Gonadal Hormones

Question 1

GnRH:

• ______ release stimulates pituitary gonadotrophins to release LH and FSH
• sustained ______ release inhibits LH and FSH release

Answer 1

pulsatile

nonpulsatile

Question 2

_____ promotes spermatogenesis/follicular development, and ______ promotes steroidogenesis

Answer 2

FSH

LH

Question 3

GnRH agonist

Answer 3

gonadorelin

Question 4

leuprolife, goserelin, nafarelin (-relin)

Answer 4

GnRH analog

Question 5

ganirelix

Answer 5

GnRH antagonist

Question 6

• agonists stimulate gonadotropins –> infertility, dx of LH responsiveness
• suppression of gonadotropins by controlled ovarian stimulation (suppress premature LH surge), endometriosis, fibroids, prostate cancer, precocious puberty
• toxicity: hypersensitivity, menopause like, gynecomastia

Answer 6

Gonadotropins (agonists and antagonists)

Question 7

urofillotropin, fillotropic alpha

Answer 7

FSH

Question 8

lutropin alpha

Answer 8

recombinant LH

Question 9

hCG and choriogonadotropin alpha are produced by the ______, LH > FSH

Answer 9

placenta

Question 10

• assisted reproduction
• protocols mimic phsyiological stimulation of ovulation
• risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies

Answer 10

-ovulation induction by gonadotropins

Question 11

• start with hCG, then hMG
• require 4-6 months to detect sperm
• black box: obesity

Answer 11

male infertility, tx by gonadotropins

Question 12

major estrogen product of the ovary?

Answer 12

estradiol (E2)

Question 13

purified crystalline estrone?

Answer 13

estropipate

Question 14

metabolically resistant prophormones with improved bioavailability and half life, readily hydrolyzed into active form

Answer 14

estrogen esters (acetate, cypionate)

Question 15

equine estrogen sulfate sodium salts, high potency

Answer 15

conjugated estrogen

Question 16

synthetic estrogen that undergoes extensive hepatic metabolism, more active than natural estrogens

Answer 16

ethinyl estradiol

Question 17

nonsteroidal, caused variety of complications in exposed female offspring including clear cell carcinoma of vagina

Answer 17

DES

Question 18

-manufactured from soybeans and yams consisitng of primarily estrone and equilin, activity depends largely on metabolic conversion to estradiol

Answer 18

esterified estrogens

Question 19

estrogenic compound that leaches from plastics

Answer 19

BPA

Question 20

• estrogens bind intracellular estrogen receptors, in nucleus
• receptor ligand complex initiates gene transcription by bining ______
• used for primary hypogonadism, hormonal contraception, ovarian suppression for endometriosis, postmenopausal hormone therapy
• non oral preps avoid _____

Answer 20

ERE

first pass metabolism

Question 21

• nausea
• breast tenderness
• hyperpigmentation
• migraine
• cholestasis, gallbladder disease
• HTN
• accelerated blood clotting
• cancer: uterine and breast with HRT, adenocarcinoma from DES
• uterine bleeding (do NOT use unopposed estrogen for hormone replacement therapy in women with a uterus )

Answer 21

estrogen side effects

Question 22

• bind IC receptor and initiate transcription at PRE
• used for hormonal contraception, ovarian suppression, postmenopause HRT
• may increase BP

Answer 22

progestins

Question 23

progesterone, norethindrone, levonorgestrel, desogestrol, drospirenone

Answer 23

progestins

Question 24

most oral contraceptives are ______

Answer 24

ethinyl estradiol

Question 25

mechanism of hormonal contraception?

Answer 25

suppress FSH/LH surge through negative feedback, decreased fallopian tube motility, thicken cervical mucus

Question 26

adverse effects of contraceptives?

Answer 26

venous thromboembolism

Question 27

SERM used for breast cancer?

Answer 27

tamoxifen, toremifene

Question 28

SERM used for osteoporosis?

Answer 28

raloxifene

Question 29

SERM used for ovulation induction, increases LH and FSH release by blocking negative feedback by estrogen

Answer 29

clomiphene

Question 30

SERM used for menopausal symptoms in combo with conjugated estrogens

Answer 30

bazedoxifene

Question 31

estrogen antagonist used in tamoxifen resistant breast cancer?

Answer 31

fulvestrant

Question 32

progesterone antagonist, used as postcoital contraceptive, abortifacient in combo with misoprostol, glucocorticoid antagonist

Answer 32

mefipristone

Question 33

- anstrazole, letrozole, exemestane | - used for breast cancer in postmenopausal women to block estrogen production by peripheral tissues

Answer 33

aromatase inhibitors

Question 34

-derivative of 17a-ethinyl-testosterone with weak progestin/androgen/glucocorticoid activity used to suppress ovarian function

Answer 34

danazol

Question 35

methyltestosterone, fluoxymetstrone, oxandrolone

Answer 35

oral antiandrogenics

Question 36

testosterone esters

Answer 36

IM antiandrogen

Question 37

testosterone given in what form?

Answer 37

transdermal patch

Question 38

- used for replacement - gynecologic disorders - anabolic agents - growth stimulation (boys w/ delayed puberty) - osteroporosis in men - aging

Answer 38

androgens

Question 39

``` acne sleep apnea gynecomastia testicular atrophy (feedback inhibition) masculinization in females sodium retention, edema hepatic dysfunction, cholestasis increased aggression ```

Answer 39

androgen side effects

Question 40

inhibits adrenal and gonadal steroid synthesis, increases estrogen:testosterone --> gynecomastia

Answer 40

ketoconazole

Question 41

17 alpha hydroxylase inhibitor

Answer 41

abiraterone

Question 42

5alpha hydroxylase inhibitor, decreases DHT

Answer 42

finasteride

Question 43

5alpha hydroxylase inhibitor with longer half life

Answer 43

dutasteride

Question 44

angrogen receptor inhibitor used for hirsutism in women and excessive sexual desire in men

Answer 44

cyproterone

Question 45

competitive antagonist of androgen receptor

Answer 45

flutamide

Question 46

competes with DHT as well as aldosterone

Answer 46

spironolactone