Class of 2017 Pharm Review

Question 1

What is the drug used for estrogen replacement during menopause?

Answer 1

17-a-ethinylestradiol

Question 2

What are the side effects of 17-a-ethinylestradiol?

Answer 2

Increased risk of MI, Stroke, endometrial carcinoma

Question 3

What is norethindrone?

Answer 3

Progesterone equivalent

Question 4

What are the side effects of norethindrone?

Answer 4

Increased risk of MI, stroke, breast cancer

Question 5

What are the indications for estrogen or progesterone therapy?

Answer 5

hypogonadism, contraception, menospause

Question 6

What is the DoC for menopausal syndrome treatment?

Answer 6

Ospemifene

Question 7

What class of drug is Ospemifene and its MoA?

Answer 7

• SERM: partial agonist for bone and endometrium, partial antagonist for breast
• Promotes vaginal epithelial growth

Question 8

What is the main concern of SERM use?

Answer 8

Endometrial hyperplasia and carcinoma

Question 9

What SERM is used for infertility and polycystic ovarian syndrome?

Answer 9

Clomiphene Citrate

Question 10

What is the MoA of clomiphene citrate?

Answer 10

Reduce estrogen hypothalamus negative feedback –> promote FSH and LH –> ovulation

Question 11

What is the main side effect associated with Clomiphene Citrate?

Answer 11

Induced menopause due to estrogen block

Question 12

What is the primary use of Letrozole?

Answer 12

Infertility

Question 13

What is the MoA of letrozole?

Answer 13

Aromatase inhibitor: Blocks estrogen production –> FSH / LH stimulation –> ovulation

Question 14

Drug for fat, infertile woman?

Answer 14

Metformin

Question 15

What drugs (2) are used in a low to medium risk premenopausal, estrogen - receptor positive patient?

Answer 15

Tomoxifen or raloxifene

Question 16

What drugs are used in a low to medium risk postmenopausal, estrogen - receptor positive breast cancer patient?

Answer 16

Tamoxifen, raloxifene, or letrozole (aromatase inhibitor)

Question 17

What treatment (Rx) is used in a estrogen negative breast cancer patient?

Answer 17

Chemo

Question 18

What is the limitation of SERMs?

Answer 18

5 year limit, will convert to breast agonist after this

Question 19

What drugs will SERMs interact with?

Answer 19

SSRIs (CYP2D6 conversion)

Question 20

What are three aromatase inhibitors?

Answer 20

Letrozole, anastrozole, exemestane

Question 21

What is the MoA of aromatase inhibitors?

Answer 21

prevent estrogen production from androgens

Question 22

What are the first line and second line drugs (classification) used in estrogen receptor positive breast cancer in post menopausal women?

Answer 22

SERM and Aromatase inhibitors, respectively

Question 23

What are the benefits of aromatase inhibitors, when compared to SERMs?

Answer 23

No risk of endometrial cancer
No risk of thromboembolic
Effective after 5 years

Question 24

What is the MoA and indication for Fulvestrant?

Answer 24

Estrogen receptor antagonist

Breast cancer resistant to tamoxifen

Question 25

What are the GnRH agonists?

Answer 25

Leuprolide, Goserelin, Abarelix

Question 26

What must be given with GnRH agonists, for how long, and why?

Answer 26

Estrogen antagonist, for two weeks, to prevent the effects of the initial FHS and LH flare

Question 27

What biotech drugs can be given for HER2/erbB-2 positive breast cancers?

Answer 27

Trastuzumab, Pertuzumab, and Lapatinib (if Trast unresponsive)

Question 28

What is the most effective contraceptive?

Answer 28

IUD

Question 29

What is the MoA of IUDs?

Answer 29

Cu coating causes sterile inflammation and PMNs kill sperm

Question 30

What is the major adverse effect of estrogen / progesterone OCPs?

Answer 30

Thromboembolism

Question 31

What are the two (one unique) major risks associated with intravaginal contraceptives?

Answer 31

Cervical displasia (unique), thromboembolism

Question 32

What is the emergency contraceptive?

Answer 32

Levonorgestrel

Question 33

What is the MoA of levonorgestrel and its limitation?

Answer 33

Progesterone analog prevents ovulation | Must be taken within 3 days of coitus

Question 34

What are the categories of medications, as they relate to pregnancy, and the categorical meanings?

Answer 34

A: No Risk, human studies performed B: Animal studies show no risk, but no human trials. Animal studies show risk, but human ones don't. C: Animal studies show increased risk, but no human trials. Or no studies conducted. D: Proven risk, but may be outweighed by benefits X: Proven risk, benefit