Hormone replacement

Question 1

When are estrogens used?

Answer 1

OCP, hormone replacement therapy for menopause, gender tranisitioning

Question 2

When are the progestins used?

Answer 2

OCP, with estrogen in HRT for menopause and with estrogen for gender transitioning

Question 3

What is estrogen in the drug world?

Answer 3

Estradiol

Question 4

What are the progestins in the drug world?

Answer 4

Promethrin, Norethindrone, Depo

Question 5

Can women with an intact uterus receive estrogen only therapy?

Answer 5

No, it poses a large risk of endometrial cancer.

Question 6

What are the adverse effects of estrogens?

Answer 6

blood clots, HTN, acne, endometrial CA, weight gain

Question 7

What are the adverse effects of progestins?

Answer 7

acne, irregular menstrual bleeding, osteoporosis, amenorrhea, weight gain

Question 8

What are the absolute contraindications for estrogen-only replacement therapy?

Answer 8

intact uterus

Question 9

What are the absolute contraindications for OCP use?

Answer 9

clotting disorders, family history of thrombophilia, CVA, CAD, cancer, liver disease, pregnancy, undiagnosed vaginal bleeding

Question 10

What are the relative contraindications for OCP use?

Answer 10

smokers, HTN, DVT, diabetes, migraines, lactation, obesity, gall bladder disease, pt > 50y/o, SCC, HLD

Question 11

What are the SERMs?

Answer 11

raloxifene (evista), tamoxifen, toremifene, bazedoxifene

Question 12

What is the mechanism of action of the SERMs?

Answer 12

selectively modulate estrogen by antagonizing some receptors and agonizing others

Question 13

What is the indication for SERMs use?

Answer 13

breast cancer, osteoporosis, post menopausal therapy

Question 14

What are the adverse effects of SERMs?

Answer 14

fatigue, hot flashes, mood swings, night sweats, vaginal discharge

Question 15

What is the first line progestin choice of HRT?

Answer 15

Micronized progesterone

Question 16

Who can be prescribed HRT?

Answer 16

Post-menopausal women needing symptom management

Question 17

Should HRT be prescribed to prevent CAD, CVA, osteoporosis?

Answer 17

Not the current recommended guidelines

Question 18

Which HRT can be used for osteoporosis?

Answer 18

Evista, topical

Question 19

When should HRT be cautioned/strongly avoided?

Answer 19

Thrombophilia, gall bladder disease, hypertriglyceridemia, transdermal with patients with migraines with aura

Question 20

Who is HRT absolutely contraindicated with?

Answer 20

Hx of breast CA, CHD, stroke/thrombus, undiagnosed vaginal bleeding, endometrial cancer, TIA

Question 21

What must be assessed prior to starting OCP?

Answer 21

Pregnancy and family history for contraindications

Question 22

What is the PATH acrynomn for OCP intiation?

Answer 22

Assess: Pregnancy Attitudes, Timing, How important is prevention

Question 23

If a patient misses a pill, what is the next step?

Answer 23

Take the missed pill as soon as it is noted even if that means 2 in a day

Question 24

What is recommended if a patient misses 2 or more pills?

Answer 24

Use a backup method of contraception, take the remaining pills at the normal time.

Question 25

When is Depo given?

Answer 25

Every 12 weeks

Question 26

Who cannot get prometherin?

Answer 26

Patients with peanut allergies

Question 27

When is osteoporosis treatment indicated?

Answer 27

T-score of -2.5 Hx of fragility fractures Hx of T-score of -2.5 - -1.0 FRAX 3%

Question 28

What medications are indicated for osteoporosis treatment?

Answer 28

``` Vitamin D and Calcium supplements Biphosphonates Prolia PTH analougues Estrogen replacement (women), testosterone replacement (men) ```

Question 29

What is the MOA of Biphosphonates (Fosamax)?

Answer 29

They inhibit osteoclasts to promote bone structure stablility

Question 30

When should Fosamax be taken?

Answer 30

In the morning with 8oz of water, 40 minutes prior to food or others medications

Question 31

How long can a patient be on Fosamax?

Answer 31

3-5 years

Question 32

What is the mechanism of action of Denosumab (Prolia)

Answer 32

It inhibits proliferation and maturation of preosteoclast to prevent them from maturing to osteoclasts

Question 33

How is Prolia administered?

Answer 33

IV (it's a monoclonal antibody)

Question 34

How long can a patient be on Prolia?

Answer 34

3-5 years

Question 35

What is the mechanism of action of the PTH analougues?

Answer 35

They stimulate the production of new collagenous bone matrix

Question 36

What is a PTH analougue medciation?

Answer 36

Forteo

Question 37

How long can Forteo be administered for?

Answer 37

2 years

Question 38

What is the adverse effects of Forteo?

Answer 38

nausea, headaches, arthrlagias, back pain, leg cramps, ortho hypotension, dizziness

Question 39

What is the BBW for Forteo?

Answer 39

Increased risk of osteoscarcoma

Question 40

What are the adverse effects of Prolia?

Answer 40

back pain, extremity pain, musculoskeletal pain, HLD, UTI

Question 41

What are the adverse effects of Fosamax?

Answer 41

esophagitis, musculoskeletal pain, ocular inflammation, atypical femur fractures, osteonecrosis of the jaw

Question 42

What are non-pharmacological treatment modalities for osteoporosis?

Answer 42

Sufficient calcium and Vitamin D intake Weight bearing exercises Avoid excessive alcohol consumption Smoking cessation

Question 43

How do OCP prevent pregnancy?

Answer 43

Inhibits ovulation, thickens cervical mucus, thins endometrium

Question 44

How does estrogen prevent pregnancy?

Answer 44

It prevents FSH and LH excretion thus preventing ovulation

Question 45

How does progestin prevent pregnancy?

Answer 45

Prevent LH production to prevent egg release, changes uterine lining to prevent implantation, blocks sperms ability to fertilize egg, thickens cervical mucus to hinder sperms ability to travel

Question 46

When should OCP be stopped?

Answer 46

Around 50-51 (onset of menopause)

Question 47

What medication effects OCP effectiveness?

Answer 47

Rifampin

Question 48

How are vaginal ring OCP used?

Answer 48

Every week in the vagina, 3 weeks a month with a one week 'bleeding' week

Question 49

What is the weight limit for vaginal ring use as an OCP option?

Answer 49

198lbs

Question 50

How does the implant work?

Answer 50

Placed under the skin, in place for up to three years

Question 51

What are the adverse effects of the implant?

Answer 51

It can move, irregular bleeding, mood swings, weight gain, depression, headache, acne, breast pain

Question 52

How is the implant removed?

Answer 52

Surgically

Question 53

How long to IUDs last?

Answer 53

3-12 years depending on the IUD

Question 54

How long do the IUDs need to stay in place?

Answer 54

They can be pulled up to 1 year into placement

Question 55

What are complications of the IUD?

Answer 55

irregular bleeding, implantation into the uterine wall, infections with placement, rejection by body ('falls out'), cramping

Question 56

How long can a patient be on Depo shots?

Answer 56

2 years d/t BBW for bone demineralization with extended use