Contraceptives & Reproductive Drugs

Question 1

What is the main action of the COCP?

Answer 1

Prevent ovulation

Endometrial thickening and mucous viscosity increased

Question 2

What is the main action of the POP?

Answer 2

Increased mucous viscosity

Question 3

How does the coil work?

Answer 3

It prevents the zygote from settling in the uterus. Some coils contain copper which is an spermacide, whereas some coils secrete progesterone which thickens cervical mucous

Question 4

Why is oestrogen only HRT not prescribed in individuals who have not undergone a hysterectomy?

Answer 4

Unopposed oestrogen increases the risk of endometrial and ovarian cancer.

Question 5

What benefits does HRT have?

Answer 5

Decreases risk of osteoporosis

Improves symptoms

Question 6

What are the risk factors for HRT

Answer 6

DVT
Endometrial and cervical cancer
Stroke

Question 7

What are the major effects of oestradiol?

Answer 7

Stimulates endometrial and breast growth

Stimulates the production of progesterone receptors

Question 8

What is the major effect of progesterone?

Answer 8

Stimulates growth of endometrium and breast
Maintain pregnancy
Inhibits production of oestrogen receptors

Question 9

What is the major effect of testosterone?

Answer 9

Stimulates male characteristics

Question 10

What are the pharamacokinetics of oestrogen

Answer 10

Absorbed readily in skin, mucous membranes and the GIT.
Metabolised in the liver
Excreted in the urine as glucoronides and sulfates

Question 11

What are the pharmacokinetics of progesterone?

Answer 11

Injected is blunt to albumin and some stored in adipose
Metabolised by liver
Metabolites excreted in urine conjugated to glucuronic acid

Question 12

What are the adverse effects of the COCP?

Answer 12

Risk of thromboembolism

• smoking and long term use over 35 is increased risk
• obesity and hypertension

Question 13

What CYP450 inducers decrease oral contraceptive efficacy?

Answer 13

• carbamazepine or phenytoin
• rifampicin and rifabutin
• st Johns wort

Question 14

What is interesting about soya protein products and oestrogen absorption?

Answer 14

Soya protein products enhance oestrogen absorption and reduce its storage in adipose and muscle, causing the half life to be reduced from 15 to 7 hours.

Question 15

Name a route of administration for HRT

Answer 15

Oral 
Transdermal
Implant
Transvaginal 
Nasal

Question 16

Which steroids are used in HRT?

Answer 16

Oestrodiol- 1-2mg/day
Premarin -0.625-1.25mg/day
Medroxyprogesterone acetate 2.5mg/day
Norethisterone 1mg/day
Levonorgestrel 1.5mg/day

Question 17

Which cancer does opposed oestrogen increase the risk of?

Answer 17

Breast

Question 18

What is mifepristone (RU486) ?

Answer 18

Progesterone and glucocorticoid receptor antagonist
Acts as an anti-progesterone
It sensitises the myometrium to prostaglandin-induced contractions and is used for terminations

Question 19

What is a SERM?

Answer 19

It is a selective oestrogen receptor modulation which has varying effects in different tissues.
It includes drugs like tamoxifen and raloxifene

Question 20

What is clomiphene and its uses?

Answer 20

It is used in the treatment of anovulation, competing with oestrogen for binding to oestrogen receptors. This induces further production of anterior pituitary hormones and induces ovulation.

Question 21

What is tamoxifen and why is it used?

Answer 21

It is a prodrug, which acts as a SERM
In the endometrium, it acts as an ER agonist, but in the breast as an antagonist.
In the breast, binding arrests cells in the cell cycle and is used as a cancer treatment.

Question 22

What is ulipristal acetate and what is its uses?

Answer 22

It is a selective progesterone receptor modulator.
It is used as an emergency contraceptive, causing delay or inhibition of ovulation.
It is also used as an effective treatment of uterine fibroids.