Shared Flashcard Set

Details

BHRT related material
BHRT, bases, and more
77
Pharmacology
Professional
04/29/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What is the major hormone released by the hypothalamus?
Definition
GnRH
Term
What roles does the anterior pituitary play?
Definition

Blocks or stimulates release of progesterone, estrogen, and testosterone through the release of...

 

-FSH and LH

Term
What hormone does FSH primarily affect?  
Definition
Estrogen
Term
What hormone does LH primarily affect?
Definition
Progesterone
Term
What short-lived "organ" is responsible for progesterone production?
Definition
The corpeus luteum
Term
In what four locations (in order of descending concentrations) can estrogen be produced?
Definition

- Ovaries

- Follicle around ovum

- Adrenal glands

- Fat cells

Term
What three forms of estrogen are there?
Definition

E2 - Estradiol, most active form of estrogen made by ovaries, adrenals, and fat cells

E3 - Estriol, weakest and least active, attaches to cell receptors making up hair, nails, skin, and mucosal membranes, affects primarily vaginal walls, little effect on bones or heart

E1 - Estrone, made after menopause primarily in fat cells from testosterone derivatives, higher levels (while not definititively causative) have shown higher levels of breast cancer in certain studies

Term
With the aging process, where does most of of the estrogen come from?
Definition

- Adrenals become main source of estrogen production

- Unused Testosterone is transformed into estrogen

- Estrogen in fat cells is called into action

Term
What are the "general" affects of estrogen?  Specifics?
Definition

- In general, estrogen makes things grow

- Specifically:

 

-Makes lining of uterus grow

- Grows breast tissues grow for milk production

- Causes ovum to mature for ovulation

- Supports follicle growth

- Promotes fetal growth

- Keeps vagina, vulva, and cervix well developed and moisturized

- Stimulates body fat accumulation to aid the fetus

- Prevents bone destruction by osteoclasts

- Relaxes lining of blood vessels, preventing HTN

- Stimulates production of lipoprotein lipase (breaks down fat), result is low cholesterole levels and good HDL/LDL balance

- Induces relaxation of blood vessels in heart

Term
If left unchecked by progesterone, estrogen can lead to negative consequences, these include:
Definition

- Increased body fat

- Increased water and salt retention

- Interferenece with normal insulin release and blood sugar control

- Increased risk of overgrowth of endometrium (lining of the uterus)

- Increased risk of overgrowth of breast tissue

- Anxiousness and irritability

- Severe headaches

- Increased risk of galbladder disease

- Increased incidence of blood clot formation

Term
While progesterone is the precursor of many hormones, what are its functions in the way of the estrogen-progesterone relationship?
Definition

- Prepare the endometrium for implantation of the fertilized ovum

- Ensure survival of the fetus in the uterus

- Prevent water retention

- Help use fat for energy at the cellular level

- Serve as a natural antidepressant (more info needed)

- Create a calming effect on the body

- Help restore regular sleep patterns

- Help keep insulin release in check and maintain even blood sugar levels

- Prevent overgrowth of the endometrium

- Prevent breast tissue overgrowth

- Maintain sex drive

- Maintain normal blood-clotting parameters

- Protect against fibricystic breasts

Term
If unbalanced by estrogen, what are progesterone's negative effects?
Definition

- A sedating effect

- Increased spotting and changes in bleeding patterns

- Bloating, when taken in large quantities

- GI discomfort

- Acne

- Hyperpigmentation of the facial skin when exposed to sunlight

Term

Where is testosterone made in men?

In women?

Definition

Men: Testes and adrenals

Women:  Adrenals, ovaries, and corpus luteum in women

Term
Name the different androgens
Definition

Testosterone

Androstenediol

Dihydrotestosterone (DHT)

androstanediol

androstenedione

dihydroepiandrosterone (DHEA)

 

Term
What are the positive effects of testosterone in men and women?
Definition

- Promotes muscle strength and exercise endurance

- Improves libido

- Increases energy levels

- Improves sense of well being

- Increases body hair production

- Produces enlargement of penis and testes as well as clitoris

- Improves sexual desire and fantasy

- Improves bone desnity

Term
What are the negative effects of testosterone?  
Definition

- Male pattern baldness

- Increased facial hair

- Aggressive behavior/irritability

- High cholesterol levels

- Too much clitoral enlargement

- Involution of testis and penis

- Growth of breast tissue in men

 

Some effects of too much testosterone are similar to estrogen because this hormone is converted TO estrogen when too abundant

Term
What are symptoms of hormone inbalance in adolescent years?
Definition

- Acne

- Mood swings

Term
What are symptoms of hormone inbalance in a person's twenties/child bearing years?
Definition

- Postpartum depression

- Night sweats

- Infertility

 

Term
What are symptoms of hormone inbalance in a person's thirties?
Definition

- Bloating

- PMS

- Migraines

- Breast tenderness

- Decreasing attention span

- Weight gain

 

Term
Why do women in their thirties experience symptoms similar to PMS? 
Definition
- The quality of progesterone produced by their corpeus luteum decreases greatly, causing an overabundance of estrogen effects
Term
How does estrogen cause migraines, decreased attention spans, and weight gain?
Definition

Migraines - widening and dilation of blood vessels in the scalp

Decreased attention - 

Weight gain - Estrogen stimulates fat accumulation, and also spikes insulin levels (progesterone tempers insulin)

Term
What is the connection between depression and hormones?
Definition

Normal levels of estrogen and progesterone stimulate the production of serotonin

 

Unopposed levels of estrogen cause the pituitary gland to pulse LH (to produce more progesterone) and keep us from staying asleep at night

Term
What is the dose of natural progesterone, and where can the cream be applied (usually)?
Definition

- 4-6mg/kg a day

- Upper chest, neck, and inner wrists

Term
What is the dose of natural estradiol?  Where is the cream applied?
Definition

- 0.006-0.008mg/kg a day

- The cream is applied to the upper chest, inner arms or wrists, or neck; generally areas that are warm and have good circulation

- The dosing is generally cycled to follow the woman's natural cycle

 

Term
What is the dose of natural testosterone?  Where are some areas of application?
Definition

Dose: 0.01mg/kg a day

 

Can be applied on bicep, 3-4 times weekly, or to the area around the labia or clitorus

Term
Dispell the following myth: Hormone treatments are risky and can increase morbidity and mortality from breast cancer, cervical cancer, stroke, and cardiovascular disease
Definition

- WHI of 1991 only focused on synthetic hormones for study

- Focused on estrogen ONLY, no progesterone

- The following statement was released after that part of the study was halted in 2004

 

"After careful consideration of the data, NIH has concluded that with an average of nearly 7 years of follow-up completed, estrogen alone does not appear to affect (either increase or decrease) heart disease, a key question of the study. It has not increased the risk of breast cancer during the time period of the study."

Term
Dispell the following myth: if a hormone supplement (example, estrogen 2.4mg/gram, 0.5 grams bid) doesn't appear to be resolving symptoms, titrate the dose upwards
Definition
- No, there are various overlaps in hormone symptoms, and one symptom of hormone excess can be the same as a symptom of another hormone's deficiency
Term
Dispell the following myth: Saliving testing is the only acceptable form of hormone testing
Definition
- Each test; saliva, blood spot, urine, and serum all have their advantages and disadvantages
Term
What is significant in regards to estrone?
Definition

- 50-70% less active than estradiol

- Produced by oxidation of estradiol and, in the peripheral tissues, of androstenedione

 

Term
What is significant in regards to estradiol?
Definition

- Most potent and active estrogen

- binds most tightly to estrogen receptors

Term
What is significant regarding estriol?
Definition

- 10% of the activity of estradiol

- produced from the hydration of estrone

- Cannot be converted INTO estrone or estradiol

- Can impede binding of estradiol

Term
Describe the major components of the hormone metabolism pathway (picture)
Definition
[image]
Term
Why are synthetic estrogens not considered to be real hormones?
Definition
They provide precursors to estrogens, but not the actual hormones
Term
What information is important in regards to synthetic hormones compared to BHRT?
Definition
Term
What are the symptoms associated with each hormone and its corresponding level?
Definition
[image]
Term
Why test patients, instead of going by patient response?
Definition

- Symptoms of different imbalances overlap (imbalance of one or more hormones can mimic the effect of other imbalances)

- Too much of one hormone can create the same symptoms as too little (too much of a hormone can work initially, but ultimately will decrease benefits and increase risks)

- must validate each hormone independently, cross-reference one test level by using another (e.g, saliva vs. serum shows relatively same elevation)

- Distinguish follicular, ovulatory, and luteal phases of the menstrual cycle

- Yield results that correlate with age and symptoms

 

Term
Saliva testing is preferred when....
Definition

- Testing for multiple points (e.g cortisol)

- Patients are using topical medications

- Saliva testing is subject to contamination from blood and supplements

- Not everything measured in saliva is clinically viable, such as Vitamin D (if blood present), or DHT

- NEVER do a saliva test within 24 hours of using a troche

Term
Cortisol testing should be done using....
Definition
A 4-point (4x/day) method
Term
Serum testing is the norm BUT....
Definition

- Subject to overdosing patients who use topical medications

- needs to include binding proteins to assess the level of "free" hormones

- Some methods innaccurate at low concentrations

 

Term
Blood spot testing.....
Definition

- Can measure factors that are too large for saliva (thyroid, Vitamin D, glucose, insulin, DHEAS)

- more convenient than serum testing

- more reflective of tissue uptake for patients on topicals

- best for evaluating cardiovascular metabolic risk factors

Term
Uring testing can be effective for baseline hormone testing  BUT....
Definition

- Does not show bioavailable hormone levels

- Not good for oral estrogens (progesterone)

- First pass effect clouds interpretation

- Not accurate when treating with topical progesterone

Term
WHEN do you do the testing?
Definition

- Cycling female -> test days 18-21 during luteal phase

- Irregular cycles -> test after next menses as above or test now

- Menopausal -> test any time

- patient to take oral hormones 12 hours prior or apply topical 12-24 hours prior

Term
Describe the levels of estrogen during the menstrual cycle (picture)
Definition
Term
What are the general treatment guidelines, in terms of evaluating/subsequently prescribing, that a practitioner should follow?
Definition

Goal: To restore hormone levels to the normal physiological levels of a younger individual, to provide the protective benefits of the hormone to the entire system

- Replenish only the hormones that are necessary

- Correct cortisol, thyroid, and progesterone first

- Use the lowest amount required to alleviate symptoms and achieve the desired physiological effect

- Start bioidentical estrogen dosage at mid-range (NEVER use unopposed estrogen)

- Start low and adjust slowly (efficacy can be improved by changing timing, application, and/or delivery route)

- Monitor symptoms (if not resolved consider other hormonal/behavioral causes)

- Re-test

Term
What are some major considerations for the various dosage forms of synthetics and bioidenticals?
Definition

Oral synthetics

- Not well absorbed in body

- Limits to amounts that can be taken (expensive, some transdermals unpleasant, liver issues)

 

Compounded BHRT's

- Vaginal delivery (creams or suppositories) have excellent absorption, have been shown to be SUPERIOR over oral delivery

- Troches have fast dissolution and rapid onset, but may need to be dosed more often, also could skew saliva testing

- SR micronized caps are good alternative

Term
What are the effects of a decreased estrogen level?
Definition

- Anxiety

- Bladder symptoms

- Cramps

- Depression

- Dry skin/hair

 - Harder to climax

- Hot flashes

- memory loss

- night sweats

- sleep disturbances

- vaginal dryness

Term
What are the effects of an increased estrogen level?  Fluctuating?
Definition

- Anxiety

- Decreased sex drive

- Fibrocystic breasts

- fluid retention

- heavy menses

- irratibility

- mood swings

- weight gain

 

Fluctuating:

- Hair loss

- Headaches

- Hot flashes

 

 

Term
What are the effects of decreased progesterone levels?
Definition

- Anxiety

- Arthritis

- Breakthrough bleeding

- breast tenderness

- Fibrocystic breast

- fluid retention

- harder to climax

- heavy or irregular menses

- hot flashes

- mood swings

- sleep disturbances

- weight gain

Term
What are the effects of INCREASED progesterone levels? Fluctuating?
Definition

- Breast tenderness

- Depression

- Fatigue

 

Fluctuating:

- hair loss

- headaches

- Irritability

 

Term
What are the effects of a DECREASED testosterone level?  Increased?
Definition

- Arthritis

- Bladder symptoms

- Decreased sex drive

- Depression

- Fatigue

- harder to climax

- headaches

- loss of memory

- vaginal dryness

 

Increased:

- Hair loss

- Sleep disturbances

Term
What are the effects of a DECREASED cortisol level? Increased? Fluctuating?
Definition

- Decreased sex drive

- Fatigue

 

 

Increased:

Depression

 

Fluctuating:

- Night sweats

Term
What are the effects of a DECREASED thyroid level?
Definition

- Decreased sex drive

- Depression

- Fatigue

- Headaches

- Weight gain

 

Fluctuating levels cause hair loss

Term
What levels of what hormones can cause anxiety?
Definition

- Decreased OR increased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause arthritis-like symptoms?
Definition

- Decreased Progesterone

- Decreased Testosterone

Term
What levels of what hormones can cause bladder symptoms?
Definition

- Decreased estrogen

- Decreased testosterone

Term
What levels of what hormones can cause breakthrough bleeding?
Definition
- Decreased progesterone
Term
What levels of what hormones can cause breast tenderness?
Definition
- Decreased OR increased progesterone
Term
What levels of what hormones can cause cramps?
Definition
- Decreased estrogen
Term
What levels of what hormones can cause decreased sex drive?
Definition

- Increased estrogen

- Decreased testosterone

- Decreased cortisol

- Decreased Thyroid

Term
What levels of what hormones can cause depression?
Definition

- Increased progesterone

- Increased cortisol

- Decreased estrogen

- Decreased testosterone

- Decreased thyroid

Term
What levels of what hormones can cause dry skin/hair?
Definition
- Decreased estrogen
Term
What levels of what hormones can cause fatigue?
Definition

- Increased progesterone

- Decreased Testosterone

- Decreased cortisol

- Decreased thyroid

Term
What levels of what hormones can cause fibrocystic breast?
Definition

- Increased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause fluid retention?
Definition

- Increased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause hair loss?
Definition

- Fluctuating levels of estrogen, progesterone, and thyroid.

- Increased testosterone

Term
What levels of what hormones can cause difficulty in climaxing? 
Definition
- decreased estrogen, progesterone, and testosterone
Term
What levels of what hormones can cause headaches?
Definition

- Fluctuating estrogen and progesterone

- Decreased testosterone

- Decreased thyroid

Term
What levels of what hormones can cause heavy or irregular menses?
Definition

- Increased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause hot flashes?
Definition

- Decreased OR flucuating levels of estrogen

- Decreased progesterone

Term
What levels of what hormones can cause irritability?
Definition

- Increased estrogen

- Fluctuating progesterone

Term
What levels of what hormones can cause memory-loss?
Definition

- Decreased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause mood swings?
Definition

- Increased estrogen

- Decreased progesterone

Term
What levels of what hormones can cause night sweats?
Definition

- Decreased estrogen

- Fluctuating cortisol

Term
What levels of what hormones can cause sleep disturbances or insomnia?
Definition

- Decreased estrogen

- Decreased progesterone

- Increased testosterone

Term
What levels of what hormones can cause vaginal dryness?
Definition

- Decreased estrogen

- Decreased testosterone

Term
What levels of what hormones can cause weight gain?
Definition

- Increase estrogen

- Decreased progesterone

- Decreased thyroid

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