Reproductive Pharm

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Reproductive Pharm
2015-04-14 14:58:15
Reproductive Pharm
Reproductive Pharm
Reproductive Pharm
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  1. Describe the use of GnRH analogs in both pulsatile and continuous dose continuous dose
    • different actions if pulse or cont
    • pulse= positive effect- give release of fsh lh
    • continuous= negative effect-through downreg mech of receptors, no fsh lh release, can use this in Ca trmt. will get a tumor flare at first
    • leuprolide
  2. Describe female hormones and how they are used
    clinically g . List side effects of each female drug.
  3. Describe male hormones/drugs and how they are used clinically. List side effects of each male drug.
  4. Describe the use of adrenergic drugs in terms of uterinerelaxation and treatment of prostate hyperplasia.
  5. Gonadotropin releasing hormones 2 effects= leuprolide
    gnrh analog- think back to phsyiology
  6. leuprolide, effect as contniuous?, pulsatile? clinical use
    • gnrh analog-
    • anatgonistic endometriosis, fibroids, prostate Ca, precocious puberty
    • agonistic for infertility
  7. gnrh analog SE, contraindications?
    • HA, nausea, flushing, light headedness
    • continuous- menopause osteoporosis
    • contra- breastfeeding and pregnancy
  8. estrogens- natural vs synthetic
    • natural has major first pass effect- not absorbed well
    • synthetic- increased oral effectiveness
  9. estrogen physiology
    • regulate transcription
    • stim development of organs ande secondary sex characteristics
    • endometiral effects- continuous exposure leads to hyperplasia
    • increase HDL, low LDL, increase TG H2O retention and water
  10. estrogen clinical uses (2)
    • primary hypogonad- age 11-13
    • postmenopausal hormone therapy- endometrial ca risk
    • uterine biopsy if bleeding occurs, contra with estrogen tumors
  11. estrogen effects
    • major cause of postmenopausal uterine bleeding
    • nausea, breast tenderness, hyperpigmentation
    • migraine ha, gallbladder, htn
  12. estrogen contraindications
    • estrogen neoplasms
    • heavy smokers increase risk over age 35
    • genital bleeding
    • use as short of time as possible
  13. progestins natural vs synthetic
    synthetic absorb better
  14. 3rd gen progestins and example
    • - lower androgenic activity
    • desogesterol
  15. progestins pharmacokinetics
    • excreted in urine
    • peanut allergy should be avoided- micronized
  16. progestin physiology
    • decrease hdl, increase ldl, increase water and Na excretion
    • opposite of estrogen
  17. progestins clinical use
    • hormone replacement
    • contraception
    • used alone- prolonged anovulation and amenorrhea
    • endometriosis
    • bleeding disorders
  18. progestin contraindications
    • increase bp
    • ha, weight gain, depression, decrease libido
  19. hormonal contraception
    • give progesterone and estrogen shuts off pit to stop lh fsh release- results in inhibition of ovulation
    • will decrease breast milk production
    • progestin alone- will not always inhibit ovulation
    • cervical mucus thickening
    • inhibits endometrial prolif
  20. OCP SE
    • nv, failure to withdraw bleeding
    • weigh gain, skin pigmentation, infections, hirsutism,
    • thromboembolism, mi risk, stroke risk
  21. ocp contraindication
    • rifampin
    • epiphysial closure has not occurred
  22. depot provera and progestin implant note
    longer these are insoma longer to reinstate ovulation
  23. estrogen receprots modulators partial ag and antagonists of estrodiol
    partial agonist- tamoxifen- bind to estogen receptor will bind slightly but inhibits estrogen + breast ca
  24. raloxifene-
    • prevention and treatment of osteoporosis after menopause
    • decrease breast ca in post menpausal women
  25. clomiphene-use, se, trmt time risk
    • ovulation disorders
    • hot flashes, ha, constip, allergic skin rxn, hair loss
    • over 1 year increase risk for ovarian ca
  26. mifepristone
    • ru486 steroid inhibitors, used mostly for early preg termination
    • proonged bleeding vomiting, diarrhea
  27. danazol
    steroid inhibitors, suppress ovarian fn and get estrogen suprression through diff mech- get weight gain, acne, edema- testosterone like, used for endometriosis
  28. anastrozole
    • aromatase inhibitors
    • nonsteroidal
    • good for tamoxifen resistance, or postmenopausal women with breast ca
  29. exemestane
    • aromatase inhibitors
    • steroid molecule, irreversable inhibitor of aromtase
    • used for advance breast ca
  30. breast can treatment order
    • tamoxifen
    • anastrozole
    • exemestane
  31. terbutaline
    • beta 2 agonist- to relax uterus to decrease premature uterine contractions
    • give time to give steroid to fetus for better survivability of lungs
  32. androgen and anabolic steroids
    • oral testosterone associated with liver tumors
    • stimulate growth in boys
    • androgen prod decreases with age
    • should not be used in infants
  33. male contraception
    combo of testosterone and progestins to suppress sperm count
  34. se of androgen
    • hisutism
    • acne
    • amennorrhea
    • clitoral enlargemnt
    • athlersclerosis- increase ldl, decrease dhl
    • aggresion, psych
    • reduce intratesticular testoserone by inhibiting lh release
  35. ketoconazole- steroid synthesis inhibitors antiandrogen- treatm,ent of PCOS increase estrogen:testosterone ratio
  36. finasteride-
    • 5alpha reductase inhibitor
    • reduce prostate size in bph, decrease dihydrotestoserone
    • also male baldness
  37. flutamide
    competitive inhibitor of test receptors- prostate ca
  38. bicalutamide
    prostate ca
  39. spiranolactone
    • inhibit dihydrotestosterone binding to androgen receptors
    • hirusitm in women with pcos
  40. tamsulosin
    sin alpha 1 blocker- prostate has particular alpha 1 receptors- greater potency in decreases prostate smooth muscle contraction good for bph
  41. sildenafil/ vardenafil
    increase cGMP- cause relax of nonvascular smooth muscle and enhance erection
  42. alprostadil
    • PGE1 analog
    • used for failed viagra