Narrated Estrogens (60)

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Lehne Ch. 60

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Chapter 60:

Chapter 60 Estrogens and Progestins : Basic Pharmacology and Noncontraceptive Applications

Estrogens and Progestins:

Estrogens and Progestins Hormones with multiple actions Promote female maturation Help regulate the ongoing activity of female reproductive organs Estrogens affect bone mineralization and lipid metabolism Principal endogenous estrogen is estradiol; principal progestational hormone is progesterone

The Menstrual Cycle:

The Menstrual Cycle

The Menstrual Cycle:

The Menstrual Cycle

Slide 5:

Fig. 60-1. The menstrual cycle: anatomic and hormonal changes. (FSH = follicle-stimulating hormone, LH = luteinizing hormone.)

Estrogens:

Estrogens Biosynthesis and elimination Ovary is the principal organ Major estrogen produced is estradiol Effects on primary and secondary sex characteristics Reproductive tract and secondary sex characteristics Physiologic processes related to reproduction

Estrogens:

Estrogens Metabolic actions Positive effect on bone mass Favorable effects on cholesterol levels Adverse effects Endometrial hyperplasia and carcinoma Breast cancer Ovarian cancer Cardiovascular events Nausea Adverse effects from use during pregnancy

Estrogens:

Estrogens Therapeutic uses Hormone therapy after menopause Female hypogonadism Acne Routes of administration Oral Transdermal Intravaginal Parenteral

Selective Estrogen Receptor Modulators (SERMs):

Selective Estrogen Receptor Modulators (SERMs) Activate and block estrogen receptors selectively Tamoxifen (Nolvadex) Activates estrogen Breast cancer treatment Protects against osteoporosis Produces hot flashes Risk for endometrial cancer and hypogonadism

Selective Estrogen Receptor Modulators (SERMs):

Selective Estrogen Receptor Modulators (SERMs) Raloxifene (Evista) Does not activate estrogen Protects against breast cancer, osteoporosis Promotes thromboembolism Induces hot flashes

Progestins:

Progestins Compounds that act like progesterone Principal endogenous progestational hormone Produced by ovaries and placenta Adverse effects Teratogenic effects Gynecologic effects Breast cancer Depression Breast tenderness

Progestins:

Progestins Therapeutic uses Postmenopausal hormone therapy Dysfunctional uterine bleeding Amenorrhea Prematurity prevention Endometrial carcinoma and hyperplasia

Menopausal Hormone Therapy Benefits:

Menopausal Hormone Therapy Benefits Relief of vasomotor symptoms Management of urogenital atrophy Prevention of osteoporosis and related fractures Prevention of colorectal cancer Positive effect on wound healing Tooth retention Glycemic control

Menopausal Hormone Therapy Benefits:

Menopausal Hormone Therapy Benefits Physiologic doses of estrogen (with or without progestin) Taken to manage symptoms caused by the loss of estrogen in menopause Hot flashes, sleep disturbances, urogenital atrophy, bone loss, altered lipid metabolism Use of HRT has declined sharply Landmark studies: WHI and HERS

Menopausal Hormone Therapy Benefits:

Menopausal Hormone Therapy Benefits Relief of vasomotor symptoms Management of urogenital atrophy Prevention of osteoporosis and related fractures Prevention of colorectal cancer Improved quality of life Others Wound healing, tooth retention, and glycemic control

Menopausal Hormone Therapy Risks:

Menopausal Hormone Therapy Risks Cardiovascular events: myocardial infarction, stroke, pulmonary embolism, and deep venous thrombosis Endometrial cancer Breast cancer Ovarian cancer Gallbladder disease Dementia Urinary incontinence

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