Exam 5- Reproductive

Question 1

contraceptives mechanism of action

Answer 1

estrogen and progesterone provide negative feedback which prevents secretion of LH and FSH

Question 2

most common combination=

Answer 2

ethinyl estradiol and synthetic progestin

called “CHCs” Combined Hormonal Contraceptives

Question 3

we don’t use estrogens alone bc

Answer 3

they increase the risk of endometrial and ovarian cancer

Question 4

progestin only contraceptives

Answer 4

=minipills or POPs
=25% of all preps
-slightly less efficacy and increased risk for breakthrough bleeding
-reduced risk for thromboembolic disease vs. CHC
-taken daily, no placebo
-prevent ovulation and thicken mucus to hinder sperm

Question 5

new preps are ___

Answer 5

extended doses

-no reduction in efficacy but increased risk for breakthrough bleeding

Question 6

mild adverse effects of hormonal contraceptives

Answer 6

mastalgia
nausea
headache

Question 7

moderate adverse effects of hormonal contraceptives

Answer 7

hyperpigmentation
edema
weight gain

Question 8

severe adverse effects of hormonal contraceptives

Answer 8

-IN HIGH RISK WOMEN ONLY:
coagulation… emboli and thrombotic stroke
(from estrogen)
coronary heart disease
- depression
-migraine with aura
-cholestatic jaundice and gallbladder dysfunction

Question 9

cancer risks with hormonal contraception

Answer 9

• no strong evidence for increased risk of breast cancer with hormonal contraception, but may want to avoid inwoven with a history
• want to avoid with active cancer

Question 10

routes of administration with highest and lowest risks for side effects

Answer 10

highest= patches, depots
lowest= vaginal rings

Question 11

drospirenone

Answer 11

=progestin component of a number of combination hormonal contraceptives
=”yaz”
-blockade of mineralocorticoid and androgen receptors
-lower occurrence of acne, PMDD, hirsutism and weight gain
-increased risk for venous thromboembolism

Question 12

missing a pill..

Answer 12

effective suppression of ovulation will persist if up to three active pills are missed in a row
(not the case with progestin-only)

Question 13

antibiotics with contraception

Answer 13

may impair absorption by messing with GI flora

Question 14

enzyme inducers and contraceptives

Answer 14

may increase estrogen metabolism via CYP450

Question 15

RU-486

Answer 15

=ABORTION PILL
=luteolytic drug (creates a destructive environment for egg)
-progesterone and glucocorticoid receptor antagonist
-administered with prostaglandin to terminate early pregnancy (within 7 wks)
-can have SEVERE effects

Question 16

Plan B

Answer 16

=high dose levonorgestrel
=synthetic progestin
-functions the same way as an oral contraceptive but at a higher dose
(controversy= it may also prevent implantation of a fertilized egg)

Question 17

drugs that promote ovulation goal=

Answer 17

increase gonadotropin secretion in an ideal pattern

Question 18

three fertility drugs

Answer 18

1. clomiphene= SERM that blocks negative feedback
2. gonadorelin=synthetic GnRH
3. gonadotropins= analogs of LH and or FSH

Question 19

menopause tx types

Answer 19

1. conjugated estrogens

2. estrogen plus progestin

Question 20

effects of combined progestin and estrogen HRT in postmenopausal women

Answer 20

• increased risk of CHD, venous thrombosis, and breast cancer
• reduced osteoporosis, hot flashes, and incidence of colorectal cancer

Question 21

effects of estrogen HRT in postmenopausal women

Answer 21

increased risk of venous thrombosis and stroke, as well as endometrial cancer
-breast cancer or heart disease was not significant

Question 22

current recommendation for post menopausal symptoms

Answer 22

• HRT still indicated for women experiencing severe vasomotor symptoms
• only administer for 3-5yrs
• local application for vaginal/urinary symptoms
• NOT first line tx for osteoporosis

Question 23

alternatives to HRT for postmenopausal symptoms of
osteoporosis
mood disturbances
increased LDL

Answer 23

osteoporosis = bispohosphonates
mood disturbances = anti-depressants/mood stabilizers
increased LDL = statins

Question 24

BPH treatment types

Answer 24

1. alpha1 andrenergic receptor agonists

2. 5alpha-reductase inhibitors

Question 25

alpha1 andrenergic receptor agonists

Answer 25

=relaxes prostate and uretral smooth muscle
tamsulosin=selective for prostate sm muscles
dixazosin= nonselective … hypotension

Question 26

5alpha-reductase inhibitors

Answer 26

= (-) testosteron to DHT
dutasteride
-take a long time to work and may not work in all men

Question 27

erectile dysfunction treatment mechanism

Answer 27

inhibit PDE-5 which metabolizes cGMP to GMP and stops erection

Question 28

erectile dysfunction drug list

Answer 28

sildenafil
vardenafil
avanafil
tadalafil (claims to be longer lasting)

Question 29

erectile dysfunction drugs side effects

Answer 29

hypotension
never use with nitrates (additive effects)
headaches
facial flushing 
visual effects