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USMLE Pharmacology > Reproductive > Flashcards

Reproductive Flashcards

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USMLE® Step 1 flashcards
1
Q

Leuprolide

A

GnRH analog
Agonist properties when used in pulsatile fashion
Antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary to decrease FSH/LH)
“Leuprolide can be used in lieu of GnRH”

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2
Q

Leuprolide uses

A 
GnRH analog
Infertility = pulsatile
Prostate cancer = continuous, used with flutamide
Uterine fibroids = continuous
Precocious puberty = continuous
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3
Q

Leuprolide toxicity

A

Antiandrogen
Nausea
Vomiting

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4
Q

Estrogens

A

Ethinyl estradiol
DES (Diethylstilbestrol)
Mestranol

Bind estrogen receptors

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5
Q

Estrogens
Toxicity?
Contraindications?

A

Increased risk of endometrial cancer
Bleeding in postmenopausal women
Clear cell adenocarcinoma of vagina in females exposed to DES in utero
Increased risk of thrombi
Contraindications = ER + breast cancer, history of DVTs

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6
Q

Selective estrogen receptor modulators = SERMs

A

Clomiphene
Tamoxifen
Raloxifene

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7
Q

Clomiphene
Uses?
Side effects?

A

SERM
Antagonist at estrogen receptors in hypothalamus
Prevents normal feedback inhibition and increases release of LH and FSH from pituitary = stimulates ovulation
Use = tx of infertility due to anovulation (PCOS)
SE = hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances

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8
Q

Tamoxifen

A

SERM
Antagonist on breast tissue
Agonist at uterus (risk cancer) and bone
Associated with endometrial cancer and thromboembolic events
Use = treat/prevent recurrence of ER + breast cancer

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9
Q

Raloxifene

A 
SERM
Agonist on bone
Antagonist at uterus
Increased risk of thromboembolic events
Decreased resorption of bone = used to treat OSTEOPOROSIS
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10
Q

Hormone replacement therapy

A

Used for relief or prevention of menopausal symptoms (hot flashes, vaginal atrophy) and osteoporosis (increase estrogen, decrease osteoclast activity)

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11
Q

What is the risk with unopposed estrogen replacement therapy?

A

Increased risk of endometrial cancer
As a result, progesterone is added
Possible increased cardiovascular risk as well

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12
Q

Anastrozole and Exemestane

A

Aromatase inhibitors

Used in postmenopausal women with breast cancer

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13
Q

Progestins

A

Bind progesterone receptors = decrease growth and increase vascularization of endometrium
Uses = oral contraceptives; tx of endometrial cancer and abnormal uterine bleeding

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14
Q

Mifepristone (RU-486)
Use?
Toxicity?

A

Competitive inhibitor of progestins at progesterone receptors
Use = termination of pregnancy; administered with misoprostol (PGE1)
Toxicity = heavy bleeding, GI effects (n/v, anorexia), abdominal pain

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15
Q

Oral contraception (synthetic progestins, estrogen)

A

Estrogen and progestins inhibit LH/FSH and thus prevent estrogen surge
No estrogen surge = no LH surge = no ovulation

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16
Q

Effects of progestins in contraception

A

Thickening of cervical mucus = limiting access of sperm to uterus
Inhibition of endometrial proliferation = less suitable for implantation of embryo

17
Q

Oral contraception contraindications

A

Smokers > 35 years old (increased risk of CV events)

Patients with history of thromboembolism and stroke or history of estrogen-dependent tumor

18
Q

Terbutaline

A

B2-agonist that relaxes uterus

Used to decrease contraction frequency in women during labor

19
Q

When might terbutaline be used?

A

To prevent premature labor

20
Q

Danazole

Uses?

A

Synthetic androgen that acts as partial agonist at androgen receptors
Uses = endometriosis and hereditary angioedema

21
Q

Danazole toxicity

A 
Synthetic androgen that acts as partial agonist at androgen receptors
Weight gain
Edema
Acne
Hirsuitism
Masculinization
Decreased HDL levels
Hepatotoxicity
22
Q

Testosterone and Methyltestosterone

Toxicity?

A

Agonist at androgen receptors

Causes masculinization in females
Decreases intratesticular testosterone in males by inhibiting release of LH (via neg feedback) = gonadal atrophy
Premature closure of epiphyseal plates
Increased LDL and decreased HDL

23
Q

Antiandrogens

A

Finasteride
Flutamide
Ketoconazole
Spironolactone

24
Q

Finasteride

A

5a-reductase inhibitor = decreases conversion of testosterone to DHT
Uses = BPH and male-pattern baldness (promotes hair growth)

25
Q

Flutamide

A

Nonsteroidal competitive inhibitor of androgens at the testosterone receptor
Uses = prostate carcinoma

26
Q

Ketoconazole

A

Inhibits steroid synthesis (inhibits 17,20-desmolase)
Use = tx PCOS to prevent hirsutism
SE = gynecomastia and amenorrhea

27
Q

Spironolactone

A

Inhibits steroid binding, 17a-hydroxylase, and 17,20-desmolase
Use = tx PCOS to prevent hirsutism
SE = gynecomastia and amenorrhea

28
Q

Which drugs can cause gynecomastia?

A 
"Some Dope Drugs Easily Create Awkward Hairy DD Knockers"
Spironolactone
Dope/marijuana
Digitalis/digoxin
Estrogen
Cimetidine
Alcohol
Heroin
Dopamine
D2 antagonists
Ketoconazole

Shortened = “Some Drugs Cause Awesome Knockers”

29
Q

Tamsulosin (FloMax)

A

a1-antagonist used to treat BPH by inhibiting smooth muscle contraction
Selective for a1A,D receptors (found on prostate) vs. vascular a1B receptors

30
Q

Sildenafil
Vardenafil
Tadalafil

A

Sildenafil = Viagra
Vardenafil = Levitra
Tadalafil = Cialis
“-fil” the penis

Inhibit phosphodiesterase 5 = increased cGMP, smooth muscle relaxation in corpus cavernosum, increased blood flow, and PENILE ERECTION

31
Q

PDE5 inhibitor toxicity

A

Headache
Flushing
Dyspepsia
Impaired blue-green color vision
Risk life-threatening hypotension in patients taking nitrates
“Hot and sweaty” but then Headache, Heartburn, Hypotension”

32
Q

What should you never give to a patient who is taking a PDE5 inhibitor?

A

NITRATES

Risk life-threatening hypotension

USMLE Pharmacology (15 decks)

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