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Pharmacology > Deja Ch 9 Endo > Flashcards

Deja Ch 9 Endo Flashcards

1
Q

What are the two general categories of drugs that are used to treat diabetes mellitus?

A
  1. Insulin
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2
Q

Which type of diabetes mellitus is each of the following statements referring to? Loss of pancreatic _-cells

A

Type 1

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3
Q

Which type of diabetes mellitus is each of the following statements referring to? Usually early onset

A

Type 1

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4
Q

Which type of diabetes mellitus is each of the following statements referring to? Decreased response to insulin

A

Type 2

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5
Q

Which type of diabetes mellitus is each of the following statements referring to? Ketoacidosis prone

A

Type 1

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6
Q

Which type of diabetes mellitus is each of the following statements referring to? Usually adult onset

A

Type 2

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7
Q

Which type of diabetes mellitus is each of the following statements referring to? Not ketoacidosis prone

A

Type 2

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8
Q

Which type of diabetes mellitus is each of the following statements referring to? Absolute dependence on insulin

A

Type 1

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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

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10
Q

Which type of diabetes mellitus is each of the following statements referring to? Usually thin

A

Type 1

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11
Q

Which type of diabetes mellitus is each of the following statements referring to? Usually obese

A

Type 2

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12
Q

Which type of diabetes mellitus is each of the following statements referring to? Islet cell antibodies

A

Type 1

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13
Q

Which type of diabetes mellitus is each of the following statements referring to? Near 100% concordance in monozygotic twins

A

Type 2

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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

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15
Q

What are the signs and symptoms of diabetic ketoacidosis?

A

Kussmaul respirations; fruity breath; abdominal pain; nausea; vomiting; polyuria; polydipsia; dehydration; fatigue

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16
Q

What chemical is responsible for causing “fruity breath” during ketoacidosis?

A

Acetone

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17
Q

What are the three ketones made during ketoacidosis?

A
  1. _-Hydroxybutyric acid
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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.

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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.

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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

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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

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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

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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

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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

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25
Q

For each of the following types of insulin give the time of onset, peak effect, and duration: Ultralente (extended insulin zinc suspension)

A

4 to 8 hours; 16 to 18 hours; > 36 hours

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26
Q

For each of the following types of insulin give the time of onset, peak effect, and duration: Glargine

A

No peak; duration is 24 hours

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27
Q

Can insulin glargine be mixed with other insulins?

A

No

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28
Q

What is the most common side effect of insulin?

A

Hypoglycemia

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29
Q

What are the signs and symptoms of hypoglycemia?

A

Confusion; diaphoresis; tremors; tachycardia; seizures; coma; lethargy

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30
Q

Which sign/symptom of hypoglycemia is not masked by _-adrenergic antagonists?

A

Diaphoresis

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31
Q

What is the name of the incretin mimetic that increases insulin secretion, slows gastric emptying, and decreases food intake?

A

Exenatide

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32
Q

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?

A

Pramlintide

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33
Q

What hypoglycemic agent is not contraindicated in a pregnant woman with diabetes mellitus?

A

Insulin

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34
Q

Other than blood glucose reduction, regular insulin can also be used for what condition?

A

Hyperkalemia. Insulin causes an intracellular shift of potassium. Insulin is given in combination with glucose to prevent hypoglycemia in this situation.

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35
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Chlorpropamide

A

First-generation sulfonylurea

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36
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Tolazamide

A

First-generation sulfonylurea

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37
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Tolbutamide

A

First-generation sulfonylurea

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38
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glyburide

A

Second-generation sulfonylurea

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39
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glipizide

A

Second-generation sulfonylurea

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40
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Glimepiride

A

Second-generation sulfonylurea

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41
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Nateglinide

A

D-phenylalanine derivative

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42
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Rosiglitazone

A

Thiazolidinedione

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43
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Pioglitazone

A

Thiazolidinedione

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44
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Acarbose

A

_-Glucosidase inhibitor

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45
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Miglitol

A

_-Glucosidase inhibitor

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46
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Metformin

A

Biguanide

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47
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Repaglinide

A

Meglitinide

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48
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Nateglinide

A

Meglitinide

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49
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Pramlintide

A

Amylin analog

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50
Q

For each of the following oral hypoglycemic agents, state which drug class it belongs to? Exenatide

A

Incretin

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51
Q

For each of the following drug classes, give the mechanism of action: Sulfonylureas

A

Block adenosine triphosphate (ATP)-dependent potassium channels, thereby depolarizing pancreatic _-cells which lead to insulin release (release mediated via calcium influx); insulin secretagogue

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52
Q

For each of the following drug classes, give the mechanism of action: Thiazolidinediones

A

Bind to nuclear peroxisome proliferator activating receptor-gamma (PPAR-_) which leads to increased sensitization of cells to insulin; decrease hepatic gluconeogenesis; upregulate insulin receptors

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53
Q

For each of the following drug classes, give the mechanism of action: D-phenylalanine derivatives

A

Newest insulin secretagogue which closes the potassium channels on the _-cells leading to a rapid but short- acting release of insulin

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54
Q

For each of the following drug classes, give the mechanism of action: _-Glucosidase inhibitors

A

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

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55
Q

For each of the following drug classes, give the mechanism of action: Biguanides

A

Decrease hepatic gluconeogenesis; increase tissue sensitivity to insulin

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56
Q

For each of the following drug classes, give the mechanism of action: Meglitinides

A

Nonsulfonylurea insulin secretagogue

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57
Q

For each of the following drug classes, give the mechanism of action: Amylin analogs

A

Suppresses glucagon release, delays gastric emptying, decreases hunger

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58
Q

For each of the following drug classes, give the mechanism of action: Incretins

A

Synthetic glucagon-like-polypeptide (GLP-1) analogs which potentiates glucose-mediated insulin release, decreases postprandial glucagon release, decreases gastric emptying, decreases hunger

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59
Q

What are the side effects of the sulfonylureas?

A

Hypoglycemia; cross-reaction with sulfonamide allergy; weight gain

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60
Q

What is the longest acting sulfonylurea?

A

Chlorpropamide

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61
Q

Which sulfonylurea can cause disulfiram-like reactions?

A

Chlorpropamide

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62
Q

Which sulfonylurea can cause syndrome of inappropriate secretion of antidiuretic hormone (SIADH)?

A

Chlorpropamide

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63
Q

The dose of what second-generation sulf onylurea should be decreased in patients with renal dysfunction?

A

Glyburide

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64
Q

dysfunction?

A

Glipizide

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65
Q

What are the side effects of the thiazolidinediones (TZDs)?

A

Edema; congestive heart failure (CHF) exacerbation; weight gain; hepatotoxicity; macular edema (rare); increased bone fractures in women due to diminished osteoblast formation

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66
Q

Name two concomitant health conditions in which TZDs may not be used in a diabetic patient.

A
  1. CHF
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67
Q

What are the side effects of the biguanides?

A

Diarrhea; lactic acidosis; decreased vitamin B12; abnormal taste

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68
Q

What are the side effects of the meglitinides?

A

Hypoglycemia; upper respiratory tract infection

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69
Q

What are the side effects of the _-glucosidase inhibitors?

A

Abdominal cramping; diarrhea; flatulence

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70
Q

What drug with positive inotropic and chronotropic activity can be used to stimulate the heart during a _- blocker overdose?

A

Glucagon

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71
Q

Based on liver function test (LFT) results, when should therapy with a thiazolidinedione be withheld?

A

When LFTs rise above 2.5 times the upper limit of normal

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72
Q

What oral hypoglycemic should be withheld when the serum creatinine is above 1.5 for males and 1.4 for females?

A

Metformin

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73
Q

When used alone, can TZDs cause hypoglycemia?

A

No, TZDs do not cause hypoglycemia.

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74
Q

When used alone, can biguanides cause hypoglycemia?

A

No, biguanides do not cause hypoglycemia.

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75
Q

What time of day should meglitinides be given?

A

15 to 30 minutes before each meal

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76
Q

Would oral sucrose be effective in a hypoglycemic patient who is currently taking an _-glucosidase inhibitor?

A

No, it would not because sucrose is a disaccharide whose absorption is competitively blocked by the _- glucosidase inhibitors.

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77
Q

Would oral glucose be effective in a hypoglycemic patient who is currently taking an _-glucosidase inhibitor?

A

Yes, it would since glucose is a monosaccharides. _-Glucosidase inhibitors do not block intestinal transporters for monosaccharides.

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78
Q

What are the two types of diabetes insipidus?

A
  1. Neurogenic
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79
Q

Which type of diabetes insipidus is characterized by insensitivity to vasopressin in the collecting ducts?

A

Nephrogenic diabetes insipidus

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80
Q

Which type of diabetes insipidus is characterized by inadequate secretion of vasopressin from the posterior pituitary gland?

A

Neurogenic diabetes insipidus

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81
Q

What types of drugs can cause a nephrogenic diabetes insipidus?

A

Lithium; demeclocycline; vincristine; amphotericin B; alcohol

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82
Q

What two effects does vasopressin have on the body?

A
  1. Antidiuresis
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83
Q

Where is theV1receptor found?

A

Vascular smooth muscle (causes vasoconstriction)

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84
Q

Where is the V2receptor found?

A

Renal collecting ducts (increases water permeability and reabsorption)

85
Q

What is the drug of choice for neurogenic diabetes insipidus?

A

Desmopressin

86
Q

What is desmopressin?

A

Synthetic analog of vasopressin with longer half-life and no vasopressor activity (antidiuresis properties only)

87
Q

What is another name for desmopressin?

A

l-Deamino-8-D-arginine vasopressin (DDAVP)

88
Q

How is desmopressin administered?

A

Intranasally; orally

89
Q

What are the side effects of vasopressin?

A

Water intoxication; hyponatremia; tremor; headache; bronchoconstriction

90
Q

What is vasopressin also used for?

A

Esophageal varices

91
Q

What is desmopressin also used for?

A

Hemophilia A; von Willebrand disease; primary nocturnal enuresis

92
Q

How is nephrogenic diabetes insipidus treated?

A

Thiazide diuretics in combination with amiloride; chlorpropamide; clofibrate

93
Q

What drug that can cause nephrogenic diabetes insipidus is used to treat SIADH?

A

Demeclocycline

94
Q

What are the signs and symptoms of hyperthyroidism?

A

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
Q

What are the signs and symptoms of hypothyroidism?

A

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
Q

What are the signs and symptoms of thyroid storm?

A

High fever; dehydration; delirium; tachycardia; tachypnea; nausea; vomiting; diarrhea; coma

97
Q

What are the two main active thyroid hormones circulating in the body?

A
  1. Thyroxine (T4)
98
Q

Which thyroid hormone is more active in the body?

A

T3 (up to five times more active)

99
Q

What is the half-life of T4?

A

7 days

100
Q

What is the half-life of T3?

A

1.5 days

101
Q

What is the name of the enzyme that converts T4 to T 3 in the periphery?

A

5’-Deiodinase (5 “prime” deiodinase)

102
Q

What is the name of the enzyme that converts active T4 to inactive reverse T3?

A

5-Deiodinase

103
Q

What is the drug of choice for hypothyroidism?

A

Levothyroxine (T4)

104
Q

When a hypothyroid patient is started on levothyroxine therapy, how long will the drug take to reach a steady state?

A

6 to 8 weeks

105
Q

What are the adverse effects of levothyroxine?

A

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
Q

What biochemical marker is used to assess for adequate thyroid replacement?

A

Thyroid-stimulating hormone (TSH)

107
Q

What antiarrhythmic agent can potentially cause either hypothyroidism or hyperthyroidism (more commonly hypothyroidism)?

A

Amiodarone (contains two iodine molecules)

108
Q

To which three proteins in the blood are T4 and T3 bound extensively?

A
  1. Thyroid-binding globulin
109
Q

The _-subunit of TSH is similar to the _-subunits of which hormones (gonadotropins) in the body?

A

Follicle-stimulating hormone (FSH); luteinizing hormone (LH); human chorionic gonadotropin (hCG)

110
Q

What drug is used to ablate thyroid tissue?

A

Radioactive iodine (I131)

111
Q

What drug is used to treat cardiovascular effects seen in thyrotoxicosis?

A

Propranolol

112
Q

What is a side effect of surgical removal of the thyroid gland?

A

Hypothyroidism almost inevitably results. Other possible complications include hypocalcemia due to removal of the parathyroid glands along with the thyroid.

113
Q

What are the drugs of choice to treat hyperthyroidism?

A

Thionamides (propylthiouracil and methimazole)

114
Q

What drugs inhibit the release of preformed thyroid hormone?

A

Iodide; lithium

115
Q

What drugs inhibit the iodination of tyrosyl residues on thyroglobulin?

A

Propylthiouracil; methimazole

116
Q

What drugs inhibit the coupling reactions that form T3 and T4?

A

Propylthiouracil; methimazole; iodide

117
Q

What drugs block the conversion of T4 to T3 in the periphery by inhibiting 5’-deiodinase?

A

Propylthiouracil; propranolol

118
Q

What are the side effects of propylthiouracil and methimazole?

A

Pruritic maculopapular rash; vasculitis; arthralgias; fever; leukopenia; agranulocytosis

119
Q

Do propylthiouracil and methimazole cross the placenta?

A

Yes

120
Q

What is the drug of choice for hyperthyroidism in pregnancy?

A

Propylthiouracil (more protein bound)

121
Q

What drugs can decrease levels of thyroid-binding globulin?

A

Androgens; glucocorticoids; L-asparaginase

122
Q

What drugs can increase levels of thyroid-binding globulin?

A

Estrogens; perphenazine; clofibrate; fluorouracil

123
Q

What are the three zones of the adrenal cortex?

A
  1. Zona glomerulosa (outer)
124
Q

Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona glomerulosa

A

Mineralocorticoids

125
Q

Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona fasciculata

A

Glucocorticoids

126
Q

Name the steroid hormones produced by each of the following layers of the adrenal cortex: Zona reticularis

A

Adrenal androgens

127
Q

What is the major precursor of all steroid hormones?

A

Cholesterol

128
Q

What is the principal mineralocorticoid?

A

Aldosterone

129
Q

What is the principal glucocorticoid?

A

Cortisol, but note that cortisol does have some mineralocorticoid activity as well.

130
Q

How do corticosteroids work biochemically in the body?

A

Bind to intracellular cytoplasmic receptors in target tissues then subsequently translocate to the nucleus where they act as transcription factors

131
Q

What is the precursor of adrenocorticotropic hormone (ACTH)?

A

Proopiomelanocortin (POMC)

132
Q

What chemicals are released when POMC is cleaved?

A

ACTH; lipotropin; _-endorphin; metenkephalin; melanocyte-stimulating hormone (MSH)

133
Q

What drug is used to diagnose adrenal insufficiency?

A

ACTH (cosyntropin)

134
Q

A cosyntropin stimulation test that results in no cortisol secretion characterizes which type of adrenal insufficiency?

A

Primary adrenal insufficiency (defect at the level of the adrenal gland)

135
Q

A cosyntropin stimulation test that results in reasonable cortisol secretion characterizes which type(s) of adrenal insufficiency?

A

Secondary adrenal insufficiency (defect at the level of the pituitary gland) and possibly tertiary adrenal insufficiency (defect at the level of the hypothalamus)

136
Q

What is the primary mechanism by which corticosteroids increase the neutrophil count?

A

Demargination, where the polymorphonuclear cells are detached from the endovascular wall and are therefore available to be counted in the peripheral blood smear

137
Q

How is the production of arachidonic acid decreased by glucocorticoids?

A

Inhibition of phospholipase A2

138
Q

How is Cushing syndrome diagnosed?

A

Dexamethasone suppression test

139
Q

Give examples of short-acting glucocorticoids:

A

Cortisone; hydrocortisone

140
Q

Give examples of intermediate-acting glucocorticoids:

A

Methylprednisolone; prednisone; triamcinolone

141
Q

Give examples of long-acting glucocorticoids:

A

Betamethasone; dexamethasone

142
Q

Give an example of a synthetic mineralocorticoid:

A

Fludrocortisone

143
Q

How long after initiation of glucocorticoid therapy does it take to suppress the hypothalamic-pituitary- adrenal (HPA) axis?

A

2 weeks

144
Q

How should long-term glucocorticoid therapy be discontinued?

A

Taper regimen (taper regimen commonly used when discontinuing >2 weeks of glucocorticoid therapy)

145
Q

How do you prevent suppression of the HPA axis while using glucocorticoids?

A

Alternate day dosing (every other day dosing)

146
Q

List the adverse effects of glucocorticoids:

A

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
Q

What drug inhibits glucocorticoid synthesis by inhibiting 11-hydroxylase activity?

A

Metyrapone

148
Q

What drug inhibits the conversion of cholesterol to pregnenolone?

A

Aminoglutethimide

149
Q

What antifungal can be used to lower cortisol levels in Gushing disease and may cause gynecomastia as an adverse effect?

A

Ketoconazole

150
Q

What diuretic blocks mineralocorticoid receptors and also inhibits the synthesis of aldosterone and androgens (eg, testosterone)?

A

Spironolactone

151
Q

What is the main side effect of spironolactone?

A

Gynecomastia; hyperkalemia

152
Q

How does spironolactone work as a diuretic?

A

Antagonizes mineralocorticoid receptors in the kidney, thereby preventing sodium reabsorption in the distal tubules but not increasing potassium loss (therefore potassium-sparing)

153
Q

Using an angiotensin-converting enzyme (ACE) inhibitor in combination with spironolactone can cause what major electrolyte abnormality?

A

Hyperkalemia

154
Q

Name a potassium-sparing diuretic that does not have anti-androgen side effects:

A

Eplerenone, which has increased specificity for the mineralocorticoid receptor when compared to spironolactone

155
Q

Is testosterone effective when administered orally?

A

No, as it is inactivated by first-pass metabolism.

156
Q

What enzyme converts testosterone to dihydrotestosterone (DHT)?

A

5-_-reductase

157
Q

Where is 5-_-reductase found?

A

Skin; epididymis; prostate; seminal vesicles

158
Q

What drug inhibits 5-_-reductase?

A

Finasteride; dutasteride

159
Q

What are the two main therapeutic indications of finasteride?

A
  1. Benign prostatic hyperplasia (BPH)
160
Q

What are the uses of testosterone and its derivatives (danazol; stanozolol; nandrolone; oxandrolone)?

A

Male hypogonadism; increase muscle mass; increase RBCs; decrease nitrogen excretion; endometriosis (not first-line therapy for endometriosis given side effects)

161
Q

What are the adverse effects of testosterone?

A

Edema; premature closing of the epiphysis; increased aggression (“road rage”); psychosis; increased low-

162
Q

What antifungal drug inhibits the synthesis of androgens and is also used as an antifungal?

A

Ketoconazole

163
Q

What drugs act as androgen receptor blockers and are used in the treatment of prostate cancer?

A

Flutamide; bicalutamide

164
Q

Which drug act as androgen receptor blocker and is used in the treatment of stomach ulcers?

A

Cimetidine (a histamine H2-receptor blocker)

165
Q

What is the mechanism of action of leuprolide?

A

Gonadotropin-releasing hormone (GnRH) agonist (daily administration suppresses LH and FSH secretion, thereby inhibiting ovarian and testicular steroidogenesis)

166
Q

What are the therapeutic uses of leuprolide?

A

Prostate cancer; endometriosis

167
Q

What is the major natural estrogen?

A

17-_ estradiol

168
Q

Where do conjugated equine estrogens (Premarin) come from?

A

Urine of pregnant mares

169
Q

What is Premarin used for?

A

Vasomotor symptoms associated with menopause; vulvar and vaginal atrophy; abnormal uterine bleeding

170
Q

Name two synthetic steroidal estrogens:

A
  1. Ethinyl estradiol
171
Q

Name one synthetic nonsteroidal estrogen:

A

Diethylstilbestrol (DBS)

172
Q

Mestranol is metabolized to what chemical compound?

A

Ethinyl estradiol

173
Q

What are the therapeutic uses of estrogens?

A

Contraception; hormone replacement therapy (HRT); female hypogonadism; dysmenorrhea; uterine bleeding; acne; osteoporosis

174
Q

How do estrogens affect serum lipids?

A

Increased triglycerides; increased HDL; decreased LDL

175
Q

How is estrogen useful in preventing osteoporosis?

A

Decreases bone resorption

176
Q

What are the adverse effects of estrogens?

A

Nausea; vomiting; headache; breast tenderness; endometrial hyperplasia; cholestasis; increased blood coagulation; increased endometrial cancer risk; increased breast cancer risk

177
Q

Estrogen use is contraindicated in which settings?

A

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
Q

How do estrogens increase blood coagulation?

A

Decrease antithrombin III; increase clotting factors II, VII, IX, and X

179
Q

What can happen to the female offspring of women who took DES during pregnancy?

A

Clear cell cervical or vaginal adenocarcinoma

180
Q

How do estrogenic compounds work as contraceptives?

A

Suppresses ovulation

181
Q

What does the enzyme aromatase do?

A

Converts testosterone to estradiol

182
Q

Name three aromatase inhibitors:

A
  1. Anastrozole
183
Q

What are aromatase inhibitors used for?

A

Breast cancer

184
Q

What is clomiphene used as?

A

Fertility drug

185
Q

How does clomiphene work?

A

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
Q

What are potential “adverse effect” of clomiphene?

A

Multiple births; hot flashes (10% patients); ovarian hyperstimulation (7% patients); reversible visual disturbances (2% patients)

187
Q

What does SERM stand for?

A

Selective estrogen receptor modulator

188
Q

Name two SERMs:

A
  1. Raloxifene
189
Q

What is raloxifene used for?

A

Prevention and treatment of osteoporosis in postmenopausal women

190
Q

How does raloxifene work?

A

Estrogen receptor agonist in bone; estrogen receptor antagonist in breast and uterus

191
Q

What is tamoxifen used for?

A

Breast cancer

192
Q

How does tamoxifen work?

A

Estrogen receptor agonist in bone; estrogen receptor antagonist in breast; estrogen receptor partial agonist in uterus

193
Q

Can tamoxifen increase endometrial cancer risk?

A

Yes, it has stimulatory effects on endometrial tissue.

194
Q

Can raloxifene increase endometrial cancer risk?

A

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
Q

What are the adverse effects of tamoxifen?

A

Endometrial hyperplasia; hot flashes; nausea; vomiting; vaginal bleeding; menstrual irregularities

196
Q

How does raloxifene affect serum lipids?

A

Decreases total and LDL cholesterol; no effect on HDL or triglycerides

197
Q

What must you tell a female patient who is using hormonal contraception when she is given a prescription for antibiotics?

A

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
Q

Which type of OCPs are used to shorten or suppress menstruations?

A

Combination OCPs

199
Q

Which OCPs are used to palliate the effects of polycystic ovary syndrome (PCOS)?

A

Combination OCPs (often in combination with (oral) hypoglycemics)

200
Q

What is the major natural progestin?

A

Progesterone

201
Q

What are the therapeutic uses of progestins?

A

Contraception; HRT (with estrogens); control of uterine bleeding; dysmenorrhea; suppression of postpartum lactation; endometriosis

202
Q

Which progestins also possess androgenic activity?

A

Norethindrone; norgestrel

203
Q

Why is progesterone added to a HRT regimen in a female with an intact uterus?

A

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
Q

How often is depot medroxyprogesterone given?

A

Every 3 months (13 wk)

205
Q

How long does the levonorgestrel contraceptive subdermal implant last?

A

5 years

206
Q

What are the adverse effects of progestins?

A

Edema; depression; glucose intolerance; breakthrough bleeding; increased LDL; decreased HDL; hirsutism (androgenic progestins); acne (androgenic progestins)

207
Q

What drug acts as a progesterone antagonist and is used in combination with prostaglandin Ej as an abortifacient?

A

Mifepristone (RU 486)

208
Q

What are the adverse effects of mifepristone?

A

Abdominal cramping; uterine bleeding; pelvic infection; ectopic pregnancy

209
Q

How do progestins work as contraceptives?

A

Prevents implantation of the early embryo into the endometrium; increases thickness of cervical mucus, thereby decreasing sperm access through the cervix

Pharmacology (25 decks)

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