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Flashcards in Gonadal Deck (62):
1

concept: Describe clinical presentation in 17 alpha-hydroxylase deficiency

decreasd androgens, cortisol
increased mineralcorticoids

XY - cryptorchidism and indistinct genitalia -- give androgens, glucocorticoids and anti hypertensives
XX - outwardly female with normal internal but no secondary charcteristics --- give estrogens and anti hypertensives

2

concept: 21 hydroxylase deficiency

decreased BP icnreased K, increased renin and volume depletion

pseudohermaphroditism in females

tx: fliuds, salt repletion and give cortisl to decreased ACTH

3

concept: 11 hydrozxylase deficiency

increased sex hormones, decreased cortisol and mineralcorticoids but increased 11 deoxycorticosterone

increased BP
overmasculinization
tx: estrogens and HTN (same as 11)

4

Which is the most potent: estriol, estrone, estradiol

estradiol because has the most letters

5

concept: effects of estronge on a) coagulation b) lipid profile c) hormone levels d) cholesterol

a) procoagulation state - increases II, VII, IX, X, XII and decreases antithrombin II, prot C and S

b) favours lipid profile

c) increases binding protein; free level fo hormone unaffected

d) increases cholesterol in bile - formation of gall stone

6

List the clinically used estrogens please

estradiol
conjugated estrogen
ethinyl estradoil
quinestrol
estrone

7

What is mestranol

prodrug converted to ethinyl estradiol (in some contraceptives)

8

Benefits of HRT please

reduced hot flashed
reudeced bone fracture and loss
decreased urogenital atrophy

9

A/se of HRT/estrogens

thromboembolism
changes in lipid/carb metabolism
increased risk of high bp
increased incidence of breast and endometrial cnacers
migraine
cholestasis
mood changes

10

What is Diethylstilbestrol (DES)?

a nonsteroidal estrogen agonist
''des daughters''

11

Name the absolute contraindications of estrogen use!!!

1) history of thromboembolism
2) breast and endometrial cancer
3) pregnancy
4) liver disease

12

Tamoxifen - repeat from boen

antag @ breat
ag @ bone
ag @ liver
ag @ endometrium

USED @ breast cancer treatment

13

a/se of tamoxifen

antag - hot flushes
ag - thrombosis
increased risk of endometrial cacners

14

Toremifene

used in metastatic breast cancer

15

Raloxifene

antag @ breast
ag @ bone
no effect @ endo

therefore, no increased risk of endometrial cancer, hurahh!!

16

Use of Raloxifene

prophylaxis vrs breast cancer in high risk patients

prevention fo osteoporosis

17

Name an estrogen receptor antagonist in all tissues

Fulvestrant

18

used of Fulvestrant

estrogen receptor antag

used @ breast cancer in tamoxifen resistant patients

19

a/se of fulvestrant

hot flushes
injection site reactions
headache

20

List the aromatase inhibitors

letrozole
anastrozole
exemestane - irreversible

21

Use of letrozole, anastrozole, exemestane

aromatase inhibitors
second line for breast cancer to tamoxifen

22

MOA Clomiphene

estrogen antag @ hypothalamus and anterior pituitary --> prevents feedback inhibito fo GnRh by hypothalamus --> continued release of GnRH from hypothalamus --> LH and FSH from pituitary --> ovulation

23

Uses of clomiphene

treatment of infertility

24

A/se of clomiphene

ovarian hyperstimulation syndrome
ovarian elargment
multiple pregnancy
visual disturbances

25

affect of progesterone on gallbladder...rando

decreases gall bladder contraction

26

effects of progesterone at high levels

suppresses gonadotropin secretion -- anovulation

27

List the progestins

medroxyprogesterone and NORgestrel and NORethindrone

28

List the antiprogestins

mifepristone
SHARK flashback --> used to treat inoperable ectpoic ACTh syndrome (inhibits glucocorticoi and progesterone receptors)

29

List some newer preps with less androgenic effects than classic progesterones ( medroxyprogesterone, norgestrol and nor ethindrone)

desoGESTREL
norelGESTROmine
etonoGESTREL
norGESTimate

GESTROL - less like a gentlemen. . . .

30

What is DROSPIRENONE?

spironolactone ( aldosterone antaga with some anti androgenic activity)

used to treat acne in feamles

31

acne in females treatment

drospirenone - spironolactone derivaitive (hirsutism, aldosternoisn, diuretic) that antagonizes aldosterone

32

a/se progestins @ long term use

weight gain
depression
oedema
acne
decreasd HDL
hypertension
thrombophlebitis
cholestatic juandice

33

Mifepristone MOA

competitive inhibitor of progesterone and glucocorticoids

34

uses of mifepristone

morning after pill - abortificant

inoperable ectopic ACTH syndrome

35

Danazol = ?

inhibitor P450 in gonadal steroid synthesis

partial agonist of progestin, androgen, glucocorticoids

36

Use of danazol

endometriosis

fibrocystic disease of breast

37

a/se danazol

parial agonist at progestin, andronge, glucocorticoids

hepatitis - abnormal liver function

since a modified androgen -- masculizing effects ie acne (despiranone), hirsutism (spironolactone), menstrual distoruabcnes

38

which is more potent androstenedione, testosterone, DHT

DHT

39

Compare and contrast the actions of testosterone and DHT

testosterone:
* wolffian duct
* boen formation
*muscle growth
* spermatogenesis

VRS

DHT
* growth of external genitalia
* prostate growth
* scalp hair loss - remember jerrys story abotu this
* acne -- OCP
* facial/body hair

40

List synthetic androgens please

-OLONE

oxandrolone
stanozolol
fluxymesterone** this one is bolded
oxymetholone
nandrolone
OLONE

41

how can you use androgens to be clinically helpful?

hypogonasim
increase bone density
increase muscle mass (positive nitrogen balance)
some cases of aplastic anaemia

42

admin route of androgens

oxandrolon, stanozolol, fluxymesterone, oxymetholon, nandrolone

transdermal
IM

43

one bolded a/se of androgens

hepatic adenomas

44

List the androgen receptor antagonists
U-T-AMIDE

flutamide
bicalutamide
nilutamide
UTAMIDE

45

use of flutamide, bicalutamide, nilutamide

LUTAMIDE

used with GnRH analogs to decrease initial tumour flare ups of prostate carcinoma

46

Finasteride MOA

5 alpha reductase inhibitors --> inhibits conversion of testosterone to DHT

47

use of finasteride

BPH
promotes hair growth

48

a/se finasteride

gynecomastia and impotence

49

Ketoconazole

inhibits 17, 20 desmolase

(no gonadal no adrenal hormones)

cushing, prostate cancer

50

GnRH analogs list please

leuprolide
goserelin
nafarelin

51

continuous does of leuprolide, goserelin and nafarelin

down regulates GnRH receptors in pituiturat

52

Used of leuprolide, goserelin and nafarelin

prostate cancer
uterine fibroids
precocious puberty

53

list other drugs with anti androgenic action

spironlactone ( hirsutism, aldosternosim, diuretic)
cimetidine
cyproterone acetate

54

uses of : leuprolide and flutamide

flutamide (androgen receptor antag)
leuprolide (GnRH analog)

prostate cancer

55

Bicalutamide

a nonsteroidal antiandrogenic
prostate cancer
hirsutism

56

Nilutamide

used for prostate cance

57

SHARK: prostate cancer

leuprolide
flutamide
nilutamide

58

Spironolactone and cyropterone

hirsutism

59

BPH and male patterned baldness

finasteride (5alpha reductase inhibitor)

60

Ketoconazole

inhibits 17,20 desmolase

treats cushing and met prostati cancer.

61

How do finasteride and dutasteride help with benign prostatic hyperplasia?

5 alpha reductase inhibitors that decrease size of prostate

62

How do terazosin, doxazosin, tamsulosin, and alfuzosin help in BPH?

reduce tension fo prostatic smooth muscle in prostate, capsule, neck