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A. Pharm II > EXAM 7 > Flashcards

EXAM 7 Flashcards

1
Q

Which hormone is responsible for the maturation of reproductive organs as well as development of secondary sex characteristics?

A

Estrogen

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2
Q

What are estradiol, estrone, and estriol?

A

Synthetic estrogen

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3
Q

What hormone is important for the limiting and stabilization of endometrial growth of the endometrial lining of the uterus?

A

Progesterone

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4
Q

What is progestin?

A

A synthetic progesterone.

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5
Q

What would be reason for the following clinical uses of hormone therapy?

  • Prevention of follicular maturation/ovulation
  • Estrogen or Progestin or combination of both
A

For contraceptive uses.

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6
Q

What are some NON-contraceptive uses of hormone therapy?

A
  • Dysfunctional uterine bleeding
  • Amenorrhea
  • Endometrial carcinoma and hyperplasia
  • Postmenopausal
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7
Q

Night sweats
Hot flashes
Vaginal atrophy
Painful intercourse

These are all symptoms of which condition?

A

Post-menopause.

The significant decline in estrogen presents with these problems.

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8
Q

Which hormone has a MA of binding to intracellular estrogen receptors, thereby stimulating the proteins that are needed for biologic effects of estrogen?

A

Conjugated Estrogens:

  • Cenestin
  • Enjuvia
  • Premarin
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9
Q

If a woman suffered from hypogonadism or postmenopausal symptoms, which estrogen therapy agents would be used?

(These are also sometimes used palliatively with prostrate CA)

A

Cenestin
Enjuvia
Premarin

Hypogonadism: Ovaries aren’t producing enough estrogen OR ovaries have been removed (oophorectomy)

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10
Q

HA, abdominal cramps, bloating, tender breasts, vaginal bleeding, dizziness, depression, N/V, D, and anorexia are all possible adverse effects of which hormone therapy?

A

Estrogen.

Additionally, it increases the risks of:

  • PE, DVT, and stroke (bc estrogen promotes clotting)
  • Increased risk of breast/ ovarian CA
  • Increased risk of endometrial hyperplasia and CA

PREGNANCY CAT X

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11
Q

This hormone, when combined with estrogen, promotes breast development. It also regulates the monthly uterine cycle, and maintains the uterus throughout pregnancy:

A

Progesterone.

It maintains the uterus throughout pregnancy by:

  • suppressing uterine contractions
  • suppressing maternal immune response

When there is a sharp decline in progesterone, this causes menses to begin if no implantation occurs.

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12
Q

This hormone therapy medication’s mechanism of action is that it antagonizes the effects of estrogen on the uterus, inhibits LH surge (preventing ovulation) and thickening cervical mucus (making it more resistant to sperm):

A

Medroxyprogesterone (Depo-Provera, Provera)

Indications:

  • Postmenopausal hormone replacement
  • Dysfunctional uterine bleeding
  • Endometrial carcinoma and hyperplasia
  • Birth control
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13
Q

What are the adverse effects of medroxyprogesterone?

A
  • Breast tenderness, breakthrough bleeding, menstrual irregularities
  • Weight gain, depression, hypertension
  • Jaundice
  • N/V, fluid retention
  • Vaginal candidiasis
  • Increased risk of breast cancer, DVT, MI, PE *When combined with Estrogen
  • Fetal risk - PREGNANCY CAT X
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14
Q

What are some beneficial treatments (non-contraceptive-wise) for hormone replacement therapy?

A

Beneficial in treating:

  • Vasomotor symptoms of menopause (hot flashes)
  • Prevent osteoporosis-related fractures
  • Protection from colorectal CA
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15
Q

There are many cautions, adverse effects, and warnings with hormone replacement therapy, the benefits should outweigh the risks. What are some increased risks associated with it?

A 
Increased risk of MI
Increased risk of DVT
Increased risk of breast CA
Increased risk of ovarian CA
Increased risk of dementia
Increased risk of urinary incontinence
Increased risk of gallbladder disease

Also, Development of selective estrogen receptor modifiers (SERMs) - used to treat menopause symptoms and reduce effects of estrogen-progestin combos.

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16
Q

What is the name of the treatment used to treat menopause symptoms and reduce the effects of estrogen-progestin combos?

A

SERMs: Selective Estrogen Receptor Modifiers

They work by sitting in the estrogen receptor site in breast cells. This blocks the estrogen from attaching to the cell and therefore preventing the signal for that cell to grow and multiply.

17
Q

Which hormone therapy induces ovulation by stimulating the release of LH, resulting in maturation of more follicles than normal?

A

Clomiphene (Clomid, Serophene)

Adverse effects: weight gain, PMS symptoms, hot flashes, allergic dermatitis, urticaria (hives).

Contraindications: 
Lactation
Gynecomastia
Fibrocystic breast disease
Liver disease

PREGNANCY CAT X

18
Q

What does LH mean?

A

Luteinizing Hormone: Helps regulate the menstrual cycle and egg production.

19
Q

Which medication is often the first-line drug used to help with infertility?

A

Clomiphene (Clomid, Serophene)

20
Q

Which infertility drug is contraindicated in lactation, gynecomastia, fibrocystic breast dz, or liver dz?

A

Comiphene (Clomid, Serophene)

Adverse effects:

  • Weight gain
  • PMS symptoms
  • Hot flashes
  • Allergic dermatitis
  • Urticaria (hives)
21
Q

What drug has the name Sildenafil?

A

Viagra

22
Q

Which hormone therapy would be used for contraception, heavy menstrual bleeding, acne, endometriosis, and hirsutism?

A

Combo Oral Contraceptives

  • Low doses of estrogen + progestin together (PO)
  • Prevents ovulation by sending a negative feedback message to pituitary (this suppresses the secretion of LH and FSH [follicle stimulating hormone], and thickening the cervical mucous).
  • There are several types available, differing in their dose and/or type of estrogen and progestin.
23
Q

What are the adverse effects of oral contraceptives?

A
  1. N/V
  2. Breast tenderness
  3. Weight gain
  4. Breakthrough bleeding
  5. HTN
  6. Thromboembolic disorders
  7. Increased risk of breast CA
  8. Potential exacerbation of lupus symptoms

CI:

  • Smoking - increased risk of cardiovascular effects, especially if over 35 years of age.
  • Lupus
  • PREGNANCY CAT X

– Progestin only pills are another pill that can lessen these effects… they’re given to women who are at high risk for estrogen side effects or nursing, but are less effective than the combo pill.

24
Q

Which medication is contraindicated with smoking, lupus, and pregnancy?

A

Oral contraceptives.

Smoking increases the risk of cardiovascular effects (especially in patients over 35)

Lupus symptoms may be exacerbated

PREG CAT X

– Progestin only pills are another pill that can lessen these effects… they’re given to women who are at high risk for estrogen side effects or nursing, but are less effective than the combo pill.

25
Q

What is an androgen?

A

A male sex hormone (testosterone)

26
Q

Testosterone is synthesized by what in men?

A

The Leydig cells of the testes

27
Q

Testosterone is synthesized by what in women?

A

The adrenal cortex and ovaries.

28
Q

What does testosterone do in men as well as in women?

A
  • Promotes synthesis of erythropoietin
  • Promotes the growth of skeletal muscle
  • Maintains libido
  • Affects puberty

In males:
- Spermatogenesis

29
Q

What medications are used to treat erectile dysfunction?

A

Sildenafil (Viagra) and Tadalafil (Cialis)

Sildenafil MA:

  • Inhibits PDE-5 enzyme… thereby increasing cGMP levels in the penis (relaxing the smooth muscle in the corpus cavernosa)
    • Vasodilation of the penile arterioles results in erection.

Has a rapid onset of action (within 1 hr) and can last up to 4 hours.

Tadalafil MA:
* Works like sildenafil BUT there is less of a drop in BP… safer to use in patients with HF or history of MI.

30
Q

Which ED med is safer to use on patients with a history of an MI or HF?

A

Tadalafil (Cialis)

31
Q

What conditions are often associated with ED, example: diabetes?

A

Diabetes

HTN

Stroke

Kidney disease

Depression

Fatigue

Stress

32
Q

What are some commonly prescribed medications that can cause ED?

ED affects 15-30 million men in the U.S.

A
  • Thiazide diuretics (used to tx HTN and edema)
  • Phenothiazines (antipsychotic)
  • SSRI’s (antidepressant used for major depressive disorder and anxiety disorder)
  • TCA’s (antidepressant)
  • propanolol (Beta Blocker: Angina, HTN, Afib, migraine)
  • diazepam (Benzo, anxiolytic/sedative: anxiety, spasms, seizures)
33
Q

Adverse effects of illegal androgen use:

A
  • Acne
  • CHF
  • Decrease in HDL, increase in LDL
  • Depression, mania, aggression
  • Gyneocomastia
  • Hepatotoxicity
  • Sterility
  • Testicular atrophy
34
Q

This COX (cyclooxygenase) is found in all tissues, and promotes vasodilation to maintain renal blood flow:

A

COX-1

Also…

  • Decreases gastric acid
  • Increases bicarbonate (HCO3)
  • Increases gastric mucus
  • Maintains submucosal blood supply

All of the above help prevent ulcers. COX-1 also…

  • Enhances renal blood flow = healthy kidneys
  • Helps stop bleeding (platelet aggregation).
35
Q

This COX is found mainly in injured tissues, supports renal function, and catalyzes the synthesis of prostaglandins at the injury:

A

COX-2

Prostaglandins are significant contributors to the inflammatory process. They are a potent mediator that cause increased blood flow, chemotaxis, and subsequent dysfunction of tissues and organs. This inflammation sends signals to the brain: fever, increased perception of pain.

Peripherally, the inflammation sensitizes pain receptors.

36
Q

What happens when you inhibit the COX-1?

A
  • Gastric erosion
  • Bleeding
  • Renal impairment (same as cox-2)
  • Prevention of MI and/or stroke
37
Q

What happens when you inhibit the COX-2?

A
  • Anti-inflammatory
  • Alleviation of pain
  • Reduction of fever
  • Renal impairment (same as cox-1)
38
Q

This is a synthetic prostaglandin and is often combined with ASA to prevent ASA’s adverse effects of GI problems such as gastric upset, heartburn, etc:

A

Misoprostol

You get the COX 1 and 2 inhibition from the ASA and the protective prostaglandin from the misoprostol.

A. Pharm II (7 decks)

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