Exam 12: Sex Hormones and Gonadotropins Flashcards Preview

Pharmacology > Exam 12: Sex Hormones and Gonadotropins > Flashcards

Flashcards in Exam 12: Sex Hormones and Gonadotropins Deck (67):
1

2 Estrogen Oral Contraceptives

Ethynyl Estradiol
Estradiol valerate

2

5 Progestin Oral Contraceptives

Levonorgestrel
Desogestrel
Norgestimate
Drospirenone
Norethindrone

3

What type of oral contraception is useful in that it does NOT interfere with lactation?

Progestins

4

Oral contraceptive most associated with weight gain

Medroxyprogesterone

5

Drug in Plan B

Levonorgestrel

6

Problem with Original Oral Contraception

Large doses
More side effects

7

Classic oral contraceptive cycle

21 days of Oral contraceptives followed by 7 days of inert pills or ferrous fumurate

8

Multiphase Combined Oral Contraceptives

Mimic normal hormonal events of the menstrual cycle
Allows inhibition of ovulation with decreased overall exposure to the synthetic hormones (lower doses)

9

Drug used in four-phasic oral contraceptives

Estradiol valerate

10

2 choices for starting date of oral contraceptive

First day of menses for more rapid contraception
First Sunday after menses (make sure they use backup contraception for 7 days)

11

Most prominent estrogen type produced in the ovary

Estradiol

12

Primary synthetic estrogen used in oral contraceptives

Ethanyl estradiol

13

Enterohepatic recirculation of oral contraceptives

1. Conjugated to sulfate or glucuronide in the liver
2. Secreted into the intestine via biliary tract
3. Bacteria cleaves conjugate, allowing reabsorption

14

2 Progestins that are less androgenic than others

Norgestimate
Desogestrel

15

Yaz combo, uses

Ethanyl estradiol and Drospirenone
Birth control, also indicated for acne

16

Most common side effects of combined oral contraceptives

Nausea
Take with dinner or at bedtime

17

Dermatological side effects of combined oral contraceptives

1. Chloasma (brown pigmentation, especially on the face)
Avoid UV light
2. Acne
3. Hirsutism

18

CV side effects of combined oral contraceptives

HTN
MI and stroke, especially in smokers

19

Serious risk of combined oral contraceptives

Thromboembolic disorders
Estrogen is implicated in increased clotting factors and decreased antithrombin III

20

Desogestrel side effect

FDA review indicated that it increased risk of nonfatal venous thrombosis

21

Hepatobilliary side effects of Combined oral contraceptives

Gallstones (not much anymore with lower doses)
Benign hepatocellular adenoma

22

Metabolic side effects of oral contraceptives

decreased glucose tolerance
may increase LDL and triglycerides

23

GU side effects of oral contraceptives

Breakthrough bleeding/spotting

24

Infection associated with combined oral contraceptives

Candida vaginitis

25

CNS side effects of oral contraceptives

depression
migraines

26

Ocular side effects of combined oral contraceptives

Worsening of myopia/nearsightedness

27

Cancer associated with oral contraceptives

Increased risk of breast cancer and cervical cancer

28

Effect of oral contraceptives on fertility

Infertility may extend for a long time after they stop the birth control

29

Problem with oral contraceptives after giving birth

Avoid use for 3-4 weeks due to risk of blood clots
Estrogen can affect the breast milk, progestins do not

30

Cancer prevented by oral contraceptives

Decreased risk of endometrial cancer and ovarian cancer

31

3 birth controls that also treat acne

Ortho tri-cyclen
Estrostep
Yaz

32

Antibiotics and oral contraceptives

Decrease gut bacteria, decreasing beconjugation and therefore reabsorption (enterohepatic recirculation)

33

When might you use progestin only contraceptives?

When they're lactating or at risk for HTN or blood clots
If they're over 35 years old

34

Ovulation in progestin only contraception

Dont consistently inhibit ovulation (40% of cycles are still ovulatory)
Other mechanisms help prevent pregnancy (inhospitable environment of the ovum)

35

Advantage of Medroxyprogesterone

It's injected once every 3 months, so they don't have to take a pill every day
This is the one that really causes weight gain
There's also a sub Q preparation

36

Morning after pill adverse side effect

Delay or inhibition of ovulation

37

Premarin

Conjugated equine estrogens

38

Pempro

Conjugated equine estrogens + medroxyprogesterone

39

2 SERMs

Raloxifine
Clomiphene

40

GnRH agonist

Leuprolide

41

2 gonadotropins drugs

Menotropins
Chorionic gonadotropin

42

2 5-alphareductase inhibitors

Finasteride
Dutasteride

43

Difference between estrogen replacement and hormone replacement therapy

HRT is estrogen + progestin

44

Who must have HRT instead of ERT?

Women with intact uterus (they need the progestin)
This prevents estrogen-induced endometrial hyperplasia and endometrial cancer

45

Estrogen effect of cholsterol

Increased HDL, decreased LDL

46

are ERT/HRT indicated in vasomotor symptoms of menopause

yes
this is a major complaint during transition

47

are ERT/HRT indicated in symptoms of vaginal atrophy and dryness

yes

48

are ERT/HRT indicated in helping to prevent osteoporosis?

consider other options (bisphosphonates)

49

are ERT/HRT indicated in prevention of cardiovascular disease

Do not use them for this
trials indicate no overall benefit

50

are ERT/HRT indicated in prevention of alzheimer's?

No
studies show no improvement

51

Adverse effects of HRT/ERT

Increase risk of breast cancer
Brease tenderness
Nausea
THROMBOEMBOLISM (mostly in first couple of years)
Gallbladder disease (less with transdermal preps)

52

Contraindications to HRT/ERT

Endometrial cancer
Breast cancer
Undiagnosed vaginal bleeding
Thromboembolism
Liver disease (maybe try transdermal)

53

When might you use a transdermal patch for ERT/HRT?

Hypertriglyceridemia, liver disease, gallbladder disease

54

Raloxifine use, mechanism

Osteoporosis
SERM

55

Clomiphene use, mechanism

Female infertility
Hypothalamus estrogen antagonist, increasing FHS and LH

56

Clomiphene contraindication

Ovarian cysts
Can cause enlargement/formation of ovarian cysts

57

Leuprilide uses

Androgen dependent prostate cancer
Endometriosis
Precocious puberty
Infertility

58

Leuprolide mehcanism

GnRH agonist (cause initial surge and then inhibition of LH and FSH)

59

Leuprolide side effects

Impotence and decreased libido
Also hot flashes and night sweats

60

Menotropins mechanism

LH and FSH isolated from urine of postmenopausal women

61

Menotropin uses

Used with hCG Induce ovulation in infertile anovulatory women
Use to stimulate spermatogenesis in men

62

Chorionic gonadotropin uses

Ovulation induction and spermatogenesis

63

Chorionic gonadotropin adverse effects

Ovarian hyperstimulation and multiple pregnancies

64

Finasteride and dutasteride mechanism

5 alpha reductase inhibitors, block conversion of testosterone to more active DHT

65

Finasteride and dutasteride uses

treat BPH
can also treat male pattern baldness

66

Finasteride and dutasteride side effect

may cause impotence

67

Risk associated with testosterone replacement therapy

Increased risk of MI
they stopped the trial early because the pattern was so clear