Reproductive Pharmacology Flashcards
1
Q
Leuprolide–mechanism pulsatile vs. continuous
A
- pulsatile: GnRH analog with agonist properties
- “Leuprolide can be used in lieu of GnRH”
- continuous: antagonist properties
- downregulates GnRH receptor in pituitary –> decrease FSH/LH
2
Q
Leuprolide–use
A
- uterine fibrinoids
- endometriosis
- precocious puberty
- prostate cancer
- infertility
3
Q
name the estrogens
A
- ethinyl estradiol
- DES
- mestranol
4
Q
estrogens–mechanism
A
- bind estrogen receptors
5
Q
estrogens–use
A
- hypogonadism or ovarian failure
- menstrual abnormalities
- hormone replacement therapy in postmenopausal women
- use in men with androgen dependent prostate cancer
6
Q
estrogens–toxicity
A
- inc risk of endometrial cancer
- bleeding in postmenopausal women
- clear cell adenocarcinoma of vagina in demales exposed to DES in utero
- inc risk of thrombi
7
Q
what are the contraindications for estrogens?
A
- ER + breast cancer
- history of DVTs
8
Q
name 3 selective estrogen receptor modulators
A
- clomiphene
- tamoxifen
- raloxifene
9
Q
clomiphene–mechanism
A
- antagonist at estrogen receptors in hypothalamus
- prevents normal feedback inhibition and increase release of LH and FSH from pituitary which stimulate ovulation
10
Q
clomiphene–use
A
- infertility due to anovulation
- ie. PCOS
11
Q
clomiphene–toxicity
A
- hot flashes
- ovarian enlargement
- multiple simultaneous pregnancies
- visual disturbances
12
Q
tamoxifen–mechanism
A
- antagonist at breast
- agonist at bone, uterus
- increase risk of thromboembolic events and endometrial cancer
13
Q
tamoxifen–use
A
- treat and prevent recurrence of ER/PR + breast cancer
14
Q
raloxifene–mechanism
A
- antagonist at breast, uterus
- agonist at bone
*
15
Q
raloxifene–use
A
- osteoporosis
16
Q
raloxifene–toxicity
A
- inc risk of thromboembolic events but no increased risk of endometrial cancer (vs tamoxifen)
17
Q
name 3 aromatase inhibitors
A
- anastrozole
- letrozole
- exemestane
18
Q
aromatase inhibitors–mechanism
A
- inhibit peripheral conversion of androgens to estrogens
19
Q
aromatase inhibitors–use
A
- ER + breast cancer in post menopausal women
20
Q
hormone replacement therapy–use
A
- used for relief or prevention of menopausal symptoms (ie. hot flashes, vaginal atrophy)
- tx of osteoporosis
- inc estrogen, dec osteoclast activity
21
Q
why is progesterone added to hormone replacement therapy?
A
- unopposed estrogen replacement therapy inc risk of endometrial cancer, so have to add progesterone
22
Q
hormone replacement therapy–toxicity
A
- possible cardiovascular risk
23
Q
name the progestins
A
- levonorgestrel
- medroxyprogesterone
- etonogestrel
- norethindrone
- megestrol
- others when combined with estrogen
24
Q
progestins–mechanism
A
- bind progesterone receptors
- decrease growth and increase vascularization of endometrium
- thicken cervical mucus
25
Q
progestins–use
A
- contraception–pill, IUD, implant, depot injection
- endometrial cancer
- abnormal uterine bleeding
- progestin challenge
26
Q
explain the progestin challenge
A
- presence of withdrawal bleeding excludes anatomic defects (ie. Asherman syndrome) and chronic anovulation without estrogen