Reproductive

Question 1

GnRH analog

Pulsatile- agonist

(for infertility)

Continuous- antagonist

(for prostate cancer, uterine fibroids, precocious puberty)

Nausea, vomiting, antiandrogen

Answer 1

Leuprolide

Question 2

Androgen receptor agonists (2)

Hypogonadism, development of secondary sex characteristics, anabolism after burns/injury

Gonadal atrophy (LH reduced), closure of epiphyseal plates, masculinization, increased LDL, decresed HDL

Answer 2

Testosterone, methyltestosterone

Question 3

5-alpha reductase inhibitor

(decreased T -> DHT)

For BPH, male-pattern baldness

Impotence, ejaculatory dysfunction, gynecomastia

Answer 3

Finasteride

Question 4

Competitive inhibitor at testosterone receptor

Prostate carcinoma

Answer 4

Flutamide

Question 5

Inhibits 17,20-desmolase

(steroid synthesis)

For polycystic ovarian syndrome, hirsutism

Gynecomastia, amenorrhea

Answer 5

Ketoconazole

Question 6

Inhibits steroid binding

For polycystic ovarian syndrome, hirsutism

Gynecomastia, amenorrhea

Answer 6

Spironolactone

Question 7

Bind estrogen receptors (3)

For hypogonadism, ovarian failure, menstrual abnormalities, hormone replacement therapy, androgen-dependent prostate cancer

Endometrial cancer, uterine bleeding, clear cell adenocarcinoma of vagina (1), thrombosis

Contra: ER+ breast ca, DVTs

Answer 7

Estrogens

Ethinyl estradiol, DES, mestranol

Clear cell adenocarcinoma- DES in utero

Question 8

Partial estrogen receptor agonist (hypothalamus)

Prevents feedback inhibition, increases LH/FSH for ovulation

For infertility, polycystic ovarian syndrome

Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances

Answer 8

SERM:

Clomiphene

Question 9

Estrogen receptor antagonist (breast tissue)

For treatment/recurrence of ER+ breast cancer

Answer 9

SERM:

Tamoxifen

Question 10

Estrogen receptor agonist (bone)

For osteoporosis

Answer 10

SERM:

Raloxifene

Question 11

For relief/prevention of menopausal symptoms and osteoporosis

Increased risk for cardiovascular disease

Increased risk for endometrial cancer (if unopposed)

Answer 11

Hormone replacement therapy

Question 12

Aromatase inhibitors (2)

Breast cancer in postmenopausal women

Answer 12

Anastrazole, exemestane

Question 13

Bind progesterone receptors

Reduce growth, increase vascularization of endometrium

Oral contraceptives, endometrial cancer, abnormal uterine bleeding

Answer 13

Progestins

Question 14

Competitive inhibitor at progesterone receptors

Medical abortion

(with what else?)

Heavy bleeding, abdominal pain, nausea, vomiting, anorexia

Answer 14

Mifepristone

(w/ misoprostol- abortion)

Question 15

Inhibits LH/FSH

For prevention of ovulation

Thickening of cervical mucus, inhibit endometrial proliferation

Contra: smokers >35 (CV events), h/x thromboembolism, stroke, estrogen-dependent tumor

Answer 15

Oral contraception

Synthetic progestins, estrogen

Question 16

Beta-2 agonist

Prevents premature uterine contractions by relaxing uterus

Answer 16

Terbutaline

Question 17

Alpha-1 antagonist

For BPH (inhibit smooth muscle contraction)

Selective for 1A, 1D found in prostate

versus

1B found in vascular smooth muscle

Answer 17

Tamsulosin

Question 18

Phosphodiesterase 5 inhibitors (2)

increase cGMP, smooth muscle relaxation

For erectile dysfunction

Headache, flushing, dyspepsia, blue-green vision impairment

Contra: nitrates- hypotension

Answer 18

Sildenafil, vardenafil

Question 19

Partial agonist at androgen receptors

(synthetic androgen)

For endometriosis, hereditary angioedema

Weight gain, edema, acne, hirsutism, masculinization, decreased HDL, hepatotoxicity

Answer 19

Danazol