Repro Exam 4 Flashcards
Name the 8 major types of phytoestrogens and give examples of herbs in which they are found.
Chalcones
Flavonols
Isoflavones
Prenylated isoflavonoids
Coumestans
Lignans
Stilbenoids
Resocyclic acids of lactones
Explain the theory of how phytoestrogens have a modulatory effect on both estrogen deficiency and excess states.
similar in structure to estradiol and are able to sit on estrogen receptors
the production of sex hormone binding globulin (SHBG) or peroxisome proliferator-activated receptors (PPARs) – nuclear transcription factors
Higher affinity for ER-β receptors
List 5 effects of phytoestrogenic constituents aside from effects on reproductive function.
- Skin: Phytoestrogen may have anti-aging effect on the skin via estrogen receptors or via increase in hyaluronic acid production, collagen, extracellular matrix proteins or via promotion of skin vascularization, cell proliferation, protection against oxidative stress and apoptosis a.o.
- Bone: Can inhibit differentiation and activation of osteoclasts, expression of tartrateresistant acid phosphatase, secretion of pyridinoline compound, enhance bone formation, increase bone mineral density, and levels of alkaline phosphatase, osteocalcin, osteopontin, and α1(I) collagen.
- CV: endothelial cells, vascular smooth muscle, and extracellular matrix, decreased arterial stiffness and antiatherosclerotic effects via NO production.
- immune system: inhibit the intracellular signaling pathway related to NF-kappaB – transcription factor activating inflammation and immune response, inhibits allergic inflammatory responses, enhance the cytotoxic response mediated by NK and cytotoxic T cells and the cytokine production from T cells
- Nervous system: improve cognitive function, sleep, a both steroid receptor and 5-hydroxytryptamine receptor or via promotion of serotonin reuptake, modulate catecholamine system
Choose 10 of the phytoestrogenic herbs listed in slide 16 and give at least one action of that herb that is not related to sex hormone function.
- Panax sp- adaptogen
- Humulus lupulus- nervine
- Trifolium pratense- nutrative
- Medicago sativa- diuretic
- Glycyrrhiza spp- demulcent
- Angelica sinensis- bitter
- Trigonella foenum-graecum- decreases insulin resistance
- Dioscorea villosa- antispasmotic
- Foeniculum vulgare- bronchodilator
- Pueraria sp- hypotentsive
Explain the theory of how Vitex agnus-castus works to treat mastalgia
inhibiting the release of excess prolactin by blocking Dopamine-2 receptor type on pituitary
Are the main hormone modulating constituents in Actea racemosa phytoestrogens?
no, triterpene glycosides
What general class of herbs does Lepidium myenii belong to? List the parameters that showed improvement when this herb was studied in perimenopausal and postmenopausal women.
General class: radish?
Perimenopasual women: reduction in body weight, blood pressure and increasing serum HDL and Iron, balancing levels of hormones (FSH, E2, PG and ACTH) and alleviating negative physiological and psychological symptoms (frequency of hot flushes, incidence in night sweating, interrupted sleep pattern, nervousness, depression and heart palpitations)
Postmenopausal women: reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction
Which part of the Trigonella foenum-graecum plant is used medicinally?
seed
Paeonia lactiflora is described in Chinese medicine as nourishing the yin. How does this relate to its effects on sex hormone regulation?
helps bring balance by allowing for grounding
Rheum rhaponticum is particularly useful in perimenopausal states with associated
depresssion and anxiety
Explain why Viburnum opulus pairs well with Cinnamomum spp. in the treatment of uterine cramps.
is an activator for anti-spasmodics
What is the difference between angelica sinensis that is prepared from fresh root versus that which is decocted.
Fresh is antispasmodic
Decoction- tonifying action
How do uterine tonics exert their action?
via tanins
What are the two major constituent types that were discussed that have styptic effects?
tannins and volitale oils
Explain why Serenoa repens and Urtica dioica root have complimentary actions in the treatment of BPH.
urtica: aromatase inhibition, inhibition of SHBGreceptor binding, Na/K ATPase inhibition in prostate epithelium, effects epithelial growth factor
Serenoa: inhibits 5 alpha reductase conversion of testosterone to dihydrotestosterone
Why is it recommend to avoid using Pygeum africanum for BPH?
because of its overuse and endangerment
Tribulus terestris was once thought to improve erectile function due to increasing testosterone. This does not appear to be its mechanism of action. What is the current proposed mechanism of action of this herb?
effect vasodilation and nitric oxide
What is the effect of Camelia sinensis on SHBG?
increases
What is the effect of Mentha spicata on androgens?
decreaese total testoterone levles
Which plants have we studied in this series of lectures that have shown measurable increases in serum free testosterone in human studies?
Withania somifera
Lepidium part used and energetics
Part: root
Energetics: tonifying
Lepidium spp actions
adaptogen, detoxification, aphrodisiac,
Lepidium spp indications
Perimenopausal symptoms, andropause, low libido, low energy, longevity, sex hormone and stress hormone balance, depression and anxiety, infertility
Trigonella foenum-graecum actions
modulates many hormones, increases insulin secretion, decreases insulin resistance, improved blood lipids, renoprotective, neuroprotective, modulates inflammation, decreases histamine, aphrodesiac
Trigonella foenum-graecum Indication and CI
Adjunctive care in diabetes, dysmenorrhea, mastalgia, perimenopausal climacteric symptoms
CI: Due to the high soluble fiber content, Trigonella should be consumed with plenty of water. A maple-like body odor is evident with significant and consistent consumption of fenugreek.
Peonia lactiflora part used
root
Peonia lactiflora actions and MOA
nourishing, blood tonic, preserves and balances the yin, anodyne, hormone balancing, antidepressant/anxiolytic
hypothalamic regulation
Peonia lactiflora indication
PCOS, dysmenorrhea, depression, anxiety, pain, digestive upset with cramping, need for grounding
Rheum rhaponticum part used
root
Rheum rhaponticum actions
phytoestrogen acting on ER-βreceptors
Rheum rhaponticum indications
depression and anxiety associated with perimenopause, climacteric symptoms.
Viburnum opulus part and energetics
Part used: bark
energetics: drying, lax
Viburnum opulus actions
antispasmodic – effective in both voluntary and involuntary muscles, astringent, nervine, hypotensive, beta 2 receptor agonist, anti-inflammatory
Valeriana officinalis part used and energetics
Part Used: Root
Energetics: warming, lax
Valeriana officinalis actions and CI
sedative, relaxant, antispasmodic, hypotensive, diuretic, diaphoretic, anticonvulsant
Contraindications: may potentiate the actions of other sleep inducing agents. Due to GABA receptor activity, long-term use of valerian was associated with benzodiazepine-like withdrawal in rats. There is one case report of life threatening withdrawal syndrome after surgery in a patient who used valerian long-term.
Dioscorea villosa part used
root
Dioscorea villosa actions
Anti-spasmodic, diaphoretic, hormone balancing
Dioscorea villosa indication
Used for spasmodic pain, headaches, and in many formulas for hormone balance. It is thought to have a progesterogenic effect
Angelica sinenses part used and energetics
Part Used: root
Energetics: warming, stimulating, moistening, tonifying
Alchemilla vulgaris part used
leaf and flower
Alchemilla vulgaris action
Astringent, Styptic, Emmenogogue
Alchemilla vulgaris indications
Used for atonic conditions or prolapse, menorrhagia, and dysmenorrhea
Rubus idaeus part used
leaf
Rubus idaeus actions
astringent, uterine tonic, nutritive
Rubus idaeus indications
Used as a partus preparator to strengthen the uterus and promote an easy labor
Capsella bursa pastoris part used
arieal parts
Capsella bursa pastoris actions
astringent, styptic
Capsella bursa pastoris indications
Menorrhagia, postpartum hemorrhage
Erigeron canadensis (Conyza canadensis) action and part used
styptic
Part used: aerial parts
Erigeron canadensis (Conyza canadensis) indications and CI
uterine hemorrhage, hemoptsis, hematemesis, hematuria
Cautions/Contraindications: be sure to understand which preparation of the plant you are using as not to overdose the essential oil.
Achillea millefolium part used and action
Part used: Arial parts
Actions: astringent, styptic, stimulating diaphoretic, decreases pelvic congestion
Achillea millefolium indications
uterine hemorrhage, menorrhagia with uterine spasms and pelvic pain
Cinnamomum spp. part used and actions
Part Used: bark
Actions: Astringent/styptic, circulatory stimulant, antispasmodic
Cinnamomum spp. indications
Uterine hemorrhage, combines well with viburnum for uterine cramps
Caulophyllum thalictroides part used and actions
Part Used: root
Actions: antispasmodic, uterine tonic
Caulophyllum thalictroides indications
Female reproductive tract tonic
Used for spasmodic menstrual cramps, amenorrhea, partus preparator . Specifically indicated for lax, prolapsed tissues with heavy, aching pain.
Serenoa repens part used and action
Part Used: berry
Actions: inhibits 5 alpha reductase conversion of testosterone to dihydrotestosterone
Serenoa repens
BPH, PCOS, difficulty with urination, erectile dysfunction, male pattern alopecia
Urtica dioica part used
root
uritca dioica indication
BPH, diarrhea, modulation of androgens
urtica dioica actions
astringent, anti-inflammatory, multiple influences on hormone modulation – aromatase inhibition, inhibition of SHBG receptor binding, Na/K ATPase inhibition in prostate epithelium, effects epithelial growth factor
Prunus africanum part used
bark
Prunus africanum actions
reduces lower urinary symptoms in BPH, antiandrogen and antiproliferative effects in the prostate. 5-alpha-reductase activity. Modulation of inflammation has also been noted as a mechanism of action.
Prunus africanum indications
BPH, possible application in prostate cancer
Tribulus terrestris part and action
Part Used: fruit
Actions: aphrodesiac
Tribulus terrestris indication
low libido, erectile dysfunction
Camellia sinensis action and part used
Actions: decreases free testosterone, increases SHBG, decreases insulin resistance and improves other glucose-related markers, promotes weight loss, decreases LDL
Part Used: Leaf
Camellia sinensis indications
PCOS (particularly in overweight individuals), androgenic alopecia
Mentha spicata part used and energetics
Part Used: aerial parts
Energetcs: moving, clearing, cooling
Mentha spicata actions
carminative, antiandrogenic effect in PCOS
Withania somifera use
increase longevity and vitality
aphrodisiac
tonic nervine
used to treat emaciation of children and debility in the elderly.
List 3 ways in which water acts to relieve symptoms and encourage healing in the body.
stress relief
moving blood around in the body
Explain how you can apply the viscero-cutaneous reflex effect of hydrotherapy to benefit your patients?
depending on where you are placing the treatment you can impact different organs
Describe how hydrotherapy can cause vasostasis – in terms of water temperature, timing of exposure and resultant effect on the circulatory system
a. hot; >5 min; bloods pool at the site
b. hot; < 5 min; bloods pool at the site
c. cold; >5 min; bloods pool at the site
d. cold; <5 min; bloods pool at the site
hot; >5 min; bloods pool at the site
Name 3 reflex actions of cold and 3 reflex actions of heat
Cold:
* Stimulation of mental activity with applications to the face and head.
* increase in respiratory rate with applications to the chest, or to the skin in general – followed by deeper, slower respirations.
* Dilatation of blood vessels to an internal organ following short, intense, cold percussion shower to the corresponding reflex area
Hot:
* reflex areas of the skin produce passive dilatation of blood vessels in the corresponding organ.
* Increased gastric secretion and motility by hot applications over the stomach after meals results in more rapid digestion
* applications to the abdomen lessen intestinal peristalsis in diarrhea and colic and increase motility in ileus
A short hot treatment is less than _____ minutes and a long hot treatment is longer than _____ minutes. A short cold treatment is less than _____ minutes and a long cold treatment is longer than _____ minutes.
5; 5; 1; 1
What is the idea of derevtaion?
hot water to the feet will pull from the most congested area
How is dose FIR sauna acts on the body to stimulate increased circulation?
a. induces nitric oxide synthase leading to vasodilation
b. inhibits platelet aggregation
You have a diabetic patient with poor blood glucose control who has a pre-tibial ulcer and you want to increase circulation to the extremities. Heat to the extremities is C/I in this situation. How can you use heat to increase the circulation to this patient’s extremities, safely?
If you want to target the uterus and ovaries with hydrotherapy, to which reflex areas would you NOT apply the treatment (either hot or cold)?
a. saddle area
b. lumbar region
c. abdomen
d. feet
saddle area
Which of the following in NOT an important tenants of Hydrotherapy?
a. heat treatment larger and longer than cold
b. always end with hot
c. friction can make cold more tolerable
d. match treatment to the patient vitality
always end with hot
If a patient is resistant to ending their shower with a cold shower, how can you modify the treatment to accommodate them?
a. start with the feet
b. start with neutral water temp
c. start with full body
d. a and b
start with feet or with neutral water temperature
What does it mean to ‘match the treatment to the patient’s vitality’ and why is this important?
It means to match the treatment to how able they are able to tolerate stress
important because working with the circulation
List some ways to assist your patient in warming up if they get chilled during a hydrotherapy treatment
a. adding blankets
b. warm drinks
c. applying heat or friction
d. alll of the above
all of the above
Ideally, how long should a patient rest after a hydrotherapy treatment?
a. 2 hour
b. 30 min
c. 1 hour
d. 10 min
30 min
Which internal organs are NOT stimulated by the sine machine during Constitutional Hydrotherapy? What effect does this have on the digestive system?
a. heart; increases movement through
b. stomach; increase movement through
c. gallbladder; increase movement through
d. pancreas; increase movement through
heart; increases movement through
Which treatment is not involved in detoxifaction?
a. castor oil pack
b. sitz bath
c. consitutional hydro
d. sauna
sitz bath
List 10 ways to support healthy liver functioning
- Avoid overeating
- Avoid high sugar containing food (such as high fructose corn syrup)
- Consume alcohol in moderation
- Moderate intake of fatty foods (avoid hidden fats, such as in fast foods)
- Avoid highly processed foods and foods containing preservatives and additives
- Eat organic to avoid pesticides in food.
- Avoid the use of pesticides and herbicides when you garden
- Increase water intake to help flush out water soluble toxins from the liver
- Use earth-friendly cleaning products at home
What are the physiologic effects of heat in the pelvic area with a hot sitz bath?
a. calming and soothing
b. decreases stagnation of blood and lymph in pelvis, increase tissue tone, and activates spinal cord reflexes to underlying pelvic and abdominal organs
c. heat relaxes and relieves muscle spasms in the pelvic area
d. all of the above
heat relaxes and relieves muscle spasms in the pelvic area
Which of the following is NOT a C/I to hot sitz bath?
a. hemmorhage
b.prolapse
c. pelvic congestion
d. painful spasms (vaginismus, tenesmus)
painful spasms (vaginismus, tenesmus)
Acute UTI is only indicated in which type of sitz bath (temperature)?
a. hot
b. neutral
c. hot and cold
d. none of the above
neutral
What is a perineal bath?
a. the entire pelvis is submerged
b. rectal and perianeal area is submerged
c. feet submerged
d. whole body submerged
rectal and perianeal area is submerged
What is the ideal temp for a hot foot bath?
a. 104-110
b. 120-130
c. 100-103
d. 112-120
104-110
Which of the following is NOT and an equipment used in douching?
a. 2- quart enema bag
b. water
c. salt water
d. add ins vinager, garlic, goldenseal tea, probiotics,
salt water
Which of the following is not a type of douches patients can do and the specific conditions they would treat?
a. vinegar for BV
b. garlic for infection
c. calendular, thyme, usnea, althea for group B strep vaginiti
d. castor oil for ovarian cysts
castor oil for ovarian cysts
Name 6 effects of castor oil packs. List several conditions that castor oil packs are used to treat.
Effects: Emollient, Softens scars and adhesions, Shrinks cysts/ non-malignant growths, Shrinks warts, Detoxifying/drawing, Stimulates smooth muscle
Conditons: uterine fibroids, non-malignant ovarian cysts, headaches, migraines, constipation, intestinal disorders, and gallbladder and liver conditions
What is the difference in the effect of using a castor oil pack vs. applying castor oil topically?
a.
What is the main use of the hot vinegar pack?
a. pain
b. bleeding
c. PID
d. PMS
pain
Which is not a condtion for the High Frequency unit?
a. dysmenorrhea
b. heavy menses
c. ovarian cysts
d. chronic prostatitis
chronic prostatitis
Which are NOT treatments for chronic prostatitis?
a. hot sitz bath
b. lower-half body pack
c. hot enema
d. sauna
sauna
Which herbs could be added to perineal bath?
a. chamolie
b. calendula
c. cratagus
d. a and b
a and b
What is the maximum temp for the hot foot bath if you have a diabetic patient with poor blood glucose control?
a. 115
b. 120
c. 100
d. 104
100
What is the rate of dilution for the vinegar?
a. 1:1
b. 2:1
c. 3:1
d. 4:1
1:1
What is the gas that high frequency/violet ray gives off that contributes to its antiseptic effect?
a. ozone
b. carbon
c. water
d. none of the above
ozone
How do you douche?
Once filled with the desired solution, the bag can be hung from the shower rod with the patient laying on a towel in the bathtub. The patient may also douche sitting on a toilet, leaning back as far as possible. This is not as effective, however. The specific douche tip is attached to the tube and inserted into the vagina. Water can be infused by modulating the clamped tube to allow a gentle stream of fluid to flow into the vagina. Allow the fluid to fill the vaginal vault to a feeling of fullness without creating pressure. If desired, the fluid can be held for several seconds (a slow count to 15) by pinching the fingers around the speculum then released by removing the hand. The patient should continue filling and releasing until all of the solution in the
bag is emptied. The douche treatment itself usually takes around 5-10 minutes.
What dosen’t effect the level of cholesterol in the body?
a. medications
b. genetics
c. liver disease
d. stress
stress
Which of the following is NOT a source of cholesterol?
a. dairy products: cheese, full-fat yogurt
b. eggs
c. shellfish
d. potatoes
potatoes
How dose statins or red yeast rice impact sex hormones?
a. inhibit 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase
b. inhibits 5a-reductase
c. inihibits 17B-HSD
d. inhibits aromatase
inhibit 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase
Which of the following is NOT an impact of more adiposity/insulin on hormones in female bodied folx?
a. more risk for hyperadnrogenism
b. lower SHBG, LH, GnRH
c. higher urinary estrone metabolites
d. late puberty
late puberty
Which of the following is TRUE regarding underweight female bodied folx?
a. hormone levels increase LH/FSH, GnRH
b. infertility increases
c. sexual responsiveness increases
d. increased interest in sex
infertility increases
What condtions is NOT adiposity linked to?
a. breast cancer
b. ovarian cancer
c. endometiral cancer
d. prostate cancer
prostate cancer
How dose insulin impact hormone levels?
a. increases IGF-1 and suppresses Hepatic Binding proteins increasing free unbound bioavailable circulating estrogens
b. has no impact on hromone levels
c. dereases IGF-1 and increases Hepatic Binding proteins increasing free unbound bioavailable circulating estrogens
increases IGF-1 and suppresses Hepatic Binding proteins increasing free unbound bioavailable circulating estrogens
What things decrease progesterone?
a. Stress and Underweight
b Insulin
c. Opioids
d. Luteal phase defect, High prolactin, Hypothyroid, and Birth control Pills
e. all
all
where is estrogen primarily produced?
a. ovaries
b. adrenal gland
c. adipose tissue
ovaries
Where are xenoestrogesn NOT found?
a. comercial meat, dairy, fruit, and vegtables
b. microwaved plastic, plastic
c. baby bottles, children toys
d. glass containers
e. synthetic hormones
f. all of the above
glass containers
how is estrogen metabolized?
Phase 1 detox: Estrone and estradiol are hydroxylated by CYP450 enzymes-> 2-hyrdoxy/4-hydroxy metabolites
Phase 2 detox in the liver: sulfotransferases, glucuronidation, COMT, glutathione
Human estrobolome: aggregate of enteric bacterial genes; products are capable of metabolizing estrogens
Which estrogen metabolites are carcinogenic?
a. 4-OHE1
b. 2-quinone E1
c. 16 a-OHE1
d. a and c
a and c
What is phase 1 detoxifcation?
a. forming intermediate chemical/toxins that are no longer physiologically active
b. conjugating toxic intermediates to non-toxic water soluable intermediates
c. creates free radical species
d. a and c
a and c
What causes hangovers?
a. formation of acetaldehyde
b. alcohol itself
c. dehydration
d. none of the above
formation of acetaldehyde
What impacts the cytochrome p450 isoenzymes?
a. SNPs
b. foods
c. herbs, meds
d. all of the above
all
What foods can enhance phase 1?
a. cruficerous veggies cabbage, broccoli, brussels sprouts
b. onion and garlic
c. antioxidant foods and flavonoids
d. all of the above
all
Which of the following describes sulfotransferases reaction?
a. enzymes that catalyze the transfer of a sulfo group from a donor molecule to an acceptor
b. methyl group from the cofactor S-adenosyl-L-methionine (SAM) is transferred to an acceptor
c. glucuronic acid is covalently linked to a substrate containing a nucleophilic functional group
d. glutathione is conjugated to an acceptor
enzymes that catalyze the transfer of a sulfo group from a donor molecule to an acceptor
Which of the following is NOT a way to increase glutathione s-transferase?
a. cruciferous vegetables
b. allium vetables
c. NAC
d. fish oil, curcumin, green tea, rooibos tea,
NAC
Which of the following is NOT a way to maintained active glutathione?
a. NAC
b. lipoic acid
c. Mg
d. rosemary
rosemary
What are factors that influence gut bacteria?
a. age
b. stress
c. diet
d. diversity
e. all of the above
all
What diet dosen’t reduce beta-glucuronidase?
a. plant-based diet or raw vegan diet
b. prebiotic and probitoics (Lactobacillus and Bifidobacteria) food/supplementation
c. vegetarian
c. carnivore diet
carnivore diet
What upregulates aromatase but not 5 a reductase activity?
a. obesity
b. insulin
c. alcohol use
alcohol use
What condtions are NOT associated with increase 5a-reductase activity?
a. BPH
b. male pattern balding
c. prostate cancer
d. erectile dysfunction
erectile dysfunction
Which of the following is not something that decreases 5a-reductase?
a. saw palmetto
b. nettles
c. zinc
d. flaxseed
flaxseed
Which of the following doesn’t lower aromatase actvity?
a. zinc
b. nettles
c. saw palmetto
d. EGCG
saw palmetto
Which of the following is TRUE regarding obesity and infertility?
a. alters sperm function
b. decreases sperm DNA damage
c. increase sperm mitochondiral activity
d. reduces seminal oxidative stress
e. helps with blastocyst development
alters sperm function
What contributes to low testosterone?
a. visceral obesity and metabolic syndrome
b. decreased leydig cell function
c. decreased TNF-a, IL-6, and leptin
d. all of the above
visceral obesity and metabolic syndrome
What promotes erection?
a. decreased excercise
b. high alcohol intake
c. low testosterone
d. high vegetable and omega 3 intake
high vegetable and omega 3 intake
Which is NOT included in the watching an waiting approach to BPH?
a. decreas PM fluids
b. decrease caffeine, ETOH, bladder irritnts
c. treat constipation
d. 5 aldpha reductase inhbiitor
5 aldpha reductase inhbiitor
What are the phytotherapy for BPH?
Saw Palmetto (Serenoa repens), African Plum (Pygeum africanum), South African Star Grass (Hypoxis rooperi), Beta-sitostero, Stinging Nettle Root (Urtica dioica), Rye-Pollen Extract (Secale cereale,), Cernilton, Pumpkin Seeds, Soy (isoflavones), Grape Juice, Cactus Flower, Zinc, Selenium, lycopene (stewed tom, watermelon, papya, grapefruit)
What do pumpkin seeds do?
a. siginifcantly decrease elevated levels of DHT
b. decrease prostate size
c. promotes apoptosis of hyperplasic prostate tissue
d. a and b
a and b
Which of the following is not a function of lycopene?
a. inhibit cell growth in normal prostatic epithelial cells
b. Promote apoptosis in hyperplasic prostate tissue
c. upregulates of 5-alpha-reductase and interleukin-6 signaling
d. May stimulate gap junction communication between cells and stop cell division
upregulates of 5-alpha-reductase and interleukin-6 signaling
What dose selenium do for the treatment of BPH?
a. inhibiting cell proliferation
b. decrease prostate size
c. stimulating apoptosis
d. a and c
a and c
Which of the following dosen’t support the adrenals?
a. stress managment, mindfulness
b. high sugar
c. adptogenic herbs
d. sleep
high sugar
What is menopause?
a. years leading up to the menopausal change
b. 1 full year of cessation of menses
c. all the years following 1 year of cessation of menses
d. period of declining fertility
1 full year of cessation of menses
What are bio-identical?
a. look like hormones that the body makes
b. things that modulate estrogen
c. naturally derived hormone
d. all of the above
look like hormone that the body makes
What is the number one FDA approved use of hormone replacement?
a. night sweats
b. vaginal dryness
c. irregular bleeding
d. hot flashes
e. b and d
b and d
Estrogen can be perscribed alone after a hysterectomy
select one:
True
False
T
Which of the following accurately describes the results of the Women’s Health Initative?
a. combined HT increased risk of breast CA, CHD, stroke, and VTE
b. combined HT decreased risk of fracture and colon cancer
c. estrogen only increased risk of stroke
d. all of the above
all of the above
How many years post menopause is using HT indicated and saftest for those in menopause?
a. 10 years post menopause
b. 5 years post menopause
c. 10 years before menopause
d. 1 year post menopause
10 years post menopause
Do you give HT when a patient is diagnosed with osteoporosis?
a. Yes
b. no
no
Which is NOT a limitations too the womens health initiative study?
a. only looked at oral, vaginal, and transdermal of estrogen administration
b. only used combined equine estrogen
c. only used medroxyprogesterone acetate
d. not very many patients were in the 50-59 age range
only looked at oral, vaginal, and transdermal of estrogen administration
Which is NOT a limitations too the womens health initiative study?
a. only looked at oral, vaginal, and transdermal of estrogen administration
b. only used combined equine estrogen
c. only used medroxyprogesterone acetate
d. not very many patients were in the 50-59 age range
only looked at oral, vaginal, and transdermal of estrogen administration
What are the benefits of using HT closer to menopause?
a. less breast cancer
b. less MIs
c. less death
d. b and c
b and c
Which of the following is NOT NAMS 2017 postion statement?
a. HT estrogen w/ or w/o progestogen is effective for vasomotor sxs
b. HT and local estrogen is most effecitive for vaginal atrophy
c. ET is supported for sexual interest, arousal, or orgasmic response
d. local ET may benefit overactive bladder and reduce UTI
ET is supported for sexual interest, arousal, or orgasmic response
What is the Menostar approved for?
a. hot flashes
b. insomnia
c. osteoporosis
d. mood changes
osteoporosis
Which of the following is TRUE regarding the NAMS 2017 on CVD?
a. protective against CHD
b. decreased risk of hemorrhagic stroke
c. decreased risk of VTE
d. all of the above
protective against CHD
Can you give HT after breast cancer?
a. yes
b. no
no
dose HT increase risk for breast cancer?
a. yes
b. no
yes
What herb is Cyp3 and 4 inhbitor and inducer?
a. hypericum
b. curcuma
c. zingiber
d. cratagus
hypericum
Progestins are more potent than bioidentical pregesterone.
True
False
T
Progestins are more potent than bioidentical pregesterone.
True
False
T
Levonorgestrel is used in?
a. COC with ethinyl estradiol
b. an emergency contraception
c. Mierna IUD
d. all of the above
all
Which of the are the antiprogesterones?
Mifepristone
Misoprostol
Drospirenone
all of the above
two of the above
two of the above
What is the impact of exogenous testoerone on fertility?
a. high testosterone in tissue causes negative feedback to the tissue decreasing spermatogensis
b. low testoterone in the tissue causes spermatogenesis
c. to much testosterone increases spermatogenesis
d. all of the above
high testosterone in tissue causes negative feedback to the tissue decreasing spermatogensis
Which of the following is a CI of testosterone therapy?
a. low hematocrit
b. healthy heart
c. BPH
d. healthy prostate
BPH
What is NOT a CI for testoreone therapy in Females?
a. low hematocrit
b. pregnancy
c. breast cancer
d. all of the above
low hematocrit
Which of the following metabolizes faster?
a. bioidentical testoterone
b. non-bioidentical testosterone
c. they metabolize at the same rate
bioidentical testoterone
What is the link between testosterone and BPH and prostate cancer?
a. more testosterone increases prostate growth
b. testosterone has no effect on prostate growth
c. testotserone decreases prostate growth
d. two of the above are correct
testosterone has no effect on prostate growth
What is the only FDA-approved use of DHEA?
a. dyspareunia
b. fatigue
c. sexual dysfunction
d. adrenal insufficiency
dyspareunia
DHEA and testosterone can both be used in pregancy
True
Fase
False
Which of the following is NOT a contraindications of DHEA?
a. breast cancer
b. uterine cancer
c. ovarian cancer
d. prostate cancer
prostate cancer
Which of the following is NOT a SE of DHEA?
a. acne
b. HTN
c. decreased hair growth
d. gynecomastia
decreased hair growth
What is the MOA of DHEA?
a. converted to estrogen and testosterone in the body
b. inhibits 5- alpha reductase
c. inhibits synthesis of steroid hormones
d. inhibits gonadotropin release
converted to estrogen and testosterone in the body
What is Finasteride MOA?
a. inhibit 5-alpha reductase
b. converted to estrogen and testosterone in the body
c. inhibits synthesis of steroid hormones
d. inhibits gonadotropin release
inhibit 5-alpha reductase
What is Leuprolide MOA?
a. increase GnRH to increase LH and FSH
b. inhibits synthesis of steroid hormones
c. inhibits 5-alpha reducatase
d. increases testoterone levels
increase GnRH to increase LH and FSH
What are the theraputic use of leuprolide?
a. percocious puberty
b. prostate cancer
c. endometriosis, adenomyosis, leiomyomas
d. all of the above
all of the above
What is the MOA bromocriptine?
a. increase GnRH to increase LH and FSH
b. inhibits synthesis of steroid hormones
c. inhibits 5-alpha reducatase
d. decreases prolactin levels via increasing dopamine
decreases prolactin levels via increasing dopamine
What are SE of bromocriptine?
a. Nausea
b. hypotenion
c. pulmonary fibrosis
d. all of the above
all of the above
When there is low hormones, fertility, or low energy what should you do?
a. screen all hormones and vitamin/mineral
b. screen for mental health
c. treat with hromone therapy right away
d. a and b
a and b
What is the MOA of levothyroxine?
a. synthetic version of T4
b. synthetic version of T3
c. synthetic version of testosterone
d. synthetic verstion of DHEA
synthetic version of T4
Why do you treat endometriosis with COC?
a.
What is the MOA of amitriptyline?
a. inhibiton of monoamine reputake via blocking sodium channels
b. reuptake inhibiton of serotonin and norepiphrine
c. blocking voltage-gated sodiu and calcium channels
d. synthetic verstion of estrogen
inhibiton of monoamine reputake via blocking sodium channels
What is amitriptyline used for?
a. volvodynia
b. hot flashes
c. chronic pelvic pain
d. a and c
a and c
What are the SE for tricyclic antidepressants?
sedation, dry mouth, constipation, urinary retention, blurred vision, tachycardia, arrhytmias, cognitve dysfunction, lower seizure threshold, serotonin syndrome, toxic at high dose, fall risk in elderly
How is amitriptyline administered?
a. oral
b. IM
c. vaginally
d. a and c
a and c
What are the MOA of velafaxine and duloxetine?
a. inhibiton of monoamine reputake via blocking sodium channels
b. reuptake inhibiton of serotonin and norepiphrine
c. blocking voltage-gated sodiu and calcium channels
d. synthetic verstion of estrogen
reuptake inhibiton of serotonin and norepiphrine
What are the use of venlafaxine and duloxetine?
a. volvodynia
b. hot flashes
c. chronic pelvic pain
d. a and c
a and c
Which drug inhibits CYP2D6?
a. venlafaxine
b. duloxetine
c.
d.
What are the guidelines around ovarian cancer and HT?
a. there are no guidelines its always safe
b. less than 5 years is safe
c. greater than 5 years is safe
d. estrogen therapy alone is safer than estrogen and progestin therapy
less than 5 years is safe
What are the guidleines around lung cancer and HT?
a. inc in lung cancer or death for those with EPT
b. recomend smoking cessation and inc surveillance in older smokers who are past or current EPT users
c. no inc in poorly differentiates and metastic tumors for those using EPT
d. all of the above
recomend smoking cessation and inc surveillance in older smokers who are past or current EPT users
What are the guidelines around mood and depression plus HT?
a. will always improve mood
b. will never improve mood
c. will only improve mood in those with clinical depression
d. will sometimes have a positive effect on mood with other menopausal symptoms
will sometimes have a positive effect on mood with other menopausal symptoms
What is the effect of HT on aging and dementia?
a. dec risk of dementia in women > 65
b. greater risk of dementia with those that are taking ET than EPT
c. ET in younger women closer to menopause may reduce risk of dementia
d. all of the above
ET in younger women closer to menopause may reduce risk of dementia
What are the guidelines of POI and HT?
a. give HT or OCPs until natural menopause
b. don’t give HT or OCPS
c. give HT or OCPS to prevent bone loss
d. a and c
give HT or OCPs until natural menopause
give HT or OCPS to prevent bone loss
What are the advantages of estrogen HT?
a. reduces tooth loss
b. increase GB dz
c. protective gainst colon cancer
d. a and c
a and c
Which of the following is NOT a disadvantages of estrogen HT?
a. CVD
b. increased risk for CA
c. helpful in osteoporosis
d. increase pancreatitis
helpful in osteoporosis
Which of the following it NOT an absolute contraindication for HT?
a. Hx of breast cancer
b. previous VTE, stroke, MI, angina, cornary bypass, or clotting disorder
c. thrombophlebitis
d. undiagnosed vaginal bleeding
thrombophlebitis
What are some tests that you should run before starting HT?
a. lipid profile and blood sugar
b. mammography
c. papanicolaou test
d. all of the above
allof the above
What are bioidenticals?
a. hormones that have the same molecular structure as endogenously produced hormones
b. hormones that sit on the receptor of endogenous hormones
c. hormones that look similar and modulate the acivity of the receptor
d. all of the above
hormones that have the same molecular structure as endogenously produced hormones
What is the biggest concern with compounded HT?
a. it isn’t efficatious
b. it could not contain the compunds it says it dose
c. it might not work
d. all of the above
all of the above
Which of the following is not a therapeutic use of estrogen?
a. lichen sclerosis
b. atrophic vaginits, menopause
c. infertility
d. uterine fibroids
uterine fibroids
Which of the following is NOT a bioidentical form of estrogen?
a. estradiol
b. estriol
c. ethinyl estradiol
d. all of the above
ethinyl estradiol
Which of the following estrogen is higher in pregancy?
a. estriol
b. estradiol
c. estrone
d. all of the above
estriol
Which of the following has higher affinity for urogenital receptors?
a. estriol
b. estradiol
c. estrone
d. all of the above
estriol
Which product can increase risk of blood clots and MI the most?
a. estriol
b. estradiol
c. ethinyl estradiol
d. conjugated equine estrogens
conjugated equine estrogens
What are the ways that estrogen is administered?
a. oral
b. transdermal
c. vaginal
d. all of the above
all of the above
Which of the following describes estrogen pharmacokinetics?
oral estrogen undergos first pass metabolism via CYP3A4
Which of the following is NOT an endogenous estrogen SE?
a. CVD events
b. breast, endometiral, cervical cancer
c. metabolic dysfunction
d. osteoprosis
osteoprosis
Why is estrogen used in transgender care?
for gender affriming care
Why is estogen used in atrophic vaginits?
because low estrogen causes the changes seen in this conditon
What is not a theraputic use of SERMs?
a. breast cancer
b. uterine fibroids
c. inferitlity
d. contraception
contraception
What is Tamoxifes MOA?
a. antagonist at breast, agonist at bone and ednometrium
b. antagonist at breast and endometrium; agonist at bone
c. antagonist at hypothalamus
d. agonist at vaginal mucosa
antagonist at breast, agonist at bone and ednometrium
What are the therapeutic uses of tamoxifen?
a. breast cancer
b. breast cancer, osteoporosis, leiomyoma
c. PCOS and infertility
d. vaginal dryness
breast cancer
How are SERMs adminstered?
a. orally
b. IV
c. vaginally
d. transdermal
oral
Which SERM is a pro-drug that is effected by inhibiton of CYP2D6?
a. Tamoxifen
b. raloxifene
c. clomiphene
d. ospemifene
Tamoxifen
What is the MOA of Raloxifene?
a. antagonist at breast, agonist at bone and ednometrium
b. antagonist at breast and endometrium; agonist at bone
c. antagonist at hypothalamus
d. agonist at vaginal mucosa
antagonist at breast and endometrium; agonist at bone
What is clomiphene MOA?
a. antagonist at breast, agonist at bone and ednometrium
b. antagonist at breast and endometrium; agonist at bone
c. antagonist at hypothalamus
d. agonist at vaginal mucosa
antagonist at hypothalamus
Which SE is specific to Tamoxifen?
a. increased risk of clotting
b. endometrial hyperlasia
c. vaginal dryness and atrophy
d. hot flashes and myalgia
endometrial hyperlasia
Which SE dose all of the SERMs have besides ospemifene?
a. increased risk of clotting
b. endometrial hyperlasia
c. vaginal dryness and atrophy
d. hot flashes and myalgia
vaginal dryness and atrophy
What are the therapeutic uses for aromatase inhibtors?
a. breat cancer
b. ovulation induction
c. endometriosis and leiomyomas
d. all of the above
all
What of the following is NOT a SE of aromatase inhibtors?
a. bone loss and MSk pain
b.vaginal atrophy and dryness and hot flashes
c. follicular cysts
d. improved lipid pannel
improved lipid pannel
Why dose anastrozole cause more severe hot flashes and MSK pain than tamoxifen?
**prevents the convesion of testoterone to estrogen which causes menopause like symptoms **
tamoxifen act on the estrogen receptors but there is till production of estrogen from testosterone
What is anastrazole?
a. aromatase inhibitor
b. estrogen receptor agonist/antagonist
c. acts on progestrone receptors
d. acts on estrogen in the way the body normally dose
aromatase inhibitor
What are some of bioidentical progesterone therapeutic use?
a. AUB, endometiral hyperplasia
b. endometriosis
c. PCOS
d. menopasue
e. all of the above
all
What forms do bioidentical prgesterone?
a. oral micronized
b. transdermal creams
c. vaginal
d. a and b
a and b
Bioidentical progesterone is used in contraception.
True
False
False
How is Medroxyprogesterone acetate administered?
a. oral
b. vaginal
c. depot injection
d. a and c
a and c
Which has a longer half-life?
a. bioidentical progesterone
b. medroxyprogesterone acetate
c. levonorgestrel
d. drospirenone
medroxyprogesterone acetate
Which of the following is NOT a use for medroxyprogesterone?
a. AUB and endometrial hyperplasia
b. PMS and menopause
c. endometriosis
d. vulvodynia
vulvodynia
What is the SE of the depot injection?
a. bone loss
b. vaginal atrophy and dryness
c. hot flashes
d. MSK pain
bone loss
What products are levonorgestrel used in?
a. combined ethinyl estradiol fo COC
b. emergency contraception
c. IUD
d. all of the above
all of the above
what SE are associated with levonorgestrel?
a. bone loss
b. vaginal atrophy and dryness
c. hot flashes
d. acne
acne
What is drospirenone combined with to make Yaz?
a. bioidenitcal estrogen
b. raloxifene
c. ethinyl estradiol
d. clomiphene
ethinyl estradiol
What are SE of drospirenone?
a. hyperkalemia
b. hot flashes
c. VTE
d. a and c
a and c
What is drospirenone indication of use?
a. PCOS
b. contaception
c. pelvic pain
d. endometriosis
PCOS
What is norethindrone used for?
a. contraception during lactation
b. PCOS
c. endometriosis
d. AUB
contraception during lactation
What is MOA mifepristone?
a. antagonist at progesterone receptors
b. agonist at progesterone receptors
c. antagonist at estrogen receptors
d. agonist at estrogen receptors
antagonist at progesterone receptors
What is mifepristone indicated for?
a. contraception
b. AUB
c. terminate pregnancy
d. PCOS
terminate pregnancy
What drug is combined with mifepristone to terminate a pregnancy?
a. norethindrone
b. misoprostol
c. tamoxifen
d. anastrazole
misoprostol
What the SE of mifepristone?
a. abdominal pain
b. uterine bleeding
c. incomplete abortion
d. all of the above
all of the above
What are progestogen?
a category for all progesterone containing drugs including bioidentical and non-bioidentical (progestins)
What are the pharmacokinetics bioidenitcal testosterone?
a. first-pass metabolism
b. second-pass meatbolism
c. poor oral bioavility
d. a and c
a and c
What ways are bioidentical testosterone administered?
a. injection
b. transermal
c. oral
d. implant
e. all of the above
all of the above
Which is NOT the theraputic use for testosterone in males?
a. transgender
b. ED, infertility
c. hypogonadism
d. bulking up for weightlifing
bulking up for weightlifing
What is the theraputic uses of testoerone in females?
a. vulvodynia
b. decreased libido
c. menopause and POI
d. all of the above
all of the above
How are testosterone esters administered?
a. oral
b. transdermal
c.IM
d. implant
IM
Which testosterone esters is adminisred orally as?
a. cypionate
b. enanthate
c. undecanoate
d. all of the above
undecanoate
How is methyltestosterone administered?
a. IM
b. oral
c. transdermal
d. local/vaginal
oral
What are the SE of methyltestosterone?
a. liver dysfunction
b. acne
c. bone loss
d. vaginal atrophy
liver dysfunction
What are the SE of testosterone?
erythrocytosis, acne, behavior changes, decreased spermatogeneiss, gynecomastia, acceleration of BPH and prostate cancer, secondary exposure risk with transdermal creams or gels, CVD, liver dysfunction, hirsutism, alopecia, voice deepening, increased mucle mass,
What is the MOA of exogenous testosterone on spermatogenesis?
a. inc testoterone causes negative feedback dec spermogenosis
b. inc testosterone inc spermatogenosis
c. inc testosterone has no effect on spermatogenosis
d. all of the above
inc testoterone causes negative feedback dec spermogenosis
What are the contraindications for testosterone therapy?
a. high heamtocrit and sevre HF
b. hx or current prostate cancer or lower urinary tract sx due to BPH
c. prgenancy
d. hx or current breast cancer
e. all of the above
all of the above
What is the only FDA approved use of DHEA?
a. adrenal insuficency
b. menopausal dyspareunia
c. fatigue
d. sexual dysfunction
menopausal dyspareunia
Which of teh following is NOT an DHEA SE?
a. gynecomastia
b. hirsutism
c. mood change
d. HTN
e. menstural irregularites
f. stomach upset
mood change
What are the CI for DHEA?
a. pregnancy
b. breast ca
c. uterine ca and ovarian ca
d. endometriosis and uterine fibroids
e. all of the above
all
what is the MOA of Danazol?
a. acts to inhibt gonadotropin release and estrogen production
b. antagonist on testoterone receptor
c. antagonist on estrogen receptor
d. agonist on estrogen receptor
acts to inhibt gonadotropin release and estrogen production
What conditons has Danazol been used to treat?
a. endometriosis
b. PCOS
c. leiomyomas
d. a and c
a and c
Which is NOT a SE of Danazol?
a. acne and hirsutism
b. weight gain and muscle cramps
c. liver dysfunction and abnormal lipid profile
d. gynocomastia
gynocomastia
What is finasteride NOT used to treat?
a. BPH
b. androgenic alopecia
c. hirsutism
d. endometeriosis
endometeriosis
Which of the following is NOT a SE of finasteride?
a. increased libido
b. gynecomastia
c. orthostatic hypotenstion
d. prostate cancer
increased libido
decrease and erectile dysfunction
What do both testosterone and finasteride have in common?
a. cause gynecomastia
b. inc testoterone
c. inc estrogen
d. a and c
a and c
what is spironolactone MOA?
a. inhibits the synthesis of steroid hormones
b. inhibtors 5-a-reducase
c. inhbits gonadotropin relase
d. antagonist on testoterone receptor
inhibits the synthesis of steroid hormones
What is spironolactones therapeutic uses?
HTN, HF, edema, hypokalemia, hyperaldosteronism, transgender care, PCOS, PMS/PMDD, acne, hirustism
What are spironolactone SE?
hyperkalemia, hyponatermia, hypotension, loss of libido, erectile dysfunction, breast tenderness, menstural irregularites
What are MOA of androgen atagnoists?
a. inhibits the synthesis of steroid hormones
b. inhibtors 5-a-reducase
c. antagonist on androgen receptors
d. inhibits GnRH
antagonist on androgen receptors
Which of the following is NOT a SE of androgen antagonists?
a. gynecomastia
b. constipation and abdominal pain
c. nausea
d. acne
acne
What is the MOA of leuprolide?
a. inhibits the synthesis of steroid hormones
b. inhibtors 5-a-reducase
c. antagonist on androgen receptors
d. inhibits GnRH by continously secreating GnRH
inhibits GnRH by continously secreating GnRH
What are the theraputtic uses of leuprolide?
precocius puberty, prostate cancer, endometriosis, adenomyosis, leiomyomas, PMDD, control of ovulation in fertility tx, breast cancer
How is leuprolide adminstered?
a. oral
b. transdermal
c. implant
d. IM
IM
What the SE of leuprolide?
bone loss, vaginal atrophy and dryness, hot flashes, MSK pain, changes in lipid profile, decreased libido, ED
What is the MOA of bromocriptine?
a. inhibits the synthesis of steroid hormones
b. inhibtors 5-a-reducase
c. acts as agonist on dopamine receptors
d. inhibits GnRH by continously secreating GnRH
acts as agonist on dopamine receptors
What are bromocriptine used for?
a. amenorrhea due to hyperprolactinemia
b. infertility due to hyperplactinemia
c. PCOS
d. a and b
a and b
Whichis NOT an adverse effect of bromacriptine?
a. Nausea
b. hypertension
c. vasospasm
d. pulmonary fribrosis
hypertension
What is levothyroxine?
a. synthetic version of T3
b. synthetic androgen
c. synthetic version of T4
d. bioidentical version of T4
synthetic version of T4
What is liothyronine?
a. synthetic version of T3
b. bioidnetical version of T3
c. synthetic version of T4
d. bioidentical version of T4
synthetic version of T3
What are the indications for using levothyroxine and liothyronine?
a. amenorrhea
b. infertility
c. hypothyroidism
d. all of the above
all
What are the SE of thyroid hormones?
anxiety, insomnia, tachycardia, heart failure, fatigue, weight loss, tremor, osteoporosis
What is amitriptyline?
a. tricyclic antidepressant
b. SSRI
c. GnRH analog
d. SNRIs
tricyclic antidepressant
What is amitriptyline MOA?
a. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
b. reuptake inhibiton of seretonin and norepipehrine
c. inhibit votlage-gated Ca channels
d. inhibit sodium channels
inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
What are amitriptyline theraputic uses?
a. vulvodynia
b. menopause
c. chronic pelvic pain
d. a and c
a and c
How is amitriptyline administered?
a. oral
b. IM
c. topical
d. a and c
a and c
What are the side effects of amitriptyline?
sedation, dry mouth, constipation, urinary retention, blurred vision, tachycardia, arrhythmias, cognitive dysfunction, lower seizure thershold, serotonin syndrome, falls in older pt, suicide
What are the MOA of Venlafaxine and Duloxetine?
a. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
b. reuptake inhibiton of seretonin and norepipehrine
c. inhibit votlage-gated Ca channels
d. inhibit sodium channels
reuptake inhibiton of seretonin and norepipehrine
What is the therapeutic use of Venlafaxine and Duloxetine?
a. vulvodynia
b. menopause
c. chronic pelvic pain
d. a and c
a and c
How are Venlafaxine and Duloxetine adminstered?
a. IM
b. topical
c. oral
d. implant
oral
Which drugs inhibit CYP2D6?
a. Venlafaxine
b. Duloxetine
c. amitriptyline
d. gabapentin
Duloxetine
What are the SE of Venlafaxine and Duloxetine?
N, constipation, insomnia, dizziness, increased HR and BP, risk of serotonin syndrome, sexual dysfunction, withdrawal symptoms
What are gabapentin and pregabalin?
a. SNRIs
b. TCAs
c. GABA analogs/calcium channel blockers
d. sodium channel blockers
GABA analogs/calcium channel blockers
What is the MOA of gabapentin and pregabalin?
a. inhibits voltage-gated ca channels
b. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
c. reuptake inhibiton of seretonin and norepipehrine
d. inhibit sodium channels
inhibits voltage-gated ca channels
What is the therapeutic use of gabapentin and pregabalin?
a. vulvodynia
b. menopause
c. chronic pelvic pain
d. a and c
a and c
How is gabapentin and pregabalin administered?
a. IM
b. topical
c. oral
d. b anc c
b and c
Which GABA analog is more potnetns and required less?
a. gabapentin
b. pregabalin
pregabalin
which of the following is NOT an SE of gabapentin and pregabalin?
a. dizziness and ataxia
b. sedation and confusion
c. GI irritation
d. sexual dysfunction
sexual dysfunction
What is lidocaine?
a. SNRIs
b. TCAs
c. local anesthetics
d. GABA analogs
local anesthetics
what is the MOA of lidocaine?
a. inhibits voltage-gated ca channels
b. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
c. reuptake inhibiton of seretonin and norepipehrine
d. inhibit sodium channels
inhibit sodium channels
What are the therapeutic uses for lidocaine?
a. vulvodynia
b. vaginsmus
c. hypertonic pelvic floor muscles
d. all of the above
all of the above
What are is the administration of lidocine?
a. oral
b. topical
c. injectable
d. b and c
ba and c
Which of the following is NOT a SE of lidocine?
a. Local irritation/hypersensitivity reactions or pain
b. Partner may experience genital numbness
c. Neurotoxicity and cardiotoxicity with systemic absorption
d. vaginal dryness
vaginal dryness
What is the MOA of baclofen?
a. bind to GABAa recpetors increasing GABA activity and ihibitng muscle contraction
b. prevent release of acteylcholine
c. agonist at the GABAb receptor
d. phosphodiesterase inhibitors
agonist at the GABAb receptor
How is baclofen administered?
a. oral
b. topical
c. injectable
d. b and c
topical
Which of the following is NOT an SE of baclofen?
a. local skin reaction
b. sedation/sleepiness
c. ataxia
d. muscle cramps
muscle cramps
What is the MOA of botulinum toxin?
a. bind to GABAa recpetors increasing GABA activity and ihibitng muscle contraction
b. prevent release of acteylcholine at the neuromusclar junction
c. agonist at the GABAb receptor
d. phosphodiesterase inhibitors
prevent release of acteylcholine at the neuromusclar junction
what are the SE of botulinum toxin?
a. urinary retention or incontenece
b. fecal incontinence
c. pelvic floor weakness
d. all of the above
all
What is the MOA of diazepam?
a. bind to GABAa recpetors increasing GABA activity and ihibitng muscle contraction
b. prevent release of acteylcholine at the neuromusclar junction
c. agonist at the GABAb receptor
d. phosphodiesterase inhibitors
bind to GABAa recpetors increasing GABA activity and ihibitng muscle contraction
How is botulinum toxin adminstered and for what?
a. injected for hypertonic plevic floor muscles
b. topical for hypertonic plevic floor muscles
c. oral for hypertonic plevic floor muscles
d. IM for hypertonic plevic floor muscles
injected for hypertonic plevic floor muscles
What is bupropion used for?
a. pelvic pain
b. vulvodynia
c. sexual desire disorders
d. menopause
sexual desire disorders
Which of the following is NOT an AE of bupropion?
a. depression
b. increased risk of seziure
c. insomnia
d. hypertension
depression
What population of women benefits from sildenafil?
a. all women
b. those with anxiety
c. those with depression
d. those on SSRIs
those on SSRIs
What is flibanserin MOA?
a. inhibits voltage-gated ca channels
b. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
c. reuptake inhibiton of seretonin and norepipehrine
d. multifunctional serotonin agonist and antagonist
multifunctional serotonin agonist and antagonist
How is flibanserin administered?
a. IM
b. topical
c. oral
d. implant
oral
Which of the following is NOT a SE of flibanserin?
a. sleepiness
b. dizziness and syncope
c. nausea
d. constipation
constipation
What is bremelanotide used for?
a. sexual desire disorder in premenopausal women
b. vulvodynia
c. PCOS
d. endometriosis
sexual desire disorder in premenopausal women
What is bremelanotide MOA?
a. agonist at melanocortin receptors
b. inhibiton of monamine reuptake, increasing the concentration of NE and 5-HT in the synapse
c. reuptake inhibiton of seretonin and norepipehrine
d. multifunctional serotonin agonist and antagonist
agonist at melanocortin receptors
How is bremelanotide adminstered?
a. oral
b. injection at least 45 min prior to sex
c. topical at least 30 min prior to sex
d. all of the above
injection at least 45 min prior to sex
Which of the following is not a SE of bremelanotide?
a. N/V
b. headache
c. hypopigmentation
d. flushing
hypopigmentation
What is the CI for bremelanotide?
a. breast cancer
b. clotting disorder
c. prostate cancer or BPH
d. CVD
CVD
What is sildenafil MOA?
a. multifunctional serotonin agonist and antagonist
b. phosphodiesterase inhibitor that prevents the breakdown of cGMP in the corpus cavernosum causing vasodilation and erection
c. acts on testosterone receptors
d. directly vasodilates the smooth muscle
phosphodiesterase inhibitor that prevents the breakdown of cGMP in the corpus cavernosum causing vasodilation and erection
what is sildenafil used for?
a. menopause
b. erectile dysfunction
c. PCOS
d. BPH
erectile dysfunction
How is sildenafil administered and when?
a. oral 5 min before sex
b. topical 60 min before sex
c. oral 60 min before sex
d. oral 30 min before sex
oral 60 min before sex
What are CI of sildenafil?
a. prostate cancer
b. nitrogylcerin or nitrates
c. alpha-1-blockers
d. b and c
b and c
What is the MOA of alprostadil?
a. multifunctional serotonin agonist and antagonist
b. phosphodiesterase inhibitor that prevents the breakdown of cGMP in the corpus cavernosum causing vasodilation and erection
c. acts on testosterone receptors
d. directly vasodilates the smooth muscle via prostaglandin E1
directly vasodilates the smooth muscle
How is alprostadil administered?
a. intra-cavernous injection
b. topical
c. intraurethral pellet
d. a and c
a and c
Which of the following is NOT a SE of alprostadil?
a. penile pain
b. dizziness and headache
c. priapism
d. low libido
low libido
What can happen to the pt partner with intraurethral administration of alprostadil?
a. vulvovaginal pruritis
b. infection
c. anal prutitis
d. a and c
a and c
What drugs are used to treat premature ejaculation?
a. SSRI
b. prostaglandin E1
c. local anesthetics
a and c
What is nystatin?
a. oral antifungal
b. oral antibacterial
c. topical antifungal
d. topical antibacterial
topical antifungal
What are SE of nystatin?
a. skin irritatation
b. rash
c. burning and stinging
d. all
all
What is fluconazole treat?
a. Group B Strep
b. candidiasis
c. BV
d. Trichomoniasis
candidiasis
How is fluconaol adminstered?
a. topical
b. oral
c. IM
d. IV
oral
What do you need to mointer with long term use of fluconazole?
a. kidney function
b. heart function
c. liver function
d. lung function
liver function
Which of teh following is not a SE of fluconazole?
a. headache
b. kidney damage
c. GI symptms
d. liver damage
kidney damage
Which drug is CYP3A4 inbitor? (2)
a. tamoxifen
b. Duloxetine
c. erythromycin
d. fluconazole
erythromycin and fluconazole
Which drugs are reccomended in those that are pregnant with a candidiasis infection?
a. clotrimazole
b. fluconazole
c. miconazole
d. a and c
a and c
What is metronidazole MOA?
a. inhibits microbial DNA synthesis
b. inhibits bacterial protein synthesis
c. antifungal
d. inhibits bacteral cell wall synthesis
inhibits microbial DNA synthesis
How is metronidazole administered?
a. oral
b. IM
c. topical
d. a and c
a and c
What are SE of metronidazole?
metallic tase, nausea, neutropenia, diarrhea, gas/bloating, peripheral neuopathy, vulvogvaginal candidiasis, alcohol induced nausea, vomitting, flushing, tachycardia, dyspnea
What is the MOA of cindamycin?
a. inhibits microbial DNA synthesis
b. inhibits bacterial protein synthesis
c. antifungal
d. inhibits bacteral cell wall synthesis
inhibits bacterial protein synthesis
How is clindamycin administered?
a. oral
b. IM
c. topical
d. a and c
a and c
What are SE with clindamycin topically?
a. local irritation
b. candidiasis
c. nausea
d. a and b
a and b
What are clindamycin SE?
nausea, vomiting, abdominal pain, hepatotoxicity, increased risk of candidiasis, increased risk of C. difficile colitis
What dose clindamycin treat?
a. Group B Strep
b. candidiasis
c. BV
d. Trichomoniasis
BV
What is penicillin G MOA?
a. inhibits microbial DNA synthesis
b. inhibits bacterial protein synthesis
c. antifungal
d. inhibits bacterial cell wall synthesis
inhibits bacterial cell wall synthesis
How is Penicillin G adminstered and what dose it treat?
a. IV; group b strep
b. oral; BV
c. topical; group b strep
d. IV; BV
IV; group b strep
What are SE of penicillin G?
Anaphylaxis, urticaria, angioedema, rash, fever, hemolytic anemia, diarrhea, rare nephrotoxicity, neurotoxicity
(2) What dose metronidazole treat?
a. Group B Strep
b. candidiasis
c. BV
d. Trichomoniasis
BV and Trichomoniasis
What are the guidelines for sex when treating STIs?
a. can have sex during treatment
b. can have sex 2 day after completing treatment
c. can have sex 7 day after completing treatment
d. can have sex after completing treatment
can have sex 7 day after completing treatment
What is azithromycin and doxycycline MOA?
a. inhibits microbial DNA synthesis
b. inhibits bacterial protein synthesis
c. antifungal
d. inhibits bacterial cell wall synthesis
inhibits bacterial protein synthesis
Which of the following is NOT azithromycins adverse effect?
a. nausea
b. diarrhea and abdominal pain
c. cardiacarrhytmias
d. photosenstivity
photosenstivity
Which of the following is NOT azithromycins adverse effect?
a. nausea
b. diarrhea and abdominal pain
c. cardiacarrhytmias
d. photosenstivity
photosenstivity
Azithromycin can be used during pregnancy and lactation but doxycycline can not
True
False
T
What are doxycyline SE?
a. nausea, diarrhea, abdominal pain, esophageal ulcer
b. photosensitivity
c. hepatotoxicity
d. all of the above
all
What interferes with Doxycycline absorbption?
a. mineral supplements
b. kale
c. diary
d. a and c
a and c
What are azithromycin and doxycycline used to treat?
a. BV
b. candidiasis
c. chlamydia
d. HIV
chlamydia
What dose levofloxacin treat?
a. BV
b. chlamydia
c. trichamonsis
d. GBS
chlamydia
Which of the following is not a SE of levofloxacin?
a. hepatotoxicity
b. tendinits/tendon rupture
c. peipheral neuropathy
d. arrhythmias and aortic aneurysm
hepatotoxicity
Which drugs fro chlamydia are not allowed to be used in pregnancy?
a. doxycycline
b. penicillins
c. levofloxacin
d. a and c
a and c
What dose erythromycin treat?
a. chlamydia
b. BV
c. GBS
d. trichamonasis
chlamydia
What is ceftriaxone MOA?
inhibit bacterial cell wall synthesis
How is ceftriazone administered?
IM
What are SE of ceftriaxone
injection site reaction), diarrhea
What are the CI for using ceftriaxone
moderate to severe β-lactam allergy.
What dose ceftriaxone treat
gonorrhea
How do you treat syphilis
IM penicillin G
What do acyclovir and valacyclovir treat?
HSV
What is the MOA of acyclovir and valacyclovir?
inhibitors of viral DNA polymerase
How is acyclovir and valacyclovir administred?
topical and oral (better)
Which has higher oral bioavailability?
acyclovir or valacyclovir
valacyclovir
What are SE of acyclovir and valacyclovir
malaise, headache, N/V
What tests do you need to run before prescribing PEP
HIV, pregancy, liver function, BUN/creatinine, STI, Hep B and C
How many hours after exposure can you give PEP?
72
What is included in PEP?
Tenofivir – Nucleotide reverse transcriptase inhibitor
Emtricitabine – Nucleoside reverse transcriptase inhibitor
Raltegravir or dolutegravir – Integrase inhibitors
What is included in PrEP?
Tenofivir – Nucleotide reverse transcriptase inhibitor
Emtricitabine – Nucleoside reverse transcriptase inhibitor
What are advantages of oral HT
Most common dosage form
Generally least expensive
Ease of use
Storage
Beyond Use Date
What is the disadvantages of oral HT?
First Pass metabolism
Subject drug to gastric pH
Gut requires active transport of molecule
some patients may have a hard time swallowing capsules
What are the advantages and disadvantages of sublingual dosing
a: rapid absoprtion, decrease firt pass meatbolism, bypass gastric system, removal of dosage form is needed
d: interfence with saliva testing , small amount of oral absorbtion, taste, can’t confer endometrial protection with sublingual progesterone
What are the advanages and disadvantages of trandermal HT?
a: ease of use, avoids first pass metabolism, quick removal of patch, adjustable dosages
d: absorption variability, compliance
