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Reproductive > Pharm Reproductive > Flashcards

Pharm Reproductive Flashcards

1
Q

Timing of drug exposure in utero is important; organogenesis occurs?

A

Weeks 3-9

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2
Q

HCV first line tx?

A

acylovir (pro-Rx = valcyclovir - lower dose
Ae - neurotoxicity/ seizures
Nephrolithiasis (dose adjust w/ renal failure)
Resistance: requires thymidine kinase activation

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3
Q

First line tx for syphillis?

A

Penicillin G

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4
Q

Caused by release of spirochetes all at once in secondary syphilis hours after tx initiation

A

Jarisch-Herxhemier Rxn

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5
Q

Macrolide given for Chlamydia; CYP3A4 interaction; in an infant can cause hypertrophic pyloric stenosis

A

Erythromycin

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6
Q

4 classes of Rx to tx Chlamydia

A

Macrolides - Azithromycin or Erythromycin
Doxycyline - Tetracycline
Flouroquinolones - Levofloxacin or ofloxacin
B lactam - Amoxicillin

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7
Q

3 class of Rx for Chanchroid

A

Similar to chlamydia except no tetracycline
Macrolides - Azithromycin or Erythromycin
Flouroquinolones -Ciprofloxacin
B lactam - Cetriaxone

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8
Q

Rx regimen for Gonorrhea

A

Ceftriaxone or Cefixime (genital not oral)

and azithromycin & doxycycline(resistance)

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9
Q

tx for trichomonas

A

Metronidazole (stops nucleic acid synthesis when reduced to ionized form) or Tinidazole
Has a disulfuram-like effect

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10
Q

For ER+ metastatic BC w/ progression following anti-estrogen therapy
Contains a bulk substituent that prevents the dimerization leading to disruption of nuclear localization
Monthly IM, sustained levels

Selective Estrogen Receptor Down-regluator

A

Fulvestrant

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11
Q

SERM
Estrogen antagonist in breast tissue and agonist in endometrial tissue
CYP2D6- suboptimal clinical effect in poor metabolizers  metabolized to enoxifen (more effective than tamoxifen),
5 years of tx
More effective for BRCA2 than BRCA1

A

Tamoxifen

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12
Q

SERM
monthly IM injections
no endometrial agonism

A

Raloxifene

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13
Q

SERM
2nd generation derived from Tamoxifen
No BBW in previous slides,
Prolongs QT (add. Moety that inhibits MTs)
Avoid w/ 3A4 inhibitors
Avoid w/ history of endometrial cancer/ hyperplasia, thromboembolic disease

A

Toremifene

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14
Q

Current recommendation, after 5 years of tamoxifen, give add 5 years of aromatase inhibitors for post-menopausal woman
AE:
1- Increased arthralgia compared to SERMS
2- produce cataracts
4- more diarrhea than tamoxifen

**no good giving this Rx pre-menopausally because most of the estrogen comes from the ovary & giving this can stimulate GnRH release and drive estrogen up further
What are the non-steroidal AIs?
the steroidal?

A

Non-steroidal: Anastrozole, letrozole

steroidal (irreversible): exemestane

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15
Q

mAb for HER2 extracellular domain

Cardiomyopathy, infusion rxns, respiratory insuffiency, hepatotoxicity

A

Trastuzumab

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16
Q

HER2 EC domain linked to DM1 w/ BBW for HF, liver disease, ventricular dysfuncion

A

Ado-Trastuzumab

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17
Q

mAb for HER2 dimerization domain

A

Pertuzumab

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18
Q

TKI for HER1 and HER2; competes w/ ATP binding site
Liver Disease
interstitial lung disease, pneuomonitis, QT prolongation

A

Lapatanib

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19
Q

Breast Cx tx
Less likely to be used; endocrine therapy
Only beneficial under limited circumstances
(will be seen less frequently)
Can be used if pre-menopausal at dx and wishes to keep option of childbearing open

Increases the pain arising from bone mets of cancer
(can cause a disease flair)

A

Goserelin

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20
Q

mTOR inhibitor (central regulator of cellular proliferation, angiogenesis, cell metabolism)

A

Everolimus

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21
Q

Tx for endometrial cx; binds to progestin receptors to decrease GnRH
Amenorrhea, edema, weakness, anorexia

A

Meroxyprogesterone

22
Q

tx for endometrial cx

synthetic oral progestin, blocks LH, increases estrogen degedation; promotes mainentance of the endometrium

23
Q

Bladder Cx
IVe instillation common
Mono & bi-funcional alkylating agent
Chemical cystitis, contact dermatitis, palmar, plantar erythema (poor hand hygiene) – contact w/ the void volume
Pulmonary infiltrates

24
Q

Bladder Cx
IVe (intravesicular instillation), can produce hemorrhagic cystitis
Polyfunctional alkylator w/ loss of aziridine (alkylator) moiety
Dysuria, urinary retention, hemorrhagic cystitis, renal dysfunction

25
Q

Prostate Cx GnRH agonists

A

Leuprolide
Triptorelin
Histrelin
Goserelin

26
Q

GnRH Antagonist

A

Degarelix

Hepatotoxic, QT prlongation

27
Q

Androgen Receptor Blockers

A

Bicalutamide
Enzalutamide
Flutamide - more hepatotoxic
Nilutamide - less hepatotoxic

28
Q

Prostate Cx

Estrogen binding protein; inhibits MTs and causes ds breaks

A

Estramustine

29
Q

Prostate Cx

Take the pt’s APCs and modify them to attack the cx - then return to the prostatic acid phosphatase (PAP)

A

Sipuleucel

30
Q

Inhibit 17 alpha hydroxylase to prevent production of DHEA and androstenedione
increase aldosterone and cortisol

A

abiraterone

31
Q

Anti-cholinergics for urinary incontinence

long acting available? - usually these are short acting selective

A

Oxybutynin - long-acting available

Tolterodine - long acting available

32
Q

Anti-cholinergics for urinary incontience
positively charged, cannot get across the blood brain barrier, so it is less likely to produce somnolence?
non-selective
quaternary amine
no CYP metabolism

A

Trospium - + charge

33
Q

Anti-cholinergics for urinary incontinence

highest oral avialability (VESicare)

A

Solifenacin - highest oral avia

34
Q

Anti-cholinergics for urinary incontinence

M3 selective, poor bioavailability

A

Darifenacin

35
Q

Used in pts response to anti-cholinerfics but who cannot tolerate the side effects

36
Q

Tx urinary incontinence
B3 agonist, increases bladder capacity by relaxing detrusser sm; decreased bioavailability with food, 3A4&raquo_space; 2D6 butylcholinesterase, UGT & alcohol dehydrogenase, ~10% as parental drug, ~50 hours
Increases blood pressure, tachycardia

A

Miragebron

37
Q

inhibits AChE; augments action of Ach at both muscarinic and nicotinic receptors; < 1 hour

A

Neostigmine [Prostigmin]

38
Q

Prostaglandins - labor induction

150 per insert, timed release, but can be removed from the vaginal fornix if uterine hyperstimulation occurs

A

Dinoprostone

39
Q

Prostaglandins - labor induction

cheapest; oral; should not be used within 4 hours of OT due to risk of uterine rupture

A

Misoprostol, PGE1 (Cytotec)

40
Q

most commonly used tocolytic Rx in the US;, which antagonizes calcium, at EC and IC levels – blocking membrane and intracellular channels which decreases myometrial contractility; neuroprotective agent (prevents cerebral palsy in infant)
Monitor petallar reflexes & urine output/
Not used in women w/ myasthenia gravis, renal insufficiency  flushing, nausea, vomiting, blurry vision, headache, lethargy , HOTN, pulmonary edema
Used to treat pre-eclampsia/ eclampsia; anti-convulsant

A

Magnesium sulfate

41
Q

OT receptor antagonist (18 min half-life); only used in Europe not, FDA approved b/c increased deaths in infants exposed to Atosiban

42
Q

2 common synthetic estrogens

A

Ethinyl estradoil

Mestranol

43
Q

3 formulations of progesterone

A

Norethindrone
Noregestrel
Levonorgestrel

44
Q

Injectable BC

A

Medroxyprogesterone

45
Q

Progesterone implant

A

Etonogestrel

46
Q

2 types of IUDs

A

Copper (kills sperm)
progestin releasing
(fertility is quickly restored after removal)

47
Q

Morning after pill?

A

2 doses of levonorgestrel within 72 hours of intercourse

48
Q

Termination of pregnancy:

A

Mifepristone (7 weeks)

Onapristone (anti-progeseterone)

49
Q

Alpha receptors
Lower - trigone, prostatic urethra, prostatic gland, penile urethra
Upper - detrusser muscle

A 
Lower = alpha 1a
Upper = alpha 1d
50
Q

Only alpha 1 blocker that requires titration

51
Q

Alpha blockers for BPH -
Common side effects?
Advantage of selective alpha -1a blockers?

A

Common side effects? xerostomia, nausea, dizziness, insomnia
No need for dose titration
Retrograde ejaculation

Reproductive (6 decks)

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