Chapter 29: Reproduction

Question 1

Once testosterone is released from sex-hormone binding globulin and goes into the cell, what does testosterone become to inflict increased androgenic change?

Answer 1

–(5-alpha-reductase)–> dihydrotestosterone,

which makes dimer with androgen receptor and causes transcription

Question 2

How does each of the following affect FSH/LH during feedback?

1) estrogen
2) testosterone
3) activin
4) inhibin
5) GnRH

Answer 2

1) + at ovulation causing surge, - all other times
2) -
3) + (just FSH)
4) - (just FSH)
5) + when pulsatile, - when continuous

Question 3

Role of LH on sex hormones in the male

Answer 3

Increase testosterone synthesis in Leydig cells

Question 4

Role of LH on sex hormones in the female

Answer 4

increase androgen synthesis in Thecal cells

Question 5

Role of FSH on sex hormones in the male

Answer 5

increases androgen binding protein, inhibin, and activin in Sertoli cells

Question 6

Role of FSH on sex hormones in the female

Answer 6

converts androgens–(aromatase)–> estrogens and increases inhibin and activin in granulosa cells

Question 7

2 common endocrine-related causes of infertility

Answer 7

polycystic ovarian syndrome (because increased androgens) and prolactinomas (because prolactin supresses estrogen via GnRH antagonism)

Question 8

3 hypotheses for Polycystic Ovarian Syndrome

Answer 8

1) LH hypothesis: increased LH –> increases androgens –> prevents normal follicle growth and secretion –> no estrogen trigger
2) Insulin theory: increased insulin –> decreases sex hormone-binding globulin production –> increases free testosterone
3) Ovarian hypothesis: thecal cell dysregulation

Question 9

What kind of estrogen is predominant in the postmenopausal woman?

Answer 9

estrone (produced by adipose tissue, less potent)

Question 10

What drug selectively inhibits type II 5-alpha-reductase to treat BPH (most effective for large prostates) and alopecia, but can cause decreased libido and ED?

Answer 10

finasteride

Question 11

What drug inhibits both type I and II 5-alpha-reductase to treat BPH, but can cause decreased libido and ED?

Answer 11

dutaseride

Question 12

What are the most effective for ER+ breast cancer treatment, but cause osteoporotic fractures?

Answer 12

anastrozole, letrozole, exemestane, formestane

Question 13

What are the reversible competitive inhibitors of aromatase, used to treat breast cancer?

Answer 13

anastrozole, letrozole

Question 14

What are the irreversible inhibitors of aromatase, used to treat breast cancer?

Answer 14

exemestane, formestane (it STAINS it = irreversible)

Question 15

What drug is an estrogen receptor antagonist in breast tissue and partial agonist in endometrium and bone, and is good (along with general breast cancer treatment) for therapy after lumpectomy? It should NOT be prescribed with DVT/pulmonary embolism.

Answer 15

tamoxifen

Question 16

What drug is an estrogen receptor antagonist in the hypothalamus and anterior pituitary and partial agonist in ovaries, increasing FSH and LH? The FSH can cause multiple follicles to grow, so side effects are ovarian cysts and hypertrophy.

Answer 16

clomiphene

Question 17

What treats female infertility due to an ovulatory disorder by inducing ovulation?

Answer 17

clomiphene

Question 18

What SERMs are agonists in bone, thus treating osteoporosis?

Answer 18

bazedoxifene and raloxifene

Question 19

What drug treats vulvovaginal dryness and atrophy?

Answer 19

ospemifene

Question 20

What drug is an agonist in bone and antagonist in both breast and endometrial tissue?

Answer 20

raloxifene

Question 21

What is a pure estrogen receptor antagonist, used to treat ER+ metastatic breast cancer in postmenopausal women?

Answer 21

fulvestrant (ful = FULL ER antagonist)

Question 22

What is a androgen receptor antagonist used to treat prostate cancer and BPH, but can cause hepatotoxicity?

Answer 22

flutamide

Question 23

What is a androgen receptor antagonist used to treat hirsutism, acne, and hypertension, but can cause hyperkalemic metabolic acidosis? It has both anti-androgen AND progesterone effects.

Answer 23

spironolactone

Question 24

What inhibits progesterone binding to receptor, causing death of the decidua and detachment of a blastocyst? It blocks glucocorticoid receptors at higher concentrations, so may be useful for ectopic ACTH syndrome too.

Answer 24

mifepristone

Question 25

What inhibits progesterone binding to receptor and may treat endometriosis and fibroids?

Answer 25

asoprisnil

Question 26

What 4 effects do oral contraceptives have in preventing transport of egg and sperm?

Answer 26

1) estrogens supress LH surge –> no ovulation
2) alter tubal peristalsis
3) decrease endometrial receptivity
4) decrease cervical mucus secretions

Question 27

What two cancers might oral contraceptives decrease?

Answer 27

endometrial cancer (WITH progesterone), ovarian cancer

Question 28

What progestin is used as emergency contraception and has high androgenic activity?

Answer 28

levonorgestrel

Question 29

What is part of an 84 day-7 day combo pack (hint: the progestin has high androgenic activity?

Answer 29

ethinyl estradiol and levonorgestrel

Question 30

What are important side effects in oral contraceptives?

Answer 30

DVT, embolism (esp in smokers), stroke, gallbladder disease, DVT, breakthrough bleeding

Question 31

What oral contraceptive combo is available as a vaginal ring that’s kept in for 21 days?

Answer 31

ethinyl estradiol and etonogestrel (eton = EYTAN gonna propose w/ ring soon)

Question 32

What oral contraceptive combo is available as a transdermal patch that is changed weekly?

Answer 32

ethinyl estradiol and norelgestromin (ROAMIN around TRANSatlantic)

Question 33

What is used as a progesterone only contraceptive and in post-menopausal women, and injectable every 3 months? Side effects are breakthrough spotting and irregular periods.

Answer 33

medroxyprogesterone acetate

Question 34

What is a progesterone only contraceptive used as a silastic implant changed every 3 years?

Answer 34

etonogestrel

Question 35

What is best used transdermally (bypass liver) to treat hypogonadism in men, but can cause acne, gynecomastia, BPH, and prostate cancer?

Answer 35

testosterone enanthate, testosterone cypionate

Question 36

What is best used transdermally (bypass liver) for male contraception, but can cause weight gain, polycythemia, and increased prostate size with progestin? By what method?

Answer 36

testosterine enanthate, testosterone undecanoate (by decreasing GnRH release –> decreases LH, FSH –> decreases spermatogenesis)