Sex Hormones

Question 1

Ethinyl estradiol

Answer 1

Oral contraceptive, hormone replacement therapy, hypogonadism

MOA: Replaces Estrogen

Question 2

Conjugated equine estrogens

Answer 2

Hormone replacement therapy

Question 3

Tansdermal estradiol

Answer 3

Hormone replacement therapy or contraception; Replaces estrogen w/o first pass metabolism

Question 4

Estradiol cypionate and estradiol valerate

Answer 4

Used for IM injections; replaces estrogen w/o first pass metabolism

Question 5

Progestins

Answer 5

MOA: Feedback inhibition prevents ovulation and thickening of cervical mucous, atrophy of endometrium

Hirsutism (less common w/ newer agents), acne, wt gain, possible glucose intolerance, decreased HDL and increases LDL, breakthrough bleeding (progestin only), depression

p450 inducers can enhance elimination, enterohepatic metab interference can enhance elimination

Question 6

Estrogen

Answer 6

Feedback inhibition prevents ovulation

Nausea, breast tenderness, increased skin pigmentation, migraine, inc coagulation, hypertension, breast cancer?, gallstones, elevate serum binding proteins, endometrial hyperplasia/cancer (if used w/o progestin in HRT)

p450 inducers can enhance elimination, enterohepatic metab interference can enhance elimination, increase bound estrogen thyroxine testosterone and iron (due to inc serum binding protein

Question 7

Medroxyprogesterone acetate

Answer 7

used for IM injections (depo-provera); progesterone analogue

Question 8

Medroxyprogesterone

Answer 8

Used in HRT; progesterone analogue

Question 9

Norgestrel and levonorgestrel

Answer 9

Used in combination oral contraceptive, progestin only formulation, levo used for postcoital contraceptive

progesterone analogue, highest androgenic activity

Question 10

Norethindrone

Answer 10

Combination OC, progestin only formulation

progesterone analogue; medium androgenic activity

Question 11

Desogestrel

Answer 11

Combination OC

progesterone analogue; lowest androgenic activity

Not commonly used due to increased DVT risk

Question 12

Drospirenone

Answer 12

Combination OC

progesterone analogue w/ anti-androgenic activity

Spironolactone derivative

Increased blood clots compared to standard contraceptives

Question 13

Ulipristal Acetate

Answer 13

Postcoital contraceptive (effective 5 days after)

Progesterone receptor modulator (similar to RU-486)

Question 14

Absolute contraindications for OC

Answer 14

Breast cancer or estr dependent neoplasia; abnormal genital bleeding; Hx of DVT or PE; Hx CVA or MI; Liver tumor; Heavy smoker after 35 y/o; Less than 6 weeks postpartum and breastfeeding