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Gonadal Flashcards

1
Q

concept: Describe clinical presentation in 17 alpha-hydroxylase deficiency

A

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

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2
Q

concept: 21 hydroxylase deficiency

A

decreased BP icnreased K, increased renin and volume depletion

pseudohermaphroditism in females

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

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3
Q

concept: 11 hydrozxylase deficiency

A

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

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

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4
Q

Which is the most potent: estriol, estrone, estradiol

A

estradiol because has the most letters

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5
Q

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

A

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

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6
Q

List the clinically used estrogens please

A 
estradiol
conjugated estrogen
ethinyl estradoil
quinestrol
estrone
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7
Q

What is mestranol

A

prodrug converted to ethinyl estradiol (in some contraceptives)

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8
Q

Benefits of HRT please

A

reduced hot flashed
reudeced bone fracture and loss
decreased urogenital atrophy

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9
Q

A/se of HRT/estrogens

A 
thromboembolism
changes in lipid/carb metabolism
increased risk of high bp
increased incidence of breast and endometrial cnacers
migraine
cholestasis
mood changes
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10
Q

What is Diethylstilbestrol (DES)?

A

a nonsteroidal estrogen agonist

‘‘des daughters’’

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11
Q

Name the absolute contraindications of estrogen use!!!

A

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

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12
Q

Tamoxifen - repeat from boen

A

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

USED @ breast cancer treatment

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13
Q

a/se of tamoxifen

A

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

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14
Q

Toremifene

A

used in metastatic breast cancer

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15
Q

Raloxifene

A

antag @ breast
ag @ bone
no effect @ endo

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

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16
Q

Use of Raloxifene

A

prophylaxis vrs breast cancer in high risk patients

prevention fo osteoporosis

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17
Q

Name an estrogen receptor antagonist in all tissues

A

Fulvestrant

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18
Q

used of Fulvestrant

A

estrogen receptor antag

used @ breast cancer in tamoxifen resistant patients

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19
Q

a/se of fulvestrant

A

hot flushes
injection site reactions
headache

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20
Q

List the aromatase inhibitors

A

letrozole
anastrozole
exemestane - irreversible

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21
Q

Use of letrozole, anastrozole, exemestane

A

aromatase inhibitors

second line for breast cancer to tamoxifen

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22
Q

MOA Clomiphene

A

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

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23
Q

Uses of clomiphene

A

treatment of infertility

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24
Q

A/se of clomiphene

A

ovarian hyperstimulation syndrome
ovarian elargment
multiple pregnancy
visual disturbances

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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

Pharmacology (70 decks)

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