Lecture 79/80 - Clinical Uses of Gonadal Hormones

Question 1

what are the primary indications for uses of androgens?

Answer 1

Hypogonadism 
		Cryptorchidism 
		Weight gain
		Anemia
		Endometriosis

Question 2

adverse effects of androgen use?

Answer 2

Stimulation of “latent” prostatic neoplasm in Elderly men

Retardation of Growth in young boys

Virilzing effects in women

High Doses – hepatotoxicity, CHF, Renal Failure, Aggressive behavior

Question 3

treatment of BPH

Answer 3

alpha blockers

5alpha reductase inhibitiors (Finasteride); prevents conversion of testosterone to DHT

Question 4

medication regimen of prostate cancer?

Answer 4

Anti-Androgen Therapy + LHRH analogs

LHRH analog – negative feedback on hypo/pit axis = no LH = no steroidogenesis

Question 5

anti-androgen medications described in this lecture

Answer 5

• = In First AID

*Flutamide - non steroidal competitive inhibitor of androgen receptors
Casodox = most commonly used for prostate cancer
Ambiraterone - androgen synthesis inhibtors

• finasteride
• ketoconazole
• sprionolactone

Question 6

what drugs are in the most common form of “the pill”

Answer 6

Estrogen and progesterone

Question 7

what are the effects of estrogen in the OCP

what are the effects of progesterone

Answer 7

1) Estrogen prevents the LH Surge
2) Progesterone changes secretions of the endometrium
3) Progesterone changes the cervical mucus such that less penetrable by sperm

Question 8

Most common / concerning side effects of OCP

Answer 8

The Main Concern:
1) Smoking women over 40 – higher mortality

The most Common side effects:

1) breakthrough bleeding – most common; but alleviated by changing proportions of estrogen/progesterone
2) N/V/ HA – but transient (progesterone effects)
3) CVD complications
4) HTN

Question 9

what are the LARCs
what drug(s) is/are used?

Answer 9

LARC – long acting reversible contraception

Depoprovera – medroxyprogesterone
injection every 3-4 months

Nexplanon / Implanon – Device containing progestin which is implanted under the arm;
Effective for up to 3 years

Question 10

what are other indications for taking estrogen/progesterone pills

Answer 10

Prolongation of cycles
Dysmenorrhea
Dysfunctional bleeding
Primary and secondary amenorrhea

Question 11

Uses for progestin alone

Answer 11

Endometriosis (don’t want unopposed estrogens)
Endometrial cancer
The morning after pill - high dose progesterone

Question 12

Mifeprestone – mechanism and clinical use?

Answer 12

Competitive inhibition of progesterone receptor

Direct action at the endometrium; leads to shedding of the endometrium, and therefore a termination of an implnated pregnancy

Question 13

Uses of hormonal replacement therapies

Answer 13

Menopausal symptoms

Osteoporosis

Question 14

Uses of anti-estrogens

Answer 14

Infertility

Breast cancer

Question 15

Drug used for inferility

Answer 15

Clomiphene

Question 16

Drugs used for ER+ breast cancer

Answer 16

Tamoxifen

Aromatoase inhibitors: Letrozole, Anastrozole, Aromasin