Deja Ch 9 Endo Flashcards
1
Q
What are the two general categories of drugs that are used to treat diabetes mellitus?
A
- Insulin
2
Q
Which type of diabetes mellitus is each of the following statements referring to? Loss of pancreatic _-cells
A
Type 1
3
Q
Which type of diabetes mellitus is each of the following statements referring to? Usually early onset
A
Type 1
4
Q
Which type of diabetes mellitus is each of the following statements referring to? Decreased response to insulin
A
Type 2
5
Q
Which type of diabetes mellitus is each of the following statements referring to? Ketoacidosis prone
A
Type 1
6
Q
Which type of diabetes mellitus is each of the following statements referring to? Usually adult onset
A
Type 2
7
Q
Which type of diabetes mellitus is each of the following statements referring to? Not ketoacidosis prone
A
Type 2
8
Q
Which type of diabetes mellitus is each of the following statements referring to? Absolute dependence on insulin
A
Type 1
9
Q
Which type of diabetes mellitus is each of the following statements referring to? May be controlled by diet and oral hypoglycemics alone
A
Type 2
10
Q
Which type of diabetes mellitus is each of the following statements referring to? Usually thin
A
Type 1
11
Q
Which type of diabetes mellitus is each of the following statements referring to? Usually obese
A
Type 2
12
Q
Which type of diabetes mellitus is each of the following statements referring to? Islet cell antibodies
A
Type 1
13
Q
Which type of diabetes mellitus is each of the following statements referring to? Near 100% concordance in monozygotic twins
A
Type 2
14
Q
What types of drugs can elevate blood glucose concentrations?
A
Alcohol; _-adrenergic blockers; calcium channel blockers; combination oral contraceptives; diazoxide; diuretics; corticosteroids; lithium; niacin; phenytoin; sympathomimetics
15
Q
What are the signs and symptoms of diabetic ketoacidosis?
A
Kussmaul respirations; fruity breath; abdominal pain; nausea; vomiting; polyuria; polydipsia; dehydration; fatigue
16
Q
What chemical is responsible for causing “fruity breath” during ketoacidosis?
A
Acetone
17
Q
What are the three ketones made during ketoacidosis?
A
- _-Hydroxybutyric acid
18
Q
What is the term used to describe a rise in blood glucose usually between 4 and 11 AM due to the release of growth hormone, cortisol, glucagons, and epinephrine?
A
Dawn phenomenon. To determine the cause of elevated morning blood sugars, the patient must measure their glucose levels throughout the night. Then alterations in diet, medication doses, or medication choice may be made.
19
Q
What is the term used to describe a rebound rise in morning blood glucose secondary to a low overnight blood glucose?
A
Somogyi effect. This usually results from hyperinsulinemia which decreases blood glucose. Glucagon is released when the patient becomes hypoglycemic, which causes a rebound spike in blood glucose levels. Decreasing the evening insulin dose is first-line therapy.
20
Q
For each of the following types of insulin give the time of onset, peak effect, and duration: Aspart
A
0.17 to 0.33 hours; 1 to 3 hours; 3 to 5 hours
21
Q
For each of the following types of insulin give the time of onset, peak effect, and duration: Lispro
A
0.25 hours; 0.5 to 1.5 hours; 6 to 8 hours
22
Q
For each of the following types of insulin give the time of onset, peak effect, and duration: Regular
A
0.5 to 1 hours; 2 to 3 hours; 8 to 12 hours
23
Q
For each of the following types of insulin give the time of onset, peak effect, and duration: NPH (isophane insulin suspension)
A
1 to 1.5 hours; 4 to 12 hours; 24 hours
24
Q
For each of the following types of insulin give the time of onset, peak effect, and duration: Lente (insulin zinc suspension)
A
1 to 2.5 hours; 8 to 12 hours; 18 to 24 hours
25
For each of the following types of insulin give the time of onset, peak effect, and duration: Ultralente (extended insulin zinc suspension)
4 to 8 hours; 16 to 18 hours; > 36 hours
26
For each of the following types of insulin give the time of onset, peak effect, and duration: Glargine
No peak; duration is 24 hours
27
Can insulin glargine be mixed with other insulins?
No
28
What is the most common side effect of insulin?
Hypoglycemia
29
What are the signs and symptoms of hypoglycemia?
Confusion; diaphoresis; tremors; tachycardia; seizures; coma; lethargy
30
Which sign/symptom of hypoglycemia is not masked by _-adrenergic antagonists?
Diaphoresis
31
What is the name of the incretin mimetic that increases insulin secretion, slows gastric emptying, and decreases food intake?
Exenatide
32
What is the name of the human amylin analog that is cosecreted with insulin and reduces postprandial glucose by prolonging gastric emptying time, reduces postprandial glucagon secretion, and suppresses appetite?
Pramlintide
33
What hypoglycemic agent is not contraindicated in a pregnant woman with diabetes mellitus?
Insulin
34
Other than blood glucose reduction, regular insulin can also be used for what condition?
Hyperkalemia. Insulin causes an intracellular shift of potassium. Insulin is given in combination with glucose to prevent hypoglycemia in this situation.
35
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Chlorpropamide
First-generation sulfonylurea
36
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Tolazamide
First-generation sulfonylurea
37
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Tolbutamide
First-generation sulfonylurea
38
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glyburide
Second-generation sulfonylurea
39
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glipizide
Second-generation sulfonylurea
40
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glimepiride
Second-generation sulfonylurea
41
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Nateglinide
D-phenylalanine derivative
42
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Rosiglitazone
Thiazolidinedione
43
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Pioglitazone
Thiazolidinedione
44
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Acarbose
_-Glucosidase inhibitor
45
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Miglitol
_-Glucosidase inhibitor
46
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Metformin
Biguanide
47
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Repaglinide
Meglitinide
48
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Nateglinide
Meglitinide
49
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Pramlintide
Amylin analog
50
For each of the following oral hypoglycemic agents, state which drug class it belongs to? Exenatide
Incretin
51
For each of the following drug classes, give the mechanism of action: Sulfonylureas
Block adenosine triphosphate (ATP)-dependent potassium channels, thereby depolarizing pancreatic _-cells which lead to insulin release (release mediated via calcium influx); insulin secretagogue
52
For each of the following drug classes, give the mechanism of action: Thiazolidinediones
Bind to nuclear peroxisome proliferator activating receptor-gamma (PPAR-_) which leads to increased sensitization of cells to insulin; decrease hepatic gluconeogenesis; upregulate insulin receptors
53
For each of the following drug classes, give the mechanism of action: D-phenylalanine derivatives
Newest insulin secretagogue which closes the potassium channels on the _-cells leading to a rapid but short- acting release of insulin
54
For each of the following drug classes, give the mechanism of action: _-Glucosidase inhibitors
Inhibit intestinal amylase and _-glucosidase causing a delay in the breakdown of complex carbohydrates into glucose which subsequently delays glucose absorption, thereby lowering postprandial glucose levels
55
For each of the following drug classes, give the mechanism of action: Biguanides
Decrease hepatic gluconeogenesis; increase tissue sensitivity to insulin
56
For each of the following drug classes, give the mechanism of action: Meglitinides
Nonsulfonylurea insulin secretagogue
57
For each of the following drug classes, give the mechanism of action: Amylin analogs
Suppresses glucagon release, delays gastric emptying, decreases hunger
58
For each of the following drug classes, give the mechanism of action: Incretins
Synthetic glucagon-like-polypeptide (GLP-1) analogs which potentiates glucose-mediated insulin release, decreases postprandial glucagon release, decreases gastric emptying, decreases hunger
59
What are the side effects of the sulfonylureas?
Hypoglycemia; cross-reaction with sulfonamide allergy; weight gain
60
What is the longest acting sulfonylurea?
Chlorpropamide
61
Which sulfonylurea can cause disulfiram-like reactions?
Chlorpropamide
62
Which sulfonylurea can cause syndrome of inappropriate secretion of antidiuretic hormone (SIADH)?
Chlorpropamide
63
The dose of what second-generation sulf onylurea should be decreased in patients with renal dysfunction?
Glyburide
64
dysfunction?
Glipizide
65
What are the side effects of the thiazolidinediones (TZDs)?
Edema; congestive heart failure (CHF) exacerbation; weight gain; hepatotoxicity; macular edema (rare); increased bone fractures in women due to diminished osteoblast formation
66
Name two concomitant health conditions in which TZDs may not be used in a diabetic patient.
1. CHF
67
What are the side effects of the biguanides?
Diarrhea; lactic acidosis; decreased vitamin B12; abnormal taste
68
What are the side effects of the meglitinides?
Hypoglycemia; upper respiratory tract infection
69
What are the side effects of the _-glucosidase inhibitors?
Abdominal cramping; diarrhea; flatulence
70
What drug with positive inotropic and chronotropic activity can be used to stimulate the heart during a _- blocker overdose?
Glucagon
71
Based on liver function test (LFT) results, when should therapy with a thiazolidinedione be withheld?
When LFTs rise above 2.5 times the upper limit of normal
72
What oral hypoglycemic should be withheld when the serum creatinine is above 1.5 for males and 1.4 for females?
Metformin
73
When used alone, can TZDs cause hypoglycemia?
No, TZDs do not cause hypoglycemia.
74
When used alone, can biguanides cause hypoglycemia?
No, biguanides do not cause hypoglycemia.
75
What time of day should meglitinides be given?
15 to 30 minutes before each meal
76
Would oral sucrose be effective in a hypoglycemic patient who is currently taking an _-glucosidase inhibitor?
No, it would not because sucrose is a disaccharide whose absorption is competitively blocked by the _- glucosidase inhibitors.
77
Would oral glucose be effective in a hypoglycemic patient who is currently taking an _-glucosidase inhibitor?
Yes, it would since glucose is a monosaccharides. _-Glucosidase inhibitors do not block intestinal transporters for monosaccharides.
78
What are the two types of diabetes insipidus?
1. Neurogenic
79
Which type of diabetes insipidus is characterized by insensitivity to vasopressin in the collecting ducts?
Nephrogenic diabetes insipidus
80
Which type of diabetes insipidus is characterized by inadequate secretion of vasopressin from the posterior pituitary gland?
Neurogenic diabetes insipidus
81
What types of drugs can cause a nephrogenic diabetes insipidus?
Lithium; demeclocycline; vincristine; amphotericin B; alcohol
82
What two effects does vasopressin have on the body?
1. Antidiuresis
83
Where is theV1receptor found?
Vascular smooth muscle (causes vasoconstriction)
84
Where is the V2receptor found?
Renal collecting ducts (increases water permeability and reabsorption)
85
What is the drug of choice for neurogenic diabetes insipidus?
Desmopressin
86
What is desmopressin?
Synthetic analog of vasopressin with longer half-life and no vasopressor activity (antidiuresis properties only)
87
What is another name for desmopressin?
l-Deamino-8-D-arginine vasopressin (DDAVP)
88
How is desmopressin administered?
Intranasally; orally
89
What are the side effects of vasopressin?
Water intoxication; hyponatremia; tremor; headache; bronchoconstriction
90
What is vasopressin also used for?
Esophageal varices
91
What is desmopressin also used for?
Hemophilia A; von Willebrand disease; primary nocturnal enuresis
92
How is nephrogenic diabetes insipidus treated?
Thiazide diuretics in combination with amiloride; chlorpropamide; clofibrate
93
What drug that can cause nephrogenic diabetes insipidus is used to treat SIADH?
Demeclocycline
94
What are the signs and symptoms of hyperthyroidism?
Heat intolerance; nervousness; fatigue; weight loss with increased appetite; increased bowel movements; palpitations; irregular menses; proximal muscle weakness; moist skin; fine hair; hyperactive deep tendon reflexes; tachycardia; widened pulse pressure; tremor
95
What are the signs and symptoms of hypothyroidism?
Growth retardation in children; slowing of physical and mental activity; weight gain; cold intolerance; constipation; weakness; depression; dry skin; cold skin; coarse skin; coarse hair; bradycardia; muscle cramps; delayed relaxation of deep tendon reflexes
96
What are the signs and symptoms of thyroid storm?
High fever; dehydration; delirium; tachycardia; tachypnea; nausea; vomiting; diarrhea; coma
97
What are the two main active thyroid hormones circulating in the body?
1. Thyroxine (T4)
98
Which thyroid hormone is more active in the body?
T3 (up to five times more active)
99
What is the half-life of T4?
7 days
100
What is the half-life of T3?
1.5 days
101
What is the name of the enzyme that converts T4 to T 3 in the periphery?
5'-Deiodinase (5 "prime" deiodinase)
102
What is the name of the enzyme that converts active T4 to inactive reverse T3?
5-Deiodinase
103
What is the drug of choice for hypothyroidism?
Levothyroxine (T4)
104
When a hypothyroid patient is started on levothyroxine therapy, how long will the drug take to reach a steady state?
6 to 8 weeks
105
What are the adverse effects of levothyroxine?
Same effects as physiologic hyperthyroidism: heat intolerance; nervousness; fatigue; weight loss with increased appetite; increased bowel movements; palpitations; irregular menses; proximal muscle weakness; moist skin; fine hair; hyperactive deep tendon reflexes; tachycardia; widened pulse pressure; tremor
106
What biochemical marker is used to assess for adequate thyroid replacement?
Thyroid-stimulating hormone (TSH)
107
What antiarrhythmic agent can potentially cause either hypothyroidism or hyperthyroidism (more commonly hypothyroidism)?
Amiodarone (contains two iodine molecules)
108
To which three proteins in the blood are T4 and T3 bound extensively?
1. Thyroid-binding globulin
109
The _-subunit of TSH is similar to the _-subunits of which hormones (gonadotropins) in the body?
Follicle-stimulating hormone (FSH); luteinizing hormone (LH); human chorionic gonadotropin (hCG)
110
What drug is used to ablate thyroid tissue?
Radioactive iodine (I131)
111
What drug is used to treat cardiovascular effects seen in thyrotoxicosis?
Propranolol
112
What is a side effect of surgical removal of the thyroid gland?
Hypothyroidism almost inevitably results. Other possible complications include hypocalcemia due to removal of the parathyroid glands along with the thyroid.
113
What are the drugs of choice to treat hyperthyroidism?
Thionamides (propylthiouracil and methimazole)
114
What drugs inhibit the release of preformed thyroid hormone?
Iodide; lithium
115
What drugs inhibit the iodination of tyrosyl residues on thyroglobulin?
Propylthiouracil; methimazole
116
What drugs inhibit the coupling reactions that form T3 and T4?
Propylthiouracil; methimazole; iodide
117
What drugs block the conversion of T4 to T3 in the periphery by inhibiting 5'-deiodinase?
Propylthiouracil; propranolol
118
What are the side effects of propylthiouracil and methimazole?
Pruritic maculopapular rash; vasculitis; arthralgias; fever; leukopenia; agranulocytosis
119
Do propylthiouracil and methimazole cross the placenta?
Yes
120
What is the drug of choice for hyperthyroidism in pregnancy?
Propylthiouracil (more protein bound)
121
What drugs can decrease levels of thyroid-binding globulin?
Androgens; glucocorticoids; L-asparaginase
122
What drugs can increase levels of thyroid-binding globulin?
Estrogens; perphenazine; clofibrate; fluorouracil
123
What are the three zones of the adrenal cortex?
1. Zona glomerulosa (outer)
124
Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona glomerulosa
Mineralocorticoids
125
Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona fasciculata
Glucocorticoids
126
Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona reticularis
Adrenal androgens
127
What is the major precursor of all steroid hormones?
Cholesterol
128
What is the principal mineralocorticoid?
Aldosterone
129
What is the principal glucocorticoid?
Cortisol, but note that cortisol does have some mineralocorticoid activity as well.
130
How do corticosteroids work biochemically in the body?
Bind to intracellular cytoplasmic receptors in target tissues then subsequently translocate to the nucleus where they act as transcription factors
131
What is the precursor of adrenocorticotropic hormone (ACTH)?
Proopiomelanocortin (POMC)
132
What chemicals are released when POMC is cleaved?
ACTH; lipotropin; _-endorphin; metenkephalin; melanocyte-stimulating hormone (MSH)
133
What drug is used to diagnose adrenal insufficiency?
ACTH (cosyntropin)
134
A cosyntropin stimulation test that results in no cortisol secretion characterizes which type of adrenal insufficiency?
Primary adrenal insufficiency (defect at the level of the adrenal gland)
135
A cosyntropin stimulation test that results in reasonable cortisol secretion characterizes which type(s) of adrenal insufficiency?
Secondary adrenal insufficiency (defect at the level of the pituitary gland) and possibly tertiary adrenal insufficiency (defect at the level of the hypothalamus)
136
What is the primary mechanism by which corticosteroids increase the neutrophil count?
Demargination, where the polymorphonuclear cells are detached from the endovascular wall and are therefore available to be counted in the peripheral blood smear
137
How is the production of arachidonic acid decreased by glucocorticoids?
Inhibition of phospholipase A2
138
How is Cushing syndrome diagnosed?
Dexamethasone suppression test
139
Give examples of short-acting glucocorticoids:
Cortisone; hydrocortisone
140
Give examples of intermediate-acting glucocorticoids:
Methylprednisolone; prednisone; triamcinolone
141
Give examples of long-acting glucocorticoids:
Betamethasone; dexamethasone
142
Give an example of a synthetic mineralocorticoid:
Fludrocortisone
143
How long after initiation of glucocorticoid therapy does it take to suppress the hypothalamic-pituitary- adrenal (HPA) axis?
2 weeks
144
How should long-term glucocorticoid therapy be discontinued?
Taper regimen (taper regimen commonly used when discontinuing >2 weeks of glucocorticoid therapy)
145
How do you prevent suppression of the HPA axis while using glucocorticoids?
Alternate day dosing (every other day dosing)
146
List the adverse effects of glucocorticoids:
Acne; insomnia; edema; hypertension; osteoporosis; cataracts; glaucoma; psychosis; increased appetite; hirsutism; hyperglycemia; muscle wasting; pancreatitis; striae; redistribution of body fat to abdomen, back, and face
147
What drug inhibits glucocorticoid synthesis by inhibiting 11-hydroxylase activity?
Metyrapone
148
What drug inhibits the conversion of cholesterol to pregnenolone?
Aminoglutethimide
149
What antifungal can be used to lower cortisol levels in Gushing disease and may cause gynecomastia as an adverse effect?
Ketoconazole
150
What diuretic blocks mineralocorticoid receptors and also inhibits the synthesis of aldosterone and androgens (eg, testosterone)?
Spironolactone
151
What is the main side effect of spironolactone?
Gynecomastia; hyperkalemia
152
How does spironolactone work as a diuretic?
Antagonizes mineralocorticoid receptors in the kidney, thereby preventing sodium reabsorption in the distal tubules but not increasing potassium loss (therefore potassium-sparing)
153
Using an angiotensin-converting enzyme (ACE) inhibitor in combination with spironolactone can cause what major electrolyte abnormality?
Hyperkalemia
154
Name a potassium-sparing diuretic that does not have anti-androgen side effects:
Eplerenone, which has increased specificity for the mineralocorticoid receptor when compared to spironolactone
155
Is testosterone effective when administered orally?
No, as it is inactivated by first-pass metabolism.
156
What enzyme converts testosterone to dihydrotestosterone (DHT)?
5-_-reductase
157
Where is 5-_-reductase found?
Skin; epididymis; prostate; seminal vesicles
158
What drug inhibits 5-_-reductase?
Finasteride; dutasteride
159
What are the two main therapeutic indications of finasteride?
1. Benign prostatic hyperplasia (BPH)
160
What are the uses of testosterone and its derivatives (danazol; stanozolol; nandrolone; oxandrolone)?
Male hypogonadism; increase muscle mass; increase RBCs; decrease nitrogen excretion; endometriosis (not first-line therapy for endometriosis given side effects)
161
What are the adverse effects of testosterone?
Edema; premature closing of the epiphysis; increased aggression ("road rage"); psychosis; increased low-
162
What antifungal drug inhibits the synthesis of androgens and is also used as an antifungal?
Ketoconazole
163
What drugs act as androgen receptor blockers and are used in the treatment of prostate cancer?
Flutamide; bicalutamide
164
Which drug act as androgen receptor blocker and is used in the treatment of stomach ulcers?
Cimetidine (a histamine H2-receptor blocker)
165
What is the mechanism of action of leuprolide?
Gonadotropin-releasing hormone (GnRH) agonist (daily administration suppresses LH and FSH secretion, thereby inhibiting ovarian and testicular steroidogenesis)
166
What are the therapeutic uses of leuprolide?
Prostate cancer; endometriosis
167
What is the major natural estrogen?
17-_ estradiol
168
Where do conjugated equine estrogens (Premarin) come from?
Urine of pregnant mares
169
What is Premarin used for?
Vasomotor symptoms associated with menopause; vulvar and vaginal atrophy; abnormal uterine bleeding
170
Name two synthetic steroidal estrogens:
1. Ethinyl estradiol
171
Name one synthetic nonsteroidal estrogen:
Diethylstilbestrol (DBS)
172
Mestranol is metabolized to what chemical compound?
Ethinyl estradiol
173
What are the therapeutic uses of estrogens?
Contraception; hormone replacement therapy (HRT); female hypogonadism; dysmenorrhea; uterine bleeding; acne; osteoporosis
174
How do estrogens affect serum lipids?
Increased triglycerides; increased HDL; decreased LDL
175
How is estrogen useful in preventing osteoporosis?
Decreases bone resorption
176
What are the adverse effects of estrogens?
Nausea; vomiting; headache; breast tenderness; endometrial hyperplasia; cholestasis; increased blood coagulation; increased endometrial cancer risk; increased breast cancer risk
177
Estrogen use is contraindicated in which settings?
History of or current deep vein thrombosis (DVT); history of or current pulmonary embolism (PE); active or recent stroke; active or recent myocardial infarction (MI); carcinoma of the breast; estrogen-dependent tumors; hepatic dysfunction; pregnancy
178
How do estrogens increase blood coagulation?
Decrease antithrombin III; increase clotting factors II, VII, IX, and X
179
What can happen to the female offspring of women who took DES during pregnancy?
Clear cell cervical or vaginal adenocarcinoma
180
How do estrogenic compounds work as contraceptives?
Suppresses ovulation
181
What does the enzyme aromatase do?
Converts testosterone to estradiol
182
Name three aromatase inhibitors:
1. Anastrozole
183
What are aromatase inhibitors used for?
Breast cancer
184
What is clomiphene used as?
Fertility drug
185
How does clomiphene work?
Antiestrogen that induces ovulation by inhibiting negative feedback of estrogen on the hypothalamus and pituitary (this suppression leads to increasing release of LH and FSH)
186
What are potential "adverse effect" of clomiphene?
Multiple births; hot flashes (10% patients); ovarian hyperstimulation (7% patients); reversible visual disturbances (2% patients)
187
What does SERM stand for?
Selective estrogen receptor modulator
188
Name two SERMs:
1. Raloxifene
189
What is raloxifene used for?
Prevention and treatment of osteoporosis in postmenopausal women
190
How does raloxifene work?
Estrogen receptor agonist in bone; estrogen receptor antagonist in breast and uterus
191
What is tamoxifen used for?
Breast cancer
192
How does tamoxifen work?
Estrogen receptor agonist in bone; estrogen receptor antagonist in breast; estrogen receptor partial agonist in uterus
193
Can tamoxifen increase endometrial cancer risk?
Yes, it has stimulatory effects on endometrial tissue.
194
Can raloxifene increase endometrial cancer risk?
No, it does not increase the risk of endometrial cancer because it has selective estrogen effects on the breast and bone but not the endometrium.
195
What are the adverse effects of tamoxifen?
Endometrial hyperplasia; hot flashes; nausea; vomiting; vaginal bleeding; menstrual irregularities
196
How does raloxifene affect serum lipids?
Decreases total and LDL cholesterol; no effect on HDL or triglycerides
197
What must you tell a female patient who is using hormonal contraception when she is given a prescription for antibiotics?
Antibiotics may decrease the effectiveness of OCPs; recommend the use of a "backup" contraceptive method in addition to the OCPs throughout the duration of the antibiotic course. This applies to both oral and intravenous antibiotics.
198
Which type of OCPs are used to shorten or suppress menstruations?
Combination OCPs
199
Which OCPs are used to palliate the effects of polycystic ovary syndrome (PCOS)?
Combination OCPs (often in combination with (oral) hypoglycemics)
200
What is the major natural progestin?
Progesterone
201
What are the therapeutic uses of progestins?
Contraception; HRT (with estrogens); control of uterine bleeding; dysmenorrhea; suppression of postpartum lactation; endometriosis
202
Which progestins also possess androgenic activity?
Norethindrone; norgestrel
203
Why is progesterone added to a HRT regimen in a female with an intact uterus?
Decrease risk of endometrial cancer by preventing unopposed action of estrogen. If the patient is status post hysterectomy then combination (estrogen + progesterone) therapy is unnecessary.
204
How often is depot medroxyprogesterone given?
Every 3 months (13 wk)
205
How long does the levonorgestrel contraceptive subdermal implant last?
5 years
206
What are the adverse effects of progestins?
Edema; depression; glucose intolerance; breakthrough bleeding; increased LDL; decreased HDL; hirsutism (androgenic progestins); acne (androgenic progestins)
207
What drug acts as a progesterone antagonist and is used in combination with prostaglandin Ej as an abortifacient?
Mifepristone (RU 486)
208
What are the adverse effects of mifepristone?
Abdominal cramping; uterine bleeding; pelvic infection; ectopic pregnancy
209
How do progestins work as contraceptives?
Prevents implantation of the early embryo into the endometrium; increases thickness of cervical mucus, thereby decreasing sperm access through the cervix
