S2 Pharm 116-154

Front 1

When is magnesium sulfate contraindicated for use as a tocolytic?

Back 1

Being phased out, but absolute contraindication in myasthenia gravis and renal impairment.

Front 2

What is the use of 17-OH Progesterone in preventing preterm labor?

Back 2

Prevention only. Progesterone receptor modulator decreases estrogen-mediated enhancement of oxytocin-induced contractions. Prophylaxis in women with history of PTL. Intramuscular / vaginal delivery.

Front 3

To avoid 1st pass effect in hormone replacement therapy, other admin options include:

Back 3

transdermal patch (less gallstones/VTE), creams (local only), rings (systemic)

Front 4

Types of progesterone used in HRT:

Back 4

MPA (medroxyprogesterone acetate), drospirenone (aldosterone antagonist), micro-ionized progesterone

Front 5

Types of progestin used in HRT:

Back 5

Androgenic progesterone: norethindrone, levonorgestrel

Front 6

Common side effects of progesterone HRT

Back 6

Hirsutism, "spotting", abnormal bleeding, weight gain, HTN

Front 7

Treatment for irregular menses and anovulation due to obesity.

Back 7

Oral contraceptives (likely has PCOS); no DepoProvera due to hirsutism (probably already bad)

Front 8

Treatment for 40 y/o w/ irregular menses, DM, HTN, normal TSH/FSH/pap/us/endometrial biopsy.

Back 8

Loevonorgestrel (not estrogen, may have vascular disease and endothelial damage- Virchow's Triad)

Front 9

1st line SERM for ER+ breast cancer

Back 9

Tamoxifen

Front 10

MOA for Tamoxifen

Back 10

Metabolized by cyp2D6 to more bioactive metabolite with high affinity for ERα & Erβ receptors. Binds co-repressor in breast/hypothalamus and co-activator in blood/uterus.

Front 11

Agonist/Antagonist effects of Tamoxifen

Back 11

Antagonist at breast / hypothalamus (hot flashes). Agonist at blood (VTE, clot) / uterus (endometrial hyperplasia). Partial agonist in bone (blocks resorption).

Front 12

Use for Toremifene

Back 12

Acts like Tamoxifen (ER receptor agonist/antagonist) more active than its metabolites (does not need cyp activation.) - Used in Tamoxifen resistant cancer.

Front 13

Raloxifene Use

Back 13

Breast cancer prevention (primary or reoccurence) (1st line in osteoporosis for agonist action in bone)

Front 14

Raloxifene vs. Tamoxifen

Back 14

Raloxifene is antagonist in uterus- no endometrial hyperplasia (no longterm risk of endometrial cancer) and more potent bone agonist (increases bone mass)

Front 15

Action of Aromatase Inhibitors

Back 15

Block action of aromatase enzyme in converting androstenedione to estrogen.

Front 16

Aromatase Inhibitors indicated in what type of patient

Back 16

Postmenopausal women (1st line for Stage III)

Front 17

MOA for Anastrazole

Back 17

Reversible Aromatase Inhibitor

Front 18

MOA for Exemestane

Back 18

Irreversible Aromatase Inhibitor

Front 19

Major side effects of Exemestane

Back 19

Androgenic effects: build-up of substrate (androstenedione) unable to out-compete drug due to "suicide" mechanism

Front 20

MOA for Fulvestrant

Back 20

Competitive antagonist @ ER receptors

Front 21

Indication for Fulvestrant Use

Back 21

Alternative for postmenopausal women if SERM or aromatase inhibitors fail.

Front 22

Progestins in order of most to least androgenic

Back 22

Levonorgestrel > Norgestrel > Etonogestrel > Norethindrone > Desogestrel > Norgestimate/Norelgestromin > Drospirenone

Front 23

Least androgenic progestin

Back 23

Dropsirenone (Yasmin) (Spironolactone derivative)

Front 24

Tx for menorrhagia if estrogen contraindicated

Back 24

Oral MPA (medroxyprogesterone acetate), Norethindrone minipill, Levonorgestrel IUS

Front 25

Fertility Tx for male hypothalamic hypogonadism

Back 25

Clomiphene citrate, hCG injections, IVF

Front 26

MOA for infertility drugs: Clomiphene citrate, Anastrozole/Letrozole

Back 26

Estrogen receptor antagonist, aromtase inhibitor. Block estrogen action on hypothalamus, increasing FSH production in HPO axis.

Front 27

MOA for infertility drugs: Gonadotropins

Back 27

FSH/LH increases, skipping HPO axis, leads to multiple gestations

Front 28

MOA for infertility drugs: hCG

Back 28

Triggers ovulation

Front 29

Prostate therapies

Back 29

GnRH antagonist (degarelix), GnRH agonist (leuprolide), androgen synthesis inhibitors (aminoglutethimide, ketoconazole), aromatase inhibitor, 5-alpha reductase inhibitor (finasteride), androgen receptor antagonist (flutamide)

Front 30

Doxazosin MOA (Terazosin, alfuzosin)

Back 30

α1-adrenergic receptor antagonist, relax prostate smooth muscle (symptomatic relief)

Front 31

Tamsulosin MOA

Back 31

Selective alpha-1A antagonist, less hypotension, nasal congestion

Front 32

Finasteride MOA

Back 32

5alpha-reductase inhibitor (Finasteride- selective, Dutasteride- nonselective); decrease serum PSA, impotence/libido, rare inc. of male breast cancer

Front 33

AE of Aminoglutethimide

Back 33

Hypothyroidism, hyperlipidemia

Front 34

Flutamide MOA

Back 34

DHT receptor antagonist in prostate; gynecomastia, libido drop, hepatix dysfunction

Front 35

Degarelix MOA

Back 35

GnRH antagonist, shuts down LH/FSH w/o testosterone spike (better for adv. Stage)

Front 36

Nitric oxide MOA

Back 36

Goes into smooth muscle cells of penis and stimulates production of cGMP: erection

Front 37

PDE5 MOA

Back 37

causes breakdown of cGMP leading to contraction of smooth muscle: decreased blood flow in / increased blood flow out.

Front 38

Viagra MOA

Back 38

PDE5 inhibitor; inc. cGMP levels, delays tumesences (Cialis, Levitra)

Front 39

Direct vasodilators MOA

Back 39

PGE1 (Caverject, Edex) or Papavarine, direct injectables into penis