Gyn-Pharm

Front 1

Selective Estrogen Receptor Modulators (SERM)

Back 1

1. clomiphene
2. tamoxifen
3. raloxifen

Front 2

clomiphene

Back 2

Tx: amenorrheic/anovulatory women who want to get pregnant

MOA: blocks est receptors in hypo & pit so that no neg feedback from estrogen on GnRH and LH
==>incr FSH/LH secretion
==>gametogenesis & estrogen
==>ovulation

PE: 80% ovulate,
30-40% get pregnant

S/E: X-ind in women with hypercoagulation b/c clomiphene acts as gonist in liver
==>incr clotting factor synthesis

Front 3

tamoxiphen

Back 3

Tx:
*breast cancer
*prophylatic Tx in women with high risk of breast cancer

MOA:
*est antagonist at breast
*est agonist at
--uterus
==>endometrial hyperplasia
--liver
==>incr clotting factor synthesis
--bone (good)

S/E:
*Endometrial hyperplasia
--minimized by coadministration of PROGESTIN like:
-progesterone
-medroxy-progesterone
-norethindrone
-norgestimate
-norelgestromin
-levanorgestrel

Front 4

raloxiphen

Back 4

Tx: breast cancer that is estrogen-sensitive

MOA:
*est antagonist at breast & uterus
*est agonist at
--liver
--bone

S/E:

Front 5

alenDRONATE, ibanDRONATE

Back 5

(bisphosphanates)

Tx: post-menopausal women who do not want anything to touch their estrogen receptors but want to maintain bone density

MOA:
*drug incorporated into bone
*inhibits osteoclastic resorption of bone

PE: incr bone density

S/E: esophagitis

*take with only 6-8 oz water and remain standing for 30 minutes after (these are corrosive compounds and can aggravata LES if water level is too high in stomach and drug approach LES)

Front 6

after using tamoxifen for 5 years, how Tx pt?

Back 6

-switch to aromatase inhibitor:
*LETrozole
*ANAstrozole

Front 7

S/E of endometrial hyperplasia

Back 7

tamoxifen

Front 8

S/E esophagitis

Back 8

___dronate (bisphosphanate)
(corrosive compounds that can irritate LES)

prevent by stand up for 30 minute after take and take iwth only 6-8 oz water)

Front 9

what drug take with only 6-8 oz water and remain standing for 30 min

Back 9

__dronates (bisphosphanates)

Front 10

aromatase inhibitors

Back 10

LETrozole
ANAstrozole

Front 11

letrozole

Back 11

Tx:
1. women who have been on tamoxifen for 5 yrs
2. women who are not responsive to tamoxifen
3. women with estrogen-sensitive breast cancer
4. women with advanced metastatic breast cancer

PE: no estrogens at all!

MOA:
*pre-menopausal woman:
block conversion of
test==>estradiol in granulosa cell
*post-menopausal:
block conversion of
DHEA==>estrone in fat cells

Front 12

anastrozole

Back 12

Tx:
1. women who have been on tamoxifen for 5 yrs
2. women who are not responsive to tamoxifen
3. women with estrogen-sensitive breast cancer
4. women with advanced metastatic breast cancer

PE: no estrogens at all!

MOA:
*pre-menopausal woman:
block conversion of
test==>estradiol in granulosa cell
*post-menopausal:
block conversion of
DHEA==>estrone in fat cells

Front 13

Tx women with est+ breas tcancer

Back 13

letrozole
anastrozole
(aromatase - )

Front 14

Tx women with advanced/metastastic breast cancer

Back 14

letrozole
anastrozole
(aromatase - )

Front 15

Tx women on tamoxifen for 5 yrs

Back 15

letrozole
anastrozole
(aromatase - )

Front 16

Tx women not responsive to tamoxifen

Back 16

letrozole
anastrozole
(aromatase - )