exam 6 - estrogens and androgens

natural estrogens

estetreol, estradiol, estradiol valerate, conjugate estrogens

synthetic estrogens

ethinyl estradiol, mestranol

oral contraceptives, hormone therapy, primary hypogonadism

estrogens indications

prevent pregnancy, regulate menstrual cycle, prevent menstrual related disorders, acne

COC oral contraceptives (estrogen and progestin) indication

edema, breakthrough bleeding, breast tenderness, thromboembolism, gallbladder disease, endometrial hyperplasia, headaches

hormone therapy (HT) ADE

pregnancy, breast cancer, mi or stroke, VTE, unexplained vaginal bleeding

hormone therapy CI

increases risk of CVD, diabetes, migraines, gallbladder and liver disease

hormone therapy precautions

natural

is progesterone natural or synthetic

contraception, in combination with estrogens to prevent uterine hyperplasia and endometrial cancer

medroxyprogesterone indication

weight gain, depression, thromboembolism, androgenic side effects (acne, hirsutism)

progesterone and progestins ADE

suppresses FSH to inhibit ovulation

estrogen MOA

suppresses LH to inhibit implantation and change cervical secretions

progestin MOA

breakthrough bleeding, acne, nausea, headaches, weight gain, breast tenderness

COC ADE

pregnancy, smoking, thromboembolic disease, major surgery, CVD, high BP, stroke, migraines with aura, breast cancer

COC absolute CI

enzyme inducers

ethinyl estradiol interaction

levonorgesterol

emergency contraception; progestin only, use within

ulipristal

emergency contraception; progesterone agonist/antagonist, use within 120 hours

tamoxifen and raloxifene

selective estrogen receptor modulators (SERM)

inhibits estrogen receptors in breast tissue, estrogen agonist effect on bone and endometrium

tamoxifen MOA

2d6

what is tamoxifen metabolized by

prevent and treat breast cancer

tamoxifen indication

N/V, hot flashes, vaginal bleeding, increases risk of endometrial cancer, increases risk of VTE

tamoxifen ADE

active or history of VTE

tamoxifen CI

selective estrogen receptor modulator

raloxifene MOA

prevent and treat osteoporosis, reduce risk of invasive breast cancer in postmenopausal women

raloxifene indication

edema, hot flashes, leg cramps, increases risk of stroke, increases risk of VTE

raloxifene ADE

pregnancy, history of stroke, history or active VTE

raloxifene CI

inhibits estrogen receptors

tamoxifen and raloxifene effects on breast tissue

estrogen agonist, increases risk of cancer

tamoxifen effect on endometrium

inhibits estrogen receptors

raloxifene effect on endometrium

estrogen agonist

tamoxifen and raloxifene effect on bone

decreases androgen conversion to estrogen to decrease estrogen levels

aromatase inhibitors MOA

aromatase inhibitors

anastrozole, letrozole, exemestane

first line treatment of postmenopausal hormone positive breast cancer patients

aromatase inhibitors indication

hot flashes, vaginal bleeding, musculoskeletal symptoms, osteoporosis, thromboembolism

aromatase inhibitors ADE

5 alpha reductase inhibitors

finasteride and dutasteride

blocks 5 alpha reductase to decrease synthesis of DHT in prostate

finasteride and dutasteride MOA

BPH and male pattern baldness

finasteride and dutasteride indications

impotence

finasteride and dutasteride ADE

end in afil

phosphodiesterase 5 inhibitors

inhibits PDE5 to prevent breakdown of cGMP which leads to vasodilation

phosphodiesterase 5 inhibitors (afil) MOA

ED, PAH, BPH

5 phosphodiesterase inhibitors (afil) indications

headache, flushing, priapism, back pain, visual disturbances

5 phosphodiesterase inhibitors (afil) ADE

nitrates/nitroglycerin, alpha 1 antagonists, 3a4 inhibitors

5 phosphodiesterase inhibitors interactions