Sex Hormones

Question 1

Estradiol

Estrogen

Answer 1

Moa: E binds to R and goes to gene transcription to produce the protein

Question 2

Ethinyl estradiol

15-20x more potent

Question 3

Slow estrogen MOA

Answer 3

E binds to R and goes to gene transcription to produce the protein

Question 4

Rapid Estrogen MOA

Answer 4

E binds to R and activates a kinase to send signals

Question 5

Subtypes MOA

Answer 5

Alpha and Beta and CF can varries the level and type of estrogen

Question 6

Estrogen effects

development, nervous, cardio, meta, hepatic

Answer 6

Dev: too much = risk of breat cancer
Ner: menopause and hot flashes
cardio: increase clotting factors and stroke, meno:dyslipidemia, Paradoxial HTN, edema and bloating
Meta and hep: TGC, gallstone, ORAL - toxic and lees bio
Repo: meno: abnormal bleeding, Imbalance endometrosis or edno cancer
Skelet: meno: osteoprosis

Question 7

HRT CI

Answer 7

Breast cancer, liver disease, stroke, DVT, CVD,

Question 8

Estrogen to right patient ( uterus intact, uterus absent, Moderate CVD)

Answer 8

1. intact - estro and proge
2. absent - estrogen
3. mod CVD - no oral

Question 9

Progestins

Answer 9

ner: drowsy, body temp increase, weight gain
repo: decreas sperm motility, supporess ovulation (decrease GnRH enchacned with estrogen), matures lining

Question 10

Estrogen and progestin levels: high and low

Answer 10

estrogen - low= Early cycle breakthrough, hypomenorrhea or amenorrhea
excess = clotting, cancer parodoxial HTN

Progestin - Low = late cycle breakthrough, HYPERmenorrhea
excess = hypomenorrhea or amenorrhea

Question 11

When to not give E and P

Answer 11

CVD, DVT/PE, Afib, Stroke, Smoker >35

Question 12

When to not give P

Answer 12

8 hr HL, need perfect adherance, same time each day

Question 13

E+P dosage forms

Answer 13

1. monophasic
2. multiphasic increase and decreasing does
3. extended interval dont want periods: improve endometriosis PMDD

Question 14

Medroxyprogesterone

Answer 14

potent and longer HF

Question 15

norethindrone

Answer 15

1st gen testoterone
OCP = pogesterone only
moderate androgen

Question 16

norgestrel

Answer 16

2nd gen
mostly androgenic and so less Estrogen side effects more like ance and hair growth

Question 17

norgestimate

Answer 17

3rd gen and less androgenic

Question 18

dospirenone

Answer 18

spironolactone derivative

Question 19

Testosterone concerns

Answer 19

all preg catagory X

Question 20

Testosterone concern

Answer 20

all preg catagory X

Question 21

Testosterone Effects

Answer 21

Ner: excess agression def depression
card: stroke, DVt, heart attack, dyslipidemia, Edema HTN DEF: anemia
meta and hepatic: insulin resitance, imbalance dyslipidemia
Repo: BPH growth, cancer, decrease libido
Muscle: defficent: weakness and osteoprosis
nero: baldness, acne, hirsutism

Question 22

Testosterone formulation

Answer 22

never oral all parental routes

Question 23

Oxandrolone

Answer 23

oral modified androgen

Question 24

Degarelix

Answer 24

MOA: GnRH antagonist
Use: Hormone dependent cancers

Question 25

Goserelin

Answer 25

MOA: GnRH agonist (increased GnRH has inhibitory effects) Use: Cancers but not common bc agonist you get Hormone flare Note: if useing for cancer need to co administer with GnRH antagonsit

Question 26

Anastrozle

Answer 26

MOA: Aromatase inhibitior blocks Testosterone to **Estradiol** Use: breast cancer

Question 27

Finasteride, Dutasteride

Answer 27

MOA: (5-alpha-reductase) testosterone to **Dihydrotestosterone** Use: BPH or baldness

Question 28

Abiraterone

Answer 28

MOA: 17-hydroxylase inhibitor (blocks progesterone to **testosterone**) Use: Prostate Cancer Notes: need to be admin with steriod bc you block coritcoid

Question 29

Tamoxifen

Answer 29

MOA:SERM Agonist: Bone, cholesterol, Uterus Antagonist: Breast Use: Breast Cancer

Question 30

Raloxifene

Answer 30

MOA: SERM Agonist: Bone, Cholesterol Antagonist: Breast, Uterus Use: Breast cancer, osteoporosis

Question 31

Ulipristal

Answer 31

MOA: SPRM Use: emergecy contraception

Question 32

Fulvestrant

Answer 32

MOA: Estrogen receptor blocker Use: Breast Cancer

Question 33

Mifeprostone

Answer 33

MOA: Progestin Receptor Blocker Use: Medical abortion (W/ misoprostol)

Question 34

Bicalutamide

Answer 34

MOA: Strong Androgen receptor blocker Use: Prostate cancer

Question 35

Spironolactone

Answer 35

MOA: Weak Androgen receptor blocker use: Hirsutism, primary hyperaldosteronism, hypokalemia, HF AD:Hyperkalemia, hyponatremia, **Gynecomastia**