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Reproductive Flashcards

1
Q

Estrogens include

A

estradiol
estrone
ethinyl estradiol

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2
Q

SERMs include

A

Clomiphene
ospemifene
raloxifene
tamoxifen
toremifene

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3
Q

Anti- progestin

A

mifepristone

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4
Q

Progesterone agonist/ antagonist

A

ulipristal acetate

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5
Q

Physiology of menstrual cycle

A

hypothalamus - gonadotropin releasing hormone is secreted
Anterior pituitary - GnRH stimulates FSH and LH by the anterior pituitary
FSH and LH downregulates the release of GnRH from the hypothalamus

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6
Q

Days of menstrual cycle

A

days 1-5 - menstruation
days 6-14 - follicular phase (estrogen driven)
day 14 - ovulation (LH driven)
days 15-28 - luteal phase (progesterone driven)

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7
Q

MOA of estrogens

A

agonist to the estrogen receptor

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8
Q

Use of estrogens

A

oral contraceptive
menopausal hormone therapy
gynecologic disorders

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9
Q

Estrogens are most often administered with a _______ in combination oral contraceptives (COC)

A

progestin

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10
Q

COC MOA

A

suppresses LH and FSH by interfering with hypothalamic gonadotropin-releasing hormone and pituitary gonadotropin secretion
Ovulation is suppressed by inhibition of the mid-cycle LH surge
Suppression of ovarian folliculogenesis via suppression of pituitary follicle stimulating hormone secretion

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11
Q

Why we give estrogen and progesterone

A

estrogen - potentiates progesterone so lower doses can be used, allows for endometrial growth so less breakthrough bleeding

progesterone - protects against estrogen-induced endometrial hyperplasia

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12
Q

Progestin related mechanisms:

A

endometrium becomes less suitable for implantation
cervical mucus thickens and becomes less permeable to penetration by sperm

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13
Q

Level of activity: High

A

Norgestrel
Levonorgestrel

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14
Q

Level of activity: Moderate

A

Norethindrone
Norethindrone acetate

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15
Q

Level of Activity: Low

A

Ethynodiol
Norgestimate
Desogestrel
Drospirenone
Dienogest

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16
Q

Benefits of COCs (Noncontraceptive)

A

Abnormal or dysfunctional uterine bleeding
Dysmenorrhea
PMS and PMDD
Endometriosis
Adenomyosis
Functional ovarian cysts
PCOS
Hormone replacement in women with primary hypogonadism

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17
Q

Potential adverse effects of COC

A

HTN
Thromboembolism: DVT, PE, stroke
Changes in lipids (decreased HDL)
Bleeding irregularities
Nausea
Mood changes
Breast changes
Wt gain
HA

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18
Q

Estrogen Deficiency can cause

A

vasomotor symptoms

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19
Q

Estrogen Excess can cause

A

chloasma (melasma)
Menorrhagia and clotting
increased breast size

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20
Q

Progestin Deficiency

A

breakthrough bleeding
delayed withdrawal bleeding
dysmenorrhea
heavy flow/ clots

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21
Q

Progestin Excess can cause

A

Candidiasis
appetite increase
depression
fatigue
libido decrease

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22
Q

Androgen Excess can cause

A

acne
Hirsutism
libido increase
oily skin and scalp
edema

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23
Q

Contraindications to estrogen-containing contraception

A

Thromboembolic disorders
smokers > 35 yo
impaired liver function
abnormal vaginal bleeding
pregnancy
cardiac disease
migraine

Consider progestin only contraceptive options

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24
Q

Drug interactions

A

Anticonvulsants - phenytoin, carbamazepine, barbiturates, topiramate
Antibiotics - rifampin
Drugs used to treat HIV

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25
Emergency Contraception MOA
works by delaying or blocking ovulation
26
Emergency contraceptives must be used within
72 hours of unprotected intercourse
27
Emergency Contraception is ineffective once
implantation has occurred
28
Options for emergency contraception include
levonorgestrel (Plan B) Ulipristal (high dose progestin) COC (higher dose hormones) Copper IUD
29
Levonorgestrel MOA
prevents ovulation or fertilization, alters endometrium
30
Levonorgestrel is contraindicated in
known or suspected pregnancy
31
Levonorgestrel adverse reactions
generally well tolerated, may cause GI upset, re-administer if vomiting within 2 hours
32
Ulipristal is a
selective progesterone receptor modulator (progesterone agonist/ antagonist)
33
Ulipristal MOA
binds to progesterone receptor and inhibits or delays ovulation, alters endometrium
34
Ulipristal contraindicated in
known or suspected pregnancy
35
Ulipristal adverse reactions
generally well tolerated, may cause HA, nausea, dysmenorrhea, dizziness, fatigue
36
Mifepristone is a
synthetic steroid compound, antiprogesterone
37
Mifepristone use
medical abortion
38
Mifepristone MOA
Competitively binds progesterone receptor (blocks progesterone receptor) Antagonizing endometrial and myometrial effects leads to contraction inducing activity - disrupts implanted embryo
39
Mifepristone used for pregnancies less than
49 days (7 weeks)
40
Mifepristone is followed by
Misoprostol for expulsion of the products of conception
41
HRT goals of therapy
decrease symptoms which may include vasomotor symptoms (hot flashes), mood lability, vaginal atrophy, sleep disturbance
42
HRT is given as
estrogen only - women that have had a hysterectomy estrogen-progestin - women with a uterus
43
HRT is only given for approximately
< 5 years - considered safe and not beyond the age of 60
44
HRT is associated with an increased risk of
coronary heart disease stroke DVT/Pulmonary embolism invasive breast cancer
45
HRT appears to be protective against:
Osteoporosis colon cancer
46
Contraindications for HRT
Hx of breast cancer Hx of coronary heart disease Previous hx of DVT/PE Hx of CVA or TIA Active liver disease Unexplained vaginal bleeding Risk of endometrial cancer
47
HRT side effects
breast soreness mood symptoms bloating (progestin) vaginal bleeding
48
HRT types that are effective in relieving menopausal symptoms
all types and routes of estrogen are effective
49
SERMs (selective estrogen receptor modulators) affect different parts of the body: Tamoxifen raloxifene ospemifene toremifene Clomiphene
Tamoxifen - breast cancer tx, antagonist in breast, agonist at bone and endometrium raloxifene - osteoporosis tx, antagonist in breast and endometrium, agonist at bone ospemifene - antagonist in breast, agonist in vaginal tissue and endometrium toremifene - antagonist in breast, agonist in bone and endometrium Clomiphene - ovulation induction, antagonist at hypothalamus, weak agonist in other tissues
50
SERMs Adverse reactions
flushing, hot flashes mood changes, depression GI upset vaginal bleeding bone marrow suppression
51
Contraindications of SERMs
Warfarin therapy Hx of DVT/PE Hx of CVA/TIA Endometrial cancer
52
Leuprolide MOA
inhibitor of gonadotropin secretion - results in transient increase in LH/FSH which leads to transient increase in testosterone and estrogen BUT continuous GnRH agonist use results in decrease in LH/FSH and suppression of testosterone/ estrogen production
53
Adverse effects of Leuprolide
HA Depression GI decreased libido
54
Leuprolide indications
prostate cancer endometriosis uterine fibroids used for some IVF protocols
55
Flutamide is a
synthetic, nonsteroidal anti-androgen antagonist at androgen receptor - competes with natural hormone for binding to the androgen receptor - blocks effect of androgens on target organs
56
Flutamide adverse reactions
GI distress Gynecomastia impotence hot flash liver failure
57
Contraindications Flutamide
Severe hepatic impairment
58
Phosphodiesterase Type V inhibitors include
sildenafil tadalafil vardenafil
59
Alpha-1 Blockers nonselective includes
Doxazosin Prazosin Terazosin
60
Alpha-1 Blockers selective include
alfuzosin tamsulosin
61
Tadalafil lasts longer than both Vardenafil and Sildenafil
up to 36 hours in some cases (only take once a day or every other day)
62
Phosphodiesterase Type V inhibitors should be taken on
an empty stomach
63
Phosphodiesterase Type V inhibitors: Contraindicated in patients taking
nitrates - can cause severe hypotension do not administer nitrate if they have taken PDE5 inhibitors in the past 24-48hrs Avoid taking in combination with drugs use to treat BPH
64
Side effects of Phosphodiesterase Type V inhibitors
Hypotension Flushing HA heartburn visual effects (blue vision) priapism
65
5-alpha reductase inhibitors include
finasteride dutasteride
66
anticholinergic agents include
tolterodine oxybutynin darifenacin
67
Alpha-1 receptor cause inhibition of
contraction of smooth muscle of: ureter vas deferens urethral sphincter
68
most common side effect of alpha-1 adrenergic antagonists
orthostatic hypotension
69
how to take alpha-1 adrenergic antagonists
initiate at bedtime, low doses and titrate up over weeks
70
Other side effects of alpha-1 adrenergic antagonists
interaction with phosphodiesterase-5 inhibitors ejaculatory dysfunction reflex tachycardia, HA, dizziness, vertigo, nausea, nasal congestion/rhinitis intraoperative floppy iris syndrome during cataract surgery (tamsulosin)
71
5-alpha reductase inhibitor MOA
inhibits type 2 5-alpha reductase -> interfering with the conversion of testosterone to 5-alpha-dihydrotestosterone (DHT stimulates prostate growth)
72
5-alpha reductase inhibitor adverse reactions
erectile dysfunction decreased libido abnormal ejactulation
73
Drugs used to treat androgen deficiency
methyltestosterone fluoxymesterone testosterone
74
Indications for androgen deficiency
primary or secondary hypogonadism delayed puberty menopausal symptoms occasionally used for metastatic breast cancer
75
Contraindications of methyltestosterone/ fluoxymesterone
prostate cancer women who are or may become pregnant caution if cardiovascular risk
76
Adverse effects of methyltestosterone/ fluoxymesterone
Males: Priapism, impotence, gynecomastia, BPH Females: masculinization, acne, facial hair may increase risk of MI or stroke
77
Anabolic Androgenic steroids include
synthetic - stanozolol, oxandrolone, nandrolone (many more)
78
indications of Anabolic Androgenic steroids include
AIDS wasting low testosterone state transgender also used at high doses by athletes for: -increasing lean muscle mass and improve performance -faster recovery -appearance

Pharmacology (7 decks)

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