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GU Flashcards

1
Q

Calcium Carbonate

A
  • Most common oral source of calcium
  • most concentrated
  • Need HCl to be absorbed
  • More GI effects than other supplements
  • Milk Alkali Syndrome: Excessiv Ca plus absorbable alkali from milk
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2
Q

Calcium Citrate

A
  • Oral tablets

- More soluble (doesn’t require HCl)

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3
Q

Calcium Gluconate

A
  • Oral or IV
  • -NOT IM route
  • Drug of choice for IV therapy in acute hypocalcemic tetany b/c less irritating to veins (infuse slowly arrhythmias)
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4
Q

Calcium Gluceptate

A

-IV or IM (only IM)

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5
Q

Cholecalciferol

A

-Oral tablets of pure D3

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6
Q

Ergocalciferol

A
  • Pure D2 (used in milk and other foods)
  • can be prescribed and therefore reimbursed
  • Tablets, capsules, oral solution, and IM injection
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7
Q

Dihydrotachysterol

A
  • 1-OH Vitamin D analog so doesn’t require renal hydroxylation (good for renal failure and hyperparathyroidism secondary to renal failure)
  • orally effective as tablets capsules and solutions
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8
Q

Calcifediol

A
  • 25-OH-D3 so no liver hydroxylation required
  • Patients with liver disease
  • Oral capsules
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9
Q

Calcitriol

A
  • the final hormone form
  • neither kidney or liver activation required
  • oral or injection
  • Too strong for most patients
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10
Q

calcitonin

A
  • Peptide hormone
  • promote Ca and phosphate secretion
  • Decrease Bone turnover; inhibits osteoclasts, Paget’s disease
  • Few side effects
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11
Q

Salmon Calcitonin

A
  • More potent and longer duration than human form

- Peptide drug (SC or IM)

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12
Q

Bisphosphonates

A
  • Bind to bone matrix and inhibit osteoclasts to decrease bone turnover
  • Hypercalcemia, osteoporosis, Paget’s disease
  • Poorly absorbed with food
  • Excreted in kidney without metabolism (avoid in kidney disease)
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13
Q

Newer Bisphosphonates

A

-Esophageal ulcers: take overnight while standing up with copious amounts of water, no food for 30 minutes, and remain standing for 30 minutes
-SIde effects:
Ab pain, nausea and vomiting
Osteonecrosis of Jaw (cancer patients)
Femur fractures w/ long term use (atypical fractures)

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14
Q

Alendronate

A
  • Osteoporosis and Pagets

- Oral, effervescent prep available

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15
Q

Ibandronate

A
  • Postmenopausal osteoporosis
  • Oral tablets (daily or monthly)
  • IV injection every 3 months
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16
Q

Zoledronate

A
  • IV use for osteoporosis
  • Prevention and treatment
  • Paget’s (recommended Tx) and hypercalcemia of malignancy
  • AVOID IN RENAL DISEASE
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17
Q

Teriparatide

A
  • PTH hormone analog (short)
  • Acts on GPCR to increase cAMP
  • Increases resorbtion of Ca and Phosphate (bone)
  • Increases reabsorption of Ca and stim vit D activation (Kidney)
  • Increases absorption of Ca and phosphate (GI tract)
  • Daily SC injection
  • stimulates bone formation because of short duration of action and low levels
  • Tx of Osteoporosis
  • Anabolic as opposed to anti-resorptive effects of calcitonin and bisphos
  • Increase risk of bone cancer: Paget’s, incr. alk phos, and open bone epiphysis
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18
Q

Denosumab

A
  • Monoclonal antibody against Rank-L which is usually suppressed by estrogen
  • Rank-L activates osteoclasts
  • Injection (2/yr)
  • Postmenopausal women with osteoporosis w/ Hx of fracture risk
  • Cancer Pts to treat bone break down from metastasis, men w/ prostate cancer (androgen deprivation)
  • Suppression of bone remodeling –> ONJ, incr fracture risk, delayed fracture healing
  • Hypocalcemia
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19
Q

Estradiol

A
  • Orally –> rapid first pass metabolism
  • Slow release depot forms
  • Topical preps (vaginal creams, vaginal rings, transdermal patches, transdermal spray, microionized oral prep.)
  • Used mainly for HRT and hypogonadism
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20
Q

Conjugated Estrogens

A
  • Natural estrogen preparations
  • Conjugates and salts of estrone and estriol
  • Premarin
  • Oral, IV, IM, and vaginal
  • Mainly used for HRT
21
Q

Ethinyl Estradiol

A
  • Ethinyl group slows degradation
  • Increases potency, oral effectiveness, and duration of action
  • Oral contraceptives
22
Q

HRT treats:

A
  • Vasomotor (hotflashes palpitations) good response
  • Urogenital atrophy: (incontinence dyspareunia, and UTI)
  • Psychological Disturbances: Mood changes, depression
  • Osteoporosis: Bone loss increased fracture, major indication for therapy. Alter cytokine synthesis and inhibit osteoclasts
  • Women who have lost gonadal function
23
Q

Cancer in HRT

A
  • Estrogens alone increase risk of CA
  • Adding progestin greatly reduces this risk
  • Estrogens and progesterone increase breast cancer risk
24
Q

Heart Disease in HRT

A
  • Estrogens alone decrease myocardial risk

- Progesterones with estrogens reverse risk reduction

25
Q

HRT preps

A
  • Conjugate estrogens commonly used
  • Ethinyl estradiol becoming more common
  • preps with estradiol itself becoming more popular (medroxyprogesterone)
26
Q

Women’s health Initiative

A
  • Reduce hip fracture
  • Red. Colorectal cancer
  • Incr. in coronary artery disease, strokes, and PE
  • Incr risk of breast & lung cancer
  • Treat menopausal symptoms (short term) is probably okay
27
Q

Selective Estrogen Response Modifiers

A
  • Steroid analogs with mixed agonist-antagonist properties
  • Some tissues full agonist while full antagonist in other tissues
  • Agonism vs. antagonism determined by position stabilized by analog
28
Q

2 SERMs currently available

A
  • Tamoxifen and Raloxifene
  • Tamoxifen: Bad at Uterus cancer, clotting factors/stroke, and menopausal symptoms
  • Raloxifene: Bad at Clotting factors/stroke, and menopausal symptoms
29
Q

Tamoxifen

A
  • Orally effective
  • Used as anti-estrogen in breast cancer but agonist in other tissues
  • Breast cancer preventative therapy (good)
  • May decrease osteoporosis and improve blood lipid panels
  • Uterine cancer incr risk, incr. risk of thrombosis, cause hot flashes
30
Q

Raloxifene

A
  • Orally effective
  • agonist on bone (OSTEOPOROSIS only use)
  • Antagonist for breast cancer prevention (no increase risk)
  • Improves lipid profile
  • Causes hot flashes and increases stroke/clot risk
31
Q

Oral Contraceptive pills

A
  • All contain ethanol estradiol and and 19-nor progestin
  • Traditionally active pill for 21 day and 7 day non-active
  • Inhibit ovulation by disrupting cyclical release of gonadotropins (Feedback suppressive therapy)
  • Decrease likelihood of fertilization if ovulation happens due to changes in cervical mucous, endometrium, and fallopian tube secretions
  • Endometrial changes that decrease likelihood of successful implantation
  • Onset of menstruation at end of pill cycle
32
Q

Norethindrone and Levonorgestrel

A

-Androgenic and anabolic

33
Q

Norethynodrel

A

-Estrogenic, not androgenic

34
Q

Norgestimate

A

-not androgenic or estrogenic (pure progesterone)

35
Q

Drospirenone

A

-anti-androgenic and anti-mineralocorticoid activity

36
Q

-Etonogestrel

A

-Used in several unique preparations

37
Q

Drugs that decrease efficacy of OCPs

A
  • Antibiotics (enterohepatic recirc and induce liver enzymes)
  • Anti-epileptic drugs induce liver enzymes
38
Q

Mini Pill

A
  • Only oral progesterone
  • Norethindrone and Norgestrel
  • Not as effective
  • Taken Daily, not cyclically
  • Lack of regular menstruation and occurrence of irregular bleeding (6-8 wks w/o blood = pregnancy test)
  • Ovulation still occurs but fertilization and implantation are prevented
39
Q

Medroxyprogesterone

A
  • Depo-Provera
  • IM injection every 3 months
  • Possible toxicity (don’t use on woman who may want kids later)
40
Q

Etonogestrel

A
  • Single rod implant effective for 3 yrs
  • Irregular bleeding
  • 4% complications with 2% causing removal
41
Q

Emergency post-coital contraceptives

A
  • Estrogen, progestin or estrogen plus progestin taken after intercourse to prevent pregnancy
  • Inhibit ovulation if it hasn’t occurred
  • inhibit fertilization and/or implantation
  • Lead to menstruation when pills are stopped
  • Reasonably effective
42
Q

Plan B

A

Levonorgestrel only

  • 2 pills within 72 hrs
  • One step = 1 pill available OTC to girls 15 yrs older
43
Q

Next Choice

A

Levonorgestrel only

-2 pills 12 hrs apart within 72 hrs

44
Q

Ella

A
  • Ulipristal
  • Agonist/antagonist progesterone receptors
  • Structurally related to mifepristone
  • Up to 5 days after intercourse
  • Prescription
  • Inhibit gonadatropin release and prevent maintenance
45
Q

Mifepristone

A
  • Progesterone receptor antagonist whihc disrupts maintenance of the endometrium
  • Increases PG synthesis -> stimulation of uterine contractility for expulsion of fetus
46
Q

Methotrexate plus misoprostol

A
  • Another abortion approach
  • Methotrexate is folic acid antagonist = cytotoxic to trophoblast
  • Mistoprostol -> uterine contraction
47
Q

Bromocriptine

A
  • Dopamine agonist
  • Inhibits prolactin secretion
  • Use if prolactinemia is cause
48
Q

Danazol

A
  • Weak androgen used in endometriosis is problem

- Androgen -> inhibition of gonadotropin secretion -> decrease estrogen synthesis

49
Q

Clomiphene

A
  • Non-steriodal estrogen partial agonist
  • Anti estrogen blocks estrogen feedback inhibition of gonadotropin release, functional pituitary is required for the function of this drug

Pharm (8 decks)

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