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Pharmacology > Exam 12: Sex Hormones and Gonadotropins > Flashcards

Exam 12: Sex Hormones and Gonadotropins Flashcards

1
Q

2 Estrogen Oral Contraceptives

A

Ethynyl Estradiol

Estradiol valerate

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2
Q

5 Progestin Oral Contraceptives

A 
Levonorgestrel
Desogestrel
Norgestimate
Drospirenone
Norethindrone
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3
Q

What type of oral contraception is useful in that it does NOT interfere with lactation?

A

Progestins

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4
Q

Oral contraceptive most associated with weight gain

A

Medroxyprogesterone

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5
Q

Drug in Plan B

A

Levonorgestrel

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6
Q

Problem with Original Oral Contraception

A

Large doses

More side effects

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7
Q

Classic oral contraceptive cycle

A

21 days of Oral contraceptives followed by 7 days of inert pills or ferrous fumurate

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8
Q

Multiphase Combined Oral Contraceptives

A

Mimic normal hormonal events of the menstrual cycle

Allows inhibition of ovulation with decreased overall exposure to the synthetic hormones (lower doses)

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9
Q

Drug used in four-phasic oral contraceptives

A

Estradiol valerate

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10
Q

2 choices for starting date of oral contraceptive

A

First day of menses for more rapid contraception

First Sunday after menses (make sure they use backup contraception for 7 days)

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11
Q

Most prominent estrogen type produced in the ovary

A

Estradiol

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12
Q

Primary synthetic estrogen used in oral contraceptives

A

Ethanyl estradiol

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13
Q

Enterohepatic recirculation of oral contraceptives

A
  1. Conjugated to sulfate or glucuronide in the liver
  2. Secreted into the intestine via biliary tract
  3. Bacteria cleaves conjugate, allowing reabsorption
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14
Q

2 Progestins that are less androgenic than others

A

Norgestimate

Desogestrel

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15
Q

Yaz combo, uses

A

Ethanyl estradiol and Drospirenone

Birth control, also indicated for acne

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16
Q

Most common side effects of combined oral contraceptives

A

Nausea

Take with dinner or at bedtime

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17
Q

Dermatological side effects of combined oral contraceptives

A
  1. Chloasma (brown pigmentation, especially on the face)
    Avoid UV light
  2. Acne
  3. Hirsutism
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18
Q

CV side effects of combined oral contraceptives

A

HTN

MI and stroke, especially in smokers

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19
Q

Serious risk of combined oral contraceptives

A

Thromboembolic disorders

Estrogen is implicated in increased clotting factors and decreased antithrombin III

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20
Q

Desogestrel side effect

A

FDA review indicated that it increased risk of nonfatal venous thrombosis

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21
Q

Hepatobilliary side effects of Combined oral contraceptives

A

Gallstones (not much anymore with lower doses)

Benign hepatocellular adenoma

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22
Q

Metabolic side effects of oral contraceptives

A

decreased glucose tolerance

may increase LDL and triglycerides

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23
Q

GU side effects of oral contraceptives

A

Breakthrough bleeding/spotting

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24
Q

Infection associated with combined oral contraceptives

A

Candida vaginitis

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25
Q

CNS side effects of oral contraceptives

A

depression

migraines

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26
Q

Ocular side effects of combined oral contraceptives

A

Worsening of myopia/nearsightedness

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27
Q

Cancer associated with oral contraceptives

A

Increased risk of breast cancer and cervical cancer

28
Q

Effect of oral contraceptives on fertility

A

Infertility may extend for a long time after they stop the birth control

29
Q

Problem with oral contraceptives after giving birth

A

Avoid use for 3-4 weeks due to risk of blood clots

Estrogen can affect the breast milk, progestins do not

30
Q

Cancer prevented by oral contraceptives

A

Decreased risk of endometrial cancer and ovarian cancer

31
Q

3 birth controls that also treat acne

A

Ortho tri-cyclen
Estrostep
Yaz

32
Q

Antibiotics and oral contraceptives

A

Decrease gut bacteria, decreasing beconjugation and therefore reabsorption (enterohepatic recirculation)

33
Q

When might you use progestin only contraceptives?

A

When they’re lactating or at risk for HTN or blood clots

If they’re over 35 years old

34
Q

Ovulation in progestin only contraception

A

Dont consistently inhibit ovulation (40% of cycles are still ovulatory)
Other mechanisms help prevent pregnancy (inhospitable environment of the ovum)

35
Q

Advantage of Medroxyprogesterone

A

It’s injected once every 3 months, so they don’t have to take a pill every day
This is the one that really causes weight gain
There’s also a sub Q preparation

36
Q

Morning after pill adverse side effect

A

Delay or inhibition of ovulation

37
Q

Premarin

A

Conjugated equine estrogens

38
Q

Pempro

A

Conjugated equine estrogens + medroxyprogesterone

39
Q

2 SERMs

A

Raloxifine

Clomiphene

40
Q

GnRH agonist

A

Leuprolide

41
Q

2 gonadotropins drugs

A

Menotropins

Chorionic gonadotropin

42
Q

2 5-alphareductase inhibitors

A

Finasteride

Dutasteride

43
Q

Difference between estrogen replacement and hormone replacement therapy

A

HRT is estrogen + progestin

44
Q

Who must have HRT instead of ERT?

A

Women with intact uterus (they need the progestin)

This prevents estrogen-induced endometrial hyperplasia and endometrial cancer

45
Q

Estrogen effect of cholsterol

A

Increased HDL, decreased LDL

46
Q

are ERT/HRT indicated in vasomotor symptoms of menopause

A

yes

this is a major complaint during transition

47
Q

are ERT/HRT indicated in symptoms of vaginal atrophy and dryness

48
Q

are ERT/HRT indicated in helping to prevent osteoporosis?

A

consider other options (bisphosphonates)

49
Q

are ERT/HRT indicated in prevention of cardiovascular disease

A

Do not use them for this

trials indicate no overall benefit

50
Q

are ERT/HRT indicated in prevention of alzheimer’s?

A

No

studies show no improvement

51
Q

Adverse effects of HRT/ERT

A

Increase risk of breast cancer
Brease tenderness
Nausea
THROMBOEMBOLISM (mostly in first couple of years)
Gallbladder disease (less with transdermal preps)

52
Q

Contraindications to HRT/ERT

A 
Endometrial cancer
Breast cancer
Undiagnosed vaginal bleeding
Thromboembolism
Liver disease (maybe try transdermal)
53
Q

When might you use a transdermal patch for ERT/HRT?

A

Hypertriglyceridemia, liver disease, gallbladder disease

54
Q

Raloxifine use, mechanism

A

Osteoporosis

SERM

55
Q

Clomiphene use, mechanism

A

Female infertility

Hypothalamus estrogen antagonist, increasing FHS and LH

56
Q

Clomiphene contraindication

A

Ovarian cysts

Can cause enlargement/formation of ovarian cysts

57
Q

Leuprilide uses

A

Androgen dependent prostate cancer
Endometriosis
Precocious puberty
Infertility

58
Q

Leuprolide mehcanism

A

GnRH agonist (cause initial surge and then inhibition of LH and FSH)

59
Q

Leuprolide side effects

A

Impotence and decreased libido

Also hot flashes and night sweats

60
Q

Menotropins mechanism

A

LH and FSH isolated from urine of postmenopausal women

61
Q

Menotropin uses

A

Used with hCG Induce ovulation in infertile anovulatory women
Use to stimulate spermatogenesis in men

62
Q

Chorionic gonadotropin uses

A

Ovulation induction and spermatogenesis

63
Q

Chorionic gonadotropin adverse effects

A

Ovarian hyperstimulation and multiple pregnancies

64
Q

Finasteride and dutasteride mechanism

A

5 alpha reductase inhibitors, block conversion of testosterone to more active DHT

65
Q

Finasteride and dutasteride uses

A

treat BPH

can also treat male pattern baldness

66
Q

Finasteride and dutasteride side effect

A

may cause impotence

67
Q

Risk associated with testosterone replacement therapy

A

Increased risk of MI

they stopped the trial early because the pattern was so clear

Pharmacology (34 decks)

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