1 / 16

Chapter 61

Chapter 61. Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications. Estrogens and Progestins. Hormones with multiple actions Promote female maturation Help regulate ongoing activity of female reproductive organs

sancho
Télécharger la présentation

Chapter 61

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 61 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications

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

  3. The Menstrual Cycle

  4. The Menstrual Cycle

  5. Estrogens Biosynthesis and elimination • Female • Ovary is the principal organ • Follicles, then corpus luteum • Placenta produces large amounts pregnancy • Major estrogen produced is estradiol • Male • Small amounts of testosterone converted into estradiol and estrone by the testes • Peripheral tissues

  6. Estrogens • Effects on primary and secondary sex characteristics • Reproductive tract and secondary sex characteristics • Physiologic processes related to reproduction • (1) ductal growth in the breast • (2) thickening and cornification of the vaginal epithelium (3) proliferation of the uterine epithelium • (4) copious secretion of thickened mucus from endocervical glands

  7. Estrogens • Metabolic actions • Positive effect on bone mass • Favorable effects on cholesterol levels • Blood coagulation • Adverse effects • Endometrial hyperplasia and carcinoma • Promotes growth of existing breast cancer • Ovarian cancer • Cardiovascular events • Nausea • Adverse effects from use during pregnancy

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

  9. Selective Estrogen Receptor Modulators (SERMs) • Activate in some tissues and block estrogen receptors selectively in others • Developed to provide benefits of estrogen while avoiding the drawbacks • Three available • None of the three offers all the benefits of estrogen and avoid all the drawbacks

  10. Selective Estrogen Receptor Modulators (SERMs) • Tamoxifen (Nolvadex) • Activates estrogen • Breast cancer treatment: inhibits cell growth in the breast • Protects against osteoporosis • Produces hot flashes • Risk for endometrial cancer and thromboembolism

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

  12. 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

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

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

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

  16. 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

More Related