Womens Health

Question 1

Estrogen therapy

Answer 1

• inhibit bone reab..increase bone mass
• increase HDL levels
• both good and bad on blood activity (coagulation activity)
• cancer
• coronary heart disease: Lower in women, high in men, after menopause is way higher in women

Question 2

Estrogen therapy

* cancer risk

Answer 2

• endometrial: science proven connection
  Depend on dose and duration of use
• use of progestin lowers the risk
• estrogen sensitive cells increase risk

Breast & ovarian is hard to tell if linked to estrogen

Question 3

Ethinyl estradiol
Estrogens (conjugated)
Estradiol
Mestranol

Answer 3

Estrogens

Question 4

Progestins

Answer 4

Act by binding to nuclear receptor inside nucleus and alters gene transcription
Many uses: BC, uterine bleeding, no period, infertility, endometrial carcinoma

Question 5

Estrogens & progestins are a?

Answer 5

Steroid
Fat soluble
Metabolized by liver

Question 6

Hormone replacement therapy

Answer 6

• post menopausal women- prevention of osteoporosis and heart disease
• surgery induced menopause
• primary hypogonadism

Works best with women who have recently hit menopause!

Question 7

Levonorgestrel 
Gestodene 
Ethynodiol diacetate 
Norelgestromin 
Cyproterone acetate 
Desogestrel 
Norgestimate 
Etonogestrel
Norethindrone
Drospirenone
Dienogest
Medroxyprogesterone 
Norgestrel

Answer 7

Progestins

Question 8

Estrogen therapy

Answer 8

Common uses: estrogen replacement, contravention, acne.
*act by binding to estrogen receptor in cell nucleus (nuclear receptor)
Works in the DNA- turns off and on certain receptors

Question 9

Hormonal contraceptives

Answer 9

Two types: combinations (e&p)
Progestin only
MOA: inhibition of ovulation, thicken cervical mucus, impair endometrial implantation.
*progestin only: block ovulation only 60-80% of cycles
* estrogen: stabilize endometrial lining and control cycle

Question 10

Hormonal contraceptives

Answer 10

Perfect use: same time ever day-large impact on effectiveness

• Drug inx- inducers (Lower the effectiveness)
• hyperkalemia- drospirone(yazmin,yaz)
• • new progestins are less androgenic

Question 11

Hormonal contraceptives

Answer 11

• monophasic: consistent hormone level
• biphasic,triphasic: variable hormone level
• extended cycle
• continuous
• *progestin only: “‘mini pill” less effective, dosing habits more critical

All patient preference!!

Question 12

Flibanserin (Addyi)

Answer 12

Treatment for premenopausal acquired low sexual DESIRE
MOA: uncertain works on serotonin and DA
Dosed at bedtime
Risk for hypotension,syncope, CNS depression
* drug inx: BC
* not for nursing mothers

Question 13

Hormonal contraceptives

Inx

Answer 13

Inducers (old AED) increase metabolism of BC = lower effectiveness
Antibiotics- inhibits second peak reabsorption of estrogen in the blood