Pharmacology

Question 1

Misoprostol: MOA?

Answer 1

Prostaglandin E1 analog, causes cervical ripening and uterine contractions

Question 2

Misoprostol: indications?

Answer 2

Induction of labor, inevitable spontaneous abortion,

medical abortion

Question 3

Mifepristone: MOA?

Answer 3

Progesterone receptor antagonist, causes: 1) necrosis of decidual layer, detachment of implanted embryo, 2) cervical ripening

Question 4

Mifepristone: indications?

Answer 4

Medical abortion

Question 5

Dopamine agonists

Answer 5

Bromocriptine
Cabergoline
Pergolide

Question 6

Letrozole: MOA?

Answer 6

Aromatase inhibitor

Question 7

Letrozole: indications?

Answer 7

Induction of ovulation

Question 8

Clomiphene citrate (Clomid): MOA

Answer 8

Estrogen receptor antagonist

Question 9

Clomiphene citrate (Clomid): indications

Answer 9

Induction of ovulation

Question 10

Hormone therapy: MOA

Answer 10

Low dose estrogen

Question 11

Hormone therapy: indications

Answer 11

Menopausal symptoms, e.g. hot flashes, sleep disturbances, vaginal dryness

Question 12

Ethinyl estradiol: MOA

Answer 12

Synthetic estradiol in pill, patch, ring

Question 13

Conjugated estrogens: MOA

Answer 13

Naturally occurring estrogens

Question 14

Conjugated estrogens: indications

Answer 14

Hormone therapy

Question 15

Medroxyprogesterone: indications

Answer 15

Contraception: IM progestin injection every 3 months
[Note: delay in return of fertility]

Tx for endometriosis

Question 16

Levonorgesterol: MOA

Answer 16

Progesterone receptor agonist

Thickens cervical mucus, preventing sperm transport

Question 17

Levonorgesterol: indications?

Answer 17

Mirena IUD

Question 18

ID: Norgestimate, desogestrel, drospirenone

Answer 18

Progestins

Question 19

Estrogen-containing contraceptives: contraindications

Answer 19

Women >35 who smoke –> increased risk of MI, stroke
Hx of blood clots: DVT’s, PE, Factor V Leiden
Migraine with aura –> increased risk of stroke

Question 20

Copper IUD: MOA

Answer 20

Causes inflammatory reaction toxic to sperm and ova

Question 21

Etonogesterol (Nexplanon): MOA

Answer 21

Progestin implant
Thickens cervical mucus, preventing sperm transport
Inhibits ovulation (progesterone suppresses GnRH)

Question 22

Mirena vs Liletta vs Kyleena vs Skyla

Answer 22

Mirena: highest dose, longest lasting, recommended for heavy and long periods

Skyla: lowest dose, smaller/narrower = less pain with insertion

Question 23

Combined estrogen and progestion contraptive methods: MOA

Answer 23

Estrogen and progesterone continually suppress HPG axis

Question 24

What is the “mini-pill,” and who is it recommended for? What is its pattern of use?

Answer 24

Progestin only pill
Contraceptive for women with contraindications to estrogen and breastfeeding women

Must be taken at same day

Question 25

Emergency contraceptive options & time frame

Answer 25

- Copper IUD: most effective, up to 5 days (120 hrs) - Levonorgesterol pills ("Plan B"): best if within 72 hrs, up to 5 days - Ulipristal acetate ("Ella"): up to 5 days, more effective than levonorgesterol in women with elevated BMI (>160 lbs)

Question 26

Ulipristal acetate: MOA

Answer 26

Progesterone receptor modulator with anti-progestin activity

Question 27

Ulipristal acetate: indications

Answer 27

Emergency contraception, esp in women with elevated BMI

Question 28

Pitocin: MOA

Answer 28

Synthetic oxytocin

Question 29

Pitocin: indications

Answer 29

Induce/increase labor contractions Decrease blood loss before placenta comes out to decrease blood loss

Question 30

Tocolytics: indications

Answer 30

Arrest labor and delay delivery

Question 31

Indomethacin: MOA

Answer 31

Prostaglandin synthesis inhibitor

Question 32

Indomethacin: indications

Answer 32

Arrest labor in pregnancy Close PDA in fetus Pain relief

Question 33

Tocolytics: drug options

Answer 33

Nifedipine (Ca channel blocker) Indomethacin (prostaglandin synthesis inhibitor) Beta-2 agonist (terbutaline) Magnesium sulfate (least effective but still widely used)

Question 34

Betamethasone (in pregnancy): indications

Answer 34

- give to moms entering preterm labor - increases maturation of type II alveolar cells - stimulates surfactant production - helps to reduce risk of neonatal respiratory distress syndrome

Question 35

Tamsulosin: MOA

Answer 35

Alpha adrenergic blocker

Question 36

Tamsulosin: indications

Answer 36

BPH

Question 37

Alpha adrenergic blockers in BPH: MOA

Answer 37

Relax bladder neck tone and prostate smooth muscle to improve urinary flow

Question 38

5-alpha-reductase inhibitors in BPH: MOA

Answer 38

Decreased conversion of testosterone to DHT decreases prostatic growth signal

Question 39

Ospemifine: MOA

Answer 39

Selective estrogen receptor modulator, targets vaginal tissue

Question 40

Ospemifine: indications

Answer 40

Dyspareunia due to atrophy