Sex Hormones

Question 1

Natural Androgens

Answer 1

Testosterone
Dihydrotestosterone
Dehydroepiandrosterone
Androstenedione

Question 2

Synthetic Androgens

Answer 2

- 17alpha-Alkylated Androgens
Methyltestosterone
Fluoxymesterone
- Esters
Testosterone Enanthate
Cypionate

Question 3

Therapeutic uses of Androgens

Answer 3

Male Hypogonadism
Growth Stimulators
Angioedema (no C1-Esterase Inhibitor)

Question 4

Androgen SE

Answer 4

• Virilization and Menstrual Irregularities
• Precocious Puberty and short stature
• Acne
• Cholestatic Jaundice (17alpha-alpkylated androgens)

Question 5

Androgens CI

Answer 5

Prostate Cancer
Pregnant Women
Children
Renal or Cardiac Dx

Question 6

Anabolic Steroids

Answer 6

Nandrolone
Oxymetholone
Methenolone
Oxandrolone

Question 7

Anabolic Steroid Uses

Answer 7

Osteoporosis
Catabolic States
Hereditary Edema
Performance Enhancement
Growth Stimulators

Question 8

Anti-Androgens: Testosterone Inhibitors

Answer 8

Leuprolide (GnRH Analog)
Histrelin (GnRH Analog)
Abarelix (GnRH Antagonist)

Question 9

Anti-Androgens: Androgen Receptor Antagonists

Answer 9

Flutamide

Bicalutamide

Question 10

Anti-Androgens Uses

Answer 10

Prostate Cancer

Hirsutism in Women

Question 11

Anti-Androgens SE

Answer 11

Hepatotoxicity

Gynecomastia

Question 12

Cyproterone Acetate

Answer 12

• Tx Hirustism (Women)

- DEC Sex drive (in men)

Question 13

Finasteride

Answer 13

• 5 Alpha Reductase Inhibitor
  MOA: DEC Dihydrotestosterone levels
  USES: BPH, Male Pattern Baldness
  SE: DEC Libido, Impotence, Rashes

Question 14

Estrogens: Natural Estrogens

Answer 14

Estradiol
Estriol
Estrone

Question 15

Estrogens: Synthetic Estrogens [STEROIDAL]

Answer 15

Ethinylestradiol
Mestranol
Tibolone

Question 16

Estrogens: Synthetic Estrogens [NON-STEROIDAL]

Answer 16

Diethystinestrol (DES)
Hexestrol
Dienestrol

Question 17

Estrogen Therapeutic Uses

Answer 17

• Combined OCPs
• HRT
• Primary Hypogonadism
• Senile Vaginitis
• Dysmenorrhea (combined w/ progestins to suppress ovulation)

Question 18

Estrogen SE

Answer 18

• Nausea Vomiting
• Fullness/Tenderness of breasts and edema
• Severe Migraine
• Gallbladder Dx
• Cancer
• Cervical/Vaginal adenocarcinoma risk in offspring of pregnant women who take DES

Question 19

Estrogen CI

Answer 19

• Endometrial/Breast Carcinoma
• Undiagnosed genital bleeding
• Liver dx
• Hx of thromboembolic dx
• Smokers

Question 20

Clomiphene

Answer 20

• Anti-estrogen
  USES: Estrogen from Anovulatory cycle, Male infertility, IVF
  SE: Hot flashes, Ovarian Hyperstimulation, INC incidence of multiple births, Ovarian Cysts

Question 21

Selective Estrogen Receptor Modulators: Tamoxifen

Answer 21

• Estrogenic Actions: Brain, Bone, Liver
• Antagonistic Actions: Breast
  USES: Breast Cancer (ER+, PR+, Preventative Agent, reduces recurrence for 5 years)

Question 22

Selective Estrogen Receptor Modulators: Raloxifene

Answer 22

• Estrogen Agonist in Bone and Liver
• Estrogen Antagonist in Breast
  USES: Osteoporosis, Breast Cancer prophylaxis
  MOA: Reduce rate of Bone loss, INC peripheral bone mass, DEC rate of Vertebral Fx

Question 23

Progestins: Natural

Answer 23

Progesterone

Question 24

Progestins: Synthetic

Answer 24

Medroxy Progesterone Acetate (MPA)
Megestrol
Nomegestrol
Norethindrone
Desogestrel
Drospirenone
Levonorgestrel

Question 25

Progestin Uses

Answer 25

- Contraceptives - HRT - Dysfunctional Uterine Bleeding (DUB) - Endometriosis SE IN DUB AND ENDOMETRIOSIS: Prolonged anovulation and amenorrhea

Question 26

Antiprogestin

Answer 26

Mifepristone MOA: Competitive Antagonist USES: Post-Coital Contraceptive, Termination of Pregnancy SE: Heavy bleeding, Nausea, Vomiting, Abdominal Discomfort

Question 27

Hormonal Contraceptive: Combined Oral Pill

Answer 27

``` Estrogen (20-50 ug) - Ethynelestradiol - Mestranol Progesterone - Norethindrone - Levonorgestrel - Desogestrel - Norgestimate *MONOPHASIC - same amount of E&P for 21 days and 7 days off *BIPHASIC - 2 and 3 pills containing varying amounts to be taken at different times during the 21 day cycle ```

Question 28

Hormonal Contraceptive: Progesterone Only Pill

Answer 28

Norgestrel (Ovrette) - Low Dose Progesterone - Taken daily w/o interruption

Question 29

Hormonal Contraceptive: Post-Coital Emergency Contraceptive

Answer 29

Plan B - 1 tablet of levonorgestrel w/i 48 hours - Rpt after 12 hours OR - Single 600 mg mifepristone w/i 72 hours

Question 30

Hormonal Contraceptive: Injectable

Answer 30

- Long Acting Progestin Only Depot Medroxyprogesterone acetate (DMPA); 150-400mg at 3-6 month intervals Norethindrone Enanthate; 200mg at 2-3 month intervals - Long Acting Progestin + Long Acting Estrogen Once a month

Question 31

Hormonal Contraceptive: Implants

Answer 31

Levonorgestrel Etonogestrel "Mirena" "NuvaRing"

Question 32

Hormonal Contraception MOA

Answer 32

- Progesterone diminishes GnRH pulses - Gondatropin Inhibition (FSH, LH) - Cervical Mucus Hostile to Sperm - Post-coital pill may dislodge newly implanted blastocyte

Question 33

Hormonal Contraception SE

Answer 33

``` Nausea/Vomiting Headache Irregular Spotting Weight gain, Acne Chloasma (facial pigmentation when pregnant) Carb intolerance INC in risk for venous and pulmonary thrombosis Coronary and Cerebral Thrombosis HTN Cancer: INC risk in predisposed individuals Gall Stones Benign Hepatomas (liver tumor) ```

Question 34

Hormonal Contraceptive CI

Answer 34

``` Thromboembolic, Coronary and cerebrovascular Dx Known or suspected carcinoma of breast/genital tract HTN Active Liver Dx Impending Major Surgery DM Migraine Gallbladder Dx ```

Question 35

Danazol

Answer 35

- Suppression of Gn secretion - inhibition of testicular/ovarian fxn USES: Endometriosis, Menorrhagia SE: Amenorrhea, Acne, Weight gain, Hirsutism, Loss of libido, Hot flashes