Female Gonadal hormones

Question 1

Conjugated estrogens

Answer 1

Estrogen analog

Question 2

Estradiol valerate

Answer 2

Estrogen analog

Question 3

Ethinyl estradiol

Answer 3

Estrogen analog - most common in BC

Question 4

Mestranol

Answer 4

Estrogen analog

Question 5

Desogestrel

Answer 5

Progestin analog - inactive prodrug

Question 6

Etonogestrel

Answer 6

Progestin analog - active metabolite

Question 7

Drospinenone

Answer 7

Progestin analog

Question 8

Medroxyprogesterone

Answer 8

Progestin analog

Question 9

Norethindrone

Answer 9

Progestin analog

Question 10

Norgestimate

Answer 10

Progestin analog

Question 11

Norgestrel

Answer 11

Progestin analog

Question 12

Mifepristone

Answer 12

Progesterone R antagonist (and glucocorticoid R)

terminate early pregnancies

Question 13

Raloxifene

Answer 13

Selective estrogen receptor modulator
agonist on lipids and bone
antagonist on endometrium and breast

Question 14

Tamoxifen

Answer 14

Selective estrogen receptor modulator
antagonist on breast - agonist other tissues
increased endometrial cancer risk

Question 15

Toremifene

Answer 15

Selective estrogen receptor modulator
antagonist on breast - agonist other tissues
increased endometrial cancer risk

Question 16

Clomiphene

Answer 16

Selective estrogen receptor downregulator

Question 17

Fulvestrant

Answer 17

Selective estrogen receptor downregulator

Question 18

Anastrazole

Answer 18

Aromatase inhibitor - inhibit estrogen synthesis from androgens(post menopausal happens in peripheral tissue) - treat breast cancer in postmenopausal women
fewer side effects than SREMs

Question 19

Exemestane

Answer 19

Aromatase inhibitor

Question 20

Letrozole

Answer 20

Aromatase inhibitor

Question 21

What drug combinations are used for hormone contraception?

Answer 21

Estrogen-progestin

Progestin only - fewer adverse effects

Question 22

What drug combinations are used for postmenopausal hormone replacement therapy?

Answer 22

Estrogen - especially if no uterus

Estrogen-progestin combinations

Question 23

What drugs are used to treat hormone response breast cancer and infertility?

Answer 23

anti-estrogens

Question 24

What drugs to prevent breast cancer and osteoporosis?

Answer 24

Selective estrogen receptor modulators

Question 25

What drugs for medical abortion?

Answer 25

anti progestin

Question 26

Adverse effects of theraputic estrogens

Answer 26

Uterine bleeding breast cancer endometrial cancer - use w/progestin nausea, breast tenderness, hyperpigmentation, migrane frequency, cholestasis, GB disease, HTN

Question 27

CI for theraputic estrogens

Answer 27

``` Estrogen dependent neoplasms genital bleeding liver disease thromboembolic disorder heavy smokers CV disease ```

Question 28

Normal fxns of progesterone

Answer 28

made during luteal phase - decrease GnRH pulses decreases estrogen driven endometrial proliferation decline at end of cycle causes menes maintains pregnancy and mammary gland dev

Question 29

AE of progenstin

Answer 29

breakthrough bleeding with Ponly BC minor increase in BP HRT may increase breast cancer risk(protects endometrial) androgenic effects

Question 30

Why so many progestins varieties?

Answer 30

Have a variety of pharmacokinetic effects | - estrogenic, androgenic, antiestrogenic, antiandrogenic, anabolic

Question 31

Progestin only Injectible preparations

Answer 31

Medroxyprogesterone acetate injected IM every 3 months fertility takes 6-18 months to return

Question 32

Progestin only IUDs

Answer 32

Levonorgestrel 5-7 years effective rapid return to fertility

Question 33

Progestin only implantable

Answer 33

Etonogestrel upper arm - good for 3 years bleeding abnormalities are common rapid return to fertility

Question 34

Combination transdermal preparations

Answer 34

Ethinyl estradiol and norelgestromin new patch per week 3 weeks then 1 week off same AE as COC - breast discomfort, dysmenorrhea

Question 35

vaginal contraceptive ring

Answer 35

ethinyl estradioal and etonogestrel ring in 3 weeks out 1 week rapid return to fertility

Question 36

Pregnancy termination

Answer 36

mifepristone (RU-485) progesterone receptor antagonist - induces luteolysis 95% effective if given during first 7 weeks AE prolonged bleeding - given in a clinic by a doc

Question 37

Morning after (plan B)

Answer 37

Levonorgesterel (plan B) progesterone receptor agonist - unknown MOA does not reverse pregnancy more effective than combinations less N/V

Question 38

Morning after (ella)

Answer 38

ulipristal acetate as effective as levonorgesteral in first 3 days more effective days 3-5 may interfere with established pregnancy