Endo Exam 2 Drugs Flashcards
(75 cards)
1
Q
options for acromegaly
A
somatostatin analogs
dopamine receptor antagonists
GH receptor antagonist
2
Q
what are the somatostatin analogs
A
octreotide
lanreotide
pasireotide
3
Q
what are the dopamine receptor agonists
A
bromocriptine
cabergoline
4
Q
what is the GH receptor antagonist
A
pegvisomat
5
Q
what are the GnRH analogs
A
leuprolide
goserelin
histrelin
nafarelin
triptorelin
6
Q
what are the GnRH antagonists
A
ganirelix
cetrorelix
7
Q
what are the SERMs
A
tamoxifen
toremifene
raloxifene
bazedoxifene
ospemifene
8
Q
what are the antiestrogens/ estrogen antagonists
A
clomiphene
fulvestrant
9
Q
what are the aromatase inhibitors
A
anastrazole
letrozole
exemestane
10
Q
antiprogestin
A
mifepristone
11
Q
androgen receptor antagonists
A
bicalutamide
flutamide
nilutamide
enzalutamide
12
Q
PDE5 inhibitors
A
sildenafil
vardenafil
tadalafil
avanafil
13
Q
prostaglandin E1
A
alprostadil
14
Q
what side effects does vardenafil have
A
peripheral vasodilation, lower blood pressure, flushing and reflex tachycardia
15
Q
what side effects does tadalafil have
A
myalgia and back muscle pain
16
Q
what side effects does sildenafil have
A
blurred vision and cyanopsia-blue tinted vision
also peripheral vasodilation, lower blood pressure, flushing and reflex tachycardia
17
Q
which PDE5 inhibitors should you avoid a fatty meal
A
sildenafil and vardenafil
18
Q
tadalafil time to peak
A
2 hours
19
Q
which PDE5 has the longest half life
A
tadalafil (18h)
20
Q
which PDE5 does NOT have an active metabolite
A
tadalafil
21
Q
which PDE5 has a sublingual form
A
vardenafil
22
Q
which PDE5 has the longest duration
A
tadalafil (24-36h)
23
Q
food interaction with PDE5 inhibitors
A
grapefruit juice: avoid
24
Q
timing of administration for PDE5 inhibitors
A
sildenafil and vardenafil 1 hour before intercourse
tadalafil can be 30 minutes prior to intercourse or once daily
avanafil 15-30 minutes prior
25
which PDE5 inhibitor can be dosed once daily
tadalafil
26
what is the PDE5 dose limit
one dose per day
27
PDE5 inhibitor drug interactions
do not administer nitrates after PDE5 inhibitor
within 24 hours for most PDE5i
within 48 hours for tadalafil
28
failure to respond to first dose PDE5i?
should continue for 7 doses before declaration of failure
29
dosage forms of alprostadil
intracavernosal injection
intraurethral insert
30
who gets alprostadil
-failed to respond to PDE5 inhibitors
- ED due to diseases that are associated with an impaired nitric oxide pathway (DM)
31
dose limits intracavernosal alprostadil
no more than one per day
no more than three per week
32
intraurethral alprostadil counseling
empty bladder before administration
avoid if the partner is pregnant
33
testosterone adverse effects
sodium retention
increase risk MI/stroke
gynecomastia
increase LFTs
erythrocytosis
34
general drugs causing erectile dysfunction
anticholinergics
dopamine antagonists (metoclopramide phenothiazines)
digoxin, spirono, ketoconazole
CNS depressants
Diuretics
Beta blockers
central sympatholytics (methyldopa, clonidine)
35
somatostatin analog adverse effects
nausea, vomiting, flatulence, gallstones
36
dopamine receptor agonist side effects
CNS effects: headache, lightheaded, dizzy, nervous, fatigue
37
options for treatment of dwarfism
Recombinant GH (somatotropin): genotropin, humatrope, norditropin, nutropin, etc
or IGF-1 (Somatomedins): rhIRG-1, mecasermin
38
what are the adverse effects of Recombinant GH
kids: intracranial hypertension, scoliosis, hypothyroidism
adults: edema, arthralgia, myalgia, hyperglycemia
39
adverse effects of IGF-1
hypoglycemia
40
what makes the prolactin axis unique
a. the only anterior pituitary hormone that does not have an endocrine target tissue and thus lacks a classical hormonal feedback system
b. inhibitory rather than stimulatory
c. involves dopamine which is a neurotransmitter rather than a pepttide
41
what meds cause hyperprolactinemia
antipsychotics, methyldopa, reserpine, verapamil
42
treatment for hyperprolactinemia
cabergoline
43
GnRH analog if given continuously?
acts as an antagonists-- inhibits FSH and LH release eventually
44
GnRH analog side effects
hot flashes, sweats, headache, bone loss & osteoporosis, decreased libido
initial flare (prostate cancer)
contraindicated pregnancy
45
main use of GnRH analogs and antagonists??
during ovulation induction to prevent natural ovulation
but can also be for endometriosis, prostate cancer, etc
46
describe how FSH and LH are used in fertility treatments like IVF
injections of gonadotropins (menotropins and follitropins) started early in menstrual cycle to cause multiple eggs to grow to mature size-- then hCG is used to trigger the release of the mature eggs
47
true or false: estrogen alone is effective for contraception
false: has to be with a progestin for contraception
48
estrogen adverse effects
nausea, breast tenderness, migraine headache, thromboembolic events, HTG, HTN, gallbladder dx
inc risk of endometrial cancer
postmenopausal ppl: small inc risk of breast cancer and CV events
49
what is clomiphene used for
to treat infertility due to no ovulation
50
treatment of amenorrhea: underlying cause is anorexia or excessive exercise
gain weight, decrease exercise, therapy
if ineffective: consider estrogen (CHC)
51
treatment of amenorrhea: underlying cause is hyperprolactinemia
dopamine agonist
52
treatment of amenorrhea: underlying cause is anovulation secondary to PCOS
pregnancy desired: letrozole
pregnancy not desired: CHC with the progesterone with antiandrogenic effects
53
treatment of amenorrhea: unknown cause
progestin to induce withdrawal bleeding
followed by estrogen/progestin therapy
54
how does letrozole help anovulation
aromatase inhibitor- decreases levels of estrogen-- which increases release of FSH-- which stimulates the ovary to produce eggs and follicles
55
options for menstrual irregularity in PCOS
first line-- combined hormonal contraception
second line-- metformin
56
options for hirsutism in PCOS
if desire to conceive-- electrolysis
first line-- hormonal contraception with non-androgenic progestin
second line-- spironolactone, flutamide, eflornithine
third line-- metformin
57
options for acne in PCOS
desire to conceive-- topical creams
first line-- hormonal contraception
second line-- spironolactone or antiandrogens
58
options for anovulation/infertility in PCOS
letrozole
clomiphene
59
how are letrozole and clomiphene dosed for anovulation and infertility in PCOS
daily for 5 days
beginning cycle day 3
after induced withdrawal bleeding with a progesterone such as MPA 10 mg daily orally for 10 days
60
endometriosis-- what is first line
NSAIDs
61
endometriosis-- what is second line
CHC
Depo Provera
Mirena
62
endometriosis-- what is 3rd line
GnRH agonists (since they inhibit FSH and LH)
63
what to know when using GnRH agonists for endometriosis
you can use add-back therapy to minimize the hypoestrogenic effects (bone mineral density loss and vasomotor symptoms)
Need to use MHT (dose is too low in CHC)
64
MHT options: had hysterectomy
can get unopposed estrogen therapy since they don't have a uterus
65
MHT: no hysterectomy
aka has a uterus
estrogen + protestogen
estrogen + bazedoxifene
vaginal estrogen low dose (don't need progestogen)
66
intravaginal estrogen: systemic or local action?
local action
except for femring which is systemic
67
transdermal estradiol in formulations used for HRT: incidence of breast tenderness and DVT?
lower incidence than oral estrogen
68
progestogen for MHT: continuous or cyclic????
cyclic regimens often cause withdrawal bleeding
continuous regimens result in the absence of vaginal bleeding
69
contraindications to MHT
unexplained vaginal bleeding
active liver disease/failure
prior estrogen-sensitive breast or endometrial cancer
history of CHD or stroke
history of/high risk VTE
untreated HTN
70
instances where transdermal estrogen is preferred over oral
hypertriglyceridemia
active gallbladder dx
thrombophilia
migraine headaches w/ aura
71
MHT risks vs benefits: CV disease
reduce risk: estrogen only, newly menopausal
no increase: estrogen-progestin, within 10 years menopause
increase risk: greater than 10 years menopause
72
MHT risks vs benefits: breast cancer
increased risk estrogen/progestin >10 years
estrogen alone maybe reduced risk
73
MHT risks vs benefits: osteoporosis
estrogen decreases bone turnover and increases bone density
reduces fractures
74
MHT risks vs benefits: ischemic stroke
increased risk estrogen alone and estrogen w/ progestin
75
MHT risks vs benefits: VTE
increased risk with personal risk factors like obesity
