ReproDrugs and More

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Author:
peachd
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11050
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ReproDrugs and More
Updated:
2010-05-18 15:16:50
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repro
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Repro Drugs for USMLE Step 1
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  1. Estrogens (DES, ethinyl estradiol, mestranol)
    Used for hypogonadism/ovarian fail, menstrual abnormalities, men w/androgen-dependent prostate cancer (just like you use testosterone for women w/estrogen-receptor-pos breast cancer!). SE's: endometrial cancer, post-menopausal bleeding, clear cell adenocarcinoma of vagina in female fetuses exposed to DES, inc'd thrombus risk, ER-positive breast cancer.
  2. Progestins
    OC's, treat endometrial cancer/abnormal bleeding
  3. SERMs: Clomiphene
    Estrogen partial agonists. Clomiphene = opposite of OC's: inc'd release of FSH & LH from pituitary. Tx: polycystic ovarian syndrome (b/c that condition has high LH, but not FSH, so hirsutism -- you aren't making any estrogen, too much testosterone!). SE's: hot flashes, visual disturbances, multiple simultaneous pregnancies, enlarged ovaries.
  4. Finasteride
    5-alpha reductase inhibitor --> dec'd DHT. Used for male-pattern baldness & BPH.
  5. Flutamide
    Testosterone receptor antagonist (competitive). Tx of prostate cancer -- could also give estrogen for androgen-dependent prostate cancer.
  6. Tamoxifen
    SERM -- antagonizes ER's on breast tissue (for ER-pos breast cancer)
  7. Ketoconazole & spironolactone
    Ketoconazole inhibits steroid synthesis (i.e. inhibits CYP450 making testosterone & androstenedione). Spironolactone inhibits steroid binding to its receptor, including aldosterone. Used for polycystic ovarian syndrome, so the woman doesn't develop hirsutism (her high LH but lack of FSH is causing her to pump out lots of testosterone). SE's: gynecomastia, amenorrhea.
  8. Raloxifene
    SERM -- agonist on bone's ER's --> dec'd resorption, to treat osteoporosis. (Because estrogen is good for bone.)
  9. Leuprolide
    Pulses: GnRH agonist (to treat infertility). Constant: GnRH antagonist (prostate cancer). Also used for uterine fibroids. SE's: nausea, vom, anti-androgen.
  10. Sildenafil, vardenafil
    Fill the penis (inc cGMP --> vasodilation). Used for ED. SE's: life-threatening hypotension if taken w/nitrates; impaired blue-green color vision; HA.
  11. Mifepristone (RU-486)
    Abortion drug -- competitively inhibits progestins. SE's: GI (nausea, vom, anorexia), heavy bleeding & pain.
  12. OC's
    Dec risk of endometrial & ovarian cancer, plus pelvic infections. Bad: Inc triglycerides, HTN, hypercoagulability, depression, weight gain, nausea. Histo: endometrium stroma is decidualized, but glands are inactive.
  13. Dinoprostone
    Induce labor -- prostaglandin E2 analog. Cervical dilation & uterine contractions.
  14. Ritodrine/terbutaline
    Inhibit premature labor contractions: B2 agonists that relax uterus.
  15. Anastrozole/exemestane
    Aromatase inhibitors: for post-menopausal women w/breast cancer (you don't need any more estrogen!)
  16. Testosterone
    Obv, it's an agonist at androgen receptors. Used for hypogonadism, stimulation of anabolism (rebuilding) after burn/injury; tx of estrogen-receptor-positive breast cancer. SE's: masculinization in females, gonadal atrophy in males (b/c Leydig cells inhibited). Inc'd LDL & dec'd HDL.
  17. Leiomyoscarcoma
    Aggressive, only 40% 5-year survival. Higher incidence in blacks just like leiomyoma (benign fibroids), but 1 doesn't progress into the other.
  18. GYN tumors: most common & most deadly
    Common = endometrial; deadly = ovarian.
  19. Chlamydia: the bacterial stains that work
    It's intracellular, so no Gram stain. Use Giemsa, iodine, or fluorescent Ab's.
  20. Placenta accreta
    Placenta invades myometrium, so lots of bleeding after delivery. Previous C-section predisposes.
  21. Placenta previa
    Placenta attaches low in uterus, maybe covering os. Previous C-section predisposes. Painless 3rd-trimester bleed.
  22. Abruptio placentae
    Painful 3rd-trimester bleed. Smoking, HTN, cocaine. Assoc with DIC. Fetal death.
  23. Vaginal clear-cell adenocarcinoma
    Young girls; associated with DES exposure in utero
  24. Draining of left vs. right ovary/testis
    • Right goes right into the IVC: Right gonadal vein --> IVC
    • Left side: Left gonadal vein --> left renal vein --> IVC
  25. Sarcoma botryoides
    Girls <4, grapefruit-like mass protruding through vagina. Desmin-positive tumor cells, spindle-shaped.
  26. Ovary & testis drain into which lymph nodes?
    Para-aortic
  27. Cardinal ligament (transverse cervical)
    Connects cervix to side wall of pelvis
  28. Round ligament
    Connects uterus to labia majora
  29. Suspensory ligament
    Connects ovaries to lateral pelvic wall
  30. Type of epithelium in: Ovary, fallopian tube, uterus, cervix, vagina
    • Ovary = simple cuboidal
    • fallopian = simple columnar (w/Peg cells to secrete nutrients)
    • uterus = simple columnar (pseudostratified)
    • cervix = endo is simple columnar, ecto is stratified squamous
    • vagina = stratified squamous, non-keratinized
  31. Nerves responsible for erection, emission, & ejaculation
    • Erection = parasympathetic (pelvic nerve)
    • Emission = sympathetic (hypogastric nerve)
    • Ejaculation = pudendal nerve
    • Point & Shoot.
  32. Epididymis
    Storage. If dilated duct: spermatocele. Secretes carnitine & acetylcarnitine into seminal fluid.
  33. Vas deferens
    First place where sperm are motile (they make forward motility factor). Seminal & prostate fluid released into vas deferens.
  34. Contents of prostatic fluid
    Acidic (citric acid), proteolytic enzymes, zinc (stabilize sperm chromatin)
  35. Contents of bulbourethral (Cowper's) glands
    Alkaline fluid
  36. Contents of seminal vesicles' seminal fluid
    Fructose & prostaglandins
  37. Kallmann syndrome
    Low GnRH --> low FSH & LH --> low testosterone
  38. Which cancer genes do HPV 16 & 18 affect?
    These viruses produce proteins to inactivate p53 & Rb tumor suppressors

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