POM-P Switches - Examples + Estradiol

Question 1

Give e.g. of medicines that have recently switched classifications. (16)

Answer 1

Amorolfine nail lacquer (GSL)
Desogestrel (P)
Estradiol (P)
Fexofenadine (GSL)
Naproxen (P)
Orlistat (P)
Momentasone Nasal Spray (P)
Maloff Protect (Atovaquone/Proguanil) (P)
PPI: Pantoprazole (P), Esomeprazole/Omeprazole (GSL)
Sildenafil (P)
Sumatriptan (P)
Tamsulosin (P)
Tranexamic Acid (P)
Ulipristal Acetate (P)

Question 2

What is the indication of Estradiol? (1)

Answer 2

Vaginal atrophy due to oestrogen deficiency in post menopausal women aged 50+ who have not has a period for at least 1 year, +/- uterus.

Question 3

What are the symptoms of vaginal atrophy? (6)

Answer 3

Dryness
Soreness
Itching
Burning
Irritation
Painful Intercourse

Question 4

What is the initial dose of Estradiol? (1)

Answer 4

1 vaginal tablet daily for 2 weeks.

Question 5

What is the maintenance dose of Estradiol? (3)

Answer 5

1 vaginal tablet twice a week:
- If effective but symptoms return after break - maintainance.
- If symptoms still not resolved initial then maintenance.

Switching from other topical oestrogen:
- If taking recommended dose > 3 months, controlled symptoms, no health changes.

Question 6

How long does it take for Estradiol to take effect? (1)

Answer 6

8-12 weeks.

Question 7

Explain the administration process of Estradiol. (5)

Answer 7

Intravaginal application
Open blister pack at the plunger end
Inset the applicator in the vagina until resistance is met (8-10cm).
Release tablet by pressing the plunger.
Withdraw applicator and discard.

Question 8

What are the c/i of Estradiol? (11)

Answer 8

Hypersensitivity or allergies to Estradiol/excipients.
Undiagnosed genital bleeding.
Untreated endometrial hyperplasia (uterus thickening)
Women with an intact uterus previously treated with unopposed systemic oestrogens.
Angina, heart attack, ischaemia stroke (current/recent)
Hx oestrogen dependent cancer: breast, ovarian, endometrial.
Hx VTE
Porphyria (blood disorder)
Vaginal - Untx infection (unusual discharge, severe itching) irregular bleeding.
Vulval dermatosis - colour/texture changes.
Acute/ previous liver disease - LFTs not normal.

Question 9

When would you consider referring a patient regarding use of Estradiol? (4)

Answer 9

No symptom improvement after 3 months of tx.
< 50 yrs or menstruation < 1 yr ago.
Hx endometriosis / endometrial hyperplasia.

Question 10

What are the common s/e of Estradiol? (6)

Answer 10

Headache
Ab. Pain
Vaginal discomfort
Discharge
Bleeding
Steroid dependent cancer

Question 11

What are the alarm symptoms of using Estradiol? (4)

Answer 11

Jaundice/ liver function deterioration.
Increase in BP
New onset of migraine-type headache.
Pregnancy.