Pharmacology of Female Reproductive System Flashcards

1
Q

What is Endometriosis?

A

Characterized by dysmenorrhea, dyspareunia, dysuria, pain during defecation and infertility

Goal of treatment is to decrease pain and induce regression/ control further growth of ectopic endometrial tissue

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2
Q

What drugs can be used for endometriosis?

A
  1. Combined oral contraceptives
  2. Progestin
  3. GnRH agonists
  4. Anastrozole
  5. Danazol
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3
Q

How do combined oral contraceptives help with endometriosis? MOA?

A

reduce pain by decreasing mestrual flow and regressing endometrial growth

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4
Q

What are the adverse effects of combined oral contraceptives?

A

Nausea, bloating, headache

C/I in women with history of thromboembolism

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5
Q

What is the MOA of Progestin?

A

Induce atrophy of endometrial tissue

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6
Q

What are the adverse effects of progestin?

A

Breakthrough bleeding, weight gain, fluid rentention and mood swings

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7
Q

Mechanism of action for Goserelin, leuprolide and nafarelin?

A

inhibit ovarian estrogen production-> estrogen deprivation diminishes endometrial implants

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8
Q

What are the adverse effects of goserelin, leuprolide, and nafarelin?

A

Bone loss -> prevented with Bisphosphonates

and vasomotor symptoms

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9
Q

What is the MOA of Anastrozole?

A

competitive inhibitor of aromatase activity

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10
Q

Adverse Effects of Anastozole?

A

arthralgia, diarrhea and osteoporosis

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11
Q

What is the MOA of Danazol?

A

synthetic derivative of 17 ethinyltestosterone

results in decrease FSH and LH

induces anovulation, amenorrhea and endometrial atrophy

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12
Q

What are the adverse effects of Danazol?

A

acne, hirsutism, occasional irreversible virilization,

menstrual irregularities, decreased breast size,

hepatotoxic and thromboembolism

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13
Q

What is Polycystic Ovarian Syndrome?

A

characterized by menstrual irregularities, amenorrhea or anovulation, hirsutism, acne and infertility

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14
Q

What medications can be used for Polycystic Ovarian Syndrome?

A
  1. Combined oral contraceptives
  2. Spironolactone
  3. Finasteride, flutamide
  4. GnRH agonist
  5. Clomiphene
  6. Metformin
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15
Q

How do combined oral contraceptives help polycystic ovarian syndrome? MOA?

A

decrease serum testosterone levels by decreasing ovarian androgen secretion and stimulating hepatic synthesis of sex hormone binding globulin SHGB

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16
Q

What is the MOA of spironolactone?

A

aldosterone receptor antagonist

weak inhibitor of testosterone synthesis also 5 alpha reductase

17
Q

what is the MOA of finasteride and flutamide

A

anti androgen agents

also inhibts 5 alpha reductase and androgen R inhibitor

18
Q

What is the MOA of GnRH agonists fo PCOS?

A

suppress ovarian androgen and estrogen synthesis

19
Q

What is the MOA of Clomiphene citrate?

A

Ovulation inducer: blocks estrogen receptors in the hypothalamus and anterior pituitary inhibits estradiols negative feedback increase FSH and LH

20
Q

What is the adverse effect of clomiphene citrate?

A

ovarian hyperstimulation increase incidence with multiple births ovarian cysts and hot flashes

21
Q

What is the MOA of metformin?

A

corrects hyperinsulinemia in PCOS and may promote ovulation

22
Q

What is menopause?

A

characterized by symptoms of estrogen deficiency (hot flashes, chills, sweating, headache, palpitations, vaginal and urethral atrophy, osteoporosis, cardiovascular changes)

23
Q

What is the treatment for menopause ? and what is its MOA?

A

Post menopausal Hormonal Replacement Therapy

oral, transdermal and vaginal

lowest dose of estrogen for limited period of time

**can use bisphosphonates for bone loss

Hot flashes are the most common indication of short course of HRT

with intact uterus should take estrogen +progestin

24
Q

what are the adverse effects of post menopausal hormonal replacement therapy

A

estogen only replacement can cause endometrial carcinoma

vasomotor symptoms can be relieved by clonidine

25
What are uterine leiomyomas?
fibroids, myomas symptoms include: irregular excessive bleeding, pressure, pain during intercourse, pelvic pain, recurrent pregnancy loss, infertility, may be asymptomatic surgery is the definitive treatment reproductive years and regress after menopause
26
What are the medications for uterine leiomyomas?
1. GnRH agonists 2. Levonorgestrel 3. Mifepristone
27
How does GnRH agonists help uterine leiomyomas?
significant reduction (35-60%) in uterine size within 3 months
28
What are the adverse effects of GnRH agonists?
hot flashes, sleep distrubances, vaginal dryness, myalgias, arthralgias, bone loss, impairment of mood cognition
29
What are the MOA of Levonorgestrel?
reduction in uterine volume and bleeding and increase in hematocrit
30
What is the MOA of mifepristone?
anti progesterone
31