Reproductive MOA

Question 1

Estrogen as a whole works by

Answer 1

supressing the release of GnRH in the hypothalamus & suppressing the release of gonadotropics from the pituitary

Decreases LH: inhibits ovulation
Decreases FSH: prevents ovarian folliculogenesis

Question 2

Progestin as a whole works by

Answer 2

inhibiting GnRh and LH secretion and suppresses endometrial proliferation

• changes the cervical mucous and impairs fallopian tube peristalsis

Question 3

Hormonal IUD

Answer 3

Releases levonorgestrel; increases the cervical mucus and prevents endometrial thickening and ovulation

Question 4

Non-Hormonal IUD

Answer 4

releases Copper which is spermicidal

Question 5

Nexplanon

Answer 5

Etonogestrel subdermal single rod that is progestin releasing

Question 6

combined oral pill

Answer 6

estrogen and progestin is released that inhibits ovulation, thins the endometrium, and thickens cervical mucus

Question 7

combination patch

Answer 7

uses estrogen and progestin to inhibit ovulation, thin the endometrium and thicken the cervical mucus

Question 8

SERM Tamoxifen (soltamox) & Raloxifene (evista)

Answer 8

COMPETITIVE ANTAGONIST on the estrogen receptors of the breast (also the bone, endometrium and myometrium)

Question 9

SERM Clomiphene

Answer 9

Blocks hypothalamic estrogen receptors that inhibit negative feedback and increases the release of FSH and LH to trigger ovulation

Question 10

MOA of synthetic estrogen Ethinyl Estradiol/Mestranol

Answer 10

Binds and activates the estrogen receptors

Question 11

Aromatase inhibitors Anastrazole, letrozole, exemstane

Answer 11

inhibits aromatase which decreases the conversion of androstendedione to estrone

decreases the conversion of testosterone to estradiol which decreases tumor growth

Question 12

MOA of Androgen agonists

Answer 12

Partial agonist action on the androgen receptor

Suppresses pituitary output of LH and FSH resulting in regression, atrophy of endometrial tissue, decreased abnormal breast tissue, decreased attack of hereditary angioedema

Question 13

MOA of antiandrogen finasteride (proscar)

Answer 13

inhibits 5-alpha reductase which inhibits the conversion of testosterone to DHT

Question 14

MOA of Flutamide and Bicalutamide (casodex)

Answer 14

decreased steroid binding acheived via non-steroid competitive inhibition at androgen receptors

Question 15

MOA of antiandrogen Spironolactone

Answer 15

Binds the androgen receptor

Inhibits 17,20-demolase and 17 a-hydroxylase

inhibits 5-alpha reductase

Question 16

MOA of antiandrogen Ketoconazole

Answer 16

inhibits steps of adrenal steroid synthesis

17,20-desmolase, 17 alpha-hydroxylase

Question 17

MOA of low dose antiprogestin

Mifepristone

Answer 17

binds to the intracellular progesterone receptors in the corpus luteum

Question 18

MOA of Antiprogestin for termination of pregnancy

Mifepristone

Answer 18

contraction inducing activity in the myometrium (in the absense of progesterone, acts as a partial progesterone agonist)

Question 19

MOA of High dose antiprogestin

Mifepristone

Answer 19

blocks the effects of cortisol at the glucocorticoid receptor (antagonizes the effects of cortisol on glucose metabolism)

increases circulating cortisol concentrations

Question 20

MOA of progestin receptor modulator

Ullipristal (ella)

Answer 20

prevent progestin from binding to progesterone receptor to impact ovulation and implantation

-inhibits or delays ovluation
-alters normal endometrium
-inhibits cellular proliferation and induces apoptosis (fibroids)

Question 21

MOA of Anti-D Immunoglobin

Rhogam

Answer 21

suppresses mom’s ability to make antibodies (blinders for moms immune system)

for a Rh- mom and Rh+ baby

Question 22

MOA of oxytocin (pitocin)

Answer 22

promotes uterine contractions during labor
-stimulates milk ejection
-closes blood vessels
-regulates the stretching of cervix or vagina

Question 23

what drug causes increased proliferation of the myometrium and endometrium

Answer 23

Tamoxifen (Soltamox)

SERM

Question 24

what does Tamoxifen and Rolaxifene do in the bone?

Answer 24

inhibition of osteoclasts (decreases risk of osteoporsis)

Question 25

what drug causes decreased endometrium and myometrium?

Answer 25

Raloxifene (evista)

SERM

Question 26

what drug can decrease tumor growth for advanced breast cancer postmenopausal pts?

Answer 26

Letrozole and Exemestane

Question 27

what drug causes regression of the endometrial tissue, decreased abnormal breast tissuse, and decreased hereditary angioedma attacks?

Answer 27

Danazol

Question 28

what is the first line treatment for uterine leiomyoma

Answer 28

Combo OCP (controls bleeding but might increase growth)
Progestin IUD (controls bleeding but does not tx fibroids)
antifibrinolytics
NSAIDS

Question 29

what drugs help reduce uterine leiomyoma tumor size?

Answer 29

• GnRh agonist: leuprolide & Nafarelin prior to surgery
• GnRh antagonists: Elagolix & relugoliz
• Danzol