Repro Pharm Flashcards by lauren Poe

Which drugs cause gynecomastia?

Some Drugs Cause Awkward Knockers:
Spironolactone 
Digoxin
Cimetidine
Alcohol 
Ketoconazole

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What is leuprolide?

GnRH analog with agonist properties when used in pulsatile
fashion
Antagonist when given continuously

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What is leuprolide used for?

Infertility (pulsatile)
Prostate cancer (continuous - use with flutamide)
Uterine fibroids (continue)
Precocious puberty (continuous)

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What are the side effects of leuprolide?

Antiandrogen
Nausea
Vom

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What is testosterone used for?

Hypogonadism
Promotion of secondary sex characteristics
Stimulation of anabolism after burns or injury

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What are the side effects of testosterone?

Masculinization in females
Inhibits LH in males so gonadal atrophy
Premature closure of epiphyseal plates 
Increases LDL
Decreases HDL

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What is finasteride?

A five alpha reductase inhibitor

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What is finasteride used for?

Male pattern baldness

benign prostatic hypertrophy

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What is flutamide?

A nonsteroidal competitive inhibitor of androgens at the testosterone receptor

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What is flutamide used for?

Prostate cancer

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What are the side effects of finasteride?

Hirsutism

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What is the drawback of finasteride?

It takes 6 months for the full effect

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What is saw palmetto?

A 5 alpha reductase inhibitor and androgen receptor blocker

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What is the MOA of ketoconazole?

Inhibits steroid synthesis (17,20 desmolase - present in theca cells)

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What is ketoconazole used for?

PCOS

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What are the side effects of spironolactone and ketoconazole?

Gynecomastia

Amenorrhea

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What is the MOA of spironolactone?

Inhibits steroid binding

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What are estrogens used for?

Hypogonadism 
Ovarian failure
Menstrual abnormalities
HRT in post meno women
And prostrate cancer

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What are the side effects of estrogen therapies?

Increased risk of endometrial cancer
Bleeding in post meno
Clear cell adenocarcinoma of vagina in women exposed to DES
Increased risk of thrombi

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What are the contraindications to using estrogen?

Hx of DVT

ER positive breast cancer

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What are the selective estrogen receptor modulators?

Clomiphene
Tamoxifen
Raloxifene

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What is clomiphene?

Partial agonist at estrogen receptors in hypothalamus
Prevents normal feedback inhibition
Increases LH and FSH from pituitary to stimulate ovulation.

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What is clomiphene used for?

Infertility

PCOS

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What are the side effects of clomiphene?

Hot flashes
Ovarian enlargement
Multiple simultaneous pregnancies
Visual disturbances

What is tamoxifen?

Antagonist of estrogen receptors at breast tissue and partial agonist at endometrium Used to treat ER positive breast cancer

What is raloxifene?

Agonist of estrogen receptors on bone --> decreases resorption of bone

What is HRT?

For relief and prevention of meno sx and osteoporosis (increase estrogen and decrease osteoclasts activity)

What is the risk of unopposed estrogen therapy?

Increased risk of endometrial cancer and CV risk

What is anastrozole/exemesrane?

Aromatase inhibitors used in post meno women with breast cancer

What are progestins used for?

OC Tx of endometrial cancer and abnormal uterine bleeding Causes reduced growth and vascularization of endometrium

What is mifepristone?

An abortifacient - competitive inhibitor of progesterone receptors. The anti-progestin effects cause release of endogenous prostaglandins and sensitize the myometrium to the effects of the hormone

What is the side effect of mifepristone?

Heavy bleeding N/V Anorexia Ab pain

What is misoprostol?

PGE1

How do OCs work?

Inhibit LH/FSH surge via negative feedback so there is no ovulation. Progestins cause thickening of cervical mucus so limits sperm access, inhibit endometrial proliferation so it is less accepting of implantation

What are the contraindications for OCs?

Smoking over age 35 Hx of thromboembolism or stroke Hx of estrogen dependent tumor

What is terbutaline?

B2-agonist that relaxes uterus - tocolysis

What is tamsulosin?

Alpha-1 antagonist used for BPH | Selective for 1AD receptors in the prostate

What are the normal side effects of alpha blockers?

Reflex tachycardia Syncope Ortho static hypotension Asthenia

What are the side effects of tamsulosin?

Ejaculation problems Nasal stuffiness Asthenia Does not cause orthostatic hypotension

What is the MOA of sildenafil?

Inhibit phosphodiesterase 5 causing an increase in cGMP, smooth muscle relaxation in corpus cavernosum

What are the side effects of sildenafil?

Headache Flushing Dyspepsia Impaired blue-green color vision

What are the contraindications for afils?

Patients with angina on nitrates | Alpha blockers for BPH

What is danazol?

Synthetic androgen that acts as a partial agonist

What is danazol used for?

Endometriosis | Hereditary angioedema

What are the side effects of danazol?

``` Weight gain Edema Acne Hirsutism Masculinization Decrease HDL Hepatotoxicity ```

Exogenous testosterone effects?

inhibits HPG axis = dec intratesticular testosterone = dec testicular size = azoospermia

How do you treat 5-alpha-reductase deficiency?

DHT

How do you treat hydatidiform mole?

Methotrexate | D&C

How do you treat Preeclampsia & Eclapsia?

IV magnesium sulfate (both prevent & treat seizures) bed rest, monitor, dec Na intake, tx HTN (methyldopa) deliver fetus as soon as viable

How do you treat endometritis?

gentamycin + clindamycin | may add ampicillin

How do you treat endometriosis?

Oral contraceptives Leuprolide Danazol NSAIDs

How do you treat Adenomyosis?

Hysterectomy

What are the treatment strategies for PCOS?

Medroxyprogesterone (dec LH & androgenesis) or low dose-OCPs Spironolactone (tx acne & hirsutism) Clomiphene (stimulates ovulation -- if want to get pregnant) Metformin (+DM or metabolic syndrome) weight reduction

What is the treatment for BPH?

alpha1- antagonists = terazosin & tamulosin (cause relaxation of smooth muscle) finasteride (inhibits production of DHT from Testosterone)

What are the effects of leuprolide in the use of prostate cancer?

It decreases circulating levels of testosterone by decreases LH release from the pituitary. Less LH influence on the Leydig cells results in less testosterone production

What are the side effects of terbutaline?

Neonatal intraventricular hemorrhage Hypoglycemia Hypocalcemia Ileus

What may cause blindness and retinal neovascularizatiom in a neonate?

Positive end expiratory pressure used for ARDS

What are the complications of surfactant treatment?

Transient hypoxia and hypotension Blockage of endotracheal tube Pulmonary hemorrhage

What is the clinical use of mifepristone?

Used for abortions up to 49 days after conception.