Prescription Therapies Flashcards

Question

estropipate

Answer 1

-type of ET -oral forme of estrone sulfate that has been solubilized and stabilized by piperazine -approved for prevention of osteoporosis

Answer 2

-type of ET -widely used in combination contraceptives

Answer 3

-most widely used form in North America -bc of first-pass uptake & metabolism in the GI & the liver -->incr HDL cholesterol, a/w 25% incr triglycerides; incr hepatic globulins, coagulation factors, & some inflammatory markers; decr E-selectin, which may affect CAD

Answer 4

-cream, tablet, insert, rings (low dose for local therapy & two higher doses for systemic therapy) available -small amounts of E administered locally are effective for treating GSM -endometrial protection is not needed w local doses of estrogen -women w uterus using one of the synthetic rings need endometrial protection (add progestogen

Answer 5

-patch, gel, spray, emulsion forms available -not subjected to first-pass hepatic metabolism -a/w more stable serum levels -minimal effect on sexual functioning -risk of skin-to-skin transfer of small amounts -some studies have shown incr in VTE & stroke w oral ET but not transdermal -stroke & VTE events were comparable across oral, transdermal, & placebo groups in the Kronos Early Estrogen Prevention Study (KEEPS)

Answer 6

-type of PT -compound identical to endogenous progesterone -prometrium is the only FDA-approved bioidentical progestogen -contraindicated in women w peanut allergy -bedtime dosing advised bc of sedating effects

Answer 7

-type of PT -synthetic products w progesterone-like activity -classified into 2 groups based on structure -1) chemical structure similar to progesterone: MPA (medroxyprogesterone acetate) most commonly used & studied in the US for endometrial protection -2) chemical structure similar to testosterone: more potent than those structurally similar to MP or progesterone

Answer 8

-daily estrogen w progestogen added cyclically for 12-14 d/mo -80% of women will experience bleeding w progestogen withdrawal

Answer 9

-daily estrogen w progestogen added 14 d/2-6mo -reduces withdrawal bleeding episodes but results in heavier, longer bleeding -not recommended as standard therapy -requires endometrial monitoring

Answer 10

-daily estrogen and progestogen -low rates of endometrial hyperplasia -higher rates of amenorrhea -decreased breakthrough bleeding after 2yrs

Answer 11

-daily estrogen w progestogen dose intermittently administered in cycles of 3 d on, 3 d off -1yr clinical trials have shown amenorrhea rates of 80% & favorable safety profiles

Answer 12

-tissue-selective estrogen complex (TSEC) -daily estrogen w daily selective estrogen-receptor modulator (SERM) -approved for tx of VMS and prevention of osteoporosis -amenorrhea rates similar to placebo -safety profile comparable to placebo

Answer 13

-progestin-containing IUD and progesterone vaginal gel -potentially may provide endometrial ca protection -long-term efficacy data is needed

Answer 14

-undiagnosed abnormal genital bleeding -known, suspected, or hx of breast ca, except in appropriately selected patients being treated for metastatic disease or w oncology involvement -suspected estrogen-dependent neoplasia -active or history of DVT, PE -active or recent (w/in past year) arterial thromboembolic disease -liver dysfunction or disease -known or suspected pregnancy -known hypersensitivity to ET or EPT -porphyria cutanea tardis

Answer 15

-uterine bleeding (starting or returning) -breast tenderness (sometimes enlargement) -nausea -abdominal bloating -fluid retention in extremities -changes to the shape of the cornea (sometimes leading to contact lens intolerance) -headache (sometimes migraine) -dizziness -mood changes w EPT, particularly w progestin -angioedema -gallstones, pancreatitis

Answer 16

-possibly less risk a/w HT use and potential CHD benefit if initiated closer to the time of menopause -in contrast, HT use initiated further from menopause may be harmful -per WHI: absolute risk of CHD was lower in younger, recent postmeno; MI risk incr during first year of EPT in older women, use of HT w/in 10yrs of menopause onset was a/w lower CHD risk than if started >20yrs from LMP; women 50-59yo in the ET arm had more favorable all0cause mortality & fewer MIs -Early Estrogen Prevention Study & the Early Versus Late Intervention Trial With Estradiol also showed safety of HT use initiated early in menopause

Answer 17

-annual return visits - more frequent visits for new starts or those with AES -annual mammogram -endometrial sampling is not required unless postmeno bleeding develops -clinical goal: use appropriate HT dose, duration, regimen, route of admin; periodic evaluation

Answer 18

-decision should be individualized on the basis of severity of sxs & risk-benefit ration considerations -approximately 50% of women will experience recurrence of sxs w discontinuation -low-dose, local ET may be continued as long as vaginal sxs are present

Answer 19

-marketing term not recognized by FDA -hormones that are chemically identical to the hormones produced by the ovaries during the reproductive yrs -term used for custom-compounded HT by compounding pharmacies - these are not FDA approved -several FDA-approved preparations on market (estradiol pills, patches, gels, sprays, vaginal ring) and oral micronized progesterone

Answer 20

-allows individualized dosing & combinations of therapy -allows for different modes of administration: subdermal implants, sublingual tablets, rectal suppositories, nasals sprays -products can be prepared so binders, fillers, dyes, preservatives, or adhesives

Answer 21

-do not have to undergo FDA approval -not FDA regulated - doesn’t require proof of claim & are not held to same standard of manufacture -often not covered by 3rd party payers -not found to be safer than FDA-approved formulations in clinical trials; may even have harms a/w unknown pharmacokinetics -lack of evidence of efficacy superior to FDA-approved products -concerns about purity & potency -lack of monitoring AEs

Answer 22

-July 2020 National Academy of Sciences, Engineering, & Medicine (NASAM) issued report that assessed clinical utility of compounded bioidentical hormone therapy (cBHT); recs: - restrict use of cBHT to certain situations such as ppl w allergies, unavailable doses in FDA-approved products, or testosterone for women w sexual dysfunction - improved education for prescribers & pharmacists who market, prescribe, compound, & dispense cBHT preparations - expending & improving oversight & review of compounding pharmacies - collection & disclosing info on conflicts of interest - the evidence base on safety, effectiveness, & use of cBHT preps should be strengthened & expanded - patient preference is not reason alone to use these products

Answer 23

-aka estrogen receptor agonists/antagonists -exhibits both agonist & antagonist properties, depending on target tissue -lipid soluble properties -like estrogen, bind to hormone receptors ER-a & ER-b -naturally occurring: phytoestrogens - isoflavones, coumestans, prenylflavonoids; food sources: nuts, oil containing seeds, legumes, & soy-containing products

Answer 24

-SERM -potent antiestrogen in breast tissue -can reduce risk of invasive ER+ breast ca in high-risk women by 49% -estrogen agonist on bone, liver, & uterus

Answer 25

-2nd gen SERM -estrogen agonist on bone -minimal effect on uterine endometrium -antiestrogen if effects on breast -lower risk of uterine ca, VTE, & cataracts compared w tamoxifen

Answer 26

-SERM -estrogen agonist on vaginal tissue -FDA approved for treatment of moderate to severe dyspareunia -modes incr in hot flashes compared w placebo (9.6% vs 3.4%) -estrogenic-type response on endometrium but was not aw incr in hyperplasia or endometrial ca w/in first year -a/w slight incr risk hemorrhagic stroke & VTE (black box warning)

Answer 27

-3rd gen SERM -estrogen agonist on bone -estrogen antagonist on breast & endometrial tissue -approved in Europe & Japan for tx of osteoporosis -combined w CEE is available in US for tx of VMS & prevention of osteoporosis

Answer 28

-SERM -r/t tamoxifen -FDA approved to treat advanced estrogen-sensitive breast ca & as adjuvant tx of early breast ca -weaker effect on endometrium compared w tamoxifen -may prolong QT interval in the heart (black box warning)

Prescription Therapies Flashcards

(52 cards)