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19 Cards in this Set
- Front
- Back
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HRT
Estrogen |
Benefits: inc bone density; dec risk colorectal CA
Indications - the lowest dose for shortest period!!! TX of severe menopausal vasomotor sx TX of vulvovaginal atrophy or dryness (consider topical) Prevention of osteoporosis where benefit >>>>risks Remember in perimenopausal women – contraception is important! Major CI: Allergy to any component; hx/current clotting disorder; breast, endometrial, other estrogen dependant tumor; hepatic dysfxn; preg Major ADE: Nausea, HA, breast tenderness, heavy bleeding, thromboembolism, gallbladder dz, cholestasis, HTN, ↑TG, Fluid retention, Migraine TO PREVENT ENDOMETRIAL HYPERPLASIA, USE PROGESTIN IN ALL WOMEN WITH INTACT UTERUS – if unable to tolerate progestin, annual biopsy |
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HRT
Progestin |
Benefit/indication – prevents endometrial hyperplasia
CI as with estrogen replacement Adverse effects: Category X in pregnancy (synthetics) but natural progesterone and 17-hydroxyprogesterone are CATEGORY B and used to prevent premature delivery PMS-like symptoms Fluid retention ↓HDL ↑LDL Glucose intolerance Breakthrough bleeding Androgenic (esp with some synthetics) Hirsutism Weight gain Acne |
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TX for women who are not candidates for HRT
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Topical (Vaginal) HRT
Antidepressants (bearing in mind ability of SSRI to decrease activation of tamoxifen in women with tamoxifen-induced hot flashes) |
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HRT
Androgens |
Indication:
Men w/ androgen deficiency syndromes & low testosterone levels Women w/ dec libido CI: preg (category X); metastatic prostate CA; breast CA; indx prostate nodule or induration; unexplained elev in PSA; erythrocytosis (Hct>50%); severe HF ADE: Acne & Oily Skin; Erythrocystosis; Prostate CA; Impaired Fertility; Cholestatic Jaundice; Roid Rage, Aggression; Dependance; Transderm absorption of gel through physical contact |
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Raloxifene***
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Estrogen Partial Ag
SERMS = Selective Estrogen Receptor Modulator USE: Osteoporosis prevention SE: Reduce risk of breast CA |
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Tamoxifen***, toremifene***
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Estrogen Partial Ag
SERMS = Selective Estrogen Receptor Modulator USE: TX ER+ CA SE: Reduce Osteoporosis |
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Clomiphene
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Estrogen Partial Ag
SERMS = selective estrogen receptor modulator --blocks estrogen receptors @ breast but allows for action @ bone-- USE: stimulate ovulation (& blocks feedback inhibition of estrogen) |
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Fulvestrant***
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SERD (Selective Estrogen Receptor Down regulation)
USE: postmenopausal ER+ ADE: hot flashes, osteoporosis. NO DVT or endometrial CA risk (...no estrogen)!*** |
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Letrozole, Anastrazole
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Competitive Aromatase Inhibs
Block estrogen synth postmenopausal ER+ breast CA ADE: fatigue, arthralgia, In risk FX, hot flashes NO DVT or endometrial CA risk (...no estrogen)!*** |
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Exemestane***
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Irreversible Aromatase Inhibs***
Block estrogen synth postmenopausal ER+ breast CA Others: Formestane, Anastrozole, Letrozole ADE: fatigue, arthralgia, inc risk FX, hot flashes NO DVT or endometrial CA risk (...no estrogen)!*** |
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Leuprolide***
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GnRH Analog
Pulsatile dosing – induce FSH/LH release (Regular) Sustained dosing – suppress hormone release (Depot) Uses: Endometriosis (sustained) Prostate CA (sustained) Advanced Breast CA (sustained) Precocious puberty (sustained) Control ovulation to harvest for in vitro fertilization (short acting) Side effects: Hot flashes; Gynecomastia; Osteoporosis; Decreased libido; VTE (pulsatile dosing and at initiation of sustained) |
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Abrelix, Ganirelix, Cetrorelix
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GnRH Antag
USE: prostate CA, control of ovulaiton during infertility TX |
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Finasteride dutasteride
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Androgen Antag
5 Alpha Reductase Inhib USE: male pattern baldness, BPH |
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Bicalutamide, Flutamide
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USE: Androgen Receptor + CA
Start the androgen receptor agonist BEFORE the GnRH analog continuous suppression - at onset of GnRH analog, will see increase of LH/FSH before suppression occurs ADE: Dec libido, hair loss, hot flushes, mood changes |
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Drosperinone***
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Progestin in YAZ.
Antiadrogenic & Antialdosterone -- watch for hyperK+ (***) esp w/ other drugs that can inc K+. It may inc the risk of thrombi, too. |
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Early cycle bleed, what should you adjust?
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Prob = too little estrogen, so inc it!
Think E=E (early=estrogen) |
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Late cycle bleed, what should you adjust?
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Prob = too little progesin, so inc it!
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Random/mid-cycle bleed, what should you adjust?
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Inc both progestin & estrogen
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When is the worst time to miss hormones w/ contraceptives?
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Around the 7d hormone free interval (wk before or after). You shouldn't be off hormones from more than 7d or you risk inc chance of preg (use back up method)
BTW, Rifampin will lower efficacy of birth control. |
