Reproductive And Post-Reproductive Health

Question 1

Name a progesterone antagonist

Answer 1

RU486

Mifepristone

Question 2

What drug sensitises the myometrium to prostaglandin-induced contractions?

Answer 2

Mifepristone

Question 3

Which drug can be used to terminate pregnancy?

Answer 3

Mifepristone - a progesterone antagonist

Question 4

Which drug is a 5a-reductase inhibitor?

Answer 4

Finasteride

Question 5

What is the action of 5a-reductase?

Answer 5

It metabolises testosterone into the more potent androgen - dihydrotestosterone

Question 6

Where is tamoxifen metabolised to active derivatives?

Answer 6

Liver

Question 7

What is the effect of Tamoxifen on the endometrium?

Answer 7

ER agonist

Question 8

What is the effect of Tamoxifen in the breast?

Answer 8

ER antagonist - causes arrest of the cell cycle

Question 9

Which drug is used as chemoprevention in women at high risk of breast cancer?

Answer 9

Raloxifene

Question 10

What drug is used to treat women with anovulation?

Answer 10

Clomiphene

Question 11

What is sometimes used as an adjunct to Clomiphene?

Answer 11

Chorionic gonadotrophin

Question 12

How does Clomiphene work to treat anovulation?

Answer 12

Competes with oestrogen for receptor leads to ovulation via increased production of anterior pituitary hormones

Question 13

Ulipristal is an example of what drug class?

Answer 13

SPRMs

Question 14

What is the primary mode of action for Ulipristal Acetate?

Answer 14

Delays or inhibits ovulation

Question 15

What SPRM can be used to treat uterine fibroids?

Answer 15

Ulipristal Acetate

Question 16

What causes ovulation?

Answer 16

LH surge

Question 17

Where do oestrogens get absorbed?

Answer 17

GI tract

Question 18

Where does oestrogen get metabolised?

Answer 18

Liver

Question 19

How is oestrogen excreted

Answer 19

In urine as glucuronides and sulphates

Question 20

Injected progesterone gets bound to what?

Answer 20

Albumin

Question 21

Where does progesterone get metabolised?

Answer 21

Liver

Question 22

How is progesterone excreted?

Answer 22

In the urine conjugated to glucuronic acid

Question 23

The combined pill has a small risk of thromboembolism, what increases this risk?

Answer 23

Smoking
Being over 35 and long term use
Obesity
Hypertension

Question 24

What in the liver metabolises hormone contraceptives?

Answer 24

CYP450

Question 25

Enzyme inducing drugs do what to the efficacy of oral contraceptives?

Answer 25

Reduces the efficacy

Question 26

What anti-epileptics reduce the efficacy of oral contraceptives as they are enzyme inducing drugs?

Answer 26

Carbamazepine

Phenytoin

Question 27

Which antibiotics induce enzymes and therefore reduce the efficacy of oral contraceptives?

Answer 27

Rifampicin and Rifabutin

Question 28

Which natural product induces enzymes and thus reduces the efficacy of the oral contraceptives?

Answer 28

St Johns Wort

Question 29

How do anti-epileptics, antibiotics and St Johns Wort reduce the efficacy of oral contraceptives?

Answer 29

They increase the production of hepatic CYP450

Question 30

How do soya products affect the oral contraceptive pill?

Answer 30

Enhance oestrogen absorption and reduce its storage in adipose and muscle and so cause the half life to reduce from 15 to 7 hours

Question 31

Why would you prescribe HRT?

Answer 31

Menopause and osteoporosis

Not in heart disease even though it does have benefits, but shouldn’t be prescribed purely for this reason

Question 32

What are the risks of taking unopposed oestrogen - ERT?

Answer 32

Endometrial and ovarian cancers

Question 33

What is a risk associated with opposed oestrogen (HRT)

Answer 33

Breast cancer risk increased

Question 34

Venous thromboembolism risk is increased due to what?

Answer 34

Increased thrombin activation
Decreased factor 7 levels
Decreased anti-thrombin 3 activity

Question 35

HRT reduces the risk of cardiovascular disease …how?

Answer 35

It’s beneficial to the lipid profile