sex hormones II

Question 1

Progesterone is produced by

Answer 1

corpus luteum

Question 2

MOA of progesterone

Answer 2

Progesterone acts on nuclear protein receptors, which interact with DNA.

Question 3

function of progesterone in the uterus

Answer 3

• converts endometrium to a secretory state
  
  • maintains pregnancy
  • suppresses contractility during pregnancy

Question 4

Progestins come in what two types

Answer 4

• 19-nortestosterones
• progesterone derivatives

Question 5

Uses of progestins

Answer 5

• contraception
• prevent endometrial hyperplasia in HRT

Question 6

List the Antiprogestins

Answer 6

• Mifepristone
• Danazol

Question 7

MOA of Mifepristone

Answer 7

• progesterone/glucocorticoid receptor antagonist

Question 8

uses of Mifepristone

Answer 8

terminate pregnancy

Question 9

use for Danazol

Answer 9

endometriosis

Question 10

What is the combination pills: estrogen and progestin that you should know

Answer 10

Drospirenone/ethinyl estradiol (Yasmin, Yaz)

Question 11

use of combination oral contraceptives

Answer 11

• inhibit ovulation
  
  • no LH surge
• Cause changes in cervical mucosa and endometrium that decreases implantation.

Question 12

what part of the combination oral contraceptives initiates bleeding at the end of the cycle with its withdrawal

Answer 12

progestin

Question 13

estrogen: progestin ratio is important. E:P ratio, estrogen stays the same and progestin increases content at each stage. List the three stages

Answer 13

• 1 stage: monophasic
• 2 stages: biphasic
• 3 stages: triphasic

Question 14

estrogen given in off period of seasonique due to

Answer 14

• estrogen decreases uterine bleeding

Question 15

Yaz is a comibination of ethinyl estradiol and drospirenone . MOA of drospirenone

Answer 15

a mineralcorticoid antagonist

Question 16

advantages of ethinyl estradiol and drospirenone

Answer 16

• less water retention (bloating): FDA approved for PMDD

Question 17

MOA of Natazia

Answer 17

bioidentical E2

Question 18

Use for Progestin-only mini pills

Answer 18

• 87-98% effective for birth control
  
  • used for adolescents and breast feeding mothers
    
    • ​(prevents estrogen effects on bone growth)

Question 19

progestin-only long term therapy causes

Answer 19

early breakthrough bleeding, later amenorrhea

Question 20

adverse effects of combination oral contraceptives

Answer 20

• common
  
  • weight gain
  • nausea
  • edema
  • depression
• breakthrough bleeding
  
  • progestin alone or too little estrogen
• cardiovascular
  
  • clotting
    
    • women over 35 or smoker
  • mild HTN
  • migrain
  • MI/stroke
• Teratogenesis
• Fertility suppressed

Question 21

combination oral contraceptive benefits

Answer 21

• effective contraceptives
• ovarian and endometrial CA

Question 22

contraindications of combination oral contraceptive

Answer 22

• absolute:
  
  • thromboembolic phenomena
  • estrogen-dependent neoplasms
• relative:
  
  • liver disease

Question 23

drug interactions with combination oral contraceptive

Answer 23

• P450 inducers will reduce effectiveness
• antibiotics can reduce effectiveness
  
  • stop enterohepatic circulation

Question 24

ovarian steroids and gonadotropin levels in menopause

Answer 24

• reduced ovarian response to gonadotropins
• decreased ovarian steroids: estrogen and progesterone
• increased gonadotropins: FSH, LH

Question 25

list the major menopausal symptoms

Answer 25

1. vasomotor problems: hot flashes 2. Genito-urinary problems: vaginal dryness, atrophy, pain 3. osteoporosis 4. heart disease

Question 26

Hormone replacement therapy for women with h/o hysterectomies

Answer 26

estrogen only

Question 27

adverse effects of Hormone replacement therapy

Answer 27

* breast cancer (1.25 fold) * cardiovascular * gallbladder disease (2.5 fold)

Question 28

general guidelines for giving Hormone replacement therapy

Answer 28

* \< 10 years after menopause = HRT has more benefits vs risks * \> 10 years after menopause = HRT not so great * \*\*before prescribing, know risks of HRT, inform patient and choose appropriate tx individually

Question 29

actions of androgens

Answer 29

1. virilizing 1. spermatogenesis 2. sexual development 2. anabolic 1. increase in bone density 2. increase amino acid incorporation into muscle 3. puberty: development of secondary sexual characteristics in male

Question 30

androgen use in men

Answer 30

testicular deficiency

Question 31

androgen use in women

Answer 31

female hypopituitarism (estrogens and androgens)

Question 32

andogen use in both sexes

Answer 32

* **hypoproteinemia of nephrosis** * proteins lost in urine, helpful because it increase anabolic activity of liver to make more proteins

Question 33

adverse effects of exogenous androgens in men

Answer 33

decreased spermatogenesis * in testes, need high level of testosterone, if you bring in testosterone, will get negative feedback and loss of LH

Question 34

adverse effects of exogenous androgens in women

Answer 34

* masculinization * pseudohermaphroditism of fetus in pregnant women

Question 35

adverse effects of exogenous androgens in both sexes

Answer 35

* oily skin, acne * decreased HDL * psychological changes

Question 36

list the Androgen Receptor Antagonists

Answer 36

* Flutamide * spironolactone

Question 37

use for Androgen Receptor Antagonist: Flutamide

Answer 37

* used in **prostate CA** with long-acting GnRH agonist * Used to suppress ‘tumor flare’ when beginning long-acting GnRH therapy.

Question 38

Use for spironolactone: high dose

Answer 38

* high dose antiandrogen * use * **hirsutism** in women * **precocious puberty**

Question 39

List the 5 alpha reductase inhibitors

Answer 39

* **Finasteride** * **Dutasteride** * MOA: no Dihydrotestosterone

Question 40

uses of 5 alpha reductase inhibitors

Answer 40

* benign prostatic hyperplasia * male pattern baldness

Question 41

adverse effects of 5 alpha reductase inhibitors

Answer 41

* impotence * teratogenic