Ch. 60 Est/Progest non-contraceptive
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General fx of estrogen/progesterone | *sexual organs/menstruation
*bone/prevent resorption, maint density,
*cholesterol favorable effects
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Estrogen given without progesterone can cause what adverse effects (first four) | *endometrial hyperplasia
*ovarian ca
*breast ca
*stimulates existing ca using estrogen receptors
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Estrogen/progestin adverse effects (second four) | *CV increase MI, DVT, CVA, VTE
*GI A, N, V
*GB cholelithiasis
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Minor s/e of both est/progest | jaundice, HA, depr, Na/H20 retent
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Major non-contraceptive uses | *HRT
*female hypogonadism
*acne
*prostate ca
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Routes of est/progest | po, transdermal, vag, parenteral
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SERMs definition | selective estrogen receptor modulator
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MOA of SERMs | mixed action - agonist and antagonist
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2 SERM drugs | *tamoxifen
*raloxifene
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positive effects of both SERMs | *tx breast ca
*prevent osteoporosis
*positive lipid effects
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negative effects SERMs tamoxifen | *hot flashes
*endometrial ca
*VTE
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negative effect of SERM raloxifene | *hot flashes
*VTE
*DOES NOT cause endometrial hyperplasia
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General fx of endogenous progesterone | *prepare/maintain uterine lining (secretory changes in leutal phase)
*cervical secretions - inc. visc, dec amt
*maint pg, inhibit uterine contractions
*some estrogenic, adrogenic, anabolic effects
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What might be given to prevent pre-term labor | progestins to inhibit uterine contractions
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first 4 ADRs of progestins | *teratogenic fetus masculinization
*menstrual irreg (BTB, amenorr)
*cervical secretions dec amt, inc visc
*if used with estrogen-->breast ca
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second 3 ADRS of progestins | *breast tenderness
*depression
*same misc as estrogen (and phto sens, wt gain, dec app)
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Noncontraceptive tx uses of progestin | *HRT
*uterine dx (bleed, amenorr, endometriosis, endometrial ca)
*PMS
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how does progest effect uterine lining? | it makes endometrium thinner to prevent ca
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benefits of HRT | *dec vasomotor menop effects
*dec uroginital dysfx, atrophy
*dec bone loss
*dec colon cancer
*maybe QOL
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Is HRT established to provide a CV benefit? | No, HRT has NOT been established to provide a CV benefit
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Risks of HRT | *CV events
*if ET only, not EPT: ovarian, uterine ca
*breast ca
*cholecystitis, lithiasis
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What do we give for HRT with in tact uterus | pempro given for this uterine status
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What do we give for HRT s/p hysterectomy? | premarin given for this uterine status
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Example of EPT drug | pempro representative of this class
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Example of ET drug | premarin representative of this class
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WHI, HERs study concenus | *HRT NOT advised >4 yrs (long term)
*IS advised < 4 years
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WHI, HERs study short term uses | *vasomotor menop sxs
*osteoporosis
*vulvar/vaginal menop atrophy
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