Reproductive - FA Pharm p640 - 643

Question 1

GnRH analog

Answer 1

Leuprolide

Question 2

How is the MOA of Leuprolide diff depending on admin?

Answer 2

GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary FSH/LH).

Question 3

CI of Estrogen?

Answer 3

ER ⊕ breast cancer, history of DVTs.

Question 4

Used to treat infertility due to anovulation (eg, PCOS), MOA?.

Answer 4

Clomiphene - Antagonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and release of LH and FSH from pituitary, which stimulates ovulation.

Question 5

How is Tamoxifen/Raloxifene effect diff in diff parts of the body?

Answer 5

(SERM)

Tamoxifen - Antagonist at breast; agonist at bone, uterus

Raloxifene - Antagonist at breast,uterus; agonist at bone,

Question 6

Diff in Cancer risk with Tamoxifen vs Raloxifene?

Answer 6

No inc risk of endometrial cancer with Raloxifene

Question 7

Inhibit peripheral conversion of androgens to estrogen.

Answer 7

Anastrozole, letrozole, exemestane. (aromatase inhibitors)

Question 8

DEC growth and INC vascularization of endometrium, thicken cervical mucus.

Answer 8

Levonorgestrel, medroxyprogesterone, etonogestrel, norethindrone, megestrol, and many others when combined with estrogen.

Question 9

Competitive inhibitors of progestins at progesterone receptors.

Answer 9

Mifepristone, ulipristal.

Question 10

Termination of pregnancy

Answer 10

mifepristone with misoprostol

Question 11

emergency contraception

Answer 11

ulipristal

Question 12

Terbutaline, ritodrine

Answer 12

β2-agonists that relax the uterus; used to dec contraction frequency in women during labor.

Question 13

Synthetic androgen that acts as partial agonist at androgen receptors.

Answer 13

Danazol

Question 14

Danazol used for?

Answer 14

Endometriosis, hereditary angioedema.

Question 15

Danazol adverse effects?

Answer 15

Weight gain, edema, acne, hirsutism, masculinization, HDL levels, hepatotoxicity,idiopathic intracranial HTN

Question 16

Testosterone, methyltestosterone

Answer 16

Treat hypogonadism and promote development of 2° sex characteristics; stimulate anabolism to promote recovery after burn or injury.

Question 17

Adverse effects?

Answer 17

Premature closure of epiphyseal plates. INC LDL, DEC HDL.

Question 18

Flutamide

Answer 18

Nonsteroidal competitive inhibitor at androgen receptors. Used for prostate carcinoma.

Question 19

Ketoconazole, Spironolactone MOA

Answer 19

Inhibits steroid synthesis (inhibits 17,20 desmolase/17α-hydroxylase).

Question 20

Tamsulosin

Answer 20

α1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for α1A/D receptors (found on prostate) vs vascular α1B receptors.

Question 21

SE of PDE 5 (-)’rs

Answer 21

Headache, flushing, dyspepsia, cyanopia (blue-tinted vision). “Hot and sweaty,” but then Headache, Heartburn, Hypotension.

Question 22

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?

Answer 22

Clomiphene can cause multiple simultaneous pregnancies and visual disturbances.

Question 23

Raloxifene is primary used to tx what? what is it C/I?

Answer 23

CI with hypercoag/DVT risk. Used to treat osteoporosis.

Question 24

letrozole is a —.

Answer 24

Aromatase inhibitors

Question 25

Unopposed estrogen replacement therapy increases the risk of? what should be co-administered?

Answer 25

endometrial cancer Progesterone

Question 26

Norethindrone MOA?

Answer 26

Bind progesterone receptors, incr growth and  vascularization of endometrium, thicken cervical mucus.

Question 27

5 Contraindications of Combined contraception?

Answer 27

• • 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

Question 28

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?

Answer 28

-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

Question 29

Describe Progestin challenge?

Answer 29

Cessation of progestrin use causes withdrawal bleeding. This excludes anatomic defects (eg, Asherman syndrome) and chronic anovulation without estrogen.

Question 30

What drug is a emergency contraception? vs. What drug is the most effective emergency contraception.

Answer 30

ulipristal vs. Copper intrauterine device

Question 31

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?

Answer 31

Danazol

Question 32

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?

Answer 32

Steroid use: Testosterone, methyltestosterone Premature closure of epiphyseal plates

Question 33

Pt with BPH and and baldness can benefit from which drug and what is the MOA?

Answer 33

Finasteride 5α-reductase inhibitor

Question 34

T or F? Finasteride is used for prostate ca?

Answer 34

F. it is Flutamide

Question 35

α1A,D receptors are found on what organ and therefore —- drug can inhibit this receptors. Vs. α1B receptors are found where?

Answer 35

Tamsulosin

α1A,D –> prostate α1B –> on vessels

Question 36

T or F? Viagra can be used for pulmonary hypertension?

Answer 36

T

Question 37

MOA of Minoxidil?

Answer 37

Direct arteriolar vasodilator clinical use: alopecia, refractory HTN