Progestins

Question 1

metabolism/excretion of progesterone

Answer 1

first pass through liver, excreted in urine

Question 2

physiological effects of progesterone

Answer 2

maturation in endometrium following ovulation
increases insulin levels
competes with aldosterone and decreases Na absorption
depressant / hypnotic effects

Question 3

clinical uses of progestins

Answer 3

hormonal contraception, hormone replacement therapy with estrogens, endometriosis, dysmenorrhea, bleeding disorders

Question 4

SAR: _____ at 3 position is essential for activity

Answer 4

ketone

Question 5

SAR: unsaturation is ___

Answer 5

tolerated

Question 6

SAR: 6 methyl group ___activity

Answer 6

increases

Question 7

SAR: 17 alpha ethynyl moiety leads to ___ activity

Answer 7

oral

Question 8

SAR: #? Me/Et group required for activity

Answer 8

C 18

Question 9

SAR: 19 methyl group can be _____

Answer 9

replaced by H (enhanced activity)

Question 10

describe the modifications

Answer 10

17 ethynyl increase oral bioavailiabiliy and half life
17 OH increases bioavailability
19 methyl for H enhances activity

Question 11

levonorgestrel (class and use)

Answer 11

progestin
used in IUDs

Question 12

norgestimate (class and use)

Answer 12

progestin
prodrug of levonorgestrel

Question 13

desogestrel (class and use)

Answer 13

progestin
prodrug of etonogestrel

Question 14

etonogestrel

Answer 14

progestin
active form desogestrel
structure analog of levonorgestrel
used in implant and vaginal ring

Question 15

drospirenone

Answer 15

4th gen progestin
weak progestognenic activity
negates negative side effects of ethynyl estradiol in combo

Question 16

medroxyprogesterone acetate

Answer 16

1st gen progestin
used for depot injection as long acting progesterone only contraceptive

Question 17

mild adverse estrogen effects

Answer 17

nausea, hypertension, edema, breast fullness

Question 18

mild adverse progestin effects

Answer 18

increased appetite, fatigue, breast regression

Question 19

moderate adverse progestin

Answer 19

breakthrough bleeding

Question 20

moderate adverse androgen combos

Answer 20

weight gain, hirsutism, acne

Question 21

severe adverse effects

Answer 21

venous thromboembolic disease, myocardial infarction, smokers over 35

Question 22

ulipristal acetate

Answer 22

SPRM
emergency contraceptive
up to 5 days after unprotected sex

Question 23

mifepristone

Answer 23

progesterone antagonist
abortifacient with misoprostol
terminates pregnancy up to 70 days

Question 24

danazol

Answer 24

weak androgen, estrogen, antiestrogen
endometriosis (inhibit LH and FSH, atropy endometrium)
contraindicated: hepatic dysfunction and pregnancy/breast feed