Chapter 29: Pharm of Reproduction

Question 1

What is the mechanism of action of finasteride?

Answer 1

5 alpha reductase inhibitor, therefore blocking conversion of testosterone to DHT

Question 2

When would you use finasteride?

Answer 2

BPH because it slows the growth of prostate tissue and reduces the size (when you STERIDE on a bike it’s uncomfortable on your prostate)

Question 3

What is the major difference between finasteride and dutasteride?

Answer 3

F - type II and can be used for alopecia

D - type I and II and used for BPH

Question 4

What is the major warning you should give your male patient who is married about finasteride and dutasteride?

Answer 4

Don’t let your woman near that shit

HIDE YO KIDS HIDE YO WIFE

Question 5

What drugs could you give to improve symptoms of decreased urine flow?

Answer 5

STERIDES

Question 6

Mechanism of action of anastrozole and letrozole?

Answer 6

aromatase inhibitor - COMPETITIVE

aromatase convertes androgens to estrogens

Question 7

How do exemestane and formestane differ in MOA from anastrazole and letrozole?

Answer 7

stanes are irreversible

Question 8

What drugs would you use to treat estrogen dependent tumors?

Answer 8

Aromatase inhibitors (Gunner Al Zole and Ef Stanes are irreversible)

Question 9

Severe estrogen repression greatly increases the risk for what..?

Answer 9

osteoporotic fractures

Question 10

What is the MOA of tamoxifen?

Answer 10

estrogen receptor agonist in BONE

estrogen receptor antagonist in TISSUE

Question 11

Major risk of tamoxifen? How do you combat this?

Answer 11

endometrium neoplasm …

limit administration to less than 5 years

Question 12

How do tamoxifen and raloxifene differ?

Answer 12

Raloxifene use to treat osteoporosis because its major capability was to increase estrogen receptor activity in bone…

tamoxifen is more to prevent breast cancer

Question 13

What is the MOA of clomiphene?

Answer 13

antagonist in hypothalamus and ant. pituitary
agonist in ovaries

therefore will increase secretion of LH and FSH –> ovulation

Clome - clone - reproduction

Question 14

Clomiphene concern?

Answer 14

potential increase in size of ovaries (hypertrophy and cysts)

Question 15

What is the major complete estrogen receptor antagonist? MOA is competitive inhibition of estrogen receptor. Used for metastatic breast cancer in postmenopausal women.

Answer 15

Fulvestrant

Full Vested Auntie - this crazy lady is post menopausal and full vested because of breast cancer…
MUST INHIBIT THAT ESTROGEN SHITS

Question 16

What drug, used to treat metastatic prostate cancer and BPH, is most effective when coupled with castration? What is it’s MOA?

Answer 16

Flutamide

Androgen receptor antagonist - blocks DHT and testosterone acitvity

Flute is high pitched so when you lose testosterone craps you get high voice

Question 17

What androgen receptor antagonist is indicated for treatment of hirsutism, acne, hypertension? What is its specific MOA?

Answer 17

Spironolactone

aldosterone receptor antagonist with activity at androgen receptor

Captain Jack Spiro has a lot of facial hair - think hirsutism

Question 18

What drug would you use for abortion through day 63 of pregnancy?

Answer 18

Mifepristone

Question 19

Levonorgestrel use?

Answer 19

Progestin

Morning after pill

1.5 mg 120 hrs

Question 20

Why is estrogen always co-administered with a progestin in women with a uterus?

Answer 20

Unopposed estrogen increases the risk of endometrial cancer

Question 21

What type of patient would you NOT give combination estrogen-progestin contraception?

Answer 21

DO NOT GIVE to women smokers over 35 because of serious cardio risks

Question 22

MOA of estrogen-progestin combos?

Answer 22

Suppress GnRH,LH, FSH and follicular development –> inhibits ovulation

Question 23

Adverse effects of estrogen-progestin contraception?

Answer 23

arterial/venous thromboembolism, pulmonary embolism, cerebral thrombosis

gallbladder disease

Question 24

Norgestrel

Answer 24

Progestin

Question 25

Ethinyl estradiol

Answer 25

Estrogen

Question 26

Mestranol

Answer 26

Estrogen

Question 27

Norethindrone

Answer 27

Progestin

Question 28

Triphasic oral formulations of estrogen-progestin contraceptives has higher or lower amounts of progestin each month?

Answer 28

LOWER

Question 29

What would you use as contraceptive in patients for whom estrogen use is contraindicated?

Answer 29

Progestin-only contraceptive

Question 30

Progestin-only contraceptive MOA?

Answer 30

Alter frequency of GnRH pulsing and decrease anterior pituitary responsiveness to GnRH

Question 31

What would you advise your patient to expect with respect to bleeding after prescribing her a progestin-only contraceptive?

Answer 31

breathrough spotting and irregular, light menstrual period during the first year of administration

Question 32

Treatment of choice for hypogonadism?

Answer 32

Androgen hormone replacement

Testosterone enanthate/testosterone cypionate

Question 33

You do NOT want to give androgen replacement therapy (i.e. testosterone) to which patients?

Answer 33

Men with prostate cancer

can INCREASE growth of the prostate…BAD!

Question 34

What could potentially be used as a male contraceptive? Is there an oral form?

Answer 34

testosterone enanthate

no oral form because of first pass hepatic metabolism

Question 35

Testosterone hormone replacement is available in a topical gel formulation…what is a risk of this?

Answer 35

Potential transfer to female partner…BAD THING

Question 36

What hormone replacement therapy can cause acne or gynecomastia

Answer 36

testosterone

Question 37

Androgen replacement therapy should not be taken lightly and could be abused by athletes. What is some criteria to avoid this abuse?

Answer 37

only offer to men with consistent signs of hypogonadism and low plasma testosterone