mid term - questions Flashcards
(146 cards)
1
Q
write the contraindication of Progesterone?
A
- Breast cancer
- Pregnancy
- Uterine bleeding
- Liver diseases
2
Q
Adverse effects of progestins?
A
- acne
- weight gain
- masculinization
- Lipid profile worsens (↓HDL, ↑LDL)
3
Q
Clinical uses of progestins?
A
- Contraception
- Hormone replacement therapy
- Treatment of infertility
- Reduce the risk of recurrent spontaneous preterm birth (off-label)
4
Q
Contraindications of estrogens?
A
- Estrogen-dependent neoplasms
- Breast cancer
- Liver disease
- Heavy smokers
5
Q
Therapeutic uses of estrogens?
A
- Contraception
- Hormone replacement therapy
- Primary hypogonadism
- Hyperandrogenism
6
Q
effects of estrogens?
A
- Growth and sexual maturation of female
- Decrease bone resorption
- Enhance coagulability of blood
- Improved lipid profiles
- Edema
7
Q
why Oxytocin is not administered orally?
A
Ph sensitive and polypeptide so it will degrade in stomach
8
Q
side effects of oxytocin
A
- Tachysystole
- tachycardia
- Hyponatremia
- Hypotension
- autism
9
Q
Most effective tocolytic drugs?
A
*COX inhibitors
*calcium channel blockers
*beta-agonists
10
Q
Less effective tocolytic drugs?
A
*Oxytocin receptor antagonists
*Magnesium sulfate
*Nitric oxide donors
11
Q
Why we add Prostaglandin E1 (misoprostol); Prostaglandin E2(dinoprostone) to oxytocin?
A
cervical ripening and an increase in myometrial contractility
12
Q
symptoms of menopause?
A
- Vasomotor symptoms
- Sleep disturbances
- Psychological disturbances
- Lipid changes
- Accelerated bone loss
13
Q
Low-dose vaginal estrogen (cream, ring) for?
A
genitourinary syndrome of menopause
14
Q
estrogen plus progestin replacement therapy?
A
- Breast cancer
- increased CHD, strokes, thrombosis
- reduced risk of colon cancer
- decrease in fracture risk
15
Q
estrogen preparations?
A
Oral
Transdermal
Topical
Vaginal
16
Q
progestin preparations?
A
- Medroxyprogesterone acetate
the most commonly prescribed progestin historically - Oral micronized progesterone
does not appear to increase the risk of either breast cancer or CHD - Levonorgestrel-releasing intrauterine device
17
Q
oral combination
A
estradiol + norethindrone acetate
CEE + medroxyprogesterone
ethinyl estradiol + norethindrone acetate
18
Q
Transdermal combination ?
A
17-beta estradiol + norethindrone acetate
19
Q
Bazedoxifene (SERM)
A
agonist on bone,
antagonist on endometrium
Side Effect/ venous thromboembolic
20
Q
give me 3 (SERM) drugs ?
A
Raloxifene
Bazedoxifene
Tomaxifene
21
Q
Side effects of Raloxifene?
A
thrombotic disease
22
Q
HRT: regimens?
A
- Unopposed estrogen
not recommended for healthy women - Cyclic combined regimens
daily estrogen with progestin on days 1 to 14 of each calendar month - Continuous combined regimens
both hormones are given every day
23
Q
ADV of cyclic and continuous regimens?
A
Decrease risk of endometrial carcinoma
24
Q
Dis Adv of continuous?
A
irregular bleeding & amenorrhea
25
HRT: contraindications?
- Breast cancer
- Endometrial cancer
- CHD
- Vaginal bleeding
26
alternative to relief of vasomotor symptoms?
Clonidine
27
what is the ttt of Hyperprolactinemic anovulation?
dopamine agonists
28
what is the ttt of Polycystic ovary syndrome (PCOS)?
Letrozole therapy & Clomiphene citrate
29
off-label use of Letrozole therapy
ovulation induction
30
Therapy for infertility?
1- Clomiphene citrate
2- Letrozole
3- Dopamine agonists
4- Pulsatile GnRH Therapy
5- Gonadotropin Therapy
6- Metformin
31
what is the MOA of Clomiphene citrate?
bind to estrogen receptors in the hypothalamus as an antagonist so it blocks the negative feedback as a result GnRH increases
32
Which of the following SERM is used for ttt of infertility?
Clomiphene citrate
33
SERM but they aren't used for infertility?
Tamoxifen and raloxifene
34
Adverse effects of Clomiphene citrate?
-ovarian enlargement
-multiple gestation
-hot flash
35
This drug is an aromatase inhibitor
Letrozole
36
For oligo-ovulatory women with polycystic ovary syndrome (PCOS)
* is not US FDA approved for Letrozole
give her clomiphene citrate
37
why are multiple pregnany caused by clomiphene citrate?
bind to estrogen receptors in the hypothalamus as an antagonist so it blocks the negative feedback as a result GnRH increases
38
give me the Dopamine agonists?
Bromocriptine
Cabergoline
39
Ovarian hyperstimulation syndrome (OHSS) is adverse effect of which drug?
Gonadotropin Therapy
40
* correction of hyperinsulinemia with metformin
* increase menstrual cyclicity and improve spontaneous ovulation
Metformin
41
define Hormonal contraception
* Uses drugs that affect the function of estrogens and progestins to essentially eliminate the possibility of pregnancy
42
Two types of oral preparations?
1. Combination oral contraceptives (COCs): estrogen plus progestin
2. Progestin only pills
43
the most commonly used estrogen
Ethinyl estradiol
44
COCs MOA
* inhibition of LH , so no ovulation
* inhibition of FSH , so suppression of ovarian folliculogenesis
45
COCs: mild adverse effects
Nausea, edema, headache, skin pigmentation
46
COCs: moderate adverse effects
* Weight gain
* Acne
* Hirsutism
* Amenorrhea
47
COCs: severe adverse effects
* Thromboembolism
*cardiovascular disorders
*MI
* Cerebrovascular disease
48
COCs: contraindications
- CVD
- HTN
- H.F
- DIBETES
49
what is the drug that accelerates COCs metaboLISM?
Phenytoin
Rifampin
50
what is the MOA of progesterone that is taken orally?
* thinning of the endometrium
* changes the composition of cervical mucous “less volume, and more thick”
* suppression of ovulation
51
Examples of Progestin-only pills (oral)
norethindrone, desogestrel
52
side effect of POP
Unplanned bleeding and menstrual irregularities
53
List Short-acting contraceptives
transdermal patch
vaginal ring
depot injection
54
List Long-acting contraceptives:
subcutaneous implant
intrauterine devices (IUDs)
55
non hormonal IUDs
Copper-releasing IUDs
56
what is the drug used as Postcoital contraceptives
levonorgestrel
57
gold standard to diagnose osteoporosis
dual-energy x-ray absorptiometry (DXA)
58
(osteopenia) is defined as
T-score between -1.0 to-2.5.
59
what drugs reduce bone lose (antiresorptive)?
bisphosphonates
calcitonin
SERMs
denusomab
calcium
60
what drugs enhance bone formation?
PTH
Teriparatide
61
TTT of Rickets and osteomalacia?
vitamin D
62
CALCIUM SALTS
- calcium gluconate
IV emergency ttt of hyperkalaemia
- calcium lactate
63
Clinical Uses of CALCIUM SALTS
* Dietary deficiency.
* Hypocalcaemia
Prevention and treatment of osteoporosis (often with estrogen or
SERM in women, bisphosphonate, vitamin D).
64
Unwanted effects of CALCIUM SALTS
in patients receiving cardiac glycosides
Intravenous administration in the emergency treatment of hyperkalaemia requires care
65
what are the vitamin D preparations?
ergocalciferol
alfacalcidol
calcitriol
Paricalcitol (synthetic vitamin D)
66
Excessive intake of vitamin D causes?
hypercalcemia
(kidney stones and renal failure)
67
what does BiPHOSPHONATE do?
they form tight complex with calcium in bone matrix then when osteoclast reach bonE THEY GOT EXPOSED TO HIGH CONC of bisphosphonate
68
MOA of bisphosphonate?
1- etidronate (cause apoptosis to osteoclast)
2- pamidronate, alendronate, risedronate, ibandronate, zoledronate
(prevent osteoclast attachment to bone)
69
Clinical Uses of bisphosphonate?
Osteoporosis
Malignant disease
Paget’s disease
70
Unwanted effects of bisphosphonate?
Peptic ulcers, oesophagitis, osteonecrosis of jaw
71
RALOXIFENE
stimulates osteoblasts and inhibits osteoclasts
agonist on CVS and antagonist on mammary tissue and the uterus
72
Calcitonin reduces calcium levels in the blood by two main mechanisms?
Bone – Inhibits osteoclastic activity
Kidney - decrease reabsorption of calcium & phosphorous
73
The main preparation available for clinical use of Calcitonin?
salcatonin (synthetic salmon calcitonin)
74
Clinical uses of Calcitonin?
Hypercalcaemia
Paget’s disease
osteoporosis
75
recombinant PTH?
teriparatide
(stimulating new bone formation and reduces osteoblast apoptosis)
76
peptide analogue
ostabolin (increase bone mass)
77
STRONTIUM
inhibits bone resorption and also stimulates bone formation
78
this drug prevents vertebral and non-vertebral fractures in older women
STRONTIUM
79
side effect of STRONTIUM
blocks potassium channels responsible for basal vasodilator tone so increased risk of cardiovascular disease
80
MOA of STRONTIUM
Strontium ions stimulate the calcium-sensing receptor causing pre osteoblasts to differentiate into osteoblasts
Strontium inhibits osteoclasts so decreasing bone resorption.
81
Drug act against RANK-L
Denosumab
(It is especially useful when bisphosphonates are not appropriate)
82
POTENTIAL NEW THERAPIES (Cathepsin K inhibitors)
odanacatib
83
2 drugs causes osteonecrosis of the jaw
Denosumab and bisphosphonate
84
Cortisol converted to cortisone by?
11 β-hydroxysteroid dehydrogenase-2
85
What are the effect of glucocorticoids?
gluconeogenesis
catabolic effect on muscles
lipolysis
conserve glucose to the brain
86
Glucocorticoids with larger doses
inhibit Antibody production
87
short-acting Glucocorticoids
Hydrocortisone
Cortisone
88
Intermediate acting Glucocorticoids
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
89
Long-acting Glucocorticoids
Betamethasone (asthma)
Dexamethason
((both 0 salt retaining activity))
90
Mineralocorticoids (12-36hr) ((Not used for anti inflammatory effect))
Fludrocortisone
91
Clinical Uses of GCs
-adrenal disorders (adesone, congenital adrenal hyperplasia, cushing)
-lung maturation in fetus
-non-adrenal disorders
92
TTT of Addison’s disease?
(weakness, fatigue, weight loss, hypotension,
hyperpigmentation, inability to maintain blood glucose)
Acute phase: IV hydrocortisone with IV fluids
Maintenance: fludrocortisone orally
93
TTT of congenital adrenal hyperplasia?
(deficiency of 21-hydroxylase)
hydrocortisone, fludrocortisone
94
what is the use of hydrocortisone in the TTT or diagnosis of crushing syndrome?
surgical resection of tumor we need large dose of hydrocortisone after and during the surgery
95
Causes of Cushing syndrome?
a) Cushing disease (pituitary adenoma)
b) ectopic ACTH secretion
c) adrenal disorders “adenoma, carcinoma”
96
Mechanism of action of antenatal steroids
- accelerate the development of type 1 and 2 pneumocytes
- increase surfactant production by type 2 pneumocytes
97
TTT of Lung maturation in fetus?
Betamethasone
98
Why betamethasone and not hydrocortisone?
Potency, half life, no mineralocorticoid, less binding to plasma proteins, and less placental metabolism
99
Glucocorticoids toxicity
insomnia, hypomania, peptic ulcer (early)
Depression (later)
- Iatrogenic Cushing syndrome (moon face)
- Adrenal suppression (if therapy > 2 wks)
100
Indication for Synthesis inhibitors & GC antagonist use?
-severe hypercortisolism
-hypercortisolism following pituitary surgery
-while awaiting radiotherapy for Cushing disease
-treatment of ectopic ACTH syndrome
101
Adrenal enzyme inhibitors?
Ketoconazole, Metyrapone, and Mitotane
102
antifungal agent
most widely (first line) for Cushing syndrome.
Ketoconazole
103
side effect of Ketoconazole
headache, Teratogenic, fertility
104
GC antagonist safe in pregnancy
Metyrapone
105
* It inhibits glucocorticoid synthesis by cleavage enzyme and 11-β-hydroxylase.
* it has a cytotoxic effect on adrenal tissue
It produces medical adrenalectomy
it produces GIT upset, so the administration is better to be at bedtime.
Mitotane
106
intravenous anesthetic drug that blocks 11-β hydroxylase
* It lowers serum cortisol to normal within approximately 10 hours and is the only available agent for patients unable to take medication by mouth
Etomidate
107
which hormone is responsible for the onset of
gamatogenic function?
FSH by the pituitary
108
With LH stimulation, testosterone is produced by?
interstitial or Leydig cells (95%)
109
what are the weak androgens secreted by the testes?
androstenedione and dehydroepiandrosterone
110
what are the strong androgens secreted by the testes?
dihydrotestosterone (more potent than testosterone )
111
what is the source of testosterone in females?
ovaries and adrenals
112
Testosterone is also present in the plasma of women in concentrations of approximately?
0.03 mcg/dL
113
what hormones or what are the conditions in which sex hormone binding globulin increases?
estrogen
thyroid hormone
Liver cirrhosis
114
what hormones or what are the conditions in which sex hormone binding globulin decreases?
androgen
growth hormone
obese individuals
115
65% of circulating testosterone is?
bound to sex hormone binding globulin (SHBG)
116
Physiologic Effects of testosterone?
- larynx grows
- vocal cords become thicker
-lower-pitched voice
- Skeletal growth
- appearance of pubic, axillary, and beard hair
117
androgens do 2 things?
stimulate renal erythropoietin secretion and decrease HDL levels
118
what is the Metabolic effects of androgens?
increased liver synthesis of clotting factors, triglyceride lipase, α 1 -antitrypsin, haptoglobin, and sialic acid.
119
Testosterone and its derivatives have been used for?
their anabolic effects as well as in the treatment of testosterone deficiency.
120
what testosterone derivates active in the mouth?
methyltestosterone and fluoxymesterone
121
derivatives of Testosterone
propionate, enanthate, undecanoate, or cypionate
122
which enzyme converts testosterone to dihydrotestosterone?
5α-reductase
123
if we give large doses of testosterone to adult males what will happen?
negative feedback so decrease the releases of (LH & FSH)
prostatic hyperplasia causing urinary retention
124
If women administer more than 200–300 mg of testosterone per month what will happen?
hirsutism, acne, amenorrhea and deepening of the voice.
125
side effect of 17-alkyl-substituted steroids ?
hepatic dysfunction
126
if we maintain the level of androgen in the blood more than 0.6 mg what will happen?
azoospermia and decrease in testicular size
127
if we give alkylated androgens in high doses what will happen?
peliosis hepatica, cholestasis, hepatic failure
128
ANTIANDROGENS
1- (Steroid Synthesis Inhibitors)
2- (5α-reductase inhibitor)
3- (Receptor Inhibitors)
4- (competitive inhibitor)
1- Ketoconazole
2- Finasteride
2- Dutasteride
3- Cyproterone and cyproterone acetate
3- Flutamide
3- Bicalutamide and nilutamide
4- Spironolactone
129
used primarily in the treatment of fungal disease
Ketoconazole
130
side effect of ketoconazole
reversible gynecomastia
131
what is the use of Finasteride?
reducing prostate size in men with benign prostatic hyperplasia
132
These drugs are not approved for use in women or children
Finasteride & Dutasteride
133
why Cyproterone and cyproterone acetate are effective antiandrogens?
they have marked progestational effect that suppresses the feedback
enhancement of LH and FSH, leading to a more effective antiandrogen effect
134
treatment of hirsutism in women?
Cyproterone acetate with estrogen
135
what is the drug has a competitive antagonist at the androgen receptor?
Flutamide
136
what are the 2 disadvantages of Flutamide?
-causes mild gynecomastia
- mild reversible hepatic toxicity.
137
what drugs have a combination with a GnRH analog?
Bicalutamide and nilutamide
138
What are the 2 MOA of Spironolactone?
1-reduces 17α-hydroxylase activity
2-lowering plasma levels of testosterone
139
what are contraceptive use in males?
testosterone and testosterone enanthate
140
which combination produces azoospermia in 94% of men?
100 mg of testosterone & 500 mg of levonorgestrel daily orally
141
adverse effect of GOSSYPOL
Hypokalemia
142
1- Sildenafil/onset, Half-life, Effect of food on absorption, use
2- Tadalafil/onset, Half-life, Effect of food on absorption, use
1- 1Hr / 3-4hR / ++ / PRN
2- 2Hr / 18Hr / -- / daily
143
contraindication of Phosphodiesterase 5 inhibitors?
Nitrates
144
Natural PDE5 inhibitors?
Epimedium
Cinnamon
Black Ginger Extract
Tongkat Ali
145
synthetic PGE1, Administered via intra-urethral suppositories
Alprostadil
146
Adverse effects of Alprostadil
Caution: sexual intercourse with pregnant woman
