Reproduction

Question 1

Name the 4 Estradiol esters…

Answer 1

Estradiol
Estrone sulfate
Equilin sulfate
Quinestrol

Question 2

How does Estradiol, Estrone sulfate, Equilin sulfate and Quinestrol enter through the body?

Answer 2

Absorbed through:
Skin
Mucus membranes
GI tract

Question 3

How is Estradiol, Estrone sulfate, Equilin sulfate and Quinestrol distributed throughout the body after absorption?

Answer 3

Sex hormone binding globulin

Question 4

Estradiol esters–Estradiol, estrone sulfate, equilin sulfate and Quinestrol are all used for the treatment of what disorders?

Answer 4

Contraception
Primary hypogonadism
Psotmenopausal hormone therapy
Osteoporosis

Question 5

What are the side effects of the estradiol esters–estradiol, Estrone sulfate, Equilin sulfate and Quinestrol?

Answer 5

Weight gain
HTN
Less commonly:
-breast cancer 
Nausea
Breast tension/pain
Vaginal bleeding
headache

Question 6

Patients who are put on an estradiol ester therapy are at an increased risk of developing what disorders?

Answer 6

Heart attack
Stoke
DVT
Cervical and endometrial cancer

Question 7

Estradiol esters—Estradiol, Estrone sulfate, Equilin sulfate and Quinestrol are strongly contraindicated in?

Answer 7

Breast or endometrial cancers
Endometriosis
Undiagnosed vaginal bleeds

Question 8

Estradiol esters—Estradiol, Estrone sulfate, Equilin sulfate and Quinestrol are relatively contraindicated in?

Answer 8

pregnancy
Thromboembolic Dz
HTN
hepatic dz
FHx of breast or uterine cancer

Question 9

Name the 2 Alkyl estrogens…

Answer 9

Ethinyl estradiol

Mestranol

Question 10

How are the alkyl estrogens, Ethinyl estradiol and Mestranol, absorbed into the body?

Answer 10

Skin
Mucus membranes
GI tract

Question 11

How are the alkyl estrogens, Ethinyl estradiol and Mestranol, distributed throughout the body?

Answer 11

Sex hormone binding globulin

Question 12

What are the primary uses of Ethinyl estradiol an Alkyl estrogen?

Answer 12

contraception
Primary hypogonadism
Postmenopausal hormone therapy
Osteoporosis

Question 13

What are the primary uses of Mestranol an Alkyl estrogen?

Answer 13

Contraception
Primary hypogonadism
Postmenopausal hormone therapy

Question 14

What are the side effects of Ethinyl estradiol and Mestranol?

Answer 14

Weight gain
HTN
Less commonly:
-breast cancer

Question 15

Patients on ethinyl estradiol or mestranol therapy are at an increased risk of developing what disorders?

Answer 15

Heart attack
Stroke
DVT
cervical and endometrial cancer

Question 16

What is Diethylstilbestrol?

Answer 16

A non-steroidal synthetic estrogen

Question 17

What reproductive drug therapy has an increased risk of developing clear cell adenocarcinoma of the vagina and cervix?

Answer 17

Diethylstilbestrol

Question 18

What is the reproductive drug therapy that is a non-steroidal anti-estrogen and selective estrogen receptor modifier—used for the treatment of ER + breast cancer?

Answer 18

Tamoxifen citrate

Question 19

What is the mechanism of action of tamoxifen citrate?

Answer 19

Blocks estrogen from binding ER and causing growth in ER+ breast cancer

Question 20

What are the side effects of Tamoxifen citrate?

Answer 20

Proestrogenic effect on uterine epithelium–increased risk of endometrial cancer

Partial estrogen agonist in bone and endometrium

Question 21

What class of drug is Clomiphene citrate?

Answer 21

Non-steroidal anti-estrogen

Question 22

What is the mechanism of action for Clomiphene citrate and what does it stimulate?

Answer 22

Blocks estrogen binding to hypothalamic receptors–increased secretion of gonadotropins and LH—> ovulation

Question 23

What is Clomiphene citrate used for?

Answer 23

Stimulate ovulation in patients who want to get pregnant

Question 24

What are the side effects of Clomiphene citrate?

Answer 24

Hot flashes
Multiple pregnancy
Stomach pain
Headache
Vomit

Question 25

What is a Cis-isomer (zuclomiphene)?

Answer 25

Weak estrogen agonist

Question 26

What is trans-isomer (enclomiphene)?

Answer 26

potent estrogen antagonist

Question 27

Name the 2 Natural progesterone drugs...

Answer 27

Micronized progesterone | Transvaginal progesterone

Question 28

What are the natural progesterone drugs, micronized and transvaginal progesterone, used for?

Answer 28

Contraception | Hormone replacement therapy

Question 29

What are the side effects of the natural progesterone drugs--micronized and transvaginal progesterone?

Answer 29

Fatigue | Drowsiness

Question 30

Natural progesterone drugs are contraindicated in?

Answer 30

``` Thromboembolic disorders Patients with a Hx of: -liver dz -undiagnosed vaginal bleeding -Pregnancy---atrophy of endometrium reading to birth defects ```

Question 31

Name the 4 synthetic progesterone drugs?

Answer 31

Medroxyprogesterone Norethindrone Norgestrel Megestrol

Question 32

What are the synthetic progesterone drugs used for?

Answer 32

Contraception | Hormone replacement

Question 33

What are the side effects of synthetic progesterone therapy with Medroxyprogesterone, Norethindrone, Norgestrel, Megestrol and patients are at an increased risk of developing what with this therapy?

Answer 33

Edema Abdominal bloating Less commonly: -strong androgenic effects--hirsutism, acne Anxiety Irritability Depression Muscular pain Increased risk of thrombus and PE

Question 34

Synthetic progesterone drugs are contraindicated in?

Answer 34

``` Thromboembolic disorders Patients with a Hx of: -liver dz -undiagnosed vaginal bleeding -Pregnancy---atrophy of endometrium reading to birth defects ```

Question 35

name the 3 combination pills used for contraception...

Answer 35

Monophasic ortho-Novum Biphasic Ortho-Novum Triphasic Ortho-Novum

Question 36

What is the mechanism of action of the combination pills used for contraception?

Answer 36

Constant level of estrogen suppresses FSH, LH surge Progesterone suppresses LH surge, thickens cervical mucus, leads to endometrial atrophy, counters estrogenic effect on endometrium

Question 37

Patients who are on a combination pill for contraception are at a decreased risk for the development of______.

Answer 37

Endometrial cancer

Question 38

Monophasic Ortho-Novum estrogen and progesterone doses are?

Answer 38

Consistent--pill taken for 21 days

Question 39

Biphasic Ortho-Novum estrogen and progesterone doses are?

Answer 39

Fixed estrogen | Progestin increased for days 11-21

Question 40

Triphasic Ortho-Novum estrogen and progesterone doses are?

Answer 40

``` Fixed or variable estrogen Progestin increases in 3 phases -1-7 -8-14 -15-21 ```

Question 41

What is mini-pill and when is it used?

Answer 41

A progestin only pill--less effective that combination pill for contraception Used when patients have estrogen contraindication Good for use in lactating women--estrogen reduces milk production

Question 42

What are the side effects of mini-pill?

Answer 42

More likely to produce irregular menstrual cycle

Question 43

Mini-pill suppresses?

Answer 43

Endometrial cancer

Question 44

What is Levonorgestrel, a synthetic progestogen, used for?

Answer 44

Plan-B | Used to prevent implantation

Question 45

What is the time window for taking Levonorgestrel?

Answer 45

within 72 hours of coitus

Question 46

Mifepristone is in what class of drug?

Answer 46

Anti-progestin; glucocorticoid receptor antagonist

Question 47

What is the mechanism of action for Mifepristone?

Answer 47

Competitively binds to progesterone receptor--leading to detachment of fetus

Question 48

What is the use of Mifepristone, an anti-progestin glucocorticoid receptor antagonist?

Answer 48

Abortion | Cushing's syndrome

Question 49

What is the time window for taking Mifepristone?

Answer 49

Must be taken early in pregnancy--by day 49 | PO administration

Question 50

Name the 3 PDE5 inhibitors?

Answer 50

Sildenafil citrate Vardenafil HCl Tadalafil

Question 51

What is the mechanism of action for the PDE5 inhibitors, Sildenafil citrate, Vardenafil HCl, Tadalafil?

Answer 51

Bind catalytic site of PDE5--inhibiting PDE5 breakdown of cGMP---> decreased Ca++ ---> smooth muscle relaxation---> erection

Question 52

What is the used of PDE5 inhibitors?

Answer 52

Erectile dysfunction--does not trigger an automatic erection, but improved response to sexual stimulation

Question 53

What are the side effects of PDE5 inhibitors?

Answer 53

Headache Dizziness Change in vision ``` Flushing Upset stomach Stuffy or runny nose UTI Diarrhea ```

Question 54

PDE5 inhibitors are contraindicated in patients who...

Answer 54

are on nitrates or a-blockers-- due to the possibility of unsafe drop in BP..