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Junior - Pharm II - 2 > 6 - Fertility And Repro > Flashcards

6 - Fertility And Repro Flashcards

1
Q

What are the menopause therapies?

A

Menopausal hormone therapy (MHT)
Estrogen therapy
Progesterone therapy

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2
Q

Who should never get estrogen mono-therapy?

A

Anyone with a uterus

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3
Q

What is estrogen therapy in menopause used to treat?

A

Relieves genitourinary atrophy, and pain w sex

Relieves vasomotor instability

Improves sleep (decreased hot flash)

Osteoporosis: reduces bone resorption

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4
Q

Adverse events with estrogen therapy for menopause?

A

Endometrial and breast cancer

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5
Q

Who is the target audience for estrogen therapy?

A

Prevention of menopausal osteoporosis post hysterectomy

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6
Q

What role does progestin therapy have in menopause?

A

Medroxyprogesteron prevents estrogen induced bleeding, lowers cancer risk

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7
Q

Adverse events with medroxyprogesterone?

A

Bloating
Wt gain
Depression

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8
Q

Do i need a high dose of progesterone for benefits to be realized?

A

Nope; micro-dosing progesterone has been found to be equally effective

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9
Q

What did the women’s health initiative study (WIH) tell us about estrogen?

A 
It is linked to: 
Lung cancer
Breast cancer
Endometrial cancer
Ovarian cancer

Good thing we gave that shit out like candy before the study

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10
Q

What is a major risk for estrogen that isnt cancer?

A

Decreased anticoagulation leading to blood clots

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11
Q

Why use estrogen + cyclic progesterone for menopause?

A

It mimics the female cycle and has a bleeding cycle (wait wasnt that the only benefit of menopause?)

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12
Q

How else can estrogen and progesterone be combined?

A

Estrogen plus continuous progesterone (no interruption)

And intermittent, 3 on 3 off

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13
Q

What are the oral estrogen products?

A 
Synthetic conjugated estrogens A
Synthetic conjugated estrogens B
17-estradiol
Esterfied estrogens
Estropipate
Conjugated estrogens

Fortunately they all end or start with estrogen

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14
Q

Whats the advantage to vaginal estrogen products?

A

They only have localized effects, this is a double edged sword though because they only treat localized stuff too

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15
Q

Formulations of vaginal estrogen products?

A

Vaginal creams
Vaginal rings: 17 B-estradiol, estradiol acetate
Vaginal tablet: estradiol hemihydrate

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16
Q

What estrogen formulation is used transdermally

A

17 B-estradiol is available in a patch, gel and spray

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17
Q

Progesterone products?

A 
Noretthidrone acetate
Megestrol acetate
Norethindrone
Levonorgestrel
Progesterone
Micronized progesterone
Medrozxyprogesterone acetae
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18
Q

Norethindronate acete used for?

A

Secondary amenorrhea, endometriosis, abnormal uterine bleeding

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19
Q

Megestrol acetate used for?

A

Appetite stimulant and treatment for metastatic breast cancer

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20
Q

What are norethindrone and levonorgestrel used for?

A

Contraceptives

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21
Q

What is progesterone gel used for?

A

Infertile women who have a progesterone deficiency or secondary menorrhea

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22
Q

What is micronized progesterone used for?

A

Prevention of endometrial hyperplasia

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23
Q

There are a bunch of combined estrogen progesterone drugs, they all have estrogen and progesterone combo names. What is the one exception?

A

Estrogen bazedoxifen

Bazedoxifen is not a progesterone drug it is a SERM

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24
Q

How does bazedoxifen work?

A

It acts as an agonist of estrogen receptors in some estrogen sensitive tissues and an antagonist in others

This reduces the risk of endometrial hyperplasia

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25
Q

What is the clinical use of estrogens/bazedoxifen (duavee)?

A

Post menopausal osteoporosis

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26
Q

What adverse events are associated with estrogens/bazedoxifen (duavee)?

A

Malignant neoplasms and gall bladder disease

Also its a pregnancy category X

Has a risk of osteoporosis

Basically this is quite a wonder drug

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27
Q

Your patient doesnt want to use hormones to treat menopausal symptoms what are her options?

A 
Lube
SERMS
SSRI’s
SNRI
Clonidine
Gabapentin
Methyldopa
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28
Q

What are some herbals/phytoestrogens used in menopause?

A

Red clover
Soy isoflavones
Black cohosh

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29
Q

Name some SERMs

A 
Tamoxifen
Raloxifen
Ospemifene
Tamoxifen 
Raloxifen

-ifen

30
Q

Tamoxifen and raloxifen MOA?

A

Remember -ifens SERM’s? We just talked about this come on…

They are estrogen agonist: they improve lipid profile
Estrogen antagonist: reduce cancer risk

31
Q

Are SERMs safer than estrogen?

A

No they have all the same adverse events

32
Q

Ospemifene clinical use?

A

Treatment of moderate to sever dyspareunia caused by valvular and vaginal atrophy (menopause)

Not approved for osteoporesis

33
Q

What is tamoxifen used for?

A

Breast cancer tx and prevention in high risk women

Not approved for osteoporosis

34
Q

Raloxifen (evista) use?

A

Prevention of osteoporesis

35
Q

What drugs interactions can you see with raloxifen?

A

Bile acid resins
Warfarin
Thyroid hormones

36
Q

What is clomiphene (clomid)?

A

MOA: ovulation inducing agent

You only get 3 chances

37
Q

What do aromatase inhibitors inhibit?

A

They inhibit production of estrogen by blocking armoatase

Used in tx of breast cancer

38
Q

What are teh aromatase inhibitors?

A

Letrozole
Anastrozole
Exemestane

39
Q

Mifepristone (mifeprex)
And
Mifepristone (korylm)

Same drug name very different use, what is it?

A

Mifepristone (mifeprex) is an abortion drug, used to terminate intrauterine pregnancy up to 70 days later

Mifepristone (korylm) is used to treat hyperglycemia in pts with cushing syndrome

40
Q

What is Mifepristone’s MOA?

A

Inhibits progesterone and binds to glucocorticoid receptors

41
Q

What are the generalized actions of anabolic hormones?

A

Anabolism: Stimulation of protein synthesis

Stimulation of RBC production

42
Q

Testosterone pills?

A

Nope, it is inactivated by the first pass effect

43
Q

What are some clinical uses for testosterone?

A

Senile osteoporosis and anemia (70+)
Males: replacement therapy
Females: hypopituitarism, breast cancer, endometriosis
Increased lean body mass, strength and performance (unapproved)

44
Q

Testosterone schedule?

A

Schedule III

45
Q

Adverse effects of testosterone therapy?

A

Males:
Azoospermia (bad sperm)
Stunted growth in pre-pubertal males

Females: masculinization, hair, acne

46
Q

Long acting testosterone drugs?

A

Testosterone cypionate IM
Depo-testosterone IM
Testosterone enthate IM
Testosterone pellets: SC implant

47
Q

Testosterone short acting?

A

Transdermal

Testosterone transdermal system
Transdermal gels solutions

Please dont put these on your genitals

48
Q

Oral androgens

A

Fluoxymesterone

Methyltestosterone

49
Q

Anabolic androgens

Oxandrolone

A

wt gain where protein breakdown is the reason

50
Q

Anabolic androgens

Oxymethalone

A

Anemia’s from deficient RBC production

51
Q

Danazole (adanocrine)

A

Androgen derivative

Use to treat endometriosis and fibrocystic breast disease

52
Q

What are anti-androgens and androgen agonists used for?

A 
Prostate cancer
Endometriosis
Breast cancer
Hirusitism
Alopecia
 acne
Precious puberty in males
BPH
53
Q

What are the drugs used to treat BPH?

A

a-blockers - zosin’s and osin’s

Terazosin
Doxazosin
Alfuozosin
Tamsulosin
5a reductase inhibitor
54
Q

What is finasteride (propecia, proscar) MOA?

A

Halts BPH progression and reduces prostate size and symptoms over time

Also works on hirsutism

55
Q

You solved your BPH and baldness with finasteride but now what happens?

A

You have decreased libido, ED, and ejaculatory dysfunction so that beautiful head of hair does you no good

56
Q

What about finasteride and pregnancy?

A

Its is bad that women cant even touch it. Oh and it messes up men’s sperm too so dont mess with this stuff in if babies are in anyone around you’s future

57
Q

PDE5 inhibitors”?

A

Slidenafil (viagra, revatio)
Verdenafil
Avanafil
Tadalafil (cialis)

58
Q

How do PDE5 inhibitors work?

A

PDE-5 is responsible for degradation of cGMP in the corpus cavernosum

  • no effect in the absence of sexual stimulation
59
Q

Besides ED what else are PDE5’s used for?

A

ED,
pulmonary arterial HTN
BPH

60
Q

How long do these pills (PDE5 inhibitors) last?

A

Vardenafil and sildenafil: 4 hrs

Tadalail: 36hrs

61
Q

What are some contraindications for slidenafil, verdenafil, and avanafil?

A

Renal and liver problems, but you can use a reduced dose of slidenafil

62
Q

What is the advantage to tadalafil (cialis)

A

You dont need to plan. It last 36 hrs so it is a once daily pill.

63
Q

What are the adverse events associated with PDE5 inhibitors?

A 
Nasal congestion
Headache
Flushing
HOTN
Vision changes (blurring and color changes)
64
Q

What drugs dont do well with PDE5 inhibitors?

A

Nitrates: HOTN (fatal)
a-blockers: HOTN tamsulosin is less likely to cause problems
ETOH: HOTN
CYP3A4 inhibitors: not recommended

65
Q

What is alprostadil?

A

Prostaglandin E1 (PGE1) vasidilator used for ED

66
Q

Administration of alprostadil?

A

Injection or urethral pellet

67
Q

Why use alprostadil?

A

It may still work with spinal injury

68
Q

What are the many approaches that are used to treat female sexual dysfunction?

A 
non pharm: psych
Hormonal therapy (androgens)
Dopamine agonist (Parkinson’s)
Fibanserine
Herbals
69
Q

Fefibanserin (addyi)

A

The only approved medication for femal sexual dysfunction

We dont know how it works but it exhibits serotonergic and dopaminergic activity

70
Q

How gets fibanserin (addyi)

A

HSSD

PREmenopausal women w hypoactive sexual desure

71
Q

What is another term for lethal dose?

A

A lifetime supply…

Junior - Pharm II - 2 (3 decks)

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