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33 Cards in this Set
- Front
- Back
Estrogen is produced by...
converted peripherally from... |
adrenal cortex
ovary from androstenedione |
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Produced in ovaries
most potent Highest affinity x ER Levels fluctuate |
E2 or estradiol
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Less potent metabolite of E2
Produced in __ and by peripheral conversion |
E1 or estrone
Adrenal cortex |
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Peripheral metabolite of __
Highest during pregnancy |
E3 or estriol
Metabolite of E2 |
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Estrogen: Lipo/hydrophic?
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highly lipid soluble
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Estradiol binds to this. It's produced in liver and present in bloodstream
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SHBG-sex-hormone binding globulin
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These estrogen receptors present in:
Liver, uterus, breast, kidney |
ER-alpha
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These Estrogen receptors present in:
Reproductive tissues, brain, bone, urinary tract, vascular system, GI |
ER-beta
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A rise in this hormone marks the beginning of post-ovulation
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progesterone
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Gonadotropins, name two and where they are released from. Also causes increase in them?
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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 |
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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 |
40%
75% 2% |
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Uses monoclonal antibodies to deteck FSH in urine
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Home test kit
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What vasomotor symptoms are presented in menopause?
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Hot flashes, night sweats.
Experienced by 85% perimenopausal women 50% disturbing 50% up to 5 years |
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Besides vasomotor symptoms, what is another common clinical presentation of menopause?
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Vaginal dryness. Which can cause dyspareunia, UTI, urinary incontinence
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Give some clinical presentations that you might see in someone who is peri/menopausal
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Mood swings
depression insomnia migraines tactile hallucination arthralgia myalgia urinary frequency |
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Short term and long term goals of HRT therapy?
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Short-term: enhance QOL, treat menopausal symptoms
Long-term: reduce morbidity/mortality associated with sex-steroid deficiency, OP, CAD |
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Absolute contraindications and relative contraindications of MHT...
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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 |
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What physical examination should be performed pre-HRT.
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Blood pressure, pelvic exam, breast exam, Pap smear, mammongraphy
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What labs performed pre-HRT tx?
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thyroid
lipid profile iron studies |
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Absolute CI with HRT.
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Pregnancy
Unexplained vaginal bleeding Active/chronic liver damage h/o breast or endometrial cancer recent vascular thrombosis informed pt refussal |
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Relative CI for HRT
-TGs -h/o this disease -FH of -___disease |
TG> 300mg/dL
h/o throboembolic disease FH of breast cancer Gallbladder disease Migraine HAs Uterine leiomyoma Seizure disorder |
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Non-Pharmacologic includes...
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exercise
weight control smoking cessation healthful diet soy protein for hot flashes -paced breathing progressive muscle relaxation |
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Placebo effect
1 in __ have 50% reduction of hot flashes while 1 in __ have 75% reduction |
5
10 |
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Short and long term benefits of HRT
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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 |
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Potential short term harm of HRT
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HA, edema, Nausea, breast tenderness, uterine bleeding, change in lipids, endometriosis, poor compliance, increased risk cholecystitis, increased risk thromboembolism
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Potential long term harm of HRT
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Breast cancer
ENdometrial cancer Ovarian cancer Venous throboembolism Gallbladder disease Leiomyoma |
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What HRT increases risk of breast cancer?
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Estrogen and progestin
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does estrogen have high first pass metabolism
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YEs
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What are some other uses of estrogen
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Contraception
Prevention/treatment of OP |
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Progestins
-reduce risk of... MPA 20mg/d reduces.... May diminish __ benefits |
reduce risk of endometrial cancer/hyperplasia
MPA(70-80% reduction in hot flashes) May diminish lipid benefits |
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ADEs of progestin
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irritability, depression, HA, mood swings, bloating, edema, sleep disturbances.
*C-19: norethisterone, norgestrel, l-norgestrel C-21: MPA, dihydrogesterone |
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Alternatives to HRT
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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 |
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This food may help reduce bone fractures
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Soy food
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