10. Hormone Therapies

Question 1

What is the different usage of Hormone therapies?

Answer 1

1. Thyroid Disease
2. Menopausal Hormone Therapy
3. Contraception
4. Selective Estrogen Receptor Modulators (SERMs)

Question 2

What are the two major thyroid hormones?

Answer 2

Triiodothyronine (T3; most active) and Thyroxine (T4)

Question 3

What are the drugs to treat hypothyroidism?

Answer 3

1. Levothyroxine [Synthroid®, Levoxyl®]

2. Liothyronine [Cytomel®]

Question 4

What are the drugs to treat hyperthyroidism?

Answer 4

1. Propylthiouracil (PTU)

1. Methimazole [Tapazole®]

Question 5

Which is the #2 highest selling drugs in America?

Answer 5

Levothyroxine Sodium

Question 6

T/F Levothyroxine Sodium makes synthetic T4 for thyroid hormone replacement.

Answer 6

True

Question 7

What kind of adverse effects to the eyes do Levothyroxine Sodium cause?

Answer 7

Ptosis, diplopia and EOM paresis

Question 8

What are the CNS adverse effects of Levothyroxine Sodium?

Answer 8

Pseudotumor cerebri (children) and hallucination

Question 9

Which drug causes profuse sweating (diaphoresis), sudden hair loss (alopecia), weight loss and headache?

Answer 9

Levothryroxine Sodium

Question 10

What is the drug interaction of Sympathomimetics with Levothyroxine Sodium?

Answer 10

Additive. Both causes hypertension.

Question 11

What are the menopausal therapies?

Answer 11

1. Estrone [Menest] “MOST COMMON”
2. Estradiol
3. Mestranol [Necon]

Question 12

What is the indication for using Estrone?

Answer 12

Menopause, Breast Cancer, Prostate Cancer, Osteoporosis prevention

Question 13

The mechanism of action of estrone is binds to _______receptors, developing and maintaining female sex characteristics and reproductive systems.

Answer 13

estrogen

Question 14

T/F Estrone doesn’t have “BLACK BOX” warnings.

Answer 14

False.

BLACK BOX: Endometrial Cancer, Stroke, DVT, MI, Invasive Breast Cancer.

Question 15

What are some common adverse effects of Estrone?

Answer 15

Headache/migraine, elevated BP, weight changes, fluid retention, contact lens intolerance, vision changes

Question 16

What is the drug interactions of Azole Antifungals with Estrone?

Answer 16

Impaired metabolism

Question 17

What can Estrone do to steroids?

Answer 17

it can increase steroids adverse effects

Question 18

What can Estrone do to Anti-hyperlipidemic drug like Omega 3 fatty acids?

Answer 18

it antagonize it. LDL levels are elevated with hormone regulating therapies.

Question 19

What is contraindicated for taking Estrone?

Answer 19

Hypertension
Smoker
Migraine [with aura] > [without aura]

Question 20

What is the most common contraceptive drug?

Answer 20

Drospirenone/Ethinyl Estradiol [Yaz®]

Question 21

How does the contraceptive groupings are done?

Answer 21

it’s done by activity profiles: monophasic, biphasic, triphasic, and four phasic vs progestin only.

Question 22

What conditions do we use YAZ (contraceptive) for?

Answer 22

Contraception, Acne Vulgaris, Dysmenorrhea (painful cramps), Endometriosis (uterus grows outside the uterus) and Polycystic ovary syndrome (PCOS).

Question 23

What is Polycystic ovary syndrome (PCOS)?

Answer 23

A hormonal disorder causing enlarged ovaries with small cysts on the outer edges.

Question 24

The mechanism of actions of YAZ Suppresses ___ and ____, inhibiting ovulation; alters cervical mucus and endometrium.

Answer 24

Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)

Question 25

T/F There's a Black Box warning in YAZ?

Answer 25

True, Smoking and CV events

Question 26

What are the possible severe adverse effects for taking YAZ?

Answer 26

MI, stroke, ocular lesions

Question 27

What are the common adverse effects of taking YAZ?

Answer 27

Headache, weight changes, BP elevated, increased cholesterol, contact lens intolerance

Question 28

T/F YAZ Impaired metabolism of Cyclosporine

Answer 28

True. it causes an increase K+ levels.

Question 29

Tetracyclines, Penicillins, Cephalosporins, Macrolides, Quinolones causes YAZ to

Answer 29

Decreased efficacy

Question 30

T/F Ascorbic Acid causes YAZ to increase metabolism.

Answer 30

False. it's decrease metabolism

Question 31

What is Selective Estrogen Receptor Modulators (SERMS)?

Answer 31

- They have the ability to inhibit or stimulate estrogen receptors depending on the tissue. - It uses for management of breast cancer, osteoporosis, menopause and anovulation

Question 32

What are the different SERMS drugs?

Answer 32

Tamoxifen [Soltamox®] "MOST COMMON" Clomiphene [Serophene®, Clomid®] Raloxifene [Evista®]

Question 33

T/F The indication for taking Tamoxifen is for metastatic breast cancer.

Answer 33

True

Question 34

The mechanism of action of Tamoxifen is to bind to estrogen receptors, producing ______ and ______ effects.

Answer 34

estrogenic, anti-estrogenic

Question 35

What are some common adverse effects for taking Tamoxifen?

Answer 35

dizziness (unique), headache (same with Estrone andn YAZ) and VA changes (same with estrone)

Question 36

What are some severe adverse effects when taking Tamoxifen?

Answer 36

Thromboembolism (unique), stroke (same with Estrone and YAZ) Pancytopenia (reduce in red and white blood cells. Unique) Retinopathy (unique), cataracts (unique)

Question 37

Which of the hormone therapy medications discussed here can cause cataracts?

Answer 37

Tamoxifen

Question 38

What is the drug interaction of NSAIDs and YAZ?

Answer 38

Additive hyperkalemia