L44 Fertility agents, contraceptives, and oxytocics →↑↓

Question 1

MoA of Oral Contraceptives Combined pill

Answer 1

Estrogen-progestin combination

Source of hormone from pills → ↑negative
feedback → selective inhibition of pituitary
function
↓ release of LH → prevent ovulation
↓ release of FSH → ↓ development of
ovarian follicle

Other actions
→Change in the cervical mucus in the uterus
→ Change motility and secretion in the uterus
→ ↓ conception & implantation

Question 2

MoA of Progestin-only contraceptives (Mini-pill)

Answer 2

Mechanism of action

Inhibit hypothalamus →slow the frequency of GnRH pulse generator → inhibit/reduce release of LH → prevent ovulation

Thickening of cervical mucus →↓sperm
penetration

Endometrial alterations →↓ implantation

Question 3

Morning after pill

Answer 3

→Temporarily stops the release of an egg from the ovary
→Prevents fertilization
→Prevents implantation

Question 4

MoA of Ulipristal acetate

Answer 4

selective progesterone receptor modulator,

Side effects
Headache, nausea, dizziness, fatigue, dysmenorrhea, abdominal pain, back pain and breast tenderness

Question 5

Some common side effects of Oral contraceptives

Answer 5

Headache, breast tenderness & depression
Nausea and vomiting
Increase risk of breast cancer for combination pill
(decrease endometrial and ovarian cancer)

Thromboembolism (blood clots) 35 yo smokers should avoid combination pill
Hypertension

Fluid retention and weight gain (less with current medication with reduced amount of hormones)

Question 6

Selective estrogen receptor modulators

(SERMs) Tamoxifen

Answer 6

tamoxifen,

Partial agonist inhibitor of estrogen receptor

S/E
Hot flushes, nausea and vomiting

Question 7

MoA, S/E of Selective estrogen receptor modulators

(SERMs) Raloxifene

Answer 7

raloxifene

Use for prevention of osteoporosis in postmenopausal women (alternative to estrogens in patients with risk and history of cancer) and prophylaxis of breast cancer in women with high risk

No effect on endometrium and breast

Question 8

Mechanism Type and S/E of Fertility Agents →↑↓

Answer 8

Partial agonist and competitive endogenous estrogen inhibitor

Clomiphene

MoA
Inhibit negative feedback of estrogen →↑secretion of LH & FSH →↑estrogen & progesterone→↑
stimulation of follicles → maturation of follicle→ ovulation

S/E
Stimulation of ovaries by FSH → enlargement, abdominal discomfort and risk of ovarian cancer (over 12 cycles)

Question 9

Other supportive treatments of Fertility agent

Answer 9

Bromocriptine and Cabergoline
→ reduce prolactin released
by pituitary

GnRH
→ stimulate LH and FSH release

Medrol
→ a steroid to assist pre-embryo implantation

Doxycyclin
→ for male partner to reduce levels of bacteria in
semen

Question 10

Drugs Affecting Uterine Motility

Oxytocics

Answer 10

Uterine-stimulating

→Oxytocin
→→Contract uterus to prevent or control bleeding after term delivery or abortion
→→Stimulate milk let-down reflex (initiate milk ejection for nursing mother) [as nasal spray],
→Increase sensitivity of uterus to oxytocin during pregnancy

→prostaglandins (E & F type)
→→Terminate early and middle pregnancy
→→→→Control persistent postpartum hemorrhage due to lack of normal uterine tone or strength

Uterine-relaxing
β2 stimulants
→Uterine relaxants are used to inhibit uterine contractions
major indiciation
→→to delay premature labor until term or until the fetus has matured sufficiently for survival.