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Junior - Pharm II - 2 > 6 - Fertility And Repro > Flashcards

6 - Fertility And Repro Flashcards

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1
Q

What are the menopause therapies?

A

Menopausal hormone therapy (MHT)
Estrogen therapy
Progesterone therapy

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2
Q

Who should never get estrogen mono-therapy?

A

Anyone with a uterus

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3
Q

What is estrogen therapy in menopause used to treat?

A

Relieves genitourinary atrophy, and pain w sex

Relieves vasomotor instability

Improves sleep (decreased hot flash)

Osteoporosis: reduces bone resorption

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4
Q

Adverse events with estrogen therapy for menopause?

A

Endometrial and breast cancer

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5
Q

Who is the target audience for estrogen therapy?

A

Prevention of menopausal osteoporosis post hysterectomy

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6
Q

What role does progestin therapy have in menopause?

A

Medroxyprogesteron prevents estrogen induced bleeding, lowers cancer risk

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7
Q

Adverse events with medroxyprogesterone?

A

Bloating
Wt gain
Depression

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8
Q

Do i need a high dose of progesterone for benefits to be realized?

A

Nope; micro-dosing progesterone has been found to be equally effective

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9
Q

What did the women’s health initiative study (WIH) tell us about estrogen?

A 
It is linked to: 
Lung cancer
Breast cancer
Endometrial cancer
Ovarian cancer

Good thing we gave that shit out like candy before the study

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10
Q

What is a major risk for estrogen that isnt cancer?

A

Decreased anticoagulation leading to blood clots

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11
Q

Why use estrogen + cyclic progesterone for menopause?

A

It mimics the female cycle and has a bleeding cycle (wait wasnt that the only benefit of menopause?)

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12
Q

How else can estrogen and progesterone be combined?

A

Estrogen plus continuous progesterone (no interruption)

And intermittent, 3 on 3 off

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13
Q

What are the oral estrogen products?

A 
Synthetic conjugated estrogens A
Synthetic conjugated estrogens B
17-estradiol
Esterfied estrogens
Estropipate
Conjugated estrogens

Fortunately they all end or start with estrogen

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14
Q

Whats the advantage to vaginal estrogen products?

A

They only have localized effects, this is a double edged sword though because they only treat localized stuff too

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15
Q

Formulations of vaginal estrogen products?

A

Vaginal creams
Vaginal rings: 17 B-estradiol, estradiol acetate
Vaginal tablet: estradiol hemihydrate

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16
Q

What estrogen formulation is used transdermally

A

17 B-estradiol is available in a patch, gel and spray

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17
Q

Progesterone products?

A 
Noretthidrone acetate
Megestrol acetate
Norethindrone
Levonorgestrel
Progesterone
Micronized progesterone
Medrozxyprogesterone acetae
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18
Q

Norethindronate acete used for?

A

Secondary amenorrhea, endometriosis, abnormal uterine bleeding

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19
Q

Megestrol acetate used for?

A

Appetite stimulant and treatment for metastatic breast cancer

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20
Q

What are norethindrone and levonorgestrel used for?

A

Contraceptives

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21
Q

What is progesterone gel used for?

A

Infertile women who have a progesterone deficiency or secondary menorrhea

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22
Q

What is micronized progesterone used for?

A

Prevention of endometrial hyperplasia

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23
Q

There are a bunch of combined estrogen progesterone drugs, they all have estrogen and progesterone combo names. What is the one exception?

A

Estrogen bazedoxifen

Bazedoxifen is not a progesterone drug it is a SERM

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24
Q

How does bazedoxifen work?

A

It acts as an agonist of estrogen receptors in some estrogen sensitive tissues and an antagonist in others

This reduces the risk of endometrial hyperplasia

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25
What is the clinical use of estrogens/bazedoxifen (duavee)?
Post menopausal osteoporosis
26
What adverse events are associated with estrogens/bazedoxifen (duavee)?
Malignant neoplasms and gall bladder disease Also its a pregnancy category X Has a risk of osteoporosis Basically this is quite a wonder drug
27
Your patient doesnt want to use hormones to treat menopausal symptoms what are her options?
``` Lube SERMS SSRI’s SNRI Clonidine Gabapentin Methyldopa ```
28
What are some herbals/phytoestrogens used in menopause?
Red clover Soy isoflavones Black cohosh
29
Name some SERMs
``` Tamoxifen Raloxifen Ospemifene Tamoxifen Raloxifen ``` -ifen
30
Tamoxifen and raloxifen MOA?
Remember -ifens SERM’s? We just talked about this come on... They are estrogen agonist: they improve lipid profile Estrogen antagonist: reduce cancer risk
31
Are SERMs safer than estrogen?
No they have all the same adverse events
32
Ospemifene clinical use?
Treatment of moderate to sever dyspareunia caused by valvular and vaginal atrophy (menopause) Not approved for osteoporesis
33
What is tamoxifen used for?
Breast cancer tx and prevention in high risk women Not approved for osteoporosis
34
Raloxifen (evista) use?
Prevention of osteoporesis
35
What drugs interactions can you see with raloxifen?
Bile acid resins Warfarin Thyroid hormones
36
What is clomiphene (clomid)?
MOA: ovulation inducing agent You only get 3 chances
37
What do aromatase inhibitors inhibit?
They inhibit production of estrogen by blocking armoatase Used in tx of breast cancer
38
What are teh aromatase inhibitors?
Letrozole Anastrozole Exemestane
39
Mifepristone (mifeprex) And Mifepristone (korylm) Same drug name very different use, what is it?
Mifepristone (mifeprex) is an abortion drug, used to terminate intrauterine pregnancy up to 70 days later Mifepristone (korylm) is used to treat hyperglycemia in pts with cushing syndrome
40
What is Mifepristone’s MOA?
Inhibits progesterone and binds to glucocorticoid receptors
41
What are the generalized actions of anabolic hormones?
Anabolism: Stimulation of protein synthesis Stimulation of RBC production
42
Testosterone pills?
Nope, it is inactivated by the first pass effect
43
What are some clinical uses for testosterone?
Senile osteoporosis and anemia (70+) Males: replacement therapy Females: hypopituitarism, breast cancer, endometriosis Increased lean body mass, strength and performance (unapproved)
44
Testosterone schedule?
Schedule III
45
Adverse effects of testosterone therapy?
Males: Azoospermia (bad sperm) Stunted growth in pre-pubertal males Females: masculinization, hair, acne
46
Long acting testosterone drugs?
Testosterone cypionate IM Depo-testosterone IM Testosterone enthate IM Testosterone pellets: SC implant
47
Testosterone short acting?
Transdermal Testosterone transdermal system Transdermal gels solutions Please dont put these on your genitals
48
Oral androgens
Fluoxymesterone | Methyltestosterone
49
Anabolic androgens | Oxandrolone
wt gain where protein breakdown is the reason
50
Anabolic androgens | Oxymethalone
Anemia’s from deficient RBC production
51
Danazole (adanocrine)
Androgen derivative Use to treat endometriosis and fibrocystic breast disease
52
What are anti-androgens and androgen agonists used for?
``` Prostate cancer Endometriosis Breast cancer Hirusitism Alopecia acne Precious puberty in males BPH ```
53
What are the drugs used to treat BPH?
a-blockers - zosin’s and osin’s ``` Terazosin Doxazosin Alfuozosin Tamsulosin 5a reductase inhibitor ```
54
What is finasteride (propecia, proscar) MOA?
Halts BPH progression and reduces prostate size and symptoms over time Also works on hirsutism
55
You solved your BPH and baldness with finasteride but now what happens?
You have decreased libido, ED, and ejaculatory dysfunction so that beautiful head of hair does you no good
56
What about finasteride and pregnancy?
Its is bad that women cant even touch it. Oh and it messes up men’s sperm too so dont mess with this stuff in if babies are in anyone around you’s future
57
PDE5 inhibitors”?
Slidenafil (viagra, revatio) Verdenafil Avanafil Tadalafil (cialis)
58
How do PDE5 inhibitors work?
PDE-5 is responsible for degradation of cGMP in the corpus cavernosum - no effect in the absence of sexual stimulation
59
Besides ED what else are PDE5’s used for?
ED, pulmonary arterial HTN BPH
60
How long do these pills (PDE5 inhibitors) last?
Vardenafil and sildenafil: 4 hrs | Tadalail: 36hrs
61
What are some contraindications for slidenafil, verdenafil, and avanafil?
Renal and liver problems, but you can use a reduced dose of slidenafil
62
What is the advantage to tadalafil (cialis)
You dont need to plan. It last 36 hrs so it is a once daily pill.
63
What are the adverse events associated with PDE5 inhibitors?
``` Nasal congestion Headache Flushing HOTN Vision changes (blurring and color changes) ```
64
What drugs dont do well with PDE5 inhibitors?
Nitrates: HOTN (fatal) a-blockers: HOTN tamsulosin is less likely to cause problems ETOH: HOTN CYP3A4 inhibitors: not recommended
65
What is alprostadil?
Prostaglandin E1 (PGE1) vasidilator used for ED
66
Administration of alprostadil?
Injection or urethral pellet
67
Why use alprostadil?
It may still work with spinal injury
68
What are the many approaches that are used to treat female sexual dysfunction?
``` non pharm: psych Hormonal therapy (androgens) Dopamine agonist (Parkinson’s) Fibanserine Herbals ```
69
Fefibanserin (addyi)
The only approved medication for femal sexual dysfunction We dont know how it works but it exhibits serotonergic and dopaminergic activity
70
How gets fibanserin (addyi)
HSSD PREmenopausal women w hypoactive sexual desure
71
What is another term for lethal dose?
A lifetime supply...

Junior - Pharm II - 2 (3 decks)

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