Mehl. drugs 03-25 (1)

Question 1

M. Decr. conversion of androgens to estrogens. Drug?

Answer 1

Aromatase inhibitors

Question 2

M. Aromatase inhibitors.
Letrozole - what does?

Answer 2

Used to stimulate ovulation by decr. negative-feedback at hypothalamus / anterior pituitary.

Some students ask about this agent in comparison to clomiphene (discussed below). The literature seems to be split on it, and I haven’t seen NBME give a fuck.

Question 3

M. Aromatase inhibitors.

Anastrozole and exemestane are used for???

Answer 3

breast cancer in post-menopausal women.

Question 4

M. BPH meds. 5a reductase inhibitor used for BPH??

Answer 4

Finasteride

Decr. conversion of testosterone to DHT. Since DHT causes prostatic growth, decr. DHT means decr. prostatic growth.

Question 5

M. BPH meds. a1 blockers that ̄ constriction of internal urethral sphincter of the bladder and help promote urinary outflow.?? 2

Answer 5

Tamsulosin/terazosin

Question 6

M. BPH meds. Tamsulosin/terazosin group?

Answer 6

a1 blockers

Question 7

M. BPH meds. Finasteride mechanism?

Answer 7

5a reductase inhibitor

Question 8

M. Clomiphene. group?

Answer 8

Selective-estrogen receptor modulator (SERM)

Question 9

M. Clomiphene. used for what?

Answer 9

Used to stimulate ovulation in those with irregular cycles (in particular those PCOS).

Question 10

M. Clomiphene.
Has partial-agonist effects at the hypothalamus that are weaker than endogenous estrogen, so the hypothalamus interprets this as decr. estrogen is present, so negative- feedback also decr. -> GnRH ­incr.

Answer 10

.

Question 11

M. Androgen-receptor partial agonist. Drug?

Answer 11

Danazol

Question 12

M. Danazol. mechanism?

Answer 12

Androgen-receptor partial agonist.

Question 13

M. Danazol. might be used in repro for what disease?

Answer 13

Theoretically a med that can be used for endometriosis, but USMLE doesn’t assess this use-case.

Question 14

M. Danazol. in what non-repro case is used?

Answer 14

Used for hereditary angioedema, where it stimulates the liver to synthesize more C1-esterase inhibitor.

Question 15

M. Danazol. adverse? 2

Answer 15

Can cause hirsutism and pseudotumor cerebri.

Question 16

M. GnRH receptor agonists. 3 drugs?

Answer 16

Leuprolide, goserelin, and nafarelin

Question 17

M. Leuprolide, goserelin, and nafarelin - group?

Answer 17

GnRH receptor agonists

Question 18

M. GnRH receptor agonists. When administered continuously, they cause what on GnRH receptors??

Answer 18

Cause desensitization of the GnRH receptor at the anterior pituitary, leading to decr. LH and FSH secretion (i.e., even though the drugs are pharmacologic agonists, they function clinically as antagonists).

Question 19

M. HTN meds. HTN emergencies in pregnancy. 1 drug?

Answer 19

Hydralazine

Question 20

M. HTN meds. 3 drugs for Tx?

Answer 20

Methyldopa (a2 receptor agonist), labetalol, and nifedipine classically used.

Question 21

M. Magnesium. Used for what pregnancy disease? 2

Answer 21

Used in severe preeclampsia to prevent seizures (eclampsia).
Used to treat seizures in eclampsia.

Question 22

M. Magnesium. given for what purpose for fetus?

Answer 22

Given to women giving birth <32 weeks’ gestation as a neuroprotective agent for the neonate.

Question 23

M. Magnesium. Can in theory be used as tocolytic (discussed below).

Answer 23

.

Question 24

!!! M. Methotrexate = WHEN GIVEN?

Answer 24

Given for small, stable ectopic pregnancies – i.e., mother is hemodynamically stable, there is no evidence of tubal rupture / fluid in the peritoneal cavity, the ectopic is <3.5 cm, and b-hCG is <5000 mIU/mL.

Question 25

M. Minoxidil in what disease?

Answer 25

Arteriolar dilator that promotes hair growth in androgenetic alopecia.

Question 26

M. Minoxidil. Arteriolar dilator that promotes hair growth in androgenetic alopecia. USMLE wants you to know the latter is polygenic and risk is ­incr. with anabolic steroids.

Answer 26

.

Question 27

M. abortion: 2 drugs?

Answer 27

Mifepristone (progesterone receptor antagonist) is used up to 10 weeks post-intercourse. This is followed by misoprostol (PGE1 analogue) 1-2 days later.

Question 28

M. SERMs. SERMs are agents that have different effects depending on the tissue. Tamoxifen and raloxifene are SERMs used for ?????

Answer 28

estrogen-receptor (+) breast cancer, where they both are antagonistic at breast and agonistic at bone.

Question 29

M. SERMs. Tamoxifen incr. risk for what?

Answer 29

Tamoxifen causes ­incr. risk of endometrial cancer due to agonistic effects at endometrium.

Question 30

M. Tocolytics. what does on uterus?

Answer 30

Suppress labor by decr. uterine contractions;

Question 31

M. Tocolytics. used when?

Answer 31

Often utilized to delay premature labor to allow for fetal lung maturity while two boluses of corticosteroids are administered.

Question 32

M. Tocolytics. 3 drugs?

Answer 32

Terbutaline (mixed b1/2 agonist), ritodrine (b2 agonist), and nifedipine are HY ones.

Question 33

M. Terbutaline (mixed b1/2 agonist), ritodrine (b2 agonist), and nifedipine are HY ones. what group?

Answer 33

tocolytics

Question 34

M. Tocolytics. Terbutaline moa?

Answer 34

Terbutaline (mixed b1/2 agonist

Question 35

M. Tocolytics. Ritodrine moa?

Answer 35

b2 agonist

Question 36

M. Tocolytics. nifedipine moa?

Answer 36

CCB

Question 37

M. Tocolytics. Indomethacin and magnesium can also technically be used for this reason.

Answer 37

.