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Pharm 6 > female reproductive and infertility > Flashcards

female reproductive and infertility Flashcards

(45 cards)

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1
Q

target cells of FSH and LH

A

FSH: Sertoli and granulosa cells
LH: Leydig and theca cells

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2
Q

inhibin and activin

A

inhibin: from Sertoli and granulosa cells, inhibits anterior pituitary release of FSH (not LH)
activin: same source, but activate ant pit release of FSH (not LH)

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3
Q

PCOS sx and cause

A

anovulation, oligo-ovulation, inc plasma androgen -> hirsutism, dysmenorrhea, acne
theories:
1- inc freq and amplitude of LH pulses = stimulates theca cells to make androgen
2- inc insulin secretion = dec sex hormone binding globulin = inc free testosterone
3- theca cell dysregulation of sex steroid synthesis

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4
Q

prolactinoma

A

benign lactotroph adenoma in ant pit -> suppressed estrogen synth by GnRH-block, dec gonadotroph sensitivity to GnRH
sx: gynecomastia, galactorrhea, dysmenorrhea, etc.

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5
Q

hypogonadism

A

sex hormone production impaired before adolescence -> no sexual maturation
inc FSH and LH

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6
Q

menopause

A

exhaustion of ovarian follicles -> dec estrogen and inhibins, inc FSH and LH

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7
Q

GnRH agonist MOA

A

continuous administration suppresses FSH and LH since they are released in a pulsatile manner
*R is in ant pit

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8
Q

leuprolide

A

continuous GnRH agonist

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9
Q

goserelin

A

continuous GnRH agonist

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10
Q

naferelin

A

continuous GnRH agonist

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11
Q

cetrorelix

A

GnRH antagonist

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12
Q

ganirelix

A

GnRH antagonist

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13
Q

uses of GnRH replacements

A 
hormone-dep tumors: prostate, some breast ca
endometriosis pain ?
central precocious puberty
PCOS
controlled ovarian hyperstimulation
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14
Q

anastrozole

A

competitive aromatase inhibitor

reversible

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15
Q

letrozole

A

competitive aromatase inhibitor

reversible

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16
Q

exemastene

A

covalently-binding aromatase inhibitor

irreversible

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17
Q

formestane

A

covalently-binding aromatase inhibitor

irreversible

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18
Q

uses and ADR of aromatase inhibitors

A

ER+ metastatic breast ca: tx and prevention of recurrence

ADR: estrogen suppression -> osteoporosis

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19
Q

tamoxifen

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A

SERM w agonistic effect on endometrium and bone, antagonistic effect on breast
for breast ca
4-6x inc risk endometrial ca, so not given >5 yr (switch to aromatase-inh)

20
Q

raloxifene

Study These Flashcards
A

SERM w agonistic effect on bone, antagonistic effect on endometrium and breast
mgmt of post-meno osteoporosis and breast ca prevention

21
Q

clomiphene

Study These Flashcards
A

SERM w antagonistic effect in hypothal and ant pit, partial agonist in ovaries = inc release GnRH and gonadotropins -> stimulates follicle growth and ovulation
use: ovulation induction
ADR: inc ovary stimulation, multiple pregnancies

22
Q

locations of ER receptors

Study These Flashcards
A

all are cytoplasmic/ nuclear
ERa - endometrium, breast ca cels, ovarian cells, hypothalamus
ERb - kidney, brain, bone, heart

23
Q

flutamide

Study These Flashcards
A

androgen-R antagonist

24
Q

spironolactone

Study These Flashcards
A

androgen-R antagonist

25
MOA androgen-R antagonist
competitively inhibit binding of endogenous androgens to receptor = blocks action of DHT and testosterone
26
uses of androgen-R antagonists
metastatic prostate ca, severe BPH spironolactone: K-sparing diuretic (aldosterone blocker), female hirsutism, male pattern baldness (but causes loss of libido)
27
mifepristone
progesterone-R antagonist to induce abortion up to 63 days of pregnancy prog stabilizes uterine lining, promotes decidua prep - inhibition -> decay of decidua, detachment of blastocyst
28
misoprostol
PG analogue given with mifepristone to stimulate uterine contractions
29
ethinyl estradiol and mestranol
estrogens for HRT and acne, also in combo OCPs ADR: HTN (inc AT2 d/t inc angiotensinogen activity), thomboembolic d/o (inc hepatic synth of clotting factors), gall bladder dz (inc cholesterol excretion in bile)
30
2 types of OCP
combo estrogen-progestin pills | progestin-only pills
31
MOA of estrogen-progestin pills
suppress GnRH, LH, FSH = no follicular development or ovulation also altered tubal peristalsis, dec endometrial receptivity, dec cervical mucus secretions
32
ADR of estrogen-progestin pills
unopposed estrogen: inc risk endometrial ca (reduce risk w progestin), DVT, and PE inc risk GB d/z (stasis) don't give to women >45 and smoke
33
androgenic activity of estrogens
highest: norgestrel, levonorgestrel lower: norethindrone lowest: norgestimate, ethynodiol anti-androgen: drosperinone (inc CV/ thromboembolic risk)
34
combo OCP drug interactions
abx like penicillin, tetracyclines - dec effect estrogen estrogen can inh metabolism of: cyclosporine, antidepressants, glucocorticoids estrogen inc synthesis of vit-K-dep clotting factors, antagonizes warfarin effect
35
norgestrel and norethindrone
progestin-only pills, used when estrogen contraindicated | pts won't menstruate but may have spotting
36
medroxyprogesterone acetate
"depot" progestin, used for sex offenders to dec sexual drive and stop spermatogenesis
37
levonorgestrel and etonorgestrel
progestin implants | *levo also emergency contraception (plan B) - most efficacious with fewest ADRs
38
ADR progestin only
androgenic effect -> acne, hirsutism, inc libido, oily skin
39
MOA plan B (levonorgestrel)
blocks LH surge, disrupting ovulation and produces endometrial changes not conducive for implantation
40
PCOS tx
estrogen-progestin contraceptive (stop ovarian testosterone production) anti-androgen (spironolactone) metformin to reduce insulin resistance -> regular ovulation and T levels GnRH analogues
41
female infertility tx
clomiphene citrate
42
prolactinoma tx
DA-R agonist: cabergoline, bromocriptine
43
breast and endometrium ca tx
SERM, aromatase inhibitors
44
endometriosis tx
OCP, GnRH analogs (continuous) | Danazol - androgen analog (suppresses FSH, LH -> hypoestrogenic state)
45
menopause tx
hormone replacement therapy

Pharm 6 (5 decks)

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