Sex Steroids and HRT

Question 1

All sex hormones share similar structures to ____

Answer 1

Adrenal steroids

Question 2

Main role of progestins

Answer 2

Promote gestation

Question 3

Sex steroids act on which receptors?

Answer 3

Nuclear transcription factor receptors (effects protein synthesis)

Question 4

Which sex steroids have active metabolites that are used as drugs?

Answer 4

Estrogen
Testosterone

Question 5

Estrogens stimulate growth of ____

Answer 5

Endometrium

Question 6

Estrogen provides feedback inhibition on anterior pituitary to suppress ___ release

Answer 6

FSH

Question 7

Progestins inhibit ___ growth

Answer 7

Endometrial

Question 8

Functions of progestin

Answer 8

Inhibit endometrial growth
Maintain vascular supply and secretory capacity

Question 9

Progestin feedback inhibition on anterior pituitary suppresses ___ release

Answer 9

LH

Question 10

Withdrawal of ____ leads to menstruation/abortion

Answer 10

Progestins

Question 11

Physiologic effects of estrogen

Answer 11

Sexual maturation
Stimulation.of long bone growth
Decreases bone resorption
Improve lipid profiles/decrease CV risk
Increases risk of clotting

Question 12

Clinical uses of estrogen

Answer 12

Hypogonadism/hypopituitarism
Postmenopausal
Birth control
Menstruql disorders

Question 13

Estrogen drug used mainly for HRT and hypogonadism

Answer 13

Estradiol

Question 14

Routes of administration for estradiol

Answer 14

Oral
Slow release IM injections (Depo)
Topical (vaginal creams or transdermal patches)

Question 15

Main use of conjugated estrogens

Answer 15

HRT

Question 16

Conjugated estrogens contain which active metabolites of estrogen?

Answer 16

Estrone and estriol

Question 17

Ethinyl estradiol main use

Answer 17

Synthetic estrogen used in almost all contraceptives
Also HRT

Question 18

Estrogen side effects

Answer 18

Nausea
Edema
Breast tenderness
Migraines
Liver disease
Increased risk of clotting
Gynecomastia and feminization in males

Question 19

Estrogens increase risk of which cancers?

Answer 19

Endometrial and breast

Question 20

Why should estrogens not be prescribed alone?

Answer 20

Need to be prescribed with progestins to reduce risk of cancer from estrogen

Question 21

Clinical uses of progestins

Answer 21

Replacement therapy with estrogens
Birth control (alone or with estrogen)
Abnormal Uterine bleeding
Endometriosis
Dysmenorrhea

Question 22

Type of progestin in IUDs

Answer 22

Progesterone

Question 23

Benefit of medroxyprogesterone acetate

Answer 23

Mainly progesterone-like effects with little/no androgen or estrogen activity

Question 24

Synthetic progestin that is structurally related to testosterone

Answer 24

Norethindrone

Question 25

Adverse effects of all progestins

Answer 25

Menstrual changes Nausea Bloating Potential teratogen

Question 26

Adverse effects of nor-progestins

Answer 26

Androgenic effects Acne Weight gain Masculinization Worsened lipid profile

Question 27

Postmenopausal HRT uses

Answer 27

Alleviate symptoms of menopause Prevent/treat osteoporosis

Question 28

When can estrogen be used alone without progesterone

Answer 28

Pre-puberty for enhancing bone growth If uterus has been removed

Question 29

Side effects of HRT

Answer 29

Return of menstrual bleeding Increased risk of cancer and CV risk (mitigated by local administration)

Question 30

Current recommendation on when to use HRT for Postmenopausal women

Answer 30

Short-term use (<5 yrs) of E+P for menopause onset symptoms Not recommended for long term health maintenance

Question 31

Selective estrogen response modifiers (SERMs) are non-steroidal analogs with ____ properties on estrogen receptors

Answer 31

Mixed agonist-antagonist

Question 32

SERM drugs

Answer 32

Raloxifene Tamoxifen

Question 33

Difference between raloxifene and tamoxifen

Answer 33

Raloxifene decreases risk of uterine cancer Tamoxifen increases risk of uterine cancer

Question 34

Similarities between Raloxifene and tamoxifen

Answer 34

Decrease osteoporosis Improve lipids Decrease breast cancer Increase risk of clotting Increase hot flashes