Leffler 1.0

Question 1

FSH

Answer 1

• hormone
• made and released by gonadotropes in the pituitary gland
• stimulates germ cells in:
  
  • females-ovarian follicles
  • males-sertoli cells
• Secreted in pulses
• works synergystically w/LH to regulate reproduction
• increase in peri/postmenopausal women
• GnRH regulates release
• Drugs:
  
  • Urofollitropin
    
    • purified from urine of PM women, w/LH
  • Follitropin alpha & beta
    
    • recombinant FSH, without LH

Question 2

LH

Answer 2

• hormone
• made and released by gonadotropes in the pituitary gland
• LH Surge triggers ovulation
• secreted in pulses
• works synergistically w/FSH to regulate reproduction
• increased in peri/postmenopausal women
• GnRH regulates release
• LH levels are measured in “ovulation prediction kits” to help couples conceive
• Drugs:
  
  • Lutropin
    
    • recombinant LH
    • administered: IM

Question 3

Menotropins

Answer 3

• aka Human Menopausal Gonadotropin; HMG
• Gonadotropin mix of FSH & LH
• Hormonally active medication to treat infertility
• stimualtes ovaries to mature ovarian follicles
  
  • increase fertility
• Are extracted from teh urin of PM women
• can be administered to men to stimulate sperm production
• Drugs:
  
  • Pergonal
  • Repronex
  • Administered IM daily

Question 4

hCG

Answer 4

• made from fertilized egg after conception
• analog of LH
• LH-like activity
  
  • some FSH
• stimulates ovulation
• helps uterus thicken
• maintain growing fetus during pregnancy
• Synthesized by placenta–>Post contraception hormone
• Major side effects:
  
  • multiple births
• Drugs:
  
  • Pregnyl
  • Admin: IM or SQ

Question 5

Clomiphene

Answer 5

• Antagonist
• Inhibits/binds to estrogen (E2) receptors in hypothalamus
  
  • Increases LH & FSH
• Major side effects:
  
  • multiple births
  • hot flashes
  • Visual disturbances
• Drugs:
  
  • Clomid
  • Admin: PO

Question 6

GnRH Agonists

Answer 6

• Synthetic 10 aa peptide
  
  • act like natural GnRH
• regulates LH & FSH
  
  • Admin:
    
    • pulse= Increase LH & FSH
    • continue= Decrease LH & FSH
• Drugs:
  
  • Leuprolide
  • Gonadorelin (-relin)
  • admin: IM, SQ

Question 7

GnRH Antagonists

Answer 7

• Synthetic 10 aa peptide
• Block GnRH receptors
  
  • Decrease LH & FSH
• Major Side effects
  
  • Headache
  • injection site reaction
  • hot flashes
  • weight gain
  • fatigue
  • increased hepatic transaminases
• Drugs: -relix
  
  • Cetrorelix
  • Ganirelix
  • Degarelix
  • Amind: SQ

Question 8

Drugs for Endometriosis

Answer 8

• GnRH Agonists
• GnRH Antagonists
• Danazol

Question 9

Danazol

Answer 9

• synthetic steroid w/weak androgen activity
• Suppresses ovarian function by inhibiting LH & FSH surge
• Therapy initiated during menstruation
  
  • continued for 3-6 months uninterupted
• Major side effects
  
  • elevated liver enzymes
  • jaundice
  • masculinization
• Drugs:
  
  • Danocrine
  • Admin: PO

Question 10

How does lactation work?

Answer 10

• Dopamine normally inhibits prolactin secretion

Question 11

Hyperprolactinemia

Answer 11

• High prolactin in blood
• suppresses gonadotropin (LH, FSH) release
• can cause:
  
  • galactorrhea
    
    • production and spontaneous flow of breast milk
  • amenorrhea
    
    • absence of menstruation
  • Gynecomastic
    
    • enlargement of breasts in men
  • infertility/impotence
• increases the risk of osteoporosis

Question 12

Drugs that affect lactation

Answer 12

• Dopamine Antagonists
  
  • increase prolactin secretion
• Dopamine agonists
  
  • decrease prolactin secretion

Question 13

Dopamine Agonists

Answer 13

• Bromocriptine
  
  • Stimulates D2 receptors
    
    • some D1 receptors
  • Side effects:
    
    • GI
    • headache
    • seizure
• Cabergoline
  
  • more selective for D2
  • fewer side effects
  • longer half life than bromocriptine
• All can cause:
  
  • nausea, headache, light head, orthostatic hypotension, fatigue, seizures (rare)