Flashcards in Menopausal Hormonal Therapy Deck (25):
what are the symptoms of menopause?
hot flashes, night sweats, vaginal dryness, painful intercourse, sleep distubances, mood problems
can you use estrogen alone as a treatment for menopausal symtpoms in a woman WITH a uterus? why?
NO- need a progestin as well
due to the increase in endometrial hyperplasia and carcinoma from unopposed estrogen
what are the available estrogens for therapy?
conjugated equine ( most common in the USA)
synthetic conjugated A
synthetic conjugated B
what are teh available progestin components?
hwo do you dose the patients?
whatever works for them, pills, patches, rings, creams... etc..
what is the MOA of the estrogen?
generate increase DNA and resulting protein regulation
what is the big risk with with estrogen therapy?
increased chances of clotting
due to decreased anti-thrombin III, increased clotting factors, and increased platelet aggregation
can you use menopausal hormone therapy for cardiovascular disease, or dementia?
what are the findings for the estrogen + progestin study? increased? decreased?
increased--> risk of CHD, stroke, PE, DVT, ovarian cancer, invasive breast cancer, dementia
DECREASED--> risk of colorectal cancer, endometrial cancer, all fractures
what were the finding of the estrogen alone study?
INCREASED- risk of stroke , DVT
NO INCREASE in invasive breast cancer
NO CHANGE in- CHD, dementia, cancers, PE, mortality
DECREASED- risk for hip fractures
what are some conditions that you do NOT use menopausal hormone therapy in?
histroy of breast/ovarian cancer, family Hx, osteoporosis Hx or risk of,
how long do you wait to reevaluate someone on MHT?
5 years, see if they can get by with no medication, ( a lot of woman can)
what are teh SERMS?
tamoxifen, toremifene, roloxefine
what do you use tomoxifen and toremifine for?
prevention/ treatment of ER + breast cancer
what do you use raloxifene for?
prevention and treatment of osteoporosis
or breast cancer PROPHYLAXIS in high risk ( GAIL score over 1.66%
what is the extra MOA that toremifine has?
HPO axis effect- promote production of transforming growth factor beta ( an inhibitory growth factor)
which drugs have a positive effect on lipid profile?
tamoxifen and toremifine ( toremifine also has HDL effects)
decreases- TC, LDL
what are the side effects of tamoxifen and toremifine?
hot flashes, nausea, menstrual irregularities
what aer teh effects of roloxifene?
estrogenic effect on bones ( anti-resorptive)
+ effects on lipid profile
NO risk of endometrial cancer
can you use raloxifene in pregnancy?
NO, categroy X
what aer teh antiestrogens?
clomiphene, and fulvestrant
what do you use the anti-estrogens for?
clomiphene- infertility in anovulatory women
fulvestrant- metastatic ER+ breast cancer after tamoxifen treatment failure
what is the MOA of clomiphene?
blocks inhibitory actions of estrogen on hypothalamus GnRH and pituitary gonadotropin release
what are teh side effects of clomiphene?