Reproductive Health Drugs

Question 1

How is estrogen metabolized?

Answer 1

binds to albumin and sex hormone binding globulin in serum, undergoes metabolism in liver and kidney excretion

Question 2

What are the Estrogen agents?

Answer 2

Conjugated estrogens, esterified estrogens, estradiol, ethinyl estradiol, chlorotrianisene

Question 3

What is estrogen used for

Answer 3

oral contraceptive, postmenopausal hormone replacement, osteoporosis, hypogonadism in girls 11-13, palliative treatment of incurable prostate cancer

Question 4

What are primary AE of estrogen tx?

Answer 4

hypertension (estrogens increase angiotensinogen), gallbladder disease, thromboembolytic complications (estrogen increases synthesis of clotting factors), melasma– skin darkening

Question 5

What are the SERMs, Selective estrogen receptor modulators?

Answer 5

Clomiphene, Tamoxifen, Raloxifene

Question 6

How do the SERMs work?

Answer 6

interfere with negative feedback of estrogens on hypothalmaus, leading to increased GnRH and gonadotropin release, stimulating ovulation

Question 7

What is Clomiphene used for?

Answer 7

treat infertility but has high risk of multiple births

Question 8

What is Tamoxifen used for?

Answer 8

palliative treatment of advanced breast cancer, decreases DVT but increased N/V/hot flashes

Question 9

What is Raloxifene used for?

Answer 9

prevention of osteoporosis in post menopausal women

Question 10

What are the Aromatase Inhibitors?

Answer 10

Anastrozole, Letrozole

Question 11

What is Fulvestrant used for?

Answer 11

pure estrogen receptor antagonist. Used to treat tamoxifen resistant cancer.

Question 12

What are the aromatase inhibitors used for

Answer 12

adjuvant tx of postmenopausal women with hormone receptor positive breast cancer

Question 13

How does the progestins work?

Answer 13

high levels inhibit gonadotropin release and thus ovulation, thickens cervical mucus, creates a thin atrophic endometrium that prevents implantation

Question 14

What are synthetic progesterone agents

Answer 14

Hydroxyprogesterone, medroxyprogesterone, Norethynodrel, Norethindrone, Norgestrel

Question 15

Which synthetic progesterone agents have androgenic activity

Answer 15

Nogestrel, Norethindrone

Question 16

What are clinical uses of progesterone agents?weight gain

Answer 16

oral, implantable birth control, tx of DUB, dysmenorrhea, suppression of postpartam lactation, management of endometriosis, tx endometrial carcinomas.

Question 17

What are adverse side effects of the progesterone agents

Answer 17

Edema, depression, Increase in BP/LDL, decrease in HDL, thrombophlebitis, PE, acne, Hirsutism & weight gain with androgenic agents

Question 18

What is Mifepristone?

Answer 18

antiprogestin that induces abortion (RU 486) by interfering with progesterone and HCG.

Question 19

What is the difference between monophasic, biphasic, and triphasic birth control pills

Answer 19

Monophasic have consistent doses of estrogen and progesterone.
Biphasic consistent doses of low progesterone for 7 - 10 days followed by higher levels of progesterone
Triphasic have consistent doses of estrogen followed by three increases in progesterone

Question 20

What is available for prevention of menstruation induced anemia?

Answer 20

BC pills with ferrous sulfate

Question 21

What are the progestin only contraceptive agents

Answer 21

Norethrindrone and norgestrel

Question 22

What is plan B

Answer 22

high dose norgestrel administered within 72 hours of unprotected sex followed by second dose in 12 hours

Question 23

What birth controls are available as implantables

Answer 23

Norgestrel, etonogestrel