Pharm-Female Estrogens-Dewitt

Question 1

Estrogen Pathway

Answer 1

Question 2

Low Estrogen: Clinical Presentation

Answer 2

• Adult
  
  • infertility
  • irregular or no menses; early menopause
  • no armpit or pubic hair
  • no libido or sexual function
• Adolescents
  
  • impaired production of gonadal steroids
  • sexual infantilism
    
    • don’t develop secondary sex characteristics at normal time of puberty or menses
  • Delayed puberty
  • associated with ambiguous external genitalia at birth

Question 3

GnRH agonists

Answer 3

• Drugs:
  
  • Gonadorelin
  • Leuprolide
• Diagnose LH responsiveness and determine if
  
  • constituiontal delay
    
    • delays in puberty
  • Hypogonadotropic hypogonadism
    
    • adults or adolescents

Question 4

Gonadorelin

Answer 4

• GnRH agonists
• diagnose LH responsiveness
• Admin: Pulsatile
  
  • initiating an LH surge and ovuluation
  • requires portable battery-powred pump and tubing to deliver pulses
  • Tx: Female infertility
    
    • NOT to induce puberty in patients with delayed puberty

Question 5

Gonadotropins

Answer 5

• LH & FSH
• Women w/anovolation-induce follicle development and ovulation
  
  • used only in women who fail to respond to other treatments
  • bc expensive
• most often used in ART procedures

Question 6

Clomiphenate citrate

Answer 6

• most common 1st line agent for infertility
  
  • used in patients who want to become pregnant
  • before controlled ovarian stimulation in ART
• partial/weak estrogen agonist
  
  • overall effect= antagonist; block endogenous feedback signals
• stimulate ovulation
• patients who fail to respond are treated with
  
  • gonadotropins
  • controlled ovarian stimulation

Question 7

Controlled ovarian stimulation

Answer 7

Produces multiple mature oocytes for ART

• daily injections w/FSH to induce follicle developement OR
• Hypogonadotropic hypogonadism require LH and FSH
  
  • GnRH agonists or antagonists added to block endogenous GnRH to prevent premature LH surge
• After appropriate follicular maturation, gonadotropins and GnRH agonists or antagonists stopped and hCG administered to indiuce ovulation