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82 Cards in this Set
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- 3rd side (hint)
Hyperandrogenism
(W Low-Normal FSH) |
Indications for hormone replacement therapy (HRT)
|
|
|
Premature Ovarian Failure
(With High FSH) Menopause (With High FSH) surgical menopause. |
Indications for hormone replacement therapy (HRT)
|
|
|
Breast Ca
Pregnancy Smoker Uterine Ca |
Contraindications for
Estrogen therapy Nm them? 4ct |
Breast Ca
Pregnancy Smoker Uterine Ca |
|
Nm Type of HRT
For women who still have their uterus but are going thru or have gone thru menopause • reduces endometrial hyperplasia |
Estrogen/Progesterone
~Indicated for what type of Pts ~reduces ? |
For women who still have their uterus
but are going thru or have gone thru menopause • reduces Endometrial Hyperplasia |
|
For women who have had a
hysterectomy/ are without a uterus |
Estrogen
~For women who? |
hysterectomy/
are without a uterus |
|
Relationship between
HRT & the risk of cardiovascular disease or stroke What population is at Risk? |
Older women w heart Dz
should not be placed on HRT Transdermal vaginal are somewhat more preferred than oral. |
|
|
Unopposed estrogen puts at higher risk for
|
Endometrial hyperplasia as well as DUB
|
|
|
Method of Rx?
Does not have to pass through the liver may cause skin irritation May decrease fat and increase lean body mass Has limited absorption. |
Transdermal HRT
List points? |
Does not have to pass through the liver
may cause skin irritation May decrease fat and increase lean body mass |
|
Rx application?
Lotion-like emulsion does not have to pass through liver. Also has variable absorption messy |
Topical HRT
List points? |
Lotion-like emulsion
does not have to pass through liver. Also has variable absorption messy |
|
Minimizes systemic exposure
but still gives relief especially in atrophy of vagina Does not have to pass through liver and causes less ~hypertriglyceridemia and -prethrombotic effects than oral. Preparations include ~rings ~tablets ~creams |
Vaginal HRT
Preparations include ? |
~rings
~tablets ~creams |
|
type of application ?
Most are estrogen only so may need to do short term or consider progesterone therapy if uterus still intact. |
Vaginal HRT
|
|
|
Scheduled monthly bleeding
Estrogen 25 d progesterone added last 10 13 days then no therapy for 5 or 6 days |
Cyclic hormone therapy
List points 4ct |
Scheduled monthly bleeding
Estrogen 25 d progesterone added last 10 13 days then no therapy for 5 or 6 days |
|
Prevents monthly bleeding
may initially cause unpredictable spotting or bleeding. Best reserved for women who are 1-2 yrs postmenopausal No breaks Estrogen constant Progesterone added first 10-13 days |
Continuous hormone therapy
|
Prevents monthly bleeding
may initially cause unpredictable spotting or bleeding. Best reserved for women who are 1-2 yrs postmenopausal No breaks Estrogen constant Progesterone added first 10-13 days |
|
Inhibits bone loss
but does not reduce hot flushes skin wrinkling breast atrophy. Does not increase risk of thromboembolism. Do not need concomitant progesterone therapy ~Nm Class ~Nm Rx |
~Serms
~Raloxifene -Selective Estrogen Receptor Modulators- |
Inhibits bone loss
but does not reduce hot flushes skin wrinkling breast atrophy. Does not increase risk of thromboembolism. Do not need concomitant progesterone therapy |
|
For women at risk of osteoporosis who
cannot/will not take HRT. Does not increase risk of breast CA |
Raloxifene
Trade Nm? List Points? |
Evista
For women at risk of osteoporosis who cannot/will not take HRT. Does not increase risk of breast CA |
|
Reduces incidence of vertebral Fx by 37%. Higher doses needed in winter months. 800-2000 IU daily - may be more in winter or pts with prolonged hospitalization.
|
Vitamin D
Reduces incidence of vertebral Fx by |
37%
|
|
Has not reduced Fx in otherwise healthy
postmenopausal women. Recommended mostly for people with diets low in the nutrient |
Calcium
|
|
|
Prevent bone resorption by inhibiting osteoclast activity. Prevention of attachment of osteoclast to bone.
............(FOR)................ ~Hypercalcemia ~Osteoporosis ~Osteolytic bone lesions of metastatic Ca ~Paget's Dz |
~Alendronate
Nm Class? ............(FOR)................ 4ct |
Bisphosphonates
............(FOR)................ ~Hypercalcemia ~Osteoporosis ~Osteolytic bone lesions of metastatic Ca ~Paget's Dz |
|
Orally administered can cause
Esophageal erosion -need to remain upright. GI distress. Mild nausea diarrhea constipation occasionally. |
Bisphosphonates
Nm Rx |
~Aendronate
What Class? |
|
Nm Rx?
Inhibits bone loss but does not reduce hot flushes skin wrinkling breast atrophy. Bone density increases about 1% over 2 years |
~Raloxifene
Nm Class? |
(SERM)
|
|
Risk of Breast CA reduced by 76% in women taking
|
Raloxifine
What risk was reduced what % |
Risk of Breast CA reduced by 76% in women taking
|
|
Causes reduction of LDL
but No rise in HDL. Reduces vertebral Fx by 40% but not in non vertebral Fx. |
Raloxifene
Reduces what ? No increase in what? reduces what type of Fx what %? |
Causes reduction of LDL
but No rise in HDL. Reduces vertebral Fx by 40% but not in non vertebral Fx. |
|
For Tx of:
Hypercalcemia Osteoporosis Paget’s Dz Usually used in women who cannot tolerate other tx. |
Calcitonin
Txs what? 3ct |
Hypercalcemia
Osteoporosis Paget’s Dz Usually used in women who cannot tolerate other tx. |
|
Five years of therapy increase bone by 2-3% and reduces Vertebral Fx.
Tx immediately in post fracture period useful because Rx's ability to reduce bone Px |
Calcitonin
Reduces what? Increases what? .... ...by what %? Post Fx helps w what? |
~Vertebral Fx
~Increase bone by 2-3% ~Bone Px Tx immediately in post fracture period useful because Rx's ability to reduce bone Px |
|
Indicated for tx of post-menopausal women with osteoporosis that are at high risk for bone fracture includes women with a history osteoporotic Fx.
|
Teriparatide
|
|
|
Increase bone mass in hypogonadal men who are at risk for Fx
such as those having gnrh therapy for prostate cancer |
Teriparatide
|
|
|
~Abnormal facial features
~Neural tube defect It is an Anticonvulscant Rx |
Carbamazepine
A/E 2ct |
~Abnormal facial features
~Neural tube defect Nm Rx? |
|
Cardiac
cleft palate growth retardation |
Anti-cancer drugs
S/E 3ct |
Cardiac
cleft palate growth retardation |
|
Hypoplasia of teeth enamel and teeth staining
|
Tetracycline
|
|
|
Cardiac
CNS spina bifida defects |
Valproate
S/E 3ct |
Cardiac
CNS spina bifida defects (Class - Antiepileptic) |
|
Effects Female and Male offspring differently
- effects gonads though coumarin-fetal warfarin syndrome |
Diethylstilbestrol
|
|
|
Fetal warfarin syndrome
~chondrodysplasia punctata ~ malformation of ears or eyes ~mental retardation ~nasal hypoplasia ~ optic atrophy ~skeletal deformities |
Coumarin
Causes What? 7ct |
~Fetal warfarin syndrome :
~chondrodysplasia punctata ~malformation of ears or eyes ~mental retardation ~nasal hypoplasia ~optic atrophy ~skeletal deformities |
|
Deafness
heart limb abnormal |
Thalidomide
|
|
|
Spontaneous abortions
Malformation ~Of particular concern for what population? |
Retinoids
A/E 2ct |
Spontaneous abortions
Malformation (Retin-A (tretinoin) an anti-acne) |
|
Deafness
heart defects limb abnormalities renal abnormalities other |
Thalidomide
|
|
|
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
|
Pregnancy Category A
|
|
|
Hyperandrogenism (With Low-Normal FSH)
|
Indications for hormone replacement therapy (HRT)
|
|
|
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women
|
Preg category B
|
|
|
Premature Ovarian Failure
(With High FSH) Menopause (With High FSH) Surgical menopause |
Indications for hormone replacement therapy (HRT)
Nm Indications? 3ct |
Premature Ovarian Failure
(With High FSH) Menopause (With High FSH) Surgical menopause |
|
Animal studies have shown an adverse effect
but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester. |
Preg category B
|
|
|
Pregnancy
uterine or breast cancer smoker |
Contraindications for estrogen therapy
|
|
|
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans
but potential benefits may warrant use of the drug in pregnant women despite potential risks. |
Pregnancy Category C
|
|
|
For women who still have their uterus but are going thru or have gone thru menopause • reduces endometrial hyperplasia
|
Estrogen/Progesterone
|
|
|
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans
but potential benefits may warrant use of the drug in pregnant women despite potential risks. |
Pregnancy Category D
|
|
|
For women who have had a hysterectomy/are without a uterus
|
Estrogen
|
|
|
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience
and the risks involved in use of the drug in pregnant woman. |
Pregnancy Category X
|
|
|
Relationship between HRT and the risk of cardiovascular disease or stroke
|
Older women with heart disease should not be placed on HRT. Transdermal and vaginal are somewhat more preferred than oral.
|
|
|
Unopposed Estrogen
Higher risk for |
Endometrial Hyperplasia
DUB is caused by what? (dub Dysfctn Uterine Bleeding) |
Unopposed Estrogen
|
|
Does not have to pass through the liver
may cause skin irritation. May decrease fat and increase lean body mass. Has limited absorption. |
Transdermal HRT
|
|
|
Lotion-like emulsion does not have to pass through liver. Also has variable absorption and is messy.
|
Topical HRT
|
|
|
Minimizes systemic exposure but still gives relief especially in atrophy of vagina. Does not have to pass through liver and causes less hypertriglyceridemia and prethrombotic effects than oral. Preparations include
rings tablets and creams. |
Vaginal HRT
|
|
|
Most are estrogen only so may need to do short term or consider progesterone therapy if uterus still intact.
|
Vaginal HRT
|
|
|
Scheduled monthly bleeding
progesterone added last 10 13 days then no therapy for 5 or 6 days |
Cyclic hormone therapy
|
|
|
Prevents monthly bleeding may initially cause unpredictable spotting or bleeding. Best reserved for women who are 1-2 years postmenopausal. No breaks
progesterone added first 10-13 days |
Continuous hormone therapy
|
|
|
Inhibits bone loss
but does not reduce hot flushes skin wrinkling breast atrophy. Does increase risk slightly for thromboembolism. Do not need concomitant progesterone therapy |
Serms -Selective Estrogen Receptor Modulators- Raloxifene
|
|
|
For women at risk of osteoporosis who cannot/will not take HRT. Does not increase risk of breast CA
|
Raloxifene which is Evista
|
|
|
Reduces incidence of vertebral Fx by 37%. Higher doses needed in winter months. 800-2000 IU daily - may be more in winter or pts with prolonged hospitalization.
|
Vitamin D
|
|
|
Has not reduced Fx in otherwise healthy postmenopausal women. Recommended mostly for people with diets low in the nutrient
|
Calcium
|
|
|
Prevent bone resorption by inhibiting osteoclast activity. Prevention of attachment of osteoclast to bone. Osteoporosis
paget's disease hypercalcemia osteolytic bone lesions of metastatic cancer |
Bisphosphonates
alendronate |
|
|
Orally administered can cause esophageal erosion - need to remain upright. GI distress. Mild nausea diarrhea
constipation occasionally. |
Bisphosphonates
alendronate |
|
|
Inhibits bone loss
but does not reduce hot flushes skin wrinkling breast atrophy. Bone density increases about 1% over 2 years |
Selective estrogen receptor modulators (SERM) (representative drug
raloxifene) |
|
|
Risk of Breast CA reduced by 76% in women taking
|
Raloxifine
|
|
|
Causes reduction of LDL but not rise in HDL. Reduces vertebral Fx by 40% but not non vertebral Fx.
|
Raloxifene
|
|
|
For Osteoporosis
paget’s disease hypercalcemia Usually used in women who cannot tolerate other tx. |
Calcitonin
|
|
|
Five years of therapy increase bone by 2-3% and reduces the incidence of vertebral Fx. Tx immediately in the post fracture period is useful because of drugs ability to reduce bone pain
|
Calcitonin
|
|
|
Indicated for tx of post-menopausal women with osteoporosis that are at high risk for bone fracture includes women with a history osteoporotic Fx.
|
Teriparatide
|
|
|
Increase bone mass in hypogonadal men who are at risk for Fx
such as those having gnrh therapy for prostate cancer |
Teriparatide
|
|
|
Abnormal facial features
neural tube defect. |
Carbamazepine
|
|
|
Cardiac
cleft palate growth retardation |
Anti-cancer drugs
|
|
|
Hypoplasia of teeth enamel and teeth staining
|
Tetracycline
|
|
|
Cardiac defects
CNS spina bifida |
Valproate
|
|
|
Effects in female offspring and male different - effects gonads though coumarin-fetal warfarin syndrome
|
Diethylstilbestrol
|
|
|
Fetal warfarin syndrome (chondrodysplasia punctata
malformation of ears or eyes mental retardation nasal hypoplasia optic atrophy skeletal deformities) |
Coumarin
|
|
|
Deafness
heart limb abnormal |
Thalidomide
|
|
|
Spontaneous abortions
malformation |
Retinoids
|
|
|
Deafness
heart defects limb abnormalities renal abnormalities other |
Thalidomide
|
|
|
Pregnancy Category
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). |
Pregnancy Category A
|
|
|
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women
|
Preg category B
|
|
|
Animal studies have shown an adverse effect
but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester. |
Preg category B
|
|
|
Pregnancy Category
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans but potential benefits may warrant use of the drug in pregnant women despite potential risks. |
Pregnancy Category C
|
|
|
Pregnancy Category
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans but potential benefits may warrant use of the drug in pregnant women despite potential risks. |
Pregnancy Category D
|
|
|
Pregnancy Category
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience and the risks involved in use of the drug in pregnant woman. |
Pregnancy Category X
|
|