Cook: Drugs are bad, m'kay.... Flashcards Preview

Reproductive > Cook: Drugs are bad, m'kay.... > Flashcards

Flashcards in Cook: Drugs are bad, m'kay.... Deck (89):
1

oxytocin

Uses: induction of labor, contractions after C-section or during uterine surgery, control postpartum hemorrhage, abortion

2

prostaglandins

use: onset of labor

3

dinoprostone

PGE2
use: induce labor

4

misoprostol

PGE1
use: induce labor

5

carboprost tromethamine

15-methyl-PGF2
use: induce labor

6

tocolytics

Use: delay premature parturition to slow delivery long enough for therapeutic measures including glucocorticoid therapy to increase pulmonary surfactant
CI: intra-amniotic infection, fetal demise, severe fetal growth restriction, pre-eclampsia

7

magnesium sulfate

tocolytic
MOA: decrease Ca availability
oral (laxative), parenteral
Tx: anticonvulsant (depress CNS, block peripheral NM transmission), hypomagnesemia, preeclampsia, eclampsia
also neuroprotective to fetus
excretion: renal: Mg reabsorbed
CI: myasthenia gravis, caution in renal insufficiency
AE: flushing, blurry vision/ headache, nausea, hypotension,, lethargy, pulmonary edema
toxicity: loss of pateller reflexes, decreased urine output, respiratory depression

8

indomethacin

tocolytic
MOA: COX inhibitor
AE: GI, platelet dysfunction
fetus: premature closure of ductus arteriosus, oligohydramnios

9

caster oil

herbal
tocolytic (Cook)
induce labor (article)

10

blue cohosh

herbal
tocolytic (Cook)
induce labor (article)

11

black cohosh

herbal
tocolytic (Cook)
induce labor (article)

12

oil of evening primrose

herbal
tocolytic (Cook)
induce labor (article)

13

gonadotropins

Use: female infertility in anovulatory women or women with hypogonadism, in vitro fertilization; male infertility reserved for time fertility is desired
Risk: multiple pregnancy (preferred in men due to this)
PULSATILE

14

pregnancy diagnostic kit

Ab to B subunit of CG
qualitative CG detection in urine

15

How can you determine the exact time of ovulation?

measure urinary LH: ovulation occurs 36 hours after onset of LH surge

16

menotropin

IM: FSH and LH
SC: rFSH

17

chorinoic gonadotropin

IM
CG: binds LH receptor

18

estrogen MOA

nuclear receptor: receptor/ligand complexes bind DNA near HRE (hormone response element)
native: rapidly degrades so can't use

19

ethinyl estradiol

synthetic estrogen
decreased hepatic metabolism
use: combination pill

20

SERM (selective estrogen receptor modulator)

estrogen activity is tissue selective
activity: bone, brain, liver
no activity or antagonistic: breast, endometrium
Tx: breast CA

21

tamoxifen

SERM

22

raloxifene

SERM

23

combination pill (contraception)

estrogen: ethanol estradiol or mestranol
progestin: norethindrone, norgestrel, or levonorgestrel
MOA: prevents LH and FSH release by feedback inhibition
CI: thromboembolic disease, cerebral vascular disease, MI, CAD, congenital hyperlipidemia, breast CA, endometrial CA
off label use: polycystic ovary syndrome

24

mini-pill (contraception)

progestin only
blocks ovulation in ONLY 60-80% of cycles, impair sperm transport by thickening cervical mucus, decreases motility of ovules in oviduct, alters endometrium to impair implantation
slightly HIGHER failure rate than combination pill
for: breastfeeding women, over 35 yrs and smoke

25

postcoital contraception

morning after pill: two doses levonorgestrel separated by 12 hours
first does within 72 hours
most effective emergency contraception

26

contragestation

antiprogestin

27

mifepristone- RU48

antiprogestin: block progesterone binding to receptor
use: termination of pregnancy within 49 days

28

clomiphene

anti-estrogen: pure antagonist
act on ER in hypothalamus to block feedback inhibition of natural estrogens and stimulate GnRH which stimulates LH/FSH leading to ovulation
use: ovulation induction

29

fulvestrant

anti-estrogen: pure antagonist
act on ER in hypothalamus to block feedback inhibition of natural estrogens and stimulate GnRH which stimulates LH/FSH leading to ovulation
use: ovulation induction

30

mestranol

synthetic estrogen
decreased hepatic metabolism
use: combination pill

31

norethindrone

progestin
use: combination pill

32

norgestrel

progestin
use: combination pill

33

levonorgestrel

progestin
use: combination pill, morning after pill

34

gonadorelin acetate

synthetic GnRH
IV pulsatile pump
AE: phlebitis

35

cetrorelix

GnRH antagonist
Tx: in vitro fertilization (delay premature LH surge to delay ovulation to allow collection of ova) following FSH therapy

36

ganirelix

GnRH antagonist

37

degarelix

GnRH antagonist
Tx: prostate CA

38

goserelin acetate

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

39

triptorelin

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

40

leuprolide

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

41

histrelin

GnRH agonist: down-regulates receptors
Tx: precocious puberty

42

nafarelin

GnRH agonist
Tx: precocious puberty and endometriosis

43

estrogen esters

estrogen: conjugated esters of estrogen, esters of estradiol

44

onapristone

antiprogestin: pure antagonist

45

anastrozole

aromatase inhibitor

46

letrozole

aromatase inhibitor

47

androgens

injection, oral, transdermal
ester: more lipid soluble, longer duration
binding of testosterone to androgen receptor that binds to DNA response element
conversion to DHT in some tissues (prostate, not muscle or kidney): more potent
use: androgen deficient man, endometriosis, PMS, elderly men to maintain muscle mass (prefer injection because transdermal can tear off skin)

48

testosterone

androgen

49

testosterone transdermal patches

androgen

50

methyl-testosterone

testosterone derivative

51

testosterone propionate

testosterone derivative

52

testosterone cypionate

testosterone derivative

53

danazol

weak testosterone
Tx: PMS

54

flutamide

androgen receptor antagonist
Tx: prostate CA
AE: hepatic, 3x administration

55

bicalutamide

androgen receptor antagonist
Tx: prostate CA

56

finasteride

inhibitor of 5alpha-reductase
Tx: BPH, male pattern baldness
should not be touched by pregnant women: absorbed in skin and causes birth defects in male fetus
men should not donate blood

57

anabolic steroids

abused by athletes
AE: low T, decreased libido, decreased spermatogenesis, HEPATOTOXICITY, CHD

58

ER alpha

estrogen receptor
female reproductive tract: uterus, vagina, ovary and many other tissues

59

ER Beta

estrogen receptor
prostate gland and ovary

60

estrogen actions

1. increase HDL, lower LDL (lower CHD in pre-menopausal women)
2. breast development
3. bone maturation, close epiphyseal plates, antagonizes bone resorption, shapes pelvis
4. increase muscle of myometrium
5. increase libido
6. increase hepatic proteins (TBG, transcortin, SHBG, clotting factors)

61

estrogen adverse effects

1. TUMORS (breast, uterus, testis, bone, kidney, etc.)
2. VENOUS THROMBOEMBOLISM: increase risk of stroke (elevated in women that smoke)

62

progesterone actions

1. aids in maintaining pregnancy
2. inhibits uterine contraction
3. alveolobular development of breast secretary apparatus
4. decrease HDL, increase LDL
5. body temperature rise at ovulation
6. depressant and hypnotic effects on brain

63

estrogen and progesterone therapeutic uses

native: rapidly degraded by liver so can't use orally
ex of uses: prostate and breast CA, fertility control, hormone replacement therapy (menopause, osteoporosis, ovarian failure), dysfunctional uterine bleeding (irregular menstrual cycle), ovulation induction in infertile women

64

DES (diethylstilbesterol)

synthetic non-steroidal estrogen
Tx: prostate CA

65

clorotrianisene

synthetic non-steroidal estrogen
Tx: prostate CA

66

benefits of shorter or fewer hormone free intervals with oral contraceptives

decrease menstrual symptoms: headache, bloating, menstrual pain

67

non-contraceptive benefits of oral contraceptives

1. reduced dysfunctional uterine bleeding and dysmenorrhea
2. menstrual regularity, increased hemoglobin
3. combination pill: raise SHBG: decrease androgens: less hirsutism and acne

68

adverse effects of oral contraceptives
1. general
2. old formulations (high dose ethinyl estradiol)
3. combination pill
4. low dose ethinyl estradiol
5. extended/continous cycle
6. with antibiotics (which ones)
7. drugs that decrease contraceptive effectiveness

1. N/V, breast tenderness and enlargement
2. old formulations (greater than 50mcg ethinyl estradiol): more MI, stroke
3. combination pill: venous thromboembolism esp. smokers
4. low dose ethinyl estradiol: breakthrough bleeding
5. unexpected bleeding
6. contraceptive failure: penicillins, tetracyclines
7. rifampin, anti-HIV, anticonvulsants, St. John's wort

69

progesterone adverse effects

acne, weight gain

70

transdermal patch (contraception)

ethinyl estradiol and progestin
new patch each week, patch free for one week
AE: skin irritation, break through bleeding first 2 cycles
CI: women over 90kg (198 lbs)

71

vaginal contraceptive ring

ethinyl estradiol and progestin
inserted intravaginally by patient: in place 3 weeks, one week ring free
considerations: do NOT remove for more than 3 hr, NOT effective until in place 7 days, rapid return to fertility after removal

72

injectable contraceptive

progesterone only: medroxyprogesterone
every 3 months
AE: amenorrhea, irregular bleeding, weight gain, headache, decreased bone density
considerations: DISCONTINUE after 2 years, delayed return to fertility (6-12 months)

73

contraceptive implant

progesterone only: etonogestrel
effective 3 years
AE: same as all progestins

74

Cu IUD

spermacidal
effective 15-20 years (recommend removal at 10 yr)
fertility quickly restored after removal
use: contraception, dysmenorrhea
AE: cramping

75

progestin releasing IUD

levonorgestrel
effective 5 yrs
use: contraception, dysmenorrhea
AE: irregular bleeding for 6-12 mo

76

condoms (male and female)

barrier contraceptive
protect against STDs

77

diaphragm/cervical cap

barrier protection with spermicide (in place 6 hr before and after sex)
unclear if it protects from STDs

78

spermacide

nonoxynol-9 (a surfactant)
foam, gel, cream, suppository, lube for condom/diaphragm
only effective for 1 hr: reapplication necessary
MUST be in contact with cervix
AE: less effective, irritation of vaginal mucosa, TSS

79

sponge

barrier with spermicide
moisten and place over cervix: effective immediately and up to 24 hr: MUST remain in place 6 hr after intercourse
NOT as good as diaphragm

80

calendar method of contraception

calculate ovulation taking temperature
avoid intercourse on presumed fertile days
HIGH FAILURE rate

81

types of emergency contraception

1. oral contraceptives: NOT recommended
2. copper IUD
3. two dose progestin
AE: N/V with ethanol estradiol, headache, breast tenderness, abdominal pain

82

oxandrolone

anabolic steroid with less conversion to estrogens and less inhibition of testosterone synthesis

83

nicalutamide

androgen receptor antagonist
Tx: prostate CA
less hepatotoxic and once a day administration compared to flutamide

84

cyproterone acetate

androgen receptor antagonist: competes with DHT for androgen receptor, prevents translation to nucleus
Tx: acne, baldness, hirsutism, virilizing syndrome, inhibit libido in sex deviant males

85

spironolactone

aldosterone antagonist, competes for testosterone receptor
Tx: hyperaldosteronism, HTN, hirsuitism

86

nifedipine

tocolytic
MOA: Ca channel blocker
AE: flush, headache, dizzy palpitations, nausea
increased CO to compensate for vasodilation
other: MI, pulmonary edema, hypoxia, hypotension, atrial fibrillation

87

terbutaline

tocolytic
MOA: Beta mimetic

88

ritodrine

tocolytic
MOA: Beta mimetic

89

beta mimetic

tocolytic
AE: maternal cardiotoxicity and death
other: hyperglycemia, pulmonary edema
fetus: hypoglycemia, cardiotoxicity