hormones

Question 1

4 types of hormone therapies

Answer 1

Thyroid Disease
Menopausal Hormone Therapy
Contraception
Selective Estrogen Receptor Modulators (SERMs)

Question 2

what does the thyroid gland do?

Answer 2

The thyroid gland, albeit non-essential for life, governs tissue metabolism

Question 3

how is normal growth and maturation made possible?

Answer 3

Normal growth and maturation is made possible by maintaining an optimal level of tissue metabolism

Question 4

what are T3 and T4? What do they stand for? Which is most active?

Answer 4

Triiodothyronine (T3; most active) and thyroxine (T4) are two major thyroid hormones

Question 5

what 3 things does hypothyroidism cause?

Answer 5

Hypothyroidism causes bradycardia, poor cold resistance, and mental/physical slowing

Question 6

what 5 things does hyperthyroidism cause?

Answer 6

Hyperthyroidism causes tachycardia, body wasting, tremor, nervousness, and heat flashes

Question 7

2 drugs for hypothyroidism?

Answer 7

Levothyroxine [Synthroid®, Levoxyl®]

Liothyronine [Cytomel®]

Question 8

2 drugs of hyperthyroidism?

Answer 8

Propylthiouracil (PTU)

Methimazole [Tapazole®]

Question 9

whats the number 2 highest selling drug in america?

Answer 9

levothyroxine sodium

Question 10

indication for levothyroxine

Answer 10

INDICATION
Hypothyroidism
DOSING [50-200ug]
1 tab qd

Question 11

moa of levothyroxine soidum?

Answer 11

CLINICAL PHARMACOLOGY
Thyroid hormone replacement
Mechanism of Action
Synthetic T4 (tetra-iodothyronine)

Question 12

adverse effects of levothyroxine sodium

Answer 12

ADVERSE EFFECTS
Common: Weight loss, diaphoresis, headache, alopecia
CV: Hypertension
CNS: Pseudotumor cerebri (children), hallucination [ψ]
OCULAR: Ptosis, diplopia, EOM paresis

Question 13

levothyroxine sodium drug interactions

Answer 13

DRUG INTERACTIONS

Sympathomimetics (Additive)

Question 14

what 3 things characterize menopause?

Answer 14

Menopause is characterized by reduced libido, vasomotor instability (hot flashes) and vaginal atrophy

Question 15

estrogen dosing for menopause compared to contraception

Answer 15

Estrogen dosing for menopause is significantly lower and therefore safer than for contraception

Question 16

what the most potent estrogen produced and secreted by the ovary?

Answer 16

estradiol

Question 17

what is a metabolite of estradiol w/ 1/3 potency, which is the primary circulating estrogen after menopause

Answer 17

estrone

Question 18

because estrogens have a chloesterol back bone, what are they able to do?

Answer 18

Having a cholesterol backbone, estrogens dissociate from their globulin or albumin binding sites and readily cross cell membranes to bind to nuclear receptors where they affect gene transcription and translation

Question 19

3 menopausal therapies

Answer 19

Estrone [Menest®]
Estradiol
Mestranol [Necon®]

Question 20

estrone indication

Answer 20

INDICATION
Menopause, Breast Cancer, Prostate Cancer, Osteoporosis prevention
DOSING [0.3-2.5mg]
1 tab PO qd

Question 21

CLINICAL PHARMACOLOGY
Hormone Replacement Therapy (HRT)
Mechanism of Action
Binds to estrogen receptors, developing and maintaining female sex characteristics and reproductive systems

Answer 21

moa of estrone

Question 22

ADVERSE EFFECTS
Common: Headache/migraine, elevated BP, weight changes, fluid retention, contact lens intolerance, vision changes
SEVERE ADVERSE EFFECTS
BLACK BOX: Endometrial Cancer, Stroke, DVT, MI, Invasive Breast Cancer

Answer 22

adverse effects of estrone

Question 23

estrone drug interactions

Answer 23

DRUG INTERACTIONS
Azole Antifungals (Impaired metabolism)
Adverse effects of systemic steroids may be increased
Anti-hyperlipidemic effects of Omega-3 FA’s may be antagonized

Question 24

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

Answer 24

estrone contraindications

Question 25

contraception drug

Answer 25

Drospirenone/Ethinyl Estradiol [Yaz®]

Question 26

ways contraceptive agents are grouped

Answer 26

monophasic, biphasic, triphasic, and four phasic vs progestin only

Question 27

indication for yaz

Answer 27

INDICATION Contraception, Acne Vulgaris, Dysmenorrhea, Endometriosis, PCOS DOSING [3 mg/20 ug] 1 tab PO qd

Question 28

moa for yaz

Answer 28

CLINICAL PHARMACOLOGY Hormone Therapy Mechanism of Action Suppresses LH and FSH, inhibiting ovulation; alters cervical mucus and endometrium

Question 29

yaz adverse effects

Answer 29

``` ADVERSE EFFECTS Common: Headache, weight changes, BP elevated, increased cholesterol, contact lens intolerance SEVERE ADVERSE EFFECTS MI, stroke, ocular lesions BLACK BOX Smoking and CV Events ```

Question 30

yaz drug interactions

Answer 30

``` DRUG INTERACTIONS Impaired metabolism of Cyclosporine NSAIDs (Additive hyperkalemia) Tetracyclines, Penicillins, Cephalosporins, Macrolides, Quinolones (Decreased efficacy) Ascorbic Acid (Decreased metabolism) ```

Question 31

yaz contraindications

Answer 31

CONTRAINDICATIONS Hypertension Smoker Migraine w/ aura > w/o aura

Question 32

selectivity property of SERMs refers to what?

Answer 32

their ability to inhibit or stimulate estrogen receptors depending on the tissue

Question 33

uses of SERMs include what?

Answer 33

Uses include management of breast cancer, osteoporosis, menopause and anovulation

Question 34

3 types of SERMS

Answer 34

Tamoxifen [Soltamox®] Clomiphene [Serophene®, Clomid®] Raloxifene [Evista®]

Question 35

INDICATION for tamoxifen

Answer 35

INDICATION Metastatic Breast Cancer DOSING [10/20 mg] 1-2 tabs qd-bid

Question 36

moa of tamoxifen

Answer 36

CLINICAL PHARMACOLOGY SERM Mechanism of Action Binds to estrogen receptors, producing estrogenic and anti-estrogenic effects

Question 37

adverse effects of tamoxifen

Answer 37

``` ADVERSE EFFECTS Common: Dizziness, headache, VA changes SEVERE ADVERSE EFFECTS Thromboembolism, stroke Pancytopenia Retinopathy, cataracts ```

Question 38

drug interactions of tamoxifen

Answer 38

TAMOXIFEN DRUG INTERACTIONS May increase Cyclosporine, Systemic Steroid, Oxycodone levels Chlorpheniramine, Macrolides (Inhibit hepatic production of active metabolite)