Pharmtx - Final - Mht

Front 1

Estrogen is produced by...
converted peripherally from...

Back 1

adrenal cortex
ovary
from androstenedione

Front 2

Produced in ovaries
most potent
Highest affinity x ER
Levels fluctuate

Back 2

E2 or estradiol

Front 3

Less potent metabolite of E2
Produced in __ and by peripheral conversion

Back 3

E1 or estrone
Adrenal cortex

Front 4

Peripheral metabolite of __
Highest during pregnancy

Back 4

E3 or estriol
Metabolite of E2

Front 5

Estrogen: Lipo/hydrophic?

Back 5

highly lipid soluble

Front 6

Estradiol binds to this. It's produced in liver and present in bloodstream

Back 6

SHBG-sex-hormone binding globulin

Front 7

These estrogen receptors present in:
Liver, uterus, breast, kidney

Back 7

ER-alpha

Front 8

These Estrogen receptors present in:
Reproductive tissues, brain, bone, urinary tract, vascular system, GI

Back 8

ER-beta

Front 9

A rise in this hormone marks the beginning of post-ovulation

Back 9

progesterone

Front 10

Gonadotropins, name two and where they are released from. Also causes increase in them?

Back 10

LH and FSH from pituitary
decline in estradiol results in compensatory increase in FSH and LH secretion
-remain elevated 2-3 years after menopause and slowly decline afterwards

Front 11

By age 45:__% of women started or completed menopause.
by age 50: __% of women have started or completed menopause.
by age 55: only __% women still premenopausal

Back 11

40%
75%
2%

Front 12

Uses monoclonal antibodies to deteck FSH in urine

Back 12

Home test kit

Front 13

What vasomotor symptoms are presented in menopause?

Back 13

Hot flashes, night sweats.
Experienced by 85% perimenopausal women
50% disturbing
50% up to 5 years

Front 14

Besides vasomotor symptoms, what is another common clinical presentation of menopause?

Back 14

Vaginal dryness. Which can cause dyspareunia, UTI, urinary incontinence

Front 15

Give some clinical presentations that you might see in someone who is peri/menopausal

Back 15

Mood swings
depression
insomnia
migraines
tactile hallucination
arthralgia
myalgia
urinary frequency

Front 16

Short term and long term goals of HRT therapy?

Back 16

Short-term: enhance QOL, treat menopausal symptoms
Long-term: reduce morbidity/mortality associated with sex-steroid deficiency, OP, CAD

Front 17

Absolute contraindications and relative contraindications of MHT...

Back 17

Not for women with a history of or active throboembolic disease, breast cancer or estrogen dependent neoplasm, pregnancy, liver disease, or undiagnosed vaginal bleeding.
*It also should not be used for the prevention or treatment of CVD, cerebrovascular disease, or dementia

Front 18

What physical examination should be performed pre-HRT.

Back 18

Blood pressure, pelvic exam, breast exam, Pap smear, mammongraphy

Front 19

What labs performed pre-HRT tx?

Back 19

thyroid
lipid profile
iron studies

Front 20

Absolute CI with HRT.

Back 20

Pregnancy
Unexplained vaginal bleeding
Active/chronic liver damage
h/o breast or endometrial cancer
recent vascular thrombosis
informed pt refussal

Front 21

Relative CI for HRT
-TGs
-h/o this disease
-FH of
-___disease

Back 21

TG> 300mg/dL
h/o throboembolic disease
FH of breast cancer
Gallbladder disease
Migraine HAs
Uterine leiomyoma
Seizure disorder

Front 22

Non-Pharmacologic includes...

Back 22

exercise
weight control
smoking cessation
healthful diet
soy protein for hot flashes

-paced breathing
progressive muscle relaxation

Front 23

Placebo effect
1 in __ have 50% reduction of hot flashes while 1 in __ have 75% reduction

Back 23

5
10

Front 24

Short and long term benefits of HRT

Back 24

ST(<5 yrs): hot flashes, sleep disturbances, urogenital atrophy, possible mood, BMD(not fracture)

LT:prevent vertebral fractures, decreased risk colon cancer

Inconclusive: Stroke, DM, lung cancer, cognitive f(x), Heart dieases

Front 25

Potential short term harm of HRT

Back 25

HA, edema, Nausea, breast tenderness, uterine bleeding, change in lipids, endometriosis, poor compliance, increased risk cholecystitis, increased risk thromboembolism

Front 26

Potential long term harm of HRT

Back 26

Breast cancer
ENdometrial cancer
Ovarian cancer
Venous throboembolism
Gallbladder disease
Leiomyoma

Front 27

What HRT increases risk of breast cancer?

Back 27

Estrogen and progestin

Front 28

does estrogen have high first pass metabolism

Back 28

YEs

Front 29

What are some other uses of estrogen

Back 29

Contraception
Prevention/treatment of OP

Front 30

Progestins
-reduce risk of...
MPA 20mg/d reduces....
May diminish __ benefits

Back 30

reduce risk of endometrial cancer/hyperplasia
MPA(70-80% reduction in hot flashes)
May diminish lipid benefits

Front 31

ADEs of progestin

Back 31

irritability, depression, HA, mood swings, bloating, edema, sleep disturbances.
*C-19: norethisterone, norgestrel, l-norgestrel
C-21: MPA, dihydrogesterone

Front 32

Alternatives to HRT

Back 32

Venlafaxine(50% reduction or greater in hot flashes)
Fluoxetine
Paroxetine(Reduced hot flashes)
Sertraline(reduced hot flashes
Gabapentin
Clonidine 0.1mg reduced hot flashes
Vitamin E

Front 33

This food may help reduce bone fractures

Back 33

Soy food