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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
Q

postcoital contraception

A

morning after pill: two doses levonorgestrel separated by 12 hours
first does within 72 hours
most effective emergency contraception

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26
Q

contragestation

A

antiprogestin

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27
Q

mifepristone- RU48

A

antiprogestin: block progesterone binding to receptor
use: termination of pregnancy within 49 days

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28
Q

clomiphene

A

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

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29
Q

fulvestrant

A

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

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30
Q

mestranol

A

synthetic estrogen
decreased hepatic metabolism
use: combination pill

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31
Q

norethindrone

A

progestin

use: combination pill

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32
Q

norgestrel

A

progestin

use: combination pill

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33
Q

levonorgestrel

A

progestin

use: combination pill, morning after pill

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34
Q

gonadorelin acetate

A

synthetic GnRH
IV pulsatile pump
AE: phlebitis

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35
Q

cetrorelix

A

GnRH antagonist
Tx: in vitro fertilization (delay premature LH surge to delay ovulation to allow collection of ova) following FSH therapy

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36
Q

ganirelix

A

GnRH antagonist

37
Q

degarelix

A

GnRH antagonist

Tx: prostate CA

38
Q

goserelin acetate

A

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

39
Q

triptorelin

A

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

40
Q

leuprolide

A

GnRH agonist: initially increases LH then decreases LH and testosterone due to receptor down-regulation
Tx: prostate CA

41
Q

histrelin

A

GnRH agonist: down-regulates receptors

Tx: precocious puberty

42
Q

nafarelin

A

GnRH agonist

Tx: precocious puberty and endometriosis

43
Q

estrogen esters

A

estrogen: conjugated esters of estrogen, esters of estradiol

44
Q

onapristone

A

antiprogestin: pure antagonist

45
Q

anastrozole

A

aromatase inhibitor

46
Q

letrozole

A

aromatase inhibitor

47
Q

androgens

A

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
Q

testosterone

A

androgen

49
Q

testosterone transdermal patches

A

androgen

50
Q

methyl-testosterone

A

testosterone derivative

51
Q

testosterone propionate

A

testosterone derivative

52
Q

testosterone cypionate

A

testosterone derivative

53
Q

danazol

A

weak testosterone

Tx: PMS

54
Q

flutamide

A

androgen receptor antagonist
Tx: prostate CA
AE: hepatic, 3x administration

55
Q

bicalutamide

A

androgen receptor antagonist

Tx: prostate CA

56
Q

finasteride

A

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
Q

anabolic steroids

A

abused by athletes

AE: low T, decreased libido, decreased spermatogenesis, HEPATOTOXICITY, CHD

58
Q

ER alpha

A

estrogen receptor

female reproductive tract: uterus, vagina, ovary and many other tissues

59
Q

ER Beta

A

estrogen receptor

prostate gland and ovary

60
Q

estrogen actions

A
  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
Q

estrogen adverse effects

A
  1. TUMORS (breast, uterus, testis, bone, kidney, etc.)

2. VENOUS THROMBOEMBOLISM: increase risk of stroke (elevated in women that smoke)

62
Q

progesterone actions

A
  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
Q

estrogen and progesterone therapeutic uses

A

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
Q

DES (diethylstilbesterol)

A

synthetic non-steroidal estrogen

Tx: prostate CA

65
Q

clorotrianisene

A

synthetic non-steroidal estrogen

Tx: prostate CA

66
Q

benefits of shorter or fewer hormone free intervals with oral contraceptives

A

decrease menstrual symptoms: headache, bloating, menstrual pain

67
Q

non-contraceptive benefits of oral contraceptives

A
  1. reduced dysfunctional uterine bleeding and dysmenorrhea
  2. menstrual regularity, increased hemoglobin
  3. combination pill: raise SHBG: decrease androgens: less hirsutism and acne
68
Q

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
A
  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
Q

progesterone adverse effects

A

acne, weight gain

70
Q

transdermal patch (contraception)

A

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
Q

vaginal contraceptive ring

A

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
Q

injectable contraceptive

A

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
Q

contraceptive implant

A

progesterone only: etonogestrel
effective 3 years
AE: same as all progestins

74
Q

Cu IUD

A 
spermacidal
effective 15-20 years (recommend removal at 10 yr)
fertility quickly restored after removal
use: contraception, dysmenorrhea
AE: cramping
75
Q

progestin releasing IUD

A

levonorgestrel
effective 5 yrs
use: contraception, dysmenorrhea
AE: irregular bleeding for 6-12 mo

76
Q

condoms (male and female)

A

barrier contraceptive

protect against STDs

77
Q

diaphragm/cervical cap

A

barrier protection with spermicide (in place 6 hr before and after sex)
unclear if it protects from STDs

78
Q

spermacide

A

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
Q

sponge

A

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
Q

calendar method of contraception

A

calculate ovulation taking temperature
avoid intercourse on presumed fertile days
HIGH FAILURE rate

81
Q

types of emergency contraception

A
  1. oral contraceptives: NOT recommended
  2. copper IUD
  3. two dose progestin
    AE: N/V with ethanol estradiol, headache, breast tenderness, abdominal pain
82
Q

oxandrolone

A

anabolic steroid with less conversion to estrogens and less inhibition of testosterone synthesis

83
Q

nicalutamide

A

androgen receptor antagonist
Tx: prostate CA
less hepatotoxic and once a day administration compared to flutamide

84
Q

cyproterone acetate

A

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
Q

spironolactone

A

aldosterone antagonist, competes for testosterone receptor

Tx: hyperaldosteronism, HTN, hirsuitism

86
Q

nifedipine

A

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
Q

terbutaline

A

tocolytic

MOA: Beta mimetic

88
Q

ritodrine

A

tocolytic

MOA: Beta mimetic

89
Q

beta mimetic

A

tocolytic
AE: maternal cardiotoxicity and death
other: hyperglycemia, pulmonary edema
fetus: hypoglycemia, cardiotoxicity

Reproductive (12 decks)

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