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Pharm II: Endometriosis and HRT (exam 3)

Terms in this set (34)

1st line pharmacologic tx for endometriosis
oral CHC
oral progestins
DMPA
GnRH agonist MOA
decreases levels of estrogen and progesterone
What type of medication is Leuprolide
GnRH agonist
AEs of GnRH agonists
bone density loss
vasomotor sx (i.e. hot flashes)
What is used to combat bone density loss when a pt is taking GnRH agonist for endometriosis
add back therapy → low dose estrogen-progestin (NOT oral CHC)
Why can you not use oral CHC for add back therapy in a pt taking GnRH agonist for endometriosis?
causes serum estrogen levels to exceed threshold and thus cancel out efficacy of actual treatment
Danazol MOA
inhibits release of gonadotropics
Danazol BBW
- pregnancy
- thrombosis risk
- peliosis hepatis, benign hepatic adenoma
- pseudotumor cerebri
Women with hyperlipidemia or liver dz should not be started on what endometriosis medication?
Danazol
What is the key enzyme in the conversion of adrenal androgens to estrogen?
aromatase
aromatase inhibitor MOA
inhibit peripheral conversion of androgens to estrogens
Aromatase inhibitors
letrozole
anastrozole
What is used to tx refractory endometriosis?
aromatase inhibitors in conjunction with progestin, CHC, or GnRH agonist+add back
1st line tx for mild menopausal sx with only vulvovaginal sx
vaginal moisturizers or lubricants (nonestrogenic)
systemic HRT indications
moderate to severe vasomotor sx
Harm outweighs benefits for pts who are on long term HRT >5 yrs due to the increased risk of what 3 complications?
CV dz
breast cancer
thromboembolism
What risk does NOT increase after long term estrogen use in postmenopausal women with a hysterectomy?
breast cancer!
57 yr old, perimenopausal woman presents to clinic with c/o vaginal dryness and mild dyspareunia. PMHx urinary urge incontinence. What is the treatment of choice?
intravaginal estrogen → can treat the vaginal atrophy and may improve urge incontinence
Which vaginal estrogen Rx can treat both local and vasomotor symptoms
Femring
Estrogen only therapy may decrease heart disease and all cause mortality in what population?
50-59 yr old women with hx of hysterectomy
In women with an intact uterus, MHT consists of...
estrogen PLUS progestogen or estrogen agonist/antagonist
What is estrogen monotherapy associated with?
endometrial hyperplasia and cancer
Pts who are not candidates for HRT can take....
SSRI/SNRIs → venlafaxine
SERMs
Tamoxifen
Raloxifene
Bazedoxifene
Ospemifene
Tamoxifen MOA
estrogen antagonist in breast cancer cells, preventing tumor growth
Pt has ductal carcinoma in situ, what is the preferred tx
tamoxifen
tamoxifen BBW
Uterine malignancies
stroke
PE
T/F Raloxifene can be used for postmenopausal osteoporosis and breast CA treatment
false - not used for breast CA treatment (only prevention!)
Raloxifene BBW
VTE and stroke
Bazedoxifene MOA
estrogen antagonist in uterus → decreased endometrial hyperplasia risk
Bazedoxifene indications
mod-severe vasomotor sx
postmenopausal osteoporosis prevention
Which medication is an estrogen agonist and therefore induces changes in vaginal wall thickness and increased endometrial proliferation?
ospemifene
Ospemifene indications
mod-severe menopausal dyspareunia
moderate to severe vaginal dryness
Raloxifene is an estrogen antagonist in ______ and __________ but an estrogen agonist in __________.
antagonist in breast and uterus; agonist in bone
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