Contraception and fertility drugs 1/4

Question 1

Estrogen only , progestin only, or E + P: MOA as contraceptive, use

Answer 1

MOA: alters uterine and tubal mobitlity –> plan B (after boning) to interfere with implantation

Question 2

Progestin only (p.o., i.m., IUD) MOA as contraceptive?

Answer 2

decrease in ovulation via decrease in LH/FSH
Increase cervical mucus viscosity
decrease tubal and uterine motility

Question 3

ADEs of Progestin only

Answer 3

33% - intolerable nuisance complaints (bleeding)

Question 4

Combination type contraceptive- an ethinylestradiol derivative + a 19-nortestosterone (low dose): MOA

Answer 4

Decreased LH/FSH release [dt -feedback]
Inhibits ovulation [dt Est effect]
Progestin assures prompt menses

Question 5

mifepristone [RU-486]: MOA

Answer 5

Progesterone Receptor Antagonist, increased uterine mobility (inhibition of implantation)

Question 6

How do you pick a contraceptive?

Answer 6

Choose the preparation with the lowest dose of estrogenic agent

Question 7

The inhibition of ovulation (goal) and the cardiovascular side effects are both attributed to Which hormonal component of contraceptives?

Answer 7

the estrogenic component.

Question 8

List the effects of estrogens on including liver function, clotting factors and thyroid hormone disposition

Answer 8

liver = increased LDL, decreasd HDL
clotting factors: increased
thyroid: increased TBG and total T4

Question 9

What are the most important types of drug-srug interactions with progestin/estrogens

Answer 9

counteract Anticoagulants
CYP450 inducer (microsomal enzyme inducer)

Question 10

deficiency of progestin or estrogenic agents will cause what?

Answer 10

menstrual irregularities

Question 11

Excess Estrogen leads to what?

Answer 11

Na and water retention (bloating)

PMS: Cervial mucorrhea, edema, nausea, bloating, breast tenderness, vascular headache, HTN

Question 12

Excess Progestin leads to what (8)

Answer 12

androgenic effects of 19-nortestosterones: Acne, hirsutism, depression, fatigue, increased appetite, increaseed weight, vaginits, alopecia

Question 13

What is the major ADE of the combo OCPs? why?

Answer 13

CVD dt increased clotting factors

Question 14

What are the manifestations of increased risk of CVD with combo OCP use?

Answer 14

^MI, ^stroke, ^ thmbotic events

Question 15

What increases risk of CVD ADE with combo OCPs? (5)

Answer 15

age (35-40), obesity, HTN, fHx, SMOKING!!!!

Question 16

Absolute Contraindications to OCP use (5)

Answer 16

1. HX of thmboembolic events
2. impaired hepatic function/obstructive jaundice
3. Estrogen-dependent neoplasia/breast CA/ genital bleeding
4. pregnancy
5. smoking >15 cigarettes/day

Question 17

infertility tx for hyperPRLemia

Answer 17

bromocryptine

Question 18

infertility dt anovulation in PCOS tx (2)

Answer 18

want to stimulate ovulation: cycling OCPs, clomiphene (

Question 19

clomiphene MOA

Answer 19

estrogen receptor antagonist in hypothalamus–> increased release of LH/FSH (dt lack of inhibitory fb)–> ovulation

Question 20

unfavorable cervical mucus (for fertility)

Answer 20

estrogen

Question 21

infertility dt endometriosis tx

Answer 21

GnRH analogs (suppress LH/FSH)

Question 22

infertility dt luteal phase dysfunction

Answer 22

progestin

Question 23

anovulatory infertility dt Pituitary hypofunction: tx?

Answer 23

FSH/LH to stimulate the ovary directly

Question 24

anovulatory infertility dt Feedback anomalies: tx?

Answer 24

Clomiphine- blocks negative feedback