Reproductive

Question 1

most potent form of endogenous estrogen in women

Answer 1

estradiol

- other forms have 1/10th the potency

Question 2

do synthesized estrogens have more or less bioavailability?

Answer 2

more because less first pass metabolism by liver

Question 3

therapeutic uese of estrogen

Answer 3

hormone replacement in post-menopausal women

contraception

Question 4

benefits of HRT

Answer 4

• decreased vasoactive responsiveness = less hot flashes and night sweats
• prevention/tx of postmenopausal atrophy of tissues
• benefits sleep quality
• estrogen decreases resorption of bone decreasing osteoporosis

Question 5

risks of exogenous estrogen

Answer 5

stroke
blood clots
ovarian ca
endometrial ca
breast ca

Question 6

medroxyprogesterone acetate (depo)

Answer 6

injected birth control
10 months
increased risk of breast ca and dementia if taken with premarin

Question 7

WHI - E + P trial arm

Answer 7

estrogen + progestin (prempro) = increased MI
stroke
DVT and PE
breast ca
colorectal ca
fewer fractures

Question 8

bio-identical hormones

Answer 8

alternative to oral CEE and MPA

- cream, patch, etc

Question 9

Bi-est

TriEst

Answer 9

estriol: estradiol 80:20 - better option
estriol: estradiol: estrone 80:10:10

Question 10

Premarin

Answer 10

conjugated estrogen
alters gene transcription
SE: vaginal bleeding, breast tenderness, increased risk of DVT, increased atherosclerosis and CAD, uterine and breast ca

Question 11

when can you give HRT with unopposed estrogen?

Answer 11

only if hysterectomy otherwise it will cause endometrial hyperplasia

Question 12

progestins

Answer 12

synthetic progesterone used alone for contraception or with estrogen
8 types

Question 13

drospirenone/yaz/Yasmin

Answer 13

synthetic progestin
4th generation progestin gonane
derived from 17a-spironlactone, not 19
3 mg drospirenone and 20mcg ethinyl estradiol
*need to test K levels before and a few months into tx because it can cause K retention

Question 14

medroxyprogesterone/provera/ depo-provera IM

Answer 14

synthetic variant of progesterone
progesterone only
contraceptive, HRT, dysfunctional uterine bleeding
increases LDL and decreases HDL
used to block hormonal aggravation of tissue with endometriosis
*chemically castrate sex offenders
contraindicated with DVT Ca, causes birth defects
- can cause metabolic disturbances
- at high doses can use to treat ca

Question 15

OCP and depression/anxiety

Answer 15

alter/lower serotonin which can lead to anxiety and depression

Question 16

benefits of OCPs

Answer 16

decreased risk of colorectal ca

decreased PID, dysmenorrhea, acne, PCOS, and PMS

Question 17

OCPs and breast cancer risk

Answer 17

slight increase in risk during and 10 years after use
no increased risk 10 or more years after stopping
- decrease in risk of ovarian ca

Question 18

what drugs reduce the efficacy of OCPs?

Answer 18

antibiotics

st johns wart

Question 19

medroxyprogesterone/depoprovera

Answer 19

many benefits

don’t use for more than 2 years due to increased risk of osteoporosis

Question 20

the use of oral contraceptives decreases risk of endometrial and ovarian cancer by what percent?

Answer 20

50%

80% after 10 years of use

Question 21

risk of drospirenone?

Answer 21

6-7 times the risk of developing thromboembolism

2 times risk of women taking levonorgestrel

Question 22

drospirenone properties

Answer 22

• anti-mineralcorticoid effect reduces water retention and bloating
• also treats premenstrual dysphoric disorder

Question 23

depo-sub-q provera 104

Answer 23

104mg aqueous suspension of medroxyprogesterone acetate.

31% less than original

Question 24

how does depo-provera work?

Answer 24

high dose progestin inhibits follicular devleopment, preventing ovulation
- decreases GnRH -> decreases release of FSH and LH

Question 25

benefits and risks of depo/medroxyprogesterone

Answer 25

• reduces risk of endometrial ca by 80%, no increased risk of DVT, stroke, MI.
• menstrual irregularities, abd discomfort, weight changes, hair loss, depression, nervousness, delayed return of fertility, bone less!

Question 26

Implanon

Answer 26

subdermal progestin implant

remove after 3 years

Question 27

ortho-evra

Answer 27

discontinued due to thrombolic events
transdermal patch
- middle layer contains 150ugm norelgestromin and 20 ugm ethinyl estradiol
- new patch every week for 3 weeks and then 1 week off

Question 28

IUDs

what types and doses?

Answer 28

ParaGard - copper, no hormones (impairs sperm mobility)
Mirena - mg progestine and 52 mg levongestrel (20mcg/day)
Liletta - progestine and 52 mg levongestrel (20mcg/day)
Skyla - progestine and 13.5mg levongestrel (14 mcg.day)

Question 29

effectiveness of IUDs

Answer 29

0.7%

Question 30

Plan B

Answer 30

Levongestrel 1. mg as 2 750 ug doses 12 hours apart or as one single dose
works up to 72 hours after sexual intercourse

Question 31

Ulipristal acetate/Ella One

Answer 31

SPRM progestin receptor modulator
morning after pill
given up to 5 days (120 hours) after intercourse
60% effective

Question 32

Mifepristone/mifeprex

Answer 32

abortion pill
synthetic steroid compound used in first two months of pregnancy
progestin antagonist - blocks receptors
85% success rate

Question 33

Clomiphene/Clomid

Answer 33

selective estrogen receptor modulator
infertility/amenorrhea
binds estrogen receptor sites in brain -> increased GnRH release -> increased LH and FSH stimulating ovulation

Question 34

testonsterone MOA

Answer 34

alteration of gene transcription
metabolized to dihydrotestosterone or estrogen
androgenic (male sex hormones) and anabolic (protein metabolism) effects.

Question 35

Leuprolide/lupron

Answer 35

anti-androgenic hormone and anti-estrogenic hormone
prostate ca, precocious puberty, endometriosis and uterine fibroids, IVF
decreased libido, impotence, nausea, vomitting, hot flashes, nigth sweats, osteoporosis