GU/Repro

Question 1

Estrogen/progestin contraceptive- MOA?

Answer 1

Suppresses FSH/LH -> inhibits ovulation

Mimics hormone changes of pregnancy -> prevents pituitary gland from stimulating ovaries -> thinning/increase in cervical mucus

Question 2

Progesterone contraceptive- MOA?

Answer 2

Suppresses LH -> inhibits ovulation

Thickens cervical mucus -> slows transport of sperm

Endometrial atrophy -> inhibits implantation of egg

Question 3

What drug is a progestin-only contraception?

Answer 3

Levonorgestrel (oral)

Medroxyprogesterone (injection)

Question 4

What drug class is levonorgestrel?

Answer 4

Progestin-only contraceptive (plan B- emergency contraception)

Must be taken within 3 days

Lower efficacy for BMI > 30

Question 5

Progestin only pills- MOA/info?

Answer 5

Suppresses ovulation
Thickens cervical mucus- slows sperm
Thin endometrium- prevents egg implantation

Safe for breastfeeding
Safe for smoker/CAD risk

Less effective than combo

Adherence schedule more strict

(Progestin-only oral contraceptive)

Question 6

What drug is a non-oral hormonal contraceptive- injection?

Answer 6

Medroxyprogesterone (progestin only)

Question 7

What drug type is medroxyprogesterone?

Answer 7

Progestin only injection - every 3 months

Contraindicated for pts w/ depression d/t CNS affect -> exacerbate depression

Question 8

What drug type is ethinyl estradiol?

Answer 8

Non-oral hormonal contraceptive- patch

Question 9

What drug is a non-oral hormonal contraceptive in patch/ring form?

Answer 9

Ethinyl estradiol

Question 10

Ethinyl estradiol- use?

Answer 10

Patch: used weekly x3weeks, 1 week off to bleed

Higher systemic estrogen exposure

Contraindicated for those w/ clotting risk d/t increased risk of DVT

Ring: insert monthly, in for 3weeks, out for 1
Store in fridge

Question 11

Adverse effects of combo hormonal contraceptives?

Answer 11

Thrombosis

Contraindicated for age > 35 who smoke d/t risk of cardiovascular events

Question 12

Contraindications for estrogen-containing contraaceptives?

Answer 12

History of thrombosis (stroke, heart attack, PE/DVT)
Migraine with aura

Question 13

Combo oral contraceptives- side effects?

Answer 13

Initiation: 7 active pills at same time/day

Estrogen- decreased milk supply

Increased risk of thrombophlebitis, cardiovascular events

(Ethinyl estradiol)

Question 14

Drug interactions with hormonal contraceptives?

Answer 14

Decrease efficacy:
Antibiotics
Anticonvulsants

Drospirenone- risk of increased K+

Question 15

What lab can be used to determine BPH?

Answer 15

PSA- serum prostate-specific antigen

If this is increased, sign of BPH

Question 16

What drug class is tamsulosin?

Answer 16

Alpha-blocker

Question 17

What drug is an alpha-blocker?

Answer 17

Tamsulosin

(can’t be used with tubes- capsules only)

Question 18

Tamsulosin- indication?

Answer 18

BPH- first line for moderate to severe symptoms

(Alpha blocker)

Question 19

Tamsulosin- MOA?

Answer 19

Dilation of urethra

Inhibits alpha1 adrenergic receptors -> relaxes smooth muscles in prostate & bladder neck ->
reduces bladder outlet obstruction
Improves urinary flow

(Alpha blocker)

Question 20

Tamsulosin- side effects?

Answer 20

Floppy iris syndrome w/ cataract surgery- notify op. doc prior to eye surgery

Retrograde ejaculation

Dizziness

Rebound HTN w/ abrupt d/c

Take at night to avoid first does hypotension

Take 30min after a meal (prevents sticking to food)

Contraindicated w/ strong CYP3A4 inhibitor

Caution w/ PDE-5 inhibitor d/t additive hypotensive effects (sildenafil / tadalafil)

(Alpha blocker)

Question 21

What drug is a 5-alpha reductase inhibitor?

Answer 21

Finasteride

Question 22

What drug class is finasteride?

Answer 22

5-Alpha reductase inhibitors

Question 23

Finasteride- indications?

Answer 23

BPH- decreases prostate size

Question 24

Finasteride- MOA?

Answer 24

Inhibits 5 alpha-reductase enzymes conversion of testosterone to DHT -> decreases prostate size

Can take >6months to work- can be taken with alpha blockers (tamsulosin) to bridge

(DHT leads to hyperplasia)

(5 Alpha-reductase inhibitor)

Question 25

Finasteride- side effects?

Answer 25

Sexual dysfunction- Sx decrease over time Gynecomastia Contraindicated for bladder obstruction w/o increased prostate size Contraindicated for pregnancy/child-bearing age- Hazardous med- women shouldn't handle this med w/o PPE- Teratogenic and can be absorbed through skin

Question 26

What is ED?

Answer 26

Persistent inability to achieve / sustain erection Nitric oxide release impaired -> decreased vasodilation -> decreased blood flow

Question 27

What drugs are first-line treatment for ED?

Answer 27

PDE-5 inhibitors (Sildenafil)

Question 28

What drug is a PDE-5i?

Answer 28

Sildenafil

Question 29

What drug class is sildenafil in?

Answer 29

PDE-5i

Question 30

Sildenafil- indication?

Answer 30

ED- first-line (PDE-5i)

Question 31

Sildenafil- MOA?

Answer 31

Inhibits PDE5-i -> increases nitric oxide prod. -> vasodilation of smooth muscle -> increased blood flow -> prolonged erection (doesn't initiate or cause an erection) (PDE-5i)

Question 32

Sildenafil- side effects?

Answer 32

Impaired color discrimination (blue vision) Hypotension Priapism (prolonged painful erection) Transient hearing loss Tadalafil lasts longer Contraindicated w/ nitrates d/t severe hypotension (PDE-5i)

Question 33

Ulipristal- indication?

Answer 33

Emergency contraception up to 5 days after unprotected sex -any weight Req. Rx

Question 34

What is a non-oral hormonal contraception IUD?

Answer 34

Levonorgestrel IUD (Mirena) Must be replaced every 3-8years

Question 34

What are two emergency contraceptives?

Answer 34

Levonorgestrel (plan B)- within 3days, BMI limit, OTC Ulipristal acetate- within 5days, no BMI limit, Rx