

If HRT cannot be stopped - prophylaxis with unfractionated or LMWH and graduated compression hosiery is advised

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22
Q

You stopped a patients HRT 4-6 weeks prior to major surgery, how long after the surgery can they restart the HRT?

A

Only after full mobilisation

If HRT cannot be stopped - prophylaxis with unfractionated or LMWH and graduated compression hosiery is advised

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23
Q

What are the reasons to stop HRT? (9)

A
  1. Sudden severe chest pain
  2. Sudden breathlessness (or cough with blood stained sputum)
  3. Unexplained swelling or severe pain in calf of one leg
  4. Severe stomach pain
  5. Serious neurological effects (e.g. severe, prolonged headache, vision loss, hearing loss, dysphasia, bad fainting attack, collapse, seizure, weakness, motor disturbance, numbness)
  6. Hepatitis, jaundice, liver enlargement
  7. BP: systolic > 160, diastolic > 95
  8. Prolonged immobility after surgery or leg injury
  9. Detection of a risk factor which contraindicated treatment
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24
Q

Which drug is licensed for short-term treatment of symptoms of oestrogen deficiency?

A

Ethinylestradiol

- Oral: 10-50 micrograms daily for 21 days, can be repeated after 7 day tablet free period

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25
Q

What must be given to women with a uterus if they take ethinylestradiol for short-term treatment of symptoms of oestrogen deficiency?

A

Progestogen for 12-14 days per cycle

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26
Q

What are the indications for the use of ethinylestradiol? (5 + one rare indication in treatment summary not drug page)

A
  1. Short term treatment of symptoms of oestrogen deficiency
  2. Osteoporosis prophylaxis if other drugs cannot be used
  3. Female hypogonadism
  4. Menstrual disorders
  5. Palliative treatment of prostate cancer
  6. Hereditary haemorrhagic telangiectasia (rare indication)
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27
Q

Why would a male patient be taking ethinylestradiol?

A

Palliative treatment of prostate cancer

- Oral: 0.15-1.5 mg daily

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28
Q

Raloxifene hydrochloride is used in the treatment and prevention of postmenopausal osteoporosis, but does it reduce menopausal vasomotor symptoms?

A

NO

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29
Q

What are the indications for the use of raloxifene hydrochloride? (2)

A
  1. Treatment and prevention of postmenopausal osteoporosis

2. Breast cancer (chemoprevention in postmenopausal women at moderate to high risk)

30
Q

What are the common side effects of raloxifene hydrochloride? (4)

A

Influenza
Leg cramps
Peripheral oedema
Vasodilation

31
Q

Progesterone and its analogues are less (?) than the testosterone derivatives

A

androgenic

Neither progesterone nor dedrogesterone (progesterone analogue) causes virilisation

32
Q

Although progestogens have been widely used for menorrhagia, which drug is more effective?

A

Tranexamic acid

If dysmenorrhoea is a factor - mefenamic acid

Also require contraception - levonorgestrel-releasing intrauterine system

33
Q

Although progestogens have been widely used for menorrhagia, which drug is preferred if dysmenorrhoea is also a factor?

A

Mefenamic acid

Tranexamic acid is the preferred drug for menorrhagia

Also require contraception - levonorgestrel-releasing intrauterine system

34
Q

In pregnant women with antiphospholipid antibody syndrome who have suffered recurrent miscarriages, the combination of which two drugs can be given to decrease the risk of fetal loss?

A

Low-dose aspirin

LMWH (prophylactic dose)

35
Q

What class of drug is ulipristal acetate?

A

Progesterone receptor modulator

36
Q

Apart from emergency contraception, what is the other indication for the use of ulipristal acetate?

A

Moderate to severe symptoms of uterine fibroids

In premenopausal women where surgery and uterine artery embolisation are unsuitable or have failed

37
Q

What are the indications for the use of clonidine hydrochloride?

A
  1. Hypertension
  2. Prevention of recurrent migraine
  3. Prevention of vascular headache
  4. Menopausal symptoms, particularly flushing and vasomotor conditions
38
Q

What is the contraindication for the use of clonidine hydrochloride?

A

Severe bradyarrhythmia secondary- or third-AV block or sick sinus syndrome

39
Q

What are the common side effects of clonidine hydrochloride?

A
  1. Constipation
  2. Depression
  3. Dizziness
  4. Dry mouth
  5. Fatigue
  6. Headache
  7. Nausea
  8. Postural hypotension
  9. Salivary gland pain
  10. Sedation
  11. Sexual dysfunction
  12. Sleep disorders
  13. Vomiting
40
Q

What may occur to the fetus if clonidine hydrochloride is taken during pregnancy?

A

Lower fetal heart rate

Avoid unless potential benefit outweighs the risk

41
Q

If clonidine hydrochloride is taken for hypertension, what may happen if the drug is stopped suddenly?

A

Severe rebound hypertension

MUST withdraw gradually

42
Q

For how long after starting continuous combined HRT is it normal for the woman to have irregular breakthrough bleeding?

A

First 4-6 months of treatment

Bleeding beyond 6 months or after a spell of amenorrhoea requires further investigation to exclude serious gynaecological pathology

43
Q

Does HRT provide contraception?

A

NO

A woman is considered potentially fertile for 2 years after her last menstrual period if she is under 50 years, and for 1 year if she is over 50 years

44
Q

How long after her last menstrual period is a woman potentially fertile if she is UNDER 50 years of age?

A

2 years

Over 50 years - 1 year

45
Q

How long after her last menstrual period is a woman potentially fertile if she is OVER 50 years of age?

A

1 year

Under 50 years - 2 years

46
Q

What can a woman use for both relief of menopausal symptoms and contraception if she is under the age of 50 and free of all risk factors for venous and arterial disease?

A

Low-oestrogen combined oral contraceptive pill

Should stop the oral contraceptive pill at 50 years

47
Q

What is the indication for use of desogestrel?

A

Contraception

Desogestrel is a progestogen

48
Q

What class of drug is desogestrel?

A

Progestogen

Contraception

49
Q

What are the two indications for use of estradiol or estriol administered by vagina using pessaries?

A
  1. Vaginal atrophy in postmenopausal women

2. Prophylaxis of recurrent UTI in postmenopausal women

50
Q

What are the indications for the use of mefenamic acid?

A
  1. Pain and inflamation in rheumatoid arthritis and osteoarthritis
  2. Post-operative pain
  3. Mild-to-moderate pain
  4. Acute pain including dysmenorrhoea
  5. Menorrhagia
51
Q

What might happen if a patient overdoses on mefenamic acid?

A

Convulsions

52
Q

What are the contraindications to the use of mefenamic acid?

A

Hypersensitivity to aspirin or other NSAID, includes
- asthma
- angioedema
- urticaria
- rhinitis
that have been precipitated by aspirin or other NSAID

53
Q

What effect does long term use of some NSAIDs (including mefenamic acid) have on a woman’s fertility?

A

Can reduce female fertility

Reversible on stopping treatment

54
Q

What class of drug is norethisterone?

A

Progestogen (Testosterone analogue)

55
Q

What are the two main groups of progestogen?

A
  1. Progesterone and its analogues

2. Testosterone analogies

56
Q

What may happen if norethisterone is used during pregnancy?

A

Masculinisation of female fetuses

Norethisterone is a testosterone analogue

57
Q

What are the indications for the use of tibolone?

A
  1. Short term treatment of symptoms of oestrogen deficiency

2. Osteoporosis prophylaxis in women at high risk of fractures when other prophylaxis contraindicated or not tolerated

58
Q

(drug?) has oestrogenic, progestogenic and weak androgenic activity

A

Tibolone

59
Q

Tibolone has (hormone?), (hormone?) and weak androgenic activity

A

Oestrogenic

Progestogenic

60
Q

Tibolone has oestrogenic, progestogenic and weak (?) activity

A

androgenic

61
Q

What are the common side effects of tibolone? (12)

A
  1. Breast abnormalities
  2. Cervical dysplasia
  3. Endometrial thickening
  4. GI discomfort
  5. Genital abnormalities
  6. Hair growth abnormal
  7. Increased risk of infection
  8. Pelvic pain
  9. Postmenopausal haemorrhage
  10. Vaginal discharge
  11. Vaginal haemorrhage
  12. Weight increased
62
Q

If a patient taking tibolone has vaginal bleeding beyond 6 months of starting the drug or after stopping treatment, what condition needs to be investigated for?

A

Endometrial cancer

63
Q

Tibolone is unsuitable for use in the premenopause unless the patient is being treated with …

A

gonadotrophin-releasing hormone analogue

64
Q

Can tibolone be used as or with an oral contraceptive?

A

NO

65
Q

Ulipristal acetate is a synthetic, selective (?) receptor modulator with a partial progesterone antagonist effect.

A

progesterone

66
Q

Ulipristal acetate is a synthetic, selective progesterone receptor modulator with a partial (?) antagonist effect.

A

progesterone

67
Q

If ulipristal acetate is used for the treatment of uterine fibroids, what can be used as contraception?

A

Non-hormonal contraceptive methods

Use during treatment and for 12 days after stopping (if required)

68
Q

What needs to be monitored before the initiation of ulipristal acetate for the treatment of uterine fibroids?

A

Liver function tests

Do NOT initiate if serum transaminases exceed 2 times the upper limit of normal

69
Q

What needs to be monitor before, during and after the use of ulipristal acetate for the treatment of uterine fibroids?

A

Liver function tests

Perform liver function tests before treatment initiation—do not initiate if serum transaminases exceed 2 times the upper limit of normal. During the first 2 treatment courses, monitor liver function monthly; for further treatment courses, perform liver function tests once before each new treatment course and when clinically indicated. At the end of each treatment course, perform liver function tests after 2-4 weeks. Discontinue treatment if serum transaminases exceed 3 times the upper limit of normal and closely monitor patient.

70
Q

You are monitoring the LFTs for a patient taking ulipristal acetate for the treatment of uterine fibroids, what result would make you decide to discontinue treatment?

A

Serum transaminases exceed 3 times the upper limit of normal

71
Q

If intermittent treatment with ulipristal acetate is used repeatedly for uterine fibroids what needs to be monitored?

A

Endometrium

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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