Drugs for Reproductive Health

Question 1

what positive effects does estrogen have?

Answer 1

positive effect on bone mass and cholesterol levels

- increase skin vascularity

Question 2

estrogen increases the risk of what?

Answer 2

thromboses

Question 3

when is estrogen used?

Answer 3

• birth control
• menopause - hormone replacement
• reproductive deficiency

Question 4

what is the action of conjugated estrogen (Premarin)?

Answer 4

stimulates estrogen production

Question 5

what form does conjugated estrogen (Premarin) come in?

Answer 5

PO, transdermal patch, IM, topical gel

Question 6

what is hormone replacement therapy? what types are there?

Answer 6

the replacement of estrogen when ovaries no longer producing it

• can be estrogen only
• can be estrogen + progestin

Question 7

what are the benefits of hormone replacement therapy?

Answer 7

• relief of vasomotor symptoms
• management of urogenital atrophy
• prevention of osteoporosis and fractures
• prevention of colon cancer

Question 8

what are the risks of hormone replacement therapy?

Answer 8

• nausea and fluid retention
• thromboembolic events
• endometrial cancer
• breast cancer
• ovarian cancer
• dementia
• gallbladder disease

Question 9

when should hormone replacement therapy be used?

Answer 9

• when benefits outway risks
• should be shorter (less than 4 years)
• use specifically for symptoms and adverse effects of menopause

Question 10

what is the action of oral contraceptives?

Answer 10

• inhibit ovulation

- thicken cervical mucous

Question 11

what are the different types of oral contraceptives?

Answer 11

• combination of estrogen and progestin

- progestin only

Question 12

what are the different types of combination oral contraceptives?

Answer 12

• monophasic
• biphasic
• triphasic

Question 13

what is unique about monophasic combination oral contraceptives?

Answer 13

• estrogen and progestin levels are constant

- more side effects

Question 14

what is unique about biphasic combination oral contraceptives?

Answer 14

• progestin dose increases second-half

Question 15

what is unique about triphasic combination oral contraceptives?

Answer 15

• progestin dose changes for each phase of the cycle

- most tolerated

Question 16

what are the uses for oral contraceptives?

Answer 16

• pregnancy prevention
• decrease menstrual cramps (endometriosis)
• acne
• reduce symptoms of PMS
• ovarian cysts

Question 17

what are dosing regimens like for oral contraceptives?

Answer 17

• 28 day cycle (21 days on, 7 days off)

- extended cycle (84 days of active pills, 7 days of low dose estrogen - better for endometriosis)

Question 18

what are the adverse effects of oral contraceptives?

Answer 18

• thromboembolism
• hypertension
• abnormal uterine bleeding
• nausea

Question 19

what are drugs that decrease the effectiveness of oral contraceptives?

Answer 19

• barbiturates
• benzodiazepines
• rifampin
• st. john’s wort
• some seizure medications (carbamazepine. phenytoin)

Question 20

what symptoms increase as progestin increases?

Answer 20

• fatigue
• weight gain
• depression

Question 21

estrogen decreases the effectiveness of what drugs?

Answer 21

• tamoxifen - breast cancer
• sulfonylureas - diabetes
• anticoagulants

Question 22

what are other forms of birth control?

Answer 22

• transdermal patch (ethinyl estradiol + progestin)
• NuvaRing (ethinyl estradiol + progestin)
• subdermal implants
• depot IM injections (progesterone)

Question 23

what drugs are used for BPH?

Answer 23

• 5-alpha-reductase inhibitors (-teride)

- alpha 1 blockers

Question 24

what is the action of 5-alpha-reductase inhibitors (-teride)?

Answer 24

inhibits metabolism of testosterone, which decreases proliferation of prostate cells

Question 25

what does finasteride (proscar) do?

Answer 25

decreases the size of the prostate by blocking the active form of testosterone in prostate - 5-alpha-reductase inhibitors (-teride)

Question 26

how long does it take for 5-alpha-reductase inhibitors (finasteride) to produce results?

Answer 26

6-12 months

Question 27

how long does it take for 5-alpha-reductase inhibitors (finasteride) to produce results?

Answer 27

6-12 months

Question 28

what is the normal dose for 5-alpha-reductase inhibitors (finasteride)?

Answer 28

5mg PO daily

Question 29

what are the adverse effects of 5-alpha-reductase inhibitors (finasteride)?

Answer 29

- decreased libido | - gynecomastia

Question 30

true or false: 5-alpha-reductase inhibitors (finasteride) are only helpful if the prostate is very enlarged

Answer 30

true

Question 31

what is the action of alpha 1 blockers?

Answer 31

relax the smooth muscle of the prostate through alpha 1 blockage

Question 32

what are examples of alpha 1 blockers used for BPH?

Answer 32

doxazosin (cardura) and tamsulosin (flomax) | - osin

Question 33

what are the adverse effects of alpha 1 blockers (-osin)?

Answer 33

- hypotension - second line treatment for HTN - dizziness - nasal congestion - blurred vision - abnormal ejaculation

Question 34

what 2 medications don't mix for men?

Answer 34

viagra and nitroglycerin

Question 35

what type of drugs can treat erectile dysfunction?

Answer 35

phosphodiesterase type 5 inhibitors (-afil) - sildenafil (Viagra) - tadalafil (Cialis)

Question 36

what is the action of phosphodiesterase type 5 inhibitors (-afil)?

Answer 36

enhances effects of nitric oxide to enhance blood flow to the corpus cavernosum

Question 37

what are adverse effects of phosphodiesterase type 5 inhibitors (-afil) ?

Answer 37

- headache - MI, sudden death - dyspepsia (indegestion) - flushing

Question 38

what are female causes of infertility?

Answer 38

- anovulation - follicular immaturity - abnormal cervical mucus - increased prolactin levels - endometriosis - PCOS

Question 39

what are male causes of infertility?

Answer 39

- decreased sperm motility | - erectile dysfunction

Question 40

what is the action of clomiphene citrate (Clomid)?

Answer 40

used for infertility - promotes follicular maturation and ovulation by blocking estrogen receptors - produces more follicles

Question 41

what should be monitored with the use of clomiphene citrate (Clomid)?

Answer 41

the risk of multiples

Question 42

what are the risks of clomiphene citrate (Clomid)?

Answer 42

- nausea, bloating, breast enlargement - visual disturbances - multiple births (8-10%) - ovarian hyperstimulation syndrome

Question 43

what is the action of menotropins and follitropins?

Answer 43

used for infertility - IM - promote follicular development directly in ovaries - can be used with IVF

Question 44

what are the adverse effects of menotropins and follitropins?

Answer 44

- ovarian hyperstimulation syndrome | - multiple births (15-20%)

Question 45

what is the difference between menotropins and follitropins?

Answer 45

menotropins - equal amounts of LH and HSG | follitropins - FSH

Question 46

what is the action of leuprolide (Lupron)?

Answer 46

prevents premature ovulation to improve the number of quality eggs

Question 47

what are the other uses of leuprolide (Lupron) besides infertility?

Answer 47

- precocious puberty - endometriosis - advanced prostate cancer

Question 48

what are the adverse effects of leuprolide (Lupron)?

Answer 48

like menopause - hot flashes - mood swings - insomnia - vaginal dryness/painful intercourse