Reproductive - FA Pharm p640 - 643 Flashcards
GnRH analog
Leuprolide
How is the MOA of Leuprolide diff depending on admin?
GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary FSH/LH).
CI of Estrogen?
ER ⊕ breast cancer, history of DVTs.
Used to treat infertility due to anovulation (eg, PCOS), MOA?.
Clomiphene - Antagonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and release of LH and FSH from pituitary, which stimulates ovulation.
How is Tamoxifen/Raloxifene effect diff in diff parts of the body?
(SERM)
Tamoxifen - Antagonist at breast; agonist at bone, uterus
Raloxifene - Antagonist at breast,uterus; agonist at bone,
Diff in Cancer risk with Tamoxifen vs Raloxifene?
No inc risk of endometrial cancer with Raloxifene
Inhibit peripheral conversion of androgens to estrogen.
Anastrozole, letrozole, exemestane. (aromatase inhibitors)
DEC growth and INC vascularization of endometrium, thicken cervical mucus.
Levonorgestrel, medroxyprogesterone, etonogestrel, norethindrone, megestrol, and many others when combined with estrogen.
Competitive inhibitors of progestins at progesterone receptors.
Mifepristone, ulipristal.
Termination of pregnancy
mifepristone with misoprostol
emergency contraception
ulipristal
Terbutaline, ritodrine
β2-agonists that relax the uterus; used to dec contraction frequency in women during labor.
Synthetic androgen that acts as partial agonist at androgen receptors.
Danazol
Danazol used for?
Endometriosis, hereditary angioedema.
Danazol adverse effects?
Weight gain, edema, acne, hirsutism, masculinization, HDL levels, hepatotoxicity,idiopathic intracranial HTN
Testosterone, methyltestosterone
Treat hypogonadism and promote development of 2° sex characteristics; stimulate anabolism to promote recovery after burn or injury.
Adverse effects?
Premature closure of epiphyseal plates. INC LDL, DEC HDL.
Flutamide
Nonsteroidal competitive inhibitor at androgen receptors. Used for prostate carcinoma.
Ketoconazole, Spironolactone MOA
Inhibits steroid synthesis (inhibits 17,20 desmolase/17α-hydroxylase).
Tamsulosin
α1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for α1A/D receptors (found on prostate) vs vascular α1B receptors.
SE of PDE 5 (-)’rs
Headache, flushing, dyspepsia, cyanopia (blue-tinted vision). “Hot and sweaty,” but then Headache, Heartburn, Hypotension.
A female previously been seen for infertility is now complaing of visual disturbances. Her lab value shows an incr in AFP. Upon ultra sound multiple heartbeats are recognized. Which drug was she taking?
Clomiphene can cause multiple simultaneous pregnancies and visual disturbances.
Raloxifene is primary used to tx what? what is it C/I?
CI with hypercoag/DVT risk. Used to treat osteoporosis.
letrozole is a —.
Aromatase inhibitors
Unopposed estrogen replacement therapy increases the risk of? what should be co-administered?
endometrial cancer Progesterone
Norethindrone MOA?
Bind progesterone receptors, incr growth and vascularization of endometrium, thicken cervical mucus.
5 Contraindications of Combined contraception?
- smokers > 35 years old ( risk of cardiovascular events), -
- cardiovascular disease (including history of venous thromboembolism, - coronary artery disease, stroke), -
- migraine (especially with aura), -
- breast cancer
- liver disease
Pregnant pt that was brought to the hospital by her husband. She is in distress since she is having contractions although she is in the 30th week of gestation. In order to gain some time to administer steroids to the mother you need to administer which drug first? Why does the mother need to be given steroids?
-normal pregnancy can range from 38 to 42 weeks. before 37 weeks–> premature - Terbutalin/Ritodrin - β2-agonists that relax the uterus - steroids help lung maturation of the baby
Describe Progestin challenge?
Cessation of progestrin use causes withdrawal bleeding. This excludes anatomic defects (eg, Asherman syndrome) and chronic anovulation without estrogen.
What drug is a emergency contraception? vs. What drug is the most effective emergency contraception.
ulipristal vs. Copper intrauterine device
Female complain of painful menstruation and pain with defecation. Upon closer look you find “chocolate cyst” and prescribe her some medicine. On her next follow up appointment you barely recognize her since she had gained wt and was growing beard. Her PCP also wrote u a note saying “stop messing w/ my pt’s HDL and LFT levels”. What drug did u previously prescribe her?
Danazol
A mother brings her 13 year old boy to the PCP and complains that her son is too short for his age. Upon interviewing the son, the physician notices bulky musculature and finds out that he works out and is into competitive wrestling. What should the doc be suspecting that is causing his growth inhibition?
Steroid use: Testosterone, methyltestosterone Premature closure of epiphyseal plates
Pt with BPH and and baldness can benefit from which drug and what is the MOA?
Finasteride 5α-reductase inhibitor
T or F? Finasteride is used for prostate ca?
F. it is Flutamide
α1A,D receptors are found on what organ and therefore —- drug can inhibit this receptors. Vs. α1B receptors are found where?
Tamsulosin
α1A,D –> prostate α1B –> on vessels
T or F? Viagra can be used for pulmonary hypertension?
T
MOA of Minoxidil?
Direct arteriolar vasodilator clinical use: alopecia, refractory HTN
