HRT/SERMS Flashcards
(18 cards)
Estrogens used for MHT
Conjugated Estrogen (horse pee), Synthetic Conjugated Estrogen A&B, Esterified estrogen, Estropipate
Progestin only used in MHT
Medroxyprogesteronen (MPA), methyltestosterone (some androgen effects), Progesterone
Progestin used in MHT and Birth control pills (low yield?)
- Used for Peri-Menopausal state (because already on BCP)
- Norgestimate (with estradiol)
- Norethindrone/ Norethindrone Acetate (with EE and Estradiol)
- Drospirenone (with EE and Estradiol)
- Levonorgestrel (with estradiol)
Side effects of Estrogen therapy
- Decrease Antithrombin III, Increase platelet aggregation/clotting factors (HYPERCOAGABLE)
- Increase HDL and Trig, some others
S/E of Estrogen and Progestin therapy
- CHD, Stroke, PE, DVT
- Ovarian/Breast cancer
- Dementia
Estrogen and Progestin therapy decreases risk of
- Colorectal/ endometrial cancer
- All fractures
S/E of Estrogen Alone
Stroke, VTE
Estrogen does not increase risk of
- Breast/colorectal Cancer (however don’t use MHT if they have cancer)
- CHD, PE
- Mortality
Estrogen decrease risk of
-Hip fractures specifically (not all fractures)
General Dosing for Estrogen/Progestin
-Low does, little duration (5 y or less), most specific route as possible (cream for bag dryness)
Tamoxifen estrogen agonist or antagonist, indication of use
- SERM
- Estrogen antagonist
- Prevent and treat of ER/breast cancer
- Has cis and trans version (cis-estrogenic agonist, trans-estrogenic antagonist), mostly used in trans form; cis used for osteoporosis. cis can cause endometrial proliferation, clots
- Does not alleviate VMS
Toremifene estrogen agonist or antagonist, indication of use
- SERM
- Estrogen antagonist
- Prevent and treat of ER/breast cancer
- Promotes production of transforming growth factor beta
- Does not Alleviate VMS
Raloxifene estrogen agonist or antagonist, indication of use
- SERM
- Estrogen agonist
- Prevent/treat osteoporosis
- INVASIVE ONLY Breast cancer prophylaxis (estrogen antagonist in breast)
- Does not alleviate VMS
Ospemifene estrogen agonist or antagonist, indication of use
- SERM
- Estrogen agonist
- Treats dyspareunia (vaginal dryness, painful intercourse)
Bazedoxifene (not on boards ) estrogen agonist or antagonist, indication of use
- SERM
- Pt with intact uterus
- Estrogen antagonist (interesting, its an estrogen with antagonist effects. Acts like progestin. Used to avoid progestin-androgen effects)
- Treat Vaso motor symptoms associate with menopause
- Prevent post-menopausal osteoporosis
SERMS
-Agonist and antagonist of estrogen receptor depending on the tissue
Clomiphene MOA, indication
- Pure Anti-estrogen (prevents neg feedback, to increase FSH/LH release)
- Infertility in anovulatory women
- Can cause twins
Fluvestrant MOA, indication
- Pure Anti-estrogen
- Metastatic ER and breast cancer (after tamoxifen failure, high cost)
