progesterone and oestrogen

Question 1

Where is estrogen synthesized?

Answer 1

ovaries and placeta

Question 2

The 3 main endogenous oestrogen types

Answer 2

oestradiol (most potent)
oestrone 1/3 potency
oestriol

Question 3

functions of estrogen

Answer 3

• sexual maturation
• responsible for follicular proliferation
• stimulate growth of milk ducts
• decreases bone reabsorption and plasma cholesterol

Question 4

Activation MOA of estrogen

Answer 4

diffuses through membrane and binds to alpha receptor on nucleus, causing activation, which will result in interaction with chromatin to initiate hormone specific RNA synthesis. Resulting in the synthesis of proteins that mediate estrogen effects

Question 5

Repressive MOA of estrogen

Answer 5

estrogen diffuses through membrane and binds to beta receptor on nucleus which has a repressor domain

Question 6

therapeutic uses of estrogen

Answer 6

• contraception
• post-menopause hormone therapy
• Osteoporosis
• Primary hypogonadism

Question 7

estrogen adverse effects

Answer 7

• breast tenderness
• nausea
• hypertension
• thromboembolism

Question 8

Selective estrogen receptor modulators SERMs

Answer 8

Tamoxifen
Raloxifene
Clomiphene
Toremifen

Question 9

Raloxifene indication and MOA

Answer 9

indication: prevention of osteoporosis
MOA: binds to estrogen receptors and inhibits bone reabsorption. Lowers total cholesterol and LDL

Question 10

Toremifen Indication and MOA

Answer 10

Indication: hormone dependent breast cancer
MOA: Is an estrogen antagonist, in breast cancer tissue. does not increase risk of endometrial cancer

Question 11

Tamoxifen Indication and MOA

Answer 11

Indication: hormone receptor positive breast cancer
MOA: Is an estrogen antagonist in breast cancer tissue. Partial agonist in the uterus

Question 12

Clomiphene Indication and MOA

Answer 12

Indication: infertility associated with anovulatory cycle
MOA: partial estrogen agonist. Inhibits ER in hypothalamus and interfere with - feedback. Increases secretion of GnRH stimulating ovulation

Question 13

Anti-estrogen drug, it indication and MOA

Answer 13

Fulvestrant
Indication: beast cancer after failure of tamoxifen
MOA: estrogen receptor down regulator. Binds to estrogen receptor competitively. Blocks trophic action of estrogen without having estrogen like activity

Question 14

functions of progesterone

Answer 14

• implantation and maintenance of pregnancy
• stimulate development of alveoli in milk duct
• alters endometrium from proliferative to secretive menstrual cycle

Question 15

Therapeutic uses of progesterone

Answer 15

• contraception
• post-menopausal hormone therapy
• endometriosis
• menstrual disorders
• luteal phase support

Question 16

progestin adverse effects

Answer 16

• Headache
• Changes in libido
• Weight gain
• Depression

Question 17

Anti-progestin, it’s indication and MOA

Answer 17

Mifepristrone
Indication: Abortifacient, sensitizes uterus to action of prostaglandind
MOA: Synthetic progesterone antagonist, with partial agonistic activity. Given orally

Question 18

Types of oral contraceptives

Answer 18

• combination
• only progesterone
• non-steroidal progestin

Question 19

Contra-indication for oral contraceptives

Answer 19

• pregnancy
• breast cancer
• liver disease
• hperlipideamia

Question 20

oral contraceptive adverse effects

Answer 20

• oedema
• weight gain
• reversible hypertension
• acne and vaginal infections

Question 21

Administration for combined contraceptives

Answer 21

Taken for 21 consecutive days, with placebo pill days

Question 22

estrogen and progesterone formulation for combined contraceptives

Answer 22

estrogen: ethinyloestradiol
Progesteon:
1st- norethisterone
2nd: levonorgestrel
3rd: desogestrel or gestodene

Question 23

which progesterone types are preferred for diabetic patients and why?

Answer 23

3rd gen desogesrel and gestodene. minimal impact on glucose levels and lipid profile

Question 24

progesterone only contraceptives

Answer 24

• Norethisterone
• Levonorgestrel
• Evogestrel

Question 25

MOA of progesterone only contraceptives

Answer 25

Cervical mucus made inhospitable to sperm. Prevents endometrial implantation

Question 26

Non steroidal progestin contraceptives

Answer 26

Drospirenone
Yasimin and Yaz
Qlaira

Question 27

Adverse effects of NSP contraceptives

Answer 27

• Irregular menstrual bleeding
• Bloating, mood changes
• nausea, headache, appetite disturbances

Question 28

Contraceptive interaction with drugs that induce CYP450 enzymes

Answer 28

drugs like rifampicin reduce absorption due to diarrhea and vomiting

Question 29

Contraceptive interaction with antibiotics

Answer 29

Lead to alterations in gut flora, result in interruption of enterohepatic cycle of OC’s, increasing fecal excretion of oestrogen and decreasing the efficacy of OC’s

Question 30

Other drug interactions with contraceptives

Answer 30

• Reduce efficacy of oral anticoagulants
• protease inhibitors
• adversely affects anti-hypertensive therapy by increasing renin conc

Question 31

mixed post coital contraception formula and dosage

Answer 31

• ethinyloestradiol and levonorgestrel
• 12 hourly for 2 doses within 72 hours

Question 32

Long acting reversible contraceptives

Answer 32

• Long acting injectable
• Intrauterine device(IUD)
• ## Subdermal progesterone implants

Question 33

Preparations used in Hormone replacement therapy

Answer 33

• Conjugated oestrogen
• Medroxyprogesterone
  used in combination with premphase

Question 34

Contraindications for HRT

Answer 34

• Oestrogen-dependent cancer
• Pregnancy
• Liver disease
• Breast feeding
• Breast nodules

Question 35

Adverse effects of HRT

Answer 35

• Nausea & vomiting
• Weight changes
• Breast enlargement
• PM like syndrome
• Fluid retention