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Reproductive > Cook: Drugs are bad, m'kay.... > Flashcards

Cook: Drugs are bad, m'kay.... Flashcards

1
Q

oxytocin

A

Uses: induction of labor, contractions after C-section or during uterine surgery, control postpartum hemorrhage, abortion

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2
Q

prostaglandins

A

use: onset of labor

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3
Q

dinoprostone

A

PGE2

use: induce labor

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4
Q

misoprostol

A

PGE1

use: induce labor

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5
Q

carboprost tromethamine

A

15-methyl-PGF2

use: induce labor

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6
Q

tocolytics

A

Use: delay premature parturition to slow delivery long enough for therapeutic measures including glucocorticoid therapy to increase pulmonary surfactant
CI: intra-amniotic infection, fetal demise, severe fetal growth restriction, pre-eclampsia

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7
Q

magnesium sulfate

A

tocolytic
MOA: decrease Ca availability
oral (laxative), parenteral
Tx: anticonvulsant (depress CNS, block peripheral NM transmission), hypomagnesemia, preeclampsia, eclampsia
also neuroprotective to fetus
excretion: renal: Mg reabsorbed
CI: myasthenia gravis, caution in renal insufficiency
AE: flushing, blurry vision/ headache, nausea, hypotension,, lethargy, pulmonary edema
toxicity: loss of pateller reflexes, decreased urine output, respiratory depression

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8
Q

indomethacin

A

tocolytic
MOA: COX inhibitor
AE: GI, platelet dysfunction
fetus: premature closure of ductus arteriosus, oligohydramnios

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9
Q

caster oil

A

herbal
tocolytic (Cook)
induce labor (article)

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10
Q

blue cohosh

A

herbal
tocolytic (Cook)
induce labor (article)

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11
Q

black cohosh

A

herbal
tocolytic (Cook)
induce labor (article)

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12
Q

oil of evening primrose

A

herbal
tocolytic (Cook)
induce labor (article)

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13
Q

gonadotropins

A

Use: female infertility in anovulatory women or women with hypogonadism, in vitro fertilization; male infertility reserved for time fertility is desired
Risk: multiple pregnancy (preferred in men due to this)
PULSATILE

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14
Q

pregnancy diagnostic kit

A

Ab to B subunit of CG

qualitative CG detection in urine

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15
Q

How can you determine the exact time of ovulation?

A

measure urinary LH: ovulation occurs 36 hours after onset of LH surge

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16
Q

menotropin

A

IM: FSH and LH
SC: rFSH

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17
Q

chorinoic gonadotropin

A

IM

CG: binds LH receptor

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18
Q

estrogen MOA

A

nuclear receptor: receptor/ligand complexes bind DNA near HRE (hormone response element)
native: rapidly degrades so can’t use

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19
Q

ethinyl estradiol

A

synthetic estrogen
decreased hepatic metabolism
use: combination pill

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20
Q

SERM (selective estrogen receptor modulator)

A

estrogen activity is tissue selective
activity: bone, brain, liver
no activity or antagonistic: breast, endometrium
Tx: breast CA

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21
Q

tamoxifen

A

SERM

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22
Q

raloxifene

A

SERM

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23
Q

combination pill (contraception)

A

estrogen: ethanol estradiol or mestranol
progestin: norethindrone, norgestrel, or levonorgestrel
MOA: prevents LH and FSH release by feedback inhibition
CI: thromboembolic disease, cerebral vascular disease, MI, CAD, congenital hyperlipidemia, breast CA, endometrial CA
off label use: polycystic ovary syndrome

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24
Q

mini-pill (contraception)

A

progestin only
blocks ovulation in ONLY 60-80% of cycles, impair sperm transport by thickening cervical mucus, decreases motility of ovules in oviduct, alters endometrium to impair implantation
slightly HIGHER failure rate than combination pill
for: breastfeeding women, over 35 yrs and smoke

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25
postcoital contraception
morning after pill: two doses levonorgestrel separated by 12 hours first does within 72 hours most effective emergency contraception
26
contragestation
antiprogestin
27
mifepristone- RU48
antiprogestin: block progesterone binding to receptor use: termination of pregnancy within 49 days
28
clomiphene
anti-estrogen: pure antagonist act on ER in hypothalamus to block feedback inhibition of natural estrogens and stimulate GnRH which stimulates LH/FSH leading to ovulation use: ovulation induction
29
fulvestrant
anti-estrogen: pure antagonist act on ER in hypothalamus to block feedback inhibition of natural estrogens and stimulate GnRH which stimulates LH/FSH leading to ovulation use: ovulation induction
30
mestranol
synthetic estrogen decreased hepatic metabolism use: combination pill
31
norethindrone
progestin | use: combination pill
32
norgestrel
progestin | use: combination pill
33
levonorgestrel
progestin | use: combination pill, morning after pill
34
gonadorelin acetate
synthetic GnRH IV pulsatile pump AE: phlebitis
35
cetrorelix
GnRH antagonist Tx: in vitro fertilization (delay premature LH surge to delay ovulation to allow collection of ova) following FSH therapy
36
ganirelix
GnRH antagonist
37
degarelix
GnRH antagonist | Tx: prostate CA
38
goserelin acetate
GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation Tx: prostate CA
39
triptorelin
GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation Tx: prostate CA
40
leuprolide
GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation Tx: prostate CA
41
histrelin
GnRH agonist: down-regulates receptors | Tx: precocious puberty
42
nafarelin
GnRH agonist | Tx: precocious puberty and endometriosis
43
estrogen esters
estrogen: conjugated esters of estrogen, esters of estradiol
44
onapristone
antiprogestin: pure antagonist
45
anastrozole
aromatase inhibitor
46
letrozole
aromatase inhibitor
47
androgens
injection, oral, transdermal ester: more lipid soluble, longer duration binding of testosterone to androgen receptor that binds to DNA response element conversion to DHT in some tissues (prostate, not muscle or kidney): more potent use: androgen deficient man, endometriosis, PMS, elderly men to maintain muscle mass (prefer injection because transdermal can tear off skin)
48
testosterone
androgen
49
testosterone transdermal patches
androgen
50
methyl-testosterone
testosterone derivative
51
testosterone propionate
testosterone derivative
52
testosterone cypionate
testosterone derivative
53
danazol
weak testosterone | Tx: PMS
54
flutamide
androgen receptor antagonist Tx: prostate CA AE: hepatic, 3x administration
55
bicalutamide
androgen receptor antagonist | Tx: prostate CA
56
finasteride
inhibitor of 5alpha-reductase Tx: BPH, male pattern baldness should not be touched by pregnant women: absorbed in skin and causes birth defects in male fetus men should not donate blood
57
anabolic steroids
abused by athletes | AE: low T, decreased libido, decreased spermatogenesis, HEPATOTOXICITY, CHD
58
ER alpha
estrogen receptor | female reproductive tract: uterus, vagina, ovary and many other tissues
59
ER Beta
estrogen receptor | prostate gland and ovary
60
estrogen actions
1. increase HDL, lower LDL (lower CHD in pre-menopausal women) 2. breast development 3. bone maturation, close epiphyseal plates, antagonizes bone resorption, shapes pelvis 4. increase muscle of myometrium 5. increase libido 6. increase hepatic proteins (TBG, transcortin, SHBG, clotting factors)
61
estrogen adverse effects
1. TUMORS (breast, uterus, testis, bone, kidney, etc.) | 2. VENOUS THROMBOEMBOLISM: increase risk of stroke (elevated in women that smoke)
62
progesterone actions
1. aids in maintaining pregnancy 2. inhibits uterine contraction 3. alveolobular development of breast secretary apparatus 4. decrease HDL, increase LDL 5. body temperature rise at ovulation 6. depressant and hypnotic effects on brain
63
estrogen and progesterone therapeutic uses
native: rapidly degraded by liver so can't use orally ex of uses: prostate and breast CA, fertility control, hormone replacement therapy (menopause, osteoporosis, ovarian failure), dysfunctional uterine bleeding (irregular menstrual cycle), ovulation induction in infertile women
64
DES (diethylstilbesterol)
synthetic non-steroidal estrogen | Tx: prostate CA
65
clorotrianisene
synthetic non-steroidal estrogen | Tx: prostate CA
66
benefits of shorter or fewer hormone free intervals with oral contraceptives
decrease menstrual symptoms: headache, bloating, menstrual pain
67
non-contraceptive benefits of oral contraceptives
1. reduced dysfunctional uterine bleeding and dysmenorrhea 2. menstrual regularity, increased hemoglobin 3. combination pill: raise SHBG: decrease androgens: less hirsutism and acne
68
adverse effects of oral contraceptives 1. general 2. old formulations (high dose ethinyl estradiol) 3. combination pill 4. low dose ethinyl estradiol 5. extended/continous cycle 6. with antibiotics (which ones) 7. drugs that decrease contraceptive effectiveness
1. N/V, breast tenderness and enlargement 2. old formulations (greater than 50mcg ethinyl estradiol): more MI, stroke 3. combination pill: venous thromboembolism esp. smokers 4. low dose ethinyl estradiol: breakthrough bleeding 5. unexpected bleeding 6. contraceptive failure: penicillins, tetracyclines 7. rifampin, anti-HIV, anticonvulsants, St. John's wort
69
progesterone adverse effects
acne, weight gain
70
transdermal patch (contraception)
ethinyl estradiol and progestin new patch each week, patch free for one week AE: skin irritation, break through bleeding first 2 cycles CI: women over 90kg (198 lbs)
71
vaginal contraceptive ring
ethinyl estradiol and progestin inserted intravaginally by patient: in place 3 weeks, one week ring free considerations: do NOT remove for more than 3 hr, NOT effective until in place 7 days, rapid return to fertility after removal
72
injectable contraceptive
progesterone only: medroxyprogesterone every 3 months AE: amenorrhea, irregular bleeding, weight gain, headache, decreased bone density considerations: DISCONTINUE after 2 years, delayed return to fertility (6-12 months)
73
contraceptive implant
progesterone only: etonogestrel effective 3 years AE: same as all progestins
74
Cu IUD
``` spermacidal effective 15-20 years (recommend removal at 10 yr) fertility quickly restored after removal use: contraception, dysmenorrhea AE: cramping ```
75
progestin releasing IUD
levonorgestrel effective 5 yrs use: contraception, dysmenorrhea AE: irregular bleeding for 6-12 mo
76
condoms (male and female)
barrier contraceptive | protect against STDs
77
diaphragm/cervical cap
barrier protection with spermicide (in place 6 hr before and after sex) unclear if it protects from STDs
78
spermacide
nonoxynol-9 (a surfactant) foam, gel, cream, suppository, lube for condom/diaphragm only effective for 1 hr: reapplication necessary MUST be in contact with cervix AE: less effective, irritation of vaginal mucosa, TSS
79
sponge
barrier with spermicide moisten and place over cervix: effective immediately and up to 24 hr: MUST remain in place 6 hr after intercourse NOT as good as diaphragm
80
calendar method of contraception
calculate ovulation taking temperature avoid intercourse on presumed fertile days HIGH FAILURE rate
81
types of emergency contraception
1. oral contraceptives: NOT recommended 2. copper IUD 3. two dose progestin AE: N/V with ethanol estradiol, headache, breast tenderness, abdominal pain
82
oxandrolone
anabolic steroid with less conversion to estrogens and less inhibition of testosterone synthesis
83
nicalutamide
androgen receptor antagonist Tx: prostate CA less hepatotoxic and once a day administration compared to flutamide
84
cyproterone acetate
androgen receptor antagonist: competes with DHT for androgen receptor, prevents translation to nucleus Tx: acne, baldness, hirsutism, virilizing syndrome, inhibit libido in sex deviant males
85
spironolactone
aldosterone antagonist, competes for testosterone receptor | Tx: hyperaldosteronism, HTN, hirsuitism
86
nifedipine
tocolytic MOA: Ca channel blocker AE: flush, headache, dizzy palpitations, nausea increased CO to compensate for vasodilation other: MI, pulmonary edema, hypoxia, hypotension, atrial fibrillation
87
terbutaline
tocolytic | MOA: Beta mimetic
88
ritodrine
tocolytic | MOA: Beta mimetic
89
beta mimetic
tocolytic AE: maternal cardiotoxicity and death other: hyperglycemia, pulmonary edema fetus: hypoglycemia, cardiotoxicity

Reproductive (12 decks)

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