Steroids

Question 1

Oral Contraceptives AA

Answer 1

ramping, bleeding, headache, decreased libido, no menses, weight gain, skin issues, acne, vaginal infections, thromboembolism, MI, hypertension, cerebrovascular disease, Gi issues, depression, cervical cancer, hypertension, diabetics, smokers, VTE, ischemic heart disease, cancer

Question 2

Estrogens and Progesterones INTERACTIONS:

Answer 2

warfarin(increased with OCs), abx(decreases efficacy via cycling), rifampin(liver metabolism increase), phenytoin(increased catabolism), cimetidine(decreased catabolism)

Question 3

Estrogens and Progesterones
LAB DRUG INTERACTIONS

Answer 3

AST and ALT levels, alter lipid panels, prothrombin time, and T4 bc of thyroid binding globulin.

Question 4

Ethinyl estradiol:

Answer 4

oral and more resistant to metabolism. Can also be transdermal patch

Question 5

conjugated equine estrogens (CEE)

Answer 5

for post menopausal women

Question 6

Estrogens:

Answer 6

stradiol binds to sex hormone bidning globulin strongly, less to albumin.
Oral estrogens undergo enterohepatic recirculation. Excreted via kidneys.Good for contraception, post menopausal women, priary hypogonadism.

Question 7

Progesterones Gestrel/gest:

Answer 7

precursor to estrogens, androgens, adrenocortical steroids. Thickens cervical mucus, maintains pregnancy, increases metabolism, decreases thyroid binding globulin and increases thyroid hormone activity. Loves albumin and transcortin. Enterohepatic recirculation. Excreted via kidneys

Question 8

Medroxyprogesterone acetate (MPA)

Answer 8

long acting depo shot, irregular bleeding

Question 9

Levonorgestrel (LNG):

Answer 9

IUDs, also a progesterone receptor modulator

Question 10

Ulipristal :

Answer 10

progesterone receptor modulator

Question 11

Anti estrogens:

Answer 11

Binds to ERa and ERB as competitive antagonists, for infertility and tamoxifen resistant BC.

Question 12

Clomifene:

Answer 12

long HL(5-7 days) bc of enterohepatic recirc and accumulation in fatty tissues

Question 13

Fluvestrant:

Answer 13

IM, anti estrogen. concentrations reached after 7 days, 13.5-18.5 h half life

Question 14

Anti progesterone:

Answer 14

blocks uterine progesterone receptors, ensures expulsion of blastocyst

Question 15

Anti progesterone drugs

Answer 15

Mifepristone, glucocorticoid antagonist

Question 16

SERMs Ifen.Ifenes:

Answer 16

to compete with 17β-estradiol (E2) at the receptor site and to block the promotional role of E2 in breast cancer

Question 17

Tamoxifen

Answer 17

agonist and antagonist effects, nonsteroidal, oral. CYP2D6

Question 18

Raloxifene:

Answer 18

post menopausal osteoporosis, prophylatically for Bc with high risk fctors

Question 19

Aromatase Inhibitors

Answer 19

blocks conversion of testosterone to estradiol(E2) and androstenedione to estrone(E1). Good for early and late stage ER+ BC and adjunct to GnRH agonists to treat premature follicular maturation, ovarian suppression. AA: loss of BMD, arthralgias, vaginal dryness, sexual dysfunction, normal ovarian function.

Question 20

Exemestane:

Answer 20

type I, steroid, aromatase inhibitors

Question 21

Anastrozole

Answer 21

type II, non steroidal, aromatase inhibitors

Question 22

Testosterones

Answer 22

major degradation in liver, 65% bound to sex hormoen binding globulin,2% free for nculear receptors. Converted to DHT for cellular effects.

Question 23

Testosterone Indications:

Answer 23

hypogonadism, chemo, endometriosis, cancer cachexia, anemia, osteoporosis, delayed puberty, slowing aging, androgen abuse in sports.

Question 24

Testosterone Contraindications:

Answer 24

pregnant women, breast or prostate cancer, developing juveniles, renal or cardiac disease, HCC.

Question 25

Higher androgenic to anabolic

Answer 25

effects is favorable for androgen replacement tx

Question 26

Higher anabolic to androgenic

Answer 26

effects is favorable for anemia, osteoporosis, and protein loss.

Question 27

Olones/zolol

Answer 27

anemia, testosterone

Question 28

Androgen receptor antagonists

Answer 28

Flutamide: competitive androgen receptor antagonist, tx of prostate cancer and for women with androgen excess.

Question 29

androgen synthesis inhibitors

Answer 29

Finasteride: 5a reductase inhibitor, treats prostatic hyperplasia and prevent male pattern baldness