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PPE Drugs - Endocrine > Reproductive Hormones > Flashcards

Reproductive Hormones Flashcards

1
Q

What is an oestrogen?

A

Any oestrogenic agent

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2
Q

What are the 3 major oestrogens in humans?

When is each most abundant?

A
  • Oestradiol - pre-menopausal women
  • Oestrone - post-menopausal women
  • Oestriol - pregnancy (produced by placenta)
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3
Q

Give 3 formulations of oral oestrogens

A
  • Oestradiol - natural
  • Oestrone + equilin
  • Synthetic oestrogens e.g. ethinylestrodiol
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4
Q

What is a progestogen?

Can you give an example?

A

Any progestational agent

Progesterone

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5
Q

What are progestins?

Give 5 examples

A

Synthetic progestogens

  • Levonorgestrel
  • Desogestrel
  • Norethisterone
  • Medroxyprogesterone - “Provera”
  • Dydrogesterone
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6
Q

Outline the drugs used in HRT

Why is this so?

A

HRT = oestradiol + progestin (usually medroxyprogesterone)

Progesterone must be given alongside oestrogen to prevent endometrial cancer

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7
Q

What is oestrogen replacement therapy? When is it used?

A

Oestrogen only

Used in women without a uterus - i.e. post-hysterectomy

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8
Q

What types of hormone are used in the combined oral contraceptive pill?

A
  • Oestradiol/synthetic oestrogen

- Progestin

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9
Q

Outline the 3 different regimens used with the COCP

A
  • Monophasic - same dose of oestrogen + progestin every day for 21 days, then 7 day break
  • Triphasic - 7 days of O+P, 7 days of O, 7 days of P, 7 day break - mimics natural cycle best
  • Every day - monophasic, but instead of stopping completely for 7 days, you take placebos for 7 days - easier for patients to remember
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10
Q

What is the mechanism of action of the COCP?

A
  • Oestrogen inhibits ovulation via negative feedback on anterior pituitary
  • Progestogen causes cervical mucus to thicken and alters endometrium so implantation cannot occur
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11
Q

Give some secondary effects of oestrogen, aside from reproductive

A
  • Anabolic
  • Sodium and water retention
  • Raises HDLs
  • Decreases bone resorption
  • Impairs glucose tolerance
  • Increases blood coagulability
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12
Q

Give some 5 ADRs of the COCP

A
  • Breast tenderness
  • Water retention/weight gain
  • Mood swings
  • Increased risk of VTE
  • Impaired glucose tolerance
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13
Q

Give some DDIs associated with the COCP

A

Metabolised by CYP450, so affected by inducers primarily -

  • Antiepileptics e.g. Carbemazepine
  • Rifampicin
  • St John’s wort
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14
Q

What should you monitor while a woman is on the COCP?

A
  • BP

- BMI

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15
Q

What is the mechanism of action of the POPs?

A
  • Thickens cervical mucus and induces changes in endometrium such that implantation cannot occur
  • MAY inhibit ovulation, but not its major action
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16
Q

Give 5 ADRs of the POP

A
  • Weight gain
  • Acne
  • Depression/PMS
  • Irregular periods
  • Nausea
    NO effect on coagulability as does not contain oestrogen - no risk of VTE
17
Q

Are POPs subject to the same DDIs as the COCP?

A

Yes but even more so

18
Q

How may HRT be administered in terms of regimen?

A
  • Sequential - oestrogen days 1 - 28, progestin only days 14 - 28 - mimics natural cycle - still have a period
  • Continuous - both for 28 days - no bleed
19
Q

Give 3 reasons why HRT may be prescribed

A
  • Reduces symptoms of menopause
  • Prevents osteoporosis
  • Also has some CVS benefits
20
Q

Give some risks associated with HRT

A
  • Oestrogen + progestin increases risk of breast cancer
  • Increased risk of stroke
  • Increased risk of VTE
21
Q

What is the maximum length of time a woman can take HRT?

A

5 years

22
Q

Give 3 forms of emergency contraception, and state how long after coitus they may be used

A
  • Levonorgestrel (a progestin) - up to 72 hours (3 days)
  • Ulipristal acetate - selective progesterone receptor modulator - up to 120 hours (5 days)
  • Copper IUD - prevents implantation - up to 120 hours (5 days)
23
Q

What are SERMs?

A

Selective oestrogen receptor modulators

Non-steroidal drugs which bind to oestrogen receptors to exert either a positive or negative effect

24
Q

List 3 SERMs

A
  • Clomiphene
  • Tamoxifen
  • Raloxifene
25
Q

What is the mechanism of action of clomiphene?

A
  • Anti-oestrogenic - inhibits oestrogen binding at anterior pituitary - hence inhibits negative feedback - increases LH/FSH - induces ovulation
26
Q

What does Raloxifene do?

A

Pro-oestrogenic effects on bone/lipid metabolism/blood coagulation - used to prevent osteoporosis, but can also increase risk of VTE
No effect on endometrium/breast, so no cancer risk

27
Q

Name an anti-progestin
What is its MoA?
What is it used for?

A

Mifepristone
Partial agonist at progesterone receptor - out-competes progesterone
Termination of pregnancy

28
Q

Name an anti-androgen

What is its MoA?

A

Cyproterone

Partial agonist at progesterone receptor - out-competes dihydrotestosterone

29
Q

What is the mechanism of action of Finasteride?

What is it used for?

A

Prevents conversion of testosterone to more potent dihydrotestosterone
Used to treat BPH

PPE Drugs - Endocrine (3 decks)

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