Reproductive And Post-Reproductive Health Flashcards
Name a progesterone antagonist
RU486
Mifepristone
What drug sensitises the myometrium to prostaglandin-induced contractions?
Mifepristone
Which drug can be used to terminate pregnancy?
Mifepristone - a progesterone antagonist
Which drug is a 5a-reductase inhibitor?
Finasteride
What is the action of 5a-reductase?
It metabolises testosterone into the more potent androgen - dihydrotestosterone
Where is tamoxifen metabolised to active derivatives?
Liver
What is the effect of Tamoxifen on the endometrium?
ER agonist
What is the effect of Tamoxifen in the breast?
ER antagonist - causes arrest of the cell cycle
Which drug is used as chemoprevention in women at high risk of breast cancer?
Raloxifene
What drug is used to treat women with anovulation?
Clomiphene
What is sometimes used as an adjunct to Clomiphene?
Chorionic gonadotrophin
How does Clomiphene work to treat anovulation?
Competes with oestrogen for receptor leads to ovulation via increased production of anterior pituitary hormones
Ulipristal is an example of what drug class?
SPRMs
What is the primary mode of action for Ulipristal Acetate?
Delays or inhibits ovulation
What SPRM can be used to treat uterine fibroids?
Ulipristal Acetate
What causes ovulation?
LH surge
Where do oestrogens get absorbed?
GI tract
Where does oestrogen get metabolised?
Liver
How is oestrogen excreted
In urine as glucuronides and sulphates
Injected progesterone gets bound to what?
Albumin
Where does progesterone get metabolised?
Liver
How is progesterone excreted?
In the urine conjugated to glucuronic acid
The combined pill has a small risk of thromboembolism, what increases this risk?
Smoking
Being over 35 and long term use
Obesity
Hypertension
What in the liver metabolises hormone contraceptives?
CYP450
Enzyme inducing drugs do what to the efficacy of oral contraceptives?
Reduces the efficacy
What anti-epileptics reduce the efficacy of oral contraceptives as they are enzyme inducing drugs?
Carbamazepine
Phenytoin
Which antibiotics induce enzymes and therefore reduce the efficacy of oral contraceptives?
Rifampicin and Rifabutin
Which natural product induces enzymes and thus reduces the efficacy of the oral contraceptives?
St Johns Wort
How do anti-epileptics, antibiotics and St Johns Wort reduce the efficacy of oral contraceptives?
They increase the production of hepatic CYP450
How do soya products affect the oral contraceptive pill?
Enhance oestrogen absorption and reduce its storage in adipose and muscle and so cause the half life to reduce from 15 to 7 hours
Why would you prescribe HRT?
Menopause and osteoporosis
Not in heart disease even though it does have benefits, but shouldn’t be prescribed purely for this reason
What are the risks of taking unopposed oestrogen - ERT?
Endometrial and ovarian cancers
What is a risk associated with opposed oestrogen (HRT)
Breast cancer risk increased
Venous thromboembolism risk is increased due to what?
Increased thrombin activation
Decreased factor 7 levels
Decreased anti-thrombin 3 activity
HRT reduces the risk of cardiovascular disease …how?
It’s beneficial to the lipid profile
