Obstetric and gynaecological

Question 1

Ethinylestradiol

Answer 1

Estrogen component

Question 2

Estetrol

Answer 2

Estrogen component

Question 3

Estradiol

Answer 3

Estrogen component

Question 4

Cyproterone

Answer 4

Progesterone component

progestogenic and anti-androgenic, and is used with an estrogen to treat women with androgenisation. The combination also provides effective contraception but is not indicated as a COC in the absence of androgenisation.

Question 5

Desogestrel

Answer 5

Progesterone component

Less androgenic activity than levonorgestrel

Question 6

Drospirenone

Answer 6

Progesterone component

Related to spironolactone
Has anti-mineralocorticoid (mild diuretic and potassium retention) and anti-androgenic activity.

Question 7

Gestodene

Answer 7

Progesterone component

Less androgenic activity than levonorgestrel

Question 8

Levonorgestrel

Answer 8

Progesterone component

Good first choice as it has lower VTE risk.

Question 9

Nomegestrol

Answer 9

Progesterone component

Some anti-androgenic activity.

Question 10

Norethisterone

Answer 10

Progesterone component

Good first choice as it has lower VTE risk.

Question 11

Dienogest

Answer 11

Progesterone component

Anti-androgenic activity

When used as contraceptives, progestogens thicken cervical mucus to impede the passage of sperm and change the endometrium, reducing the potential for implantation. They act on the hypothalamus and suppress pituitary LH surge and may inhibit ovulation. Depot injection and implant reliably suppress ovulation; oral progestogen-only contraceptives suppress ovulation to varying extents (eg levonorgestrel suppresses ovulation in up to 60% of cycles, drospirenone in up to 100% of cycles).

Progestogens also induce atrophy within ectopic endometrium.

Question 12

Combined oral contraceptives (COC)

Answer 12

All COCs contain an estrogen and progestogen. They inhibit ovulation, reduce receptivity of endometrium to implantation and thicken cervical mucus to form a barrier to sperm.

Question 13

Etonogestrel

Answer 13

Progesterone

When used as contraceptives, progestogens thicken cervical mucus to impede the passage of sperm and change the endometrium, reducing the potential for implantation. They act on the hypothalamus and suppress pituitary LH surge and may inhibit ovulation. Depot injection and implant reliably suppress ovulation; oral progestogen-only contraceptives suppress ovulation to varying extents (eg levonorgestrel suppresses ovulation in up to 60% of cycles, drospirenone in up to 100% of cycles).

Progestogens also induce atrophy within ectopic endometrium.

Question 14

Levonorgestrel IUD

Answer 14

Levonorgestrel released from the IUD has a local effect on the endometrium, preventing implantation; thickening of cervical mucus impedes passage of sperm. Ovulation is suppressed in some women.

Plus progesterone effect.

Question 15

Progesterone

Answer 15

When used as contraceptives, progestogens thicken cervical mucus to impede the passage of sperm and change the endometrium, reducing the potential for implantation. They act on the hypothalamus and suppress pituitary LH surge and may inhibit ovulation. Depot injection and implant reliably suppress ovulation; oral progestogen-only contraceptives suppress ovulation to varying extents (eg levonorgestrel suppresses ovulation in up to 60% of cycles, drospirenone in up to 100% of cycles).

Progestogens also induce atrophy within ectopic endometrium.

Question 16

Medroxyprogesterone

Answer 16

When used as contraceptives, progestogens thicken cervical mucus to impede the passage of sperm and change the endometrium, reducing the potential for implantation. They act on the hypothalamus and suppress pituitary LH surge and may inhibit ovulation. Depot injection and implant reliably suppress ovulation; oral progestogen-only contraceptives suppress ovulation to varying extents (eg levonorgestrel suppresses ovulation in up to 60% of cycles, drospirenone in up to 100% of cycles).

Progestogens also induce atrophy within ectopic endometrium.

Question 17

Ulipristal

Answer 17

Progesterone receptor modulator with antagonist and partial agonist effects, which prevents or delays ovulation.

Question 18

Etonogestrel with ethinylestradiol (Vaginal ring)

Answer 18

Hormones released from the vaginal ring are absorbed into the systemic circulation, inhibiting ovulation. They may also reduce receptivity of endometrium to implantation and thicken cervical mucus to form a barrier to sperm.

Question 19

Conjugated estrogens

Answer 19

Estrogen relieves menopausal symptoms (eg hot flushes, night sweats, urogenital atrophy) and prevents BMD loss caused by reduced endogenous estradiol production. Progestogen reduces risk of endometrial cancer associated with unopposed estrogen.

Question 20

Bazedoxifene

Answer 20

Bazedoxifene is a selective estrogen receptor modulator with estrogen agonist effects on bone, and antagonist effects on breast and uterine tissue. It reduces the risk of endometrial hyperplasia associated with unopposed estrogen.

Question 21

Estradiol (HRT)

Answer 21

Estrogen relieves menopausal symptoms (eg hot flushes, night sweats, urogenital atrophy) and prevents BMD loss caused by reduced endogenous estradiol production. Progestogen reduces risk of endometrial cancer associated with unopposed estrogen.

Question 22

Tibolone

Answer 22

Acts as an estrogen on vagina, bone and thermoregulatory centres in brain. Has progestogenic and anti-estrogenic effects on breast and endometrium.

Question 23

Danazol

Answer 23

SAS product

Steroid hormone that inhibits ovulation and suppresses menstruation. In hereditary angioedema danazol increases concentration of C1 esterase inhibitor.

Question 24

Nifediipine (Obstetrics)

Answer 24

Relaxes uterine smooth muscle via blockade of calcium channels.

Question 25

Salbutamol (Obstetrics)

Answer 25

Relaxes uterine smooth muscle via effect on uterine beta2 receptors

Question 26

Magnesium sulfate

Answer 26

Unclear; neuroprotective effect (including in pre-eclampsia and eclampsia) may be related to blocking of glutamate receptors, preventing post-hypoxic brain injury. Effect in pre-eclampsia and eclampsia may also include vasodilation (via smooth muscle relaxation), resulting in reduction of cerebral ischaemia.

In asthma, effect involves relaxation of bronchial smooth muscle.

Question 27

Carbetocin

Answer 27

Oxytocin analogue

Stimulates uterine muscle contraction.

Question 28

Ergometrine

Answer 28

Ergot alkaloid

Stimulates contraction of uterine smooth muscle.

Question 29

Oxytocin

Answer 29

Stimulates uterine muscle contraction.

Question 30

Dinoprostone/ Prostaglandin E2

Answer 30

Soften and dilate the cervix and induce uterine contractions via their actions on smooth muscle (may also have other effects, eg on blood vessels, bronchi, GIT).

Question 31

Gemeprost

Answer 31

Prostaglandin E1 analogue

Soften and dilate the cervix and induce uterine contractions via their actions on smooth muscle (may also have other effects, eg on blood vessels, bronchi, GIT).

Question 32

Misoprostol

Answer 32

Prostaglandin E1 analogue

Soften and dilate the cervix and induce uterine contractions via their actions on smooth muscle (may also have other effects, eg on blood vessels, bronchi, GIT).

Question 33

Mifepristone

Answer 33

Progesterone receptor antagonist that dilates the cervix and sensitises the myometrium to the effects of prostaglandins. It also has dose-dependent antiglucocorticoid effects (whether this occurs after a single dose of 200 mg is unclear).