chapter 29- reproduction

Question 1

what is the mechanism of action of finasteride

Answer 1

selective inhibitor of type 2 5alpha-redutcase (inhibits peripheral testosterone conversion to DHT)

Question 2

where is type 2 5alpha-reductase highly expressed

Answer 2

prostate

Question 3

what is the mechanism of action of dutasteride

Answer 3

inhibits both type 1 and type 2 5alpha-reductase

Question 4

what is the clinical application of finasteride

Answer 4

androgenic alopecia and BPH

Question 5

what is the clinical application of dutasteride

Answer 5

BPH

Question 6

what are some side effects seen with finasteride and dutasteride

Answer 6

breast tenderness, decreased libido, ED, ejaculatory disorder

Question 7

what are some contraindications for finasteride/dutasteride use

Answer 7

known/suspected pregnancy; women and children

Question 8

what symptoms does finasteride and dutasteride improve

Answer 8

symptoms of decreased urine flow

Question 9

what is the mechanism of action of anastrozole and letrozole

Answer 9

competitive inhibitors of aromatase

Question 10

what is the mechanism of action of exemestane and formestane

Answer 10

irreversible (covalent) inhibitors of aromatase

Question 11

what is the clinical application of anastrozole, letrozole, exemestane, formestane

Answer 11

treatment and prevention of estrogen receptor-positive early stage, locally advanced and metastatic breast cancer

Question 12

what is the most serious common adverse effect seen with anastrozole, letrozole, exemestane, formestane use

Answer 12

osteoporotic fractures

Question 13

what is the mechanism of action of tamoxifen

Answer 13

estrogen recetor antagonist in breast tissue and partial agonist in endometrium and bone

Question 14

what is the mechanism of action of clomiphene

Answer 14

estrogen receptor antagonist in hypothalamus and anterior pituitary gland and a partial agonist in ovaries

Question 15

what is the mechanism of action of raloxifene

Answer 15

estrogen receptor agonist activity in bone, but antagonist in breast and endometrium

Question 16

what is the clinical application of tamoxifen

Answer 16

prevention of breast cancer; palliative treatment of metastatic breast cancer

Question 17

what is the clinical application of clomiphene

Answer 17

female infertility due to ovulatory disorder (induces ovulation)

Question 18

what is the clinical application of bazedoxifene

Answer 18

osteoporosis

Question 19

what is the clinical application of ospemifene

Answer 19

vulvovagnial atrophy, vaginal dryness

Question 20

what is the clinical application of fulvestrant

Answer 20

treatment of ER positive metastatic breast cancer in postmenopausal women with disease progression following anti-estrogen therapy

Question 21

what are some adverse effects seen with tamoxifen

Answer 21

malignant neoplasm of endometrium, strokes, hot flashes, abnormal menstruation

Question 22

what are some adverse effects seen with clomiphene

Answer 22

thromboembolism; ovarian cysts, ovarian hypertrophy, vasomotor symptoms

Question 23

what are some adverse effects seen with fulvestrant

Answer 23

nausea, asthenia, pain, vasodilation (hot flashes)

Question 24

what are some contraindications for tamoxifen

Answer 24

history of DVT or PE

Question 25

what are some contraindications for clomiphene

Answer 25

pregnancy; uncontrolled thyroid or adrenal dysfunction; liver disease; endometrial carcinoma; ovarial cysts; organic intracranial lesion

Question 26

what are some contraindications for fulvestrant

Answer 26

pregnancy

Question 27

what are some contraindications for flutamide

Answer 27

severe hepatic impairment

Question 28

what are some contraindications for spironolactone

Answer 28

anuria, hyperkalemia, acute renal insufficiency

Question 29

what are some contraindications for mifepristone

Answer 29

chronic adrenal failure, ectopic pregnancy, inherited porphyria, undiagnosed adnexal mass

Question 30

what is the clinical application of flutamide

Answer 30

metastatic prostate cancer; BPH

Question 31

what are some adverse effects seen with flutamide

Answer 31

hepatotoxicity, disorders of hematopoietic system

Question 32

what are some adverse effects seen with spironolactone

Answer 32

hyperkalemic metabolic acidosis, GI hemorrhage, agranulocytosis, SLE

Question 33

what is the mechanism of action of spironolactone

Answer 33

aldosterone receptor antagonist that also has significant antagonist activity at the androgen receptor

Question 34

what derivation of spironolactone is sometimes used as progestin in some estrogen-progestin contraceptives

Answer 34

drospirenone

Question 35

what are some adverse effects seen with mifepristone

Answer 35

prolonged bleeding time, bacterial infections, sepsis

Question 36

what is the clinical application of mifepristone

Answer 36

abortion (through day 63 of pregnancy)

Question 37

what is the clinical application of asoprisnil

Answer 37

investigational agent for treatment of endometriosis and uterine leiomyomata (fibroids)

Question 38

what is the mechanism of action of mifepristone

Answer 38

progesterone receptro antagonist

Question 39

what is the mechanism of acute of asoprisnil

Answer 39

progesterone receptor antagonist that inhibits growth of tissues derived from endometrium and myometrium

Question 40

what combination estrogen-progestin contraception participants have the highest androgenic activity

Answer 40

Norgestrel and levonorgestrel

Question 41

what combination estrogen-progestin contraception participants have moderate androgenic activity

Answer 41

norethindrone and norethindone acetate

Question 42

what combination estrogen-progestin contraception participants have low androgen receptor cross reactivity

Answer 42

ethynodiol, norgestimate, gestodene, desogestrel

Question 43

what combination estrogen-progestin contraceptive component can also be used as emergency contraception (morning after)

Answer 43

Levonorgestrel

Question 44

what are some adverse effects for progestin-only contraceptives

Answer 44

irregular periods, breast tenderness, nausea, dizziness, headache

Question 45

what are some contraindications for progestin-only contraceptives

Answer 45

acute liver disease, benign or malignant liver tumors, known/suspected breast cancer, pregnancy

Question 46

what progestin-only contraceptive can be given parenterally every 3 months

Answer 46

medroxyprogestoerone acetate

Question 47

what are some contraindications for androgens used for hormone replacement

Answer 47

breast cancer in men; prostate cancer; pregnancy when used in women