repro pharm Flashcards
leuprolide
goserelin
nafarelin
histrelin
act as GNRH agonist when used in a pulsatile fashion
when used in a continues fashion first transiently act as a GNRH agonist (tumor flare) but subsequently act as a gnrh Antagoinst dec FSH and LH
uterine fibroids ,endometriosis ,precocious puberty ,prostate ca ,infertility ,pulsatile for pregnancy ,continues for ca
a/e hypogonadism, dec libido, erectile dysfunction ,n.v
degarelix
gnrh antagonist . no start up flare
prostate cancer
hot flashes ,liver toxicity
estrogens
ethinyl estradiol ,des,mestranol
bind estrogen receptors
hypogonadism or ovarian failure menstrual abnormalities combined ocp hormone replacement therapy in postmenopausal females
inc risk of endometrial ca when given without progesterone bleeding in postmenopausal patients,clear cell adenoca of vagina in females exposed to des in utero ,inc risk of thrombi ,ca er breast ca ,history of DVT ,tobacco use in females >35 years old
clomiphene
antagonist at estrogen receptors in hypothalamus ,prevents normal feedback inhibition and inc release of lh and fsh from pituitary ,which stimulates ovulation ,used to treat infirtility due to anovulation (pcos) .may cauase hot flashes ovarian enlargment multiple simultaneous pregnancies visual disturbances
tamoxifen
antagonist at breast ,partial agonist at uterus bone,hot flashes inc risk of thromboembolic events ,especially with tobacco smoking and endometrial ca ,used to treat and prevent recurrence of ER/PR+ breast ca and to prevent gynecomastia in pts undergoing prostate ca therapy
raloxifene
antagonist at breat,uterus ,agonist at bone ,hot flashes ,,inc risk of thromboembolic events ,especially with tobacco smoking ,but no inc risk of endometrial ca
aromatase inhibitors anastrozole,letrozole,exemstane
inhibit peripheral conversion of androgens to estrogen ,er + breast ca in post menopausal women
progestins
bind progesterone receptors, dec growth and increase vascularization of endometrium ,thicken mucus
contraception ( forms include pill ,intrauterine device, implant ,depot injection ) endometrial ca ,abnormal uterine bleeding ,progestin challenge ,presence of bleeding upon withwdrawl of progestins exclude anatomic defects, asherman syndrome , chronic anovultion without estrogen
antiprogestins (mifepristone ,ulipristal)
competitive inhibitors of progestins at progesterone receptors
termination of pregnancy (mifepristone with misoprostol) ,emergency contraception ulipristal
combined contraception
progestins and ethinyl estradiol .forms include patch ,vaginal ring
estrogen and progestins inhibit LH/FSH and thus prevent estrogen surge ,no ovulation
progestins cause thickening of cervical mucus ,thereby limiting access of sperm to uterus
progestins also inhibit endometrial proliferation
a/e breakthrough menstrual bleeding ,breast tenderness, vte ,hepatic adenomas
contraindications : people >35 who smoke tobacco ,inc risk of cvs events ,patients inc risk of cvs disease ,stroke ,migraine especially with aura ,breast ca ,liver disease .
combined contraception
progestins and ethinyl estradiol .forms include patch ,vaginal ring
estrogen and progestins inhibit LH/FSH and thus prevent estrogen surge ,no ovulation
progestins cause thickening of cervical mucus ,thereby limiting access of sperm to uterus
progestins also inhibit endometrial proliferation
a/e breakthrough menstrual bleeding ,breast tenderness, vte ,hepatic adenomas
contraindications : people >35 who smoke tobacco ,inc risk of cvs events ,patients inc risk of cvs disease ,stroke ,migraine especially with aura ,breast ca ,liver disease .
copper intrauterine device
produces local inflammatory reaction toxic to sperm and ova,preventing fertilization and implantation ,hormone free
long acting reversible contraception ,most effective emergency contraception
heavier or longer menses ,dymenorrhea ,insertion contraindicated in active PID ,iud may impede pid resolution
copper intrauterine device
produces local inflammatory reaction toxic to sperm and ova,preventing fertilization and implantation ,hormone free
long acting reversible contraception ,most effective emergency contraception
heavier or longer menses ,dymenorrhea ,insertion contraindicated in active PID ,iud may impede pid resolution
tocolytics ,
medication that relax the uterus ,include terbutaline (b2 agonist) nifedipine (ca channel blocker) ,indomethacin ,nsaid . used to dec contraction frequency in preterm labor and allow time for administration of steriods (To promote fetal lung maturity ) or transfer to appropriate medical center with ob care
danazol
synthetic androgen that acts as partial agonist on androgen receptors
endometriosis ,hereditary angioedema
weight gain, edema, acne ,hirsutism ,masculinization ,dec hdl levels, hapatotoxicity ,idiopathic intracranial htn
