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Pharm Part II > E2: Endocrine Pt 2: Sex hormones > Flashcards

E2: Endocrine Pt 2: Sex hormones Flashcards

1
Q

This seems like it would be one of her layup questions: Natural Estrogen: a steroid, called ________….Produced and secreted by the ______

A

estradiol…. ovary

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2
Q

What are the 3 main,ongoing duties of Estrogen (estradiol)?

A

1.Promotes growth of endometrium 2.and mammary ducts 3. secondary sex characteristics

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3
Q

INTERESTING!!! IN Estrogen Replacement therapy—The estradiol structure is rapidly inactivated in GI tract and liver By placing an _______ group (C=CH) at C 17, the derivative is orally active…Called ________(e.g. found in ORAL CONTRACEPTIVES and other female hormone products)

A

ethinyl…..ethinyl estradiol

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4
Q

Conjugated equine estrogens (Premarin)..haha horse pee….Effective in treatment of vasomotor symptoms of ________

A

menopause

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5
Q

Conjugated equine estrogens (Premarin)..haha horse pee….May also be beneficial to prevent bone loss with __________

A

osteoporosis

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6
Q

What are 4 common side effects of Conjugated equine estrogens (Premarin) (haha horse pee)? (NOT the SERIOUS SIDE EFFECTS)

A

1.Peripheral Edema 2. Breast Tenderness 3.Bloating 4.Headache

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7
Q

What are the 2 SERIOUS side effects of Conjugated equine estrogens (Premarin) (haha horse pee)?

A

1.Increased risk for endometrial (uterine) cancer 2.Taking estrogen (such as Premarin) after menopause may also increase risk for breast cancer…wow holy shit

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8
Q

KEY STUDY TIP: Esterified Estrogens (Estratab; Menest) same effects as _______ at _____ of the dose

A

Premarin…1/2 the dose

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9
Q

Combination HRT Drugs: What is the brand name for adding Estrogen and Progesterone?…what are the generic drug names???

A

PremPro…Premarin (conjugated equine estrogen) + Provera (MED-roxy-progesterone)

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10
Q

Combination HRT Drugs: What is the purpose of adding progesterone to estrogen?

A

reduces risk for endometrial cancer!

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11
Q

Aunt Sue!! When taking JUST estrogen for HRT, Women on HRT saw cholesterol levels go down, but they suffered increases in ________ and no reduction of heart disease!!!

A

blood clots

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12
Q

Hmmmmmm…Nurses Health Study found that estrogen in combination with progestin may increase risk of _____ BUTTTT…..This outweighs long term use to prevent ______

A

stroke….. osteoporosis

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13
Q

NIH PremPro Study: NIH recommeded STOPING PremPro because of these 4 results… (more than 16K women studied!!) the benefits of less colorectal cancer and less bone fracture DO NOT outweigh these 4 risks!!

A

1.Heart Disease 2.Stroke 3.Pulmonary embolism 4.invasive breast cancer

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14
Q

What is the recommendation/indication for DURATION of HRT use today?

A

Short term use: less than 5 years for symptoms of menopause

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15
Q

Where is natural Progesterone produced and secreted?

A

the corpus luteum

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16
Q

What does Progesterone physiologically induce?

A

induces a secretory endometrium…its the pregnancy hormone!

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17
Q

What are the 4 indications for Progesterone Replacement Drugs?

A

1.Tx of Menstrual Disorders 2.Prevention of habitual abortion 3.Tx of Endometriosis 4.Contraception

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18
Q

Oral progesterone is almost completely inactivated in the ______….Synthetic modification is necessary to produce the orally active forms of progesterone

A

liver

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19
Q

What are the two synthetic preparations of Progesterone?

A
  1. Nor-eth-in-drone (oral contraceptives) 2.Med-roxy-progesterone (Provera)
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20
Q

What are the 3 indications for Med-roxy-progesterone (Provera)?

A

1.Abnormal Uterine Bleeding 2.Secondary Amenorrhea 3.Endometrial Cancer

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21
Q

Testosterone is responsible for: Maintain the ______,

male _______ sex characteristics (androgenic effects), and ________ bulk (anabolic effect)

A

testes…. secondary… Muscular

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22
Q

Much like progesterone, testosterone is metabolized by the liver if taken orally…so we can _____ it! (whats the name)

A

methylate it! (methyl testosterone)

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23
Q

What are the 4 indications for Testosterone Tx?

A

1.Delayed male poooberty 2.Hypogonadism 3.female breast cancer 4.loss of libido in postmeno WOMEN!

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24
Q

ANOTHER really common indication for testosterone Tx is male “menopausal” symptoms…when does this usually begin?

A

40’s or 50’s

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25
Q

What is a normal Testosterone range for a MAN?

A

250-800ng/dl

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26
Q

What is a normal Testosterone range for a WOMAN?

A

15-40ng/dl

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27
Q

What is a normal Testosterone range for a POSTMENOPAUSAL WOMAN?

A

0-20ng/dl

28
Q

What are 4 common conditions observed with male aging?

A

1.obesity 2.type 2 DM 3.Pain 4.Depression

29
Q

_________ is a Clinical syndrome which comprises both symptoms and biochemical evidence of T deficiency

A

HypoGonadism

30
Q

Testosterone status is linked to ________ of male population

A

general health

31
Q

Testosterone status is a biomarker for presence of these 3 occult diseases….

A
  1. Atherosclerosis 2. cancer 3.early death
32
Q

How many Testosterone drugs are there? What are 3 of them?

A

10!!!…1.Androderm 2.Fortesta 3.Testim

33
Q

BOOOOOM: BENEFITS OF TESTOSTERONE TX!!!!Decreases _______, Increases _______

A

fat mass…muscle power GIVE ME SOME!

34
Q

BOOOOOM: BENEFITS OF TESTOSTERONE TX!!!! Really benefits these 4 signs of diabetes!

A

1.insulin resistance 2.HbA1C 3.Lipids 4.Libido

35
Q

RISKS of Testosteron Tx (psh who cares, look at those benefits!) Impairs ability to generate ________ testosterone, Problems with ______, Increase in size of ______, Water retention, Worsening of sleep ______, Polycythemia, Increased risk for blood _____, Cardiovascular risks?, ________ cancer?

A

endogenous… fertility… prostate… apnea… clots…. Prostate

36
Q

WOW lots of oral side effects to this Tx if taken buccally: Bitter taste, gingival edema, gingival or mouth irritation, gingival tenderness, taste perversion (dysgeusia)

A

Testosterone

37
Q

Testosterone tx is normally not indicated in women (in fact there are no American FDA approved products); however, what group IS indicated for it? How long is the tx?

A

postmenopausal women with hypoactive sexual desire disorder…3-6 month trial

38
Q

What are the two brand names for Estrogen (esterified) and methyl testosterone?

A

CovAryx, EEMT

39
Q

Estrogen (esterified) and methyl testosterone: _______ administered Taken DAILY for ___ weeks, then 1 week off….Indicated for moderate-to-severe _______ symptoms associated with menopause not improved by estrogens alone….What schedule? C-___ (can’t touch this)

A

Orally…3… vasomotor…C-III

40
Q

Anabolic steriods: Exhibit more anabolic effects: no _______ effects…WOOO Increases muscle mass = can increase mass by ____%

A

androgenic…30%

41
Q

Anabolic steroids: Probably allows for formation of more ________ cells….Schedule ____ controlled substance

A

striated muscle…III

42
Q

What are 4 anabolic steroids?

A

1.Nandrolone Phen-pro-pionate 2.MethANDROstenolone 3.Oxandrolone 4.StanozoLOL

43
Q

What are the 4 side effects of anabolic steroids?

A

1.Mental depression 2.Sodium Retention 3.Cholestatic Jaundice 4.Temporary impotence

44
Q

THE DOWN LOW on Progestational contraceptives: Contain _________…___% effective….Usually taken on days ___ through ____ of the menstrual cycle (21 days)…7 days of ______ (sugar pill) during menstruation

A

both estrogen and progestin..99%…days 5-25… placebo

45
Q

Sequential Contraceptives: Contain different amounts of ______ with same amount of _______

A

progestin… estrogen

46
Q

What is the post-coital (coitus, you mean sex?) aka morning after pill aka plan B made of?

A

Estrogen alone

47
Q

Which OC Inhibits fertilization and nidation, motility of oviduct altered and endometrium is changed and is for rape/incest?

A

DES (DiEthyl Stilbesterol)

48
Q

What are the class and generic/brand names for the abortion pill (terminates intrauterine pregnancy)? What is its off label indication?….WHAT IS ITS MECH of action?

A

Class: RU-486…mi-fep-ri-stone (Mi-Fep-rex)…off label for certain cancers…mech: progesterone ANtagonist

49
Q

What is the long-acting progestin that abolishes menstrual cycle as long as it is given leading to ovarian and endometrial atrophy…What is the dose time?

A

IM (DepoProvera)…every 3 or 6 months

50
Q

What is the name of the Patch form of contraceptive? What is the SIGNIFICANT risk? How much more [ ]’d is it than other Tx?

A

patch (Ortho Evra) = significantly higher risk of adverse clotting events/stroke…40x more [ ]

51
Q

Mechanism of Action of OC: Inhibition of ovulation…______ inhibits FSH secretion and thus ovulatory stimulation is inhibited

A

Estrogen

52
Q

Mechanism of Action of OC: ________ inhibits release of LH thus follicular growth is inhibited

A

Progesterone

53
Q

Mechanism of Action of OC: _________ alters endometrium development

A

Progesterone

54
Q

Mechanism of Action of OC: Endometrium must be in right stage of development under the influence of _______ AND _________ for nidation to occur

A

estrogen AND progesterone

55
Q

Mechanism of Action of OC: Thick, tenacious ______ secreted under the influence of _________ is probably a hostile environment for SPERM

A

mucus… progesterone

56
Q

How many adverse effects of oral contraceptives are there? What is the major one?

A 
12+....increased  risk for MI and stroke... Increased risk for MI and stroke
􏰀 Stroke risk increases if smoker over the age of 35 years
􏰀 Nausea/vomiting
􏰀 Headache
􏰀 Breast pain
􏰀 Weight gain
􏰀 Breakthrough menstrual bleeding
􏰀 Mental depression 􏰀 Fatigue
􏰀 Lack of initiative 􏰀 Ocular conditions
􏰁 Corneal sensitivity
􏰁 Retinal thrombosis 􏰀 Optic neuritis
􏰁 diplopia...in case you were wondering
57
Q

DENTAL CONSIDERATIONS of women on OC’s: Mimic effects of _______ on the gingiva

A

pregnancy

58
Q

DENTAL CONSIDERATIONS of women on OC’s: Mild inflammation, hyperemia, spontaneous gingival _______

A

bleeding

59
Q

DENTAL CONSIDERATIONS of women on OC’s: Loss of tissue ____

A

TONE

60
Q

DENTAL CONSIDERATIONS of women on OC’s: _______ and ulceration

A

tenderness

61
Q

DENTAL CONSIDERATIONS of women on OC’s: May decrease defense to plaque bacteria resulting in irritation or progression of ________ disease

A

periodontal

62
Q

OC & Antibiotics-drug interaction? (Really cool mechanism) case reports of antimicrobial-induced OC failure represent normal ___% to ___% rate of pregnancy which occurs with typical OC use = very rare

A

1% to 3%

63
Q

How to combat the SMALL chance of having an accidental baby while on Ab’s…short-term use of antimicrobials = consider _______ non-hormonal contraception at initiation and for duration of antimicrobial therapy (or for 14 days, which ever is longer), plus 7 more days after completion of antimicrobial therapy

A

additional

64
Q

WHAT ARE THE 6 Antibiotics that are GOOD TO GO while taking OC’s (no accidental baby)…

A

(TDAMFF) 1.Tetracycline 2. Doxy-cycline 3.Amp-icillin 4.Fluconazole 5.FluroQuinolones

65
Q

**add a SECOND form of contraception if the pt is going to take _______ or ______

A

RG….Rifampin or Gris-eo-fluvin

Pharm Part II (28 decks)

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