SEXXX

Question 1

Estrogens and Progestins Functions

Answer 1

• promote and regulate female maturation
• pigmentation of nipples and genitals
• help regulate ongoing activity of female reproductive organs
• affect bone mineralization and lipid metabolism*
• positive effect on bone mass and lipid metabolism (raise HDL, lower LDL)

Question 2

Estrogens : Biosynthesis and elimination

Answer 2

ovary

Question 3

Estrogens: Effects on sex characteristics

Answer 3

• ductal growth in the breast
• thickening and cornification of the vaginal epithelium
• proliferation of uterine epithelium
• secretion of thickened mucus in endocervical glands

Question 4

Estrogens: Metabolic Actions

Answer 4

• provide effect on bone mass
• favorable effect on cholesterol levels

Question 5

Estrogens: Adverse Effects

Answer 5

• endometrial hyperplasia and carcinoma - risk of cancer decreases when used with progestin
• promotes growth of existing breast cancer
• ovarian cancer
• cardiovascular effects
• nausea - most common
• gallbladder disease
• jaundice
• headache
• cholasma
• increases body fat
• depression, headache/migraine
• interferes with thyroid hormone
• increases blood clotting
• decreases libido
• impairs blood sugar control

Question 6

Estrogens are classified as US FDA Pregancy Category ___ becuase _____

Answer 6

1. X
2. they have no legitimate use in pregnancy

Question 7

Estrogen: Therapeutic Effects

Answer 7

• menopausal hormone
• female hypogonadism
• acne

Question 8

Selective Estrogen Receptor Modulators (SERMs): Overview

Answer 8

• active in some tissues and block estrogen receptors selectively in others
• provide benefits of estrogen while avoiding its drawbacks

three available: Tamoxifen, Toremifene, raloxifene

Question 9

Progestins: Overview

Answer 9

• compounds that act like progesterone
• produced by ovaries and placenta

Question 10

Progestins: Adverse Effects

Answer 10

• teratogenic effects
• gynecologic effects
• breast cancer
• depression
• breast tenderness
• bloating

Question 11

Progestins: Therapeutic Uses

Answer 11

• postmenstrual hormone therapy
• dysfunctional uterine bleeding
• amennorrhea
• infertility
• prematurity prevention
• endometrial carcinoma and hyperplasia

Question 12

Progestins: Menopausal Hormone Therapy Benefits

Answer 12

• relief of vasomotor symptoms
• management of urogenital atrophy
• prevention of osteoporosis-related fractures
• cardioprotection
• prevention of colorectal cancer
• positive effect on wound healing
• tooth retention
• glycemic control

Question 13

Physiologic Dose of Estrogen (w/ or w/o progestin) during menopausal hormone therapy

Answer 13

taken to manage symptoms caused by loss of estrogen in menopause
* hot flashes
* sleep disturbances
* urogenital atrophy
* bone loss
* altered lipid metabolism

Question 14

Major Risks of Hormone Therapy

Answer 14

• congestive heart disease
• myocardial infarction
• deep vein thrombosis
• pulmonary embolism
• stroke
• breast cancer
• gallbladder disease
• dementia
  ovarian cancer and lung cancer also a concern

Question 15

Drugs that affect uterine function

three main categories

Answer 15

1. uterine relaxants - toxolytics
2. uterine stimulants - oxytocics
3. drugs used to decrease menorrhagia (heavy menstrual bleeding)

Question 16

Tocolytics: Therapeutic Uses

Answer 16

• used to delay delivery in preterm labor
• can accelerate lung development when used with glucocorticoids
• used to buy time to treat infection

Question 17

Control of Myometrial Contraction

Overview and drug classes (4)

Answer 17

• regulated by multiple mediators inc. beta-adrenergic agonists, oxytocin, prostaglandins
• 4 classes of drugs: decrease availability of phosphorylated light chain
  1. b-adrenergic agonists
  2. calcium channel blockers
  3. COX inhibitors
  4. oxytocin-receptor agonists

Question 18

Tocolytics: Overview

Answer 18

• drugs that promote uterine relaxation and delay delivery when used with glucocorticoids
• indicated for births that occur before 37 weeks gestation

Question 19

Drugs for Cervical Ripening and Induction of Labor (overview)

Answer 19

stimulate uterine contractions before the onset of labor in a pregnancy that is beyond term which poses risk to mom or baby

Question 20

Indications for early induction

Answer 20

• placental abruption
• premature rupture of membranes
• gestational hypertension
• pre-eclampsia or eclampsia
• maternal medical conditions - diabetes, renal disease, chronic pumonary disease, chronic htn)
• fetal death
• fetal compromise

Question 21

Contraindications to Induction

Answer 21

• umbilical cord relapse
• transverse fetal position
• active genital herpes infection
• previous C-section
• hystory of myomectomy (fibroid removal)
• placental previa

cervical ripening MUST occur before induction of labor - maternal and fetal injury can occur

Question 22

Post-partum hemorrhage causes

Answer 22

may occur post delivery if the fetus fails to contract enough to squeeze blood vessels that supplied the placenta shut.

commonly caused by:
* uterine atony
* lacerations
* maternal coagulopathies
* retention of placental tissue

Question 23

Drug class for PPH

Answer 23

uterotonic drugs

Question 24

Menorrhagia Overview

Answer 24

excessive or prolonged menstrual bleeding associated with an otherwise normal cycle

• characterizzed by bleeding that lasts more than 7 days or blood loss that exceeds 80mL
• can cause iron-deficiency anemia if left untreated
• excessive bleeding reduced by drugs or endometrial ablation

Question 25

Therapeutic Uses of Testosterone

Answer 25

• male hypogonadism
• replacement therapy
• delayed puberty
• replacement in menopausal women
• wasting in pateints with AIDS
• anemias

Question 26

Adverse Effects: Testosterone

Answer 26

• virilization in women, girls, boys
• premature epiphyseal closure
• hepatotoxicity
• effects on cholesterol levels
• use in pregnancy
• prostate cancer
• edema
• abuse potential *athletic performance

Question 27

Significant Risks of Anabolic Steroids

Especially Testerone

Answer 27

• hypertension
• suppression of LH and FSH release
• testicular shrinkage
• sterility
• gynecomastia
• acne
• reduction in HDL, increase in HDL
• hepatotoxicity with 17-alpha-alkylated compounds
• renal damage
• psychological effects *mentally healthy, minimal impact; unbalanced, can intensify aggression

Question 28

Erectile Dysfunction - Overview

Answer 28

Persistent inability to achieve or sustain an erection suitable for sexual intercourse
* commonly associated with chronic illness
* risk for ED increases with advancing age

Question 29

BPH: Overview

Answer 29

• nonmalignant prostate enlargement
• caused by excessive growth of epithelial cells and smooth muscle cells

Question 30

BPH: Signs and Symptoms

Answer 30

• urinary hesitancy
• urinary urgency
• increased frequency of urination
• dysuria
• nocturia
• straining to void
• postvoid dribbling
• decreased force and caliber of urinary system
• sensation of incomplete bladder emptying