Reproductive Drugs

Question 0

Progesterone

Answer 0

Metabolic Actions:
   -Changes in endometrium
   -Sustains Pregnancy
   -Stimulates mammary tissue growth
Therapeutic uses:
   -Hormone replacement therapy
   -Tx of dysfunctional uterine bleeding
   -amenorrhea
   -Tx of endometrial cancer and hyperplasia
   -Contraceptives
AE:
   -Teratogenic Effects
   -Gynecological Effects
   -Breast Cancer

Question 1

Estrogens

Answer 1

Metabolic actions:
-Dev and function of reproductive organs
-Dev of secondary sex characteristics
-Increased bone mass
-Effects on Cholesterol
Therapeutic uses:
-Hormone replacement therapy after menopause
-Contraceptives
-Female hypogonadism
-Acne
AE:
-Endometrial Cancer: increased risk, no increase if used with progestin.
-Breast Cancer: Increased risk if used with progestin.
-Ovarian Cancer: Increased risk
-CV events: Increases risk of clot formation
-GI Effects

Question 2

Androgens

Answer 2

Metabolic action:
   -Promote puberty and expression of male sex characteristics
   -Spermatogenesis
   -Promotion of sex characteristics in females
Therapeutic uses:
   -Male hypogonadism 
   -Delayed puberty
   -Breast cancer
   -Replacement therapy in menopausal women
   -Waisting syndrome in AIDS patients
AE:
   -Virilization
   -Hepatotoxicity
   -Cholesterol Levels
   -Premature epiphyseal closure
   -Edema
   -Gynecomastia
   -Abuse potential

Question 3

Estrogen Delivery

Answer 3

Oral: Conjugated estrogens, equine/ Premarin
Estradiol, Micronized/ Estrace
Ethinyl estradiol/ Estinyl
Estrogen/Progesterone Combo- conjugated estrogens+medroxyprogesterone/ Prempro, Premphase
Transdermal patch:
Estradiol/ Alora, Climara, Estraderm
Intravaginal:
Estradiol/ EstroGel

Question 4

Benefits of HRT

Answer 4

• Relief of Vasomotor symptoms
• Prevention of urogenital atrophy
• Prevention of bone loss and fractures
• Prevention of Colon Cancer: only if using combo

Question 5

Risks of HRT

Answer 5

• Cardiovascular events
• Endometrial Cancer
• Breast Cancer: Inc risk wit estrogen and progesterone use
• Ovarian Cancer: Inc Risk with estrogen use only.

Question 6

Combination Oral Contraceptives

Answer 6

MOA: Inhibit ovulation, thicken the cervical mucus, alter endometrium.

AE: Thromboembolic disorders.

 - Hypertension
 - Cancer
 - Effects related to estrogen and progesterone imbalances

CI: Pregnancy

 - Breast feeding
 - Hx of thromboembolic disorders
 - Hx of breast Cancer 
 - Smoking

DI: P450 Inducers

 - Antibiotics: Tetracyclines, Ampicillin
 - Warfarin
 - Insulin, oral hypo glycemic agents
 - Theophylline

Question 7

Norplant

Answer 7

Sub-dermal Contraceptive Implant
MOA: Contains Levonorgestrel, a synthetic progestin. Six capsules, implanted on the inside of the arm. Release the med over 5 years. Causes changes in the cervical mucus, affects the endometrium.

AE: Menstrual irregularities

 - Abdominal discomfort
 - Vaginitis
 - Breast Discharge

Question 8

Depo-Provera

Answer 8

Depot Injection

MOA: Same Mechanism of oral cont. IM injection q3 months

AE: Menstrual irregularities

 - Weight gain
 - Abdominal Bloating
 - Bone Loss

Question 9

Clomiphine/ Clomid

Answer 9

Infertility drug: Promotes follicular maturation

MOA: Blocks receptors for estrogen in hypothalamus and pituitary. Pituitary gland compensates and releases LH and FSH which stimulates ovaries.

AE: Hot flashes, abdominal discomfort, Bloating, Breast enlargement, ovarian enlargement, multiple births

Question 10

Human Chorionic Gonadotropin (hCG)

Answer 10

Drug that stimulates Ovulation.

MOA: Functions like Luteinizing hormone (LH). Acts on ovaries to stimulate ovulation. Used in combo with meds that help with follicle maturation.

AE: Pain at Injection site
- CNS symptoms, Edema, Ovarian Hyper-stimulation syndrome

Question 11

Magnesium Sulfate

Answer 11

MOA: Inhibits acetylcholine release at uterine neuromuscular junction.

IND: Suppress Pre-term labor
- Seizures
- Low doses - replacement therapy
- Laxative
AE: Maternal: Therapeutic doses- hypotension, HA, Dizziness
Higher Doses - Pulmonary Edema, Muscle weakness, Resp Arrest
Infant: Muscle weakness, sleepiness
NURS: Monitor magnesium levels
Monitor urine output, renal function.

Question 12

Oxytocin/ Pitocin

Answer 12

MOA: Increase force, Frequency, and duration of contractions.

IND: Induce labor for pregnancy near term or beyond term.

AE: Uterine Rupture

NURS: Monitor contractions and maternal BP, HR
Monitor fetal response to contractions, HR

Question 13

Sildenafil/ Viagra

Answer 13

Erectile disfunction Med.

MOA: Enhances vasodilation effects of nitric oxide. Nitric Oxide activates and enzyme (cyclic GMP). cGMP creates erection by relaxing smooth muscle and causing arterial vasodilation. cGMP gets broken down by PDE5. Viagra inhibits PDE5.

IND: ED, Pulmonary arterial hypertension

AE: Hypotansion, Priapism(erection longer than 4 hours), HA

DI: Nitrates, Alpha Blockers, Hepatic microsomal enzyme inhibitors