Week 9 Pharm

Question 1

What drugs are a combined hormonal contraception?

Answer 1

Combo of estrogen/progestin: Ethinyl estradiol/drospirenone (Yaz, Yasmin), thinyl esetradiol/norgestimate (Ortho Cyclen, Ortho Tri-cyclen).

Question 2

What is the MOA of Ethinyl estradiol/drospirenone (Yaz, Yasmin), and thinyl esetradiol/norgestimate (Ortho Cyclen, Ortho Tri-cyclen)?

Answer 2

Estrogen: inhibition of FSH release leading to inhibition of ovulation; inhibition of development of dominant follicle. Stabilizes endometrium to improve bleeding patterns (for reduced adverse effects).

Progestin: decreased tubal motility, increased cervical mucous viscosity, thinned/absent endometrium, and inhibition of ovulation.

Question 3

What are the side effects of Ethinyl estradiol/drospirenone (Yaz, Yasmin), and thinyl esetradiol/norgestimate (Ortho Cyclen, Ortho Tri-cyclen)?

Answer 3

Common: breakthrough bleeding and spotting, nausea, breast tenderness. Rare/Serious: “ACHES” VTE, stroke, MI, benign liver tumors, hypertension (all due to estrogen component)

Question 4

What drugs are Estrogens used for hormonal contraception?

Answer 4

Ethinyl estradiol and Mestranol

Question 5

What is the MOA of Ethinyl estradiol and Mestranol?

Answer 5

Estrogen: inhibition of FSH release leading to inhibition of ovulation; inhibition of development of dominant follicle. Stabilizes endometrium to improve bleeding patterns (for reduced adverse effects).

Question 6

What are the side effects of Ethinyl estradiol and Mestranol?

Answer 6

Common: breakthrough bleeding and spotting, nausea, breast tenderness. Rare/Serious: “ACHES” VTE, stroke, MI, benign liver tumors, hypertension (all due to estrogen component)

Question 7

What drugs are Progestins that are used for hormonal contraception?

Answer 7

Desogestrel, Levonorgestrel, Norgestimate, Norethindrone, and Drospirinone

Question 8

What is the MOA of Desogestrel, Levonorgestrel, Norgestimate, Norethindrone, and Drospirinone?

Answer 8

Progestin: decreased tubal motility, increased cervical mucous viscosity, thinned/absent endometrium, and inhibition of ovulation.

Question 9

What are the side effects of Desogestrel, Levonorgestrel, Norgestimate, Norethindrone, and Drospirinone?

Answer 9

Common: breakthrough bleeding and spotting, nausea, breast tenderness. Rare/Serious: “ACHES” VTE, stroke, MI, benign liver tumors, hypertension (all due to estrogen component)

Question 10

What drugs are Progestin only, oral contraception?

Answer 10

Norethindrone and Norgestrel

Question 11

Which drug is a Progestin only, Injectable Contraception?

Answer 11

Depomedroxyprogesterone

Question 12

Which drug is a Progestin only, Implant contraception?

Answer 12

3-ketodesogestrel (Nexplanon)

Question 13

What is the MOA of Progestin only Contraception?

Answer 13

decreased tubal motility, increased cervical mucous viscosity, thinned/absent endometrium, and inhibition of ovulation

Pregnancy prevention when estrogen is contraindicated or not wanted and an oral formulation is desired. Often used short-term post-partum.

Question 14

What are the side effects of Progestin only Contraception?

Answer 14

Breakthrough bleeding/spotting, breast tenderness, mood changes

Question 15

What is a common Hormonal Intrauterine Device that uses Progesterone?

Answer 15

Levonorgestrel (in varying doses/sizes of delivery system)

Question 16

What is the MOA of Levonorgestrel?

Answer 16

decreased tubal motility, increased cervical mucous viscosity, thinned/absent endometrium, and inhibition of ovulation (potentially less consistent effect on ovulation than progestin)

Pregnancy prevention, cycle control. Can also be used as endometrial protection when using estrogen for menopausal symptoms

Question 17

What are the side effects of Levonorgestrel?

Answer 17

Breakthrough bleeding/spotting, breast tenderness, mood changes, Rare: uterine perforation, expulsion. Typically results in amenorrhea after 6-12 months of use.

Question 18

Which intrauterine device does not use hormones to prevent pregnancy and can be used as emergency contraception?

Answer 18

Copper Intrauterine Device

Question 19

What is the MOA of a Copper Intrauterine Device?

Answer 19

Spermicidal

Question 20

What are the side effects of Copper Intrauterine Device?

Answer 20

Heavier menstrual bleeding, increased menstrual cramping. Rare uterine perforation, expulsion.

Question 21

What medication is used for oral hormonal emergency contraception?

Answer 21

Levonorgestrel (commercial product). Any combination estrogen/progestin pill in a specific dose (multiple pills needed)

Question 22

What is the MOA of oral hormonal emergency contraception?

Answer 22

Delay ovulation and follicular development and prevent pregnancy if given in a timely manner after unprotected intercourse (72-120 hours). If pregnancy already implanted, no effect.

Question 23

What are the side effects of oral hormonal emergency contraception?

Answer 23

Nausea, GI upset

Question 24

What drug causes a medical abortion up to 10 weeks gestation?

Answer 24

Mifepristone

Question 25

What is the MOA of Mifepristone?

Answer 25

Progesterone receptor competetive antagonist

Question 26

What are the side effects of Mifepristone?

Answer 26

Abdominal pain, vaginal bleeding, dizziness, nausea, and vomiting.

Question 27

What drugs is used for a medical abortion up to 10 weeks gestation, cervical ripening at term, and as GI protective agent for people on NSAIDS?

Answer 27

Misoprostol

Question 28

What is the MOA of Misoprostol?

Answer 28

Prostaglandin analogue that induces cervical contractions and facilitates removal of uterine contents

Question 29

What are the side effects of Misoprostol?

Answer 29

Abdominal pain, diarrhea

Question 30

What drug was commonly used for therapeutic abortion (1st trimester) before mifepristone was approved and is still used in select cases for abortion of ectopic pregnancy and for moderate IBD?

Answer 30

Methotrexate

Question 31

What is the MOA of Methotrexate?

Answer 31

Inhibits dihydrofolate reductase, producing anti-inflammatory effects used in autoimmune diseases.

Question 32

What are the side effects of Methotrexate?

Answer 32

Nausea, stomatitis, headache; risk reduced with folate supplementation; more serious ADRs less common

Question 33

Which SERM drug treats anovulatory infertility?

Answer 33

Clomiphene

Question 34

What is the MOA of Clomiphene?

Answer 34

Selective estrogen receptor modulator (SERM)-inhibits estradiol's negative feedback on GnRH, FSH and LH-increasing their secretion, leading to ovulation.

Question 35

What are the side effects of Clomiphene?

Answer 35

Hot flashes, headache, twins/triplet pregnancy (10%)

Question 36

What drug is a purified hMG that treats infertility?

Answer 36

Menotropins (purified hMG)

Question 37

What is the MOA of Menotropins (purified hMG)?

Answer 37

FSH:LH in a 1:1 ratio--stimulates follicular growth and maturation and stimulates ovulation

Question 38

What are the side effects of Menotropins (purified hMG)?

Answer 38

Injection site reactions, twins/triplet pregnancies

Question 39

Which drugs are FSH analogs that treat infertility?

Answer 39

Follatropin Alfa, Follatropin Beta, and Urofollitropin

Question 40

What is the MOA of Follatropin Alfa, Follatropin Beta, and Urofollitropin?

Answer 40

Stimulates follicular growth and maturation (FSH analogs)

Question 41

What are the side effects of Follatropin Alfa, Follatropin Beta, and Urofollitropin?

Answer 41

Abdominal pain, nausea, twin/triplet pregnancies

Question 42

What drugs treat fertility by stimulating ovulation after use of FSH analogs to stimulate follicular development?

Answer 42

hCG and choriogonadotropin alfa

Question 43

What are the side effects of hCG and choriogonadotropin alfa?

Answer 43

Injection site reactions, twins/triplet pregnancies

Question 44

What drugs are estrogen receptor agonists that treat Menopausal symptoms (Hot flashes and vaginal dryness)?

Answer 44

Estradiol, Conjugated estrogens, Esterified Estrogens, and Estropipate

Question 45

What is the MOA of Estradiol, Conjugated estrogens, Esterified Estrogens, and Estropipate?

Answer 45

Estrogen receptor agonists. Estradiol is bio-identical.

Question 46

What are the side effects of Estradiol, Conjugated estrogens, Esterified Estrogens, and Estropipate?

Answer 46

Variable cardiovascular and breast cancer risk depending on patient characteristics. Risk of stroke and blood clots for all.

Question 47

Which progesterone receptor agonists are used to reduce the risk of endometrial cancer when estrogen is used for menopausal symptoms in patients with an intact uterus?

Answer 47

Medroxyprogesterine, norethindrone, and micronized progesterone (bio-identical)

Question 48

What is the MOA of Medroxyprogesterine, norethindrone, and micronized progesterone?

Answer 48

Progesterone receptor agonists. Micronized progesterone is bio-identical

Question 49

What are the side effects of Medroxyprogesterine, norethindrone, and micronized progesterone?

Answer 49

Mood symptoms, weight gain

Question 50

Which Selective Estrogen Receptor Modulators (SERM) are used to treat Menopausal symptoms?

Answer 50

Raloxifene and Bazedoxifene Raloxifene-for treatment of postmenopausal osteoporosis. Bazedoxifene-for tx of menopausal symptoms (combo pill with conjugated estrogens).

Question 51

What is the MOA of Raloxifene and Bazedoxifene?

Answer 51

Selective estrogen receptor modulator (SERM): estrogen agonist at vaginal tissues and bone, estrogen antagonist at breast.

Question 52

What are the side effects of Raloxifene and Bazedoxifene?

Answer 52

Raloxifene-hot flashes, leg cramps, blood clots. Bazedoxifene-blood clots