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Gyn pharmacotherapy
gyn pharmacotherapy.
91
Medical
Graduate
03/19/2012

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Term
hormonal elvelsi n emnstrual cycle
Definition
follicles enalrge due to fsh stimualtion, they make estradiol, stimualting endometrium prolfieration.

E2 tirggers the prevoulatory surge of LHand FSH.

follciular rupture and ovualtin ooccurs, eleasing ovum.

ruptured follcie lbecomes corups luteum andp odrudces P and some E, P cuasing the endometrium to differneitate int o secreatoyr gnaldules. i nabsecne of pregnancy , corpus lutem ceasest o funciton, P and E leels drop and mensturation occurs
Term
basis of oral contraceptives
Definition
in pregnancay, post oulation progesteronand estrogen levels keep increasing, so there is no vovaultion.
Term
norethindroe
Definition
progestin only pill
Term
ethyndiol diacetate
Definition
progestin only pill
Term
levonorgestereal
Definition
progestin only pill
Term
desogesterel
Definition
progestin only pill
Term
which pill has mroe stringetn on time requriements
Definition
progest only
Term
adverse effecst of preoesterone pill
Definition
commonly irregular menstrual bleeding. Sometimesi ncerases ecotpic pregnancy
Term
use of POP pill
Definition
when estrogen is contraindicated such as during breastfeeding where estrogen reduced breast milk
Term
long term reversible contraception using progtesin
Definition
implantation (etonogesterel)

Injection (medroxyproegsteron acetatte (mpa)).
IU (levonogesterel)
Term
progestin uses
Definition
hormonal conraception, preveniton of endometrial hyeprpleasia due to unospposed estrogen, secondary ammenorhea, endometriosis, ndometrial cancer, lutealsupporti nIF protocols, prevention of preterm birth.
Term
POP doses and effects
Definition
low dose- ovulatory cessation incossitent, most of effects is cervicual muscoas thickening, reducing sperm viabiity and penetration

intermediate dose: soem follicular development, more consistiently inbhiting ovulation. same cervicual muc changes occur.

High dose, comepletley inhibits follciualr developmetn and ovualtion.

Endometrium- thin/atorphic interfeing with implanation of blastocyst
Term
how does progesterone exert its effects
Definition
e2 decreasesfamplitude of fsh anwd lh, but triggers surge ofLH mid cycle. P4 decrases frequency o GNrh, and thus frency of LH/FSH
Term
progesteron receptors fucntioning
Definition
both oded by hPR. pr-b contributs to prolfieration, Pr-A isoform is necessary to oppose estrogeni nduced prolfieraiton.

Estrogen is necessary to induce hpR epressioin in endometrium
Term
DRUG names
Definition
focus mainly on estrogen , progesterone, and inhibotrs: antagonists,agonists, selective agoanists
Term
COC formulations
Definition
the estrogen level remains constant while progesteron increases in monphasic biphasic triphasic etc.
Term
estrogens used in COC
Definition
ehtinyl estradiol or mestranol- mestranol is m etabolized to EE
Term
side effects of COC
Definition
irregular menstrua lbleeding ,ammenohrea, headaches, blaoting ,a nd fatigue
Term
cotnious COC pill advantage
Definition
cuts cycle to once every 3 months
Term
natural huma nesdtrogen names
Definition
e1 (estrone) , e2 (eastradiol), e3 - estriol
Term
most potent human estrogen
Definition
estradiol
Term
least active human estrogen
Definition
estriol
Term
estrogen receptor t ypes
Definition
Era: foudn in endometrium, breast cancer,ovarian celsl and hypothalamus

ErB: kidney, brain. the differnet estrogens differentiall yb ind to each receptor
Term
ethinylestradiol metabolci features
Definition
17a ethinyl group as wel las 3 m rethyl groups inhibit hydroxylation and sfulation respectively, > Decreased meatbolism leads to inccreased oral bioavialbiltily
Term
estrogen med contradincations
Definition
MI, stroke or v eous thromboemsbolism . caution with smokers adn obese.
Term
estrogen site of metabolization
Definition
hepatic
Term
levonogesterol
Definition
emergency contraceptive
Term
combined oral concentrative
Definition
emergency contraceptive
Term
uliprastal
Definition
emergency contraceptive
Term
mifeprestone
Definition
emergency contraceptive
Term
levonogesterol adverse effects
Definition
nausea, abdominal pain,votmitting. DETERIOATION IN glucose tolerance, DIABETIC women need to be monitored
Term
COMBINED ORAL CONCENTRATIVE adverse efects
Definition
nausea vomitting
Term
uilpristal moa
Definition
selective PR modulator
Term
Mifepristone moa
Definition
anti progestin, disrupts follic ular maturaiton, mid cycle LH surge, and alter endometrium
Term
ultipstail,mifepristone vs. levonogestrel/cocp timing of use
Definition
uiltiprastal/m remai ne qulaly effective within time frframe, wheras levonogesterl are hte sooner hte more effective (because this one relies on inhibiting ovulation)
Term
which emidcaiton also indictated for treating fibroid bleeding
Definition
ulipristal
Term
side effects common to al lemergency contraceptives
Definition
ectorpic pregnancy increase
Term
contraception/abortion for emergency contraceptives
Definition
levonorgestreal and COCp will not effect while pregnant, ulipristal and mifepristone mah ahve abortive effects.
Term
22 min
Definition
2
Term
abortifaciento
Definition
mifepristone- progestoerne recpeotr and glucoritocid recpetor antagonist, can be used through 9 weeks pregnancy (prostaglandine E1, as misprotol added later to induce uterine contraciton).
Term
mifepristone abortive mechanism
Definition
blocks uterine prostaglandin receptor causign decidual reakdown and deatchment ofblastocyst. this decreases hCG prodution and progesteron secretion from corpus luteum. hcg produciton down and progestone secrestion from corpus lutem down. this casuesf urhter decidual reakdown. you icnraese uterine prostaglandian and epxulsion of detached blastorcyst.
Term
drug used tot reat heyeprglycemia
Definition
mefipristone due to glucotiroicd receptor activity.
Term
Diethylstilbesterol (DES)
Definition
synthetic estrogen, origianlly used to prevent miscarragies, hwoever causes cancer andi nfertility.
Term
DES side effects
Definition
causebreast cance in hromone replacement therapy.

caused repdocutive deformities and cacners in the children
Term
miscarriage treatment
Definition
be rest, avoid aspiorin/nsaids, also progesterone supplement.

unlike to do harm, hwoever no clear indication thati t works
Term
predinosoloen nad misscarriage
Definition
believe that tehere is aroel for uterine natural kilelr cells. prednisolone ay preent this
Term
incomplete miscarraige
Definition
bascially abbort it via mifepristone or misporostl
Term
preeclampsia intro
Definition
hypertension- new onset, which causes peripehral edema, renal/hepatic dyfucntion and seizures.
Term
management preeclampsia
Definition
DONT use RAAS antagonists. use a-adrenecic agonists. and hydralazine for severe cases. mGso4 to prevvent seizure and saefe to use.
Term
labor repressants tocolytics
Definition
work via relaxing smooth muscle.

B2 agonists, calcium channel blockers- nifedippine,

oxytocin antagonist.

Nsadis-

mgSo4
Term
atosiban
Definition
oxytocin antagonist, used as labor repressant.
Term
indomethacin
Definition
nsaid used for labor repression
Term
mgso4 as labor reperssant
Definition
calcium chanel blcoekr which inhibit myosin light chains
Term
druugs tositualte labor
Definition
oxytocin,

misprostol

ergots- associated with severe side effects, but effect.
Term
lactation natural process
Definition
increases i estrogen produces prolactin, starting alctation process, oxytocin stimulates labor and stimualtes milk ejeciton during lactation. cobination contraceptives can be useful for this.
Term
glacatogue
Definition
promotes lactatation, herbal galactagoggues,

pharmacolgoical: dompaine atnagonists
Term
domperidone
Definition
dopamien antagonist
Term
metoclopramide
Definition
dopamine atnagonist
Term
lactation supression
Definition
can sdimply nto stimautle the brest- medically- cabergoline- potent dopamine agonist
Term
selective estergoen receptor modulator target organas
Definition
beneficial efffect for bone and cv system however increased risk of breast and tuerine cancer
Term
tamoxifen
Definition
serm
Term
tamoxsifen agonist and antoagnist effect
Definition
antaognist on breast tisue parial agonist on uterine and bone tissues.
Term
tamoxifen pharmacokinetics
Definition
ac tive metaoblite 4 hydroyxtamoxifen.
Term
toremifine
Definition
derivative of tamoxifen with simliar profertes as tamoxifen
Term
tamoxifen side effect
Definition
increased risk of endometrial carcinoma
Term
raloxifene receptor selecitivty
Definition
serm , nonsteroidral serm with estrogn actions on bone, and antiestrogenic aciotns on uterus and breast.
Term
raloxifene indications
Definition
treamtent of osteoperisis and breast cancer
Term
side effects of raloxifene-tamoxifene
Definition
hot flashes leg gramps increased dvt and pulmoanr yembolism
Term
fluvestrant
Definition
pure estrogen antagonisdt
Term
fulvestrant
Definition
met breast cancer restant to tamoxifen
Term
fulvestrant adva ntage to tamoxifen
Definition
laso downregulats era receptor.
Term
fulcvestrant adverse effects
Definition
some of the same wones as tamoxifen also crosses the PLACENTA
Term
exemstane
Definition
tyep i irreversible steroids. similar to andoraestnedione. can bind to aromatase. - causign suicicdei nbhition.
Term
exemaestane indicaiton
Definition
dfor postmenopasual women with er positive earl ybreast cancer. more effective tha ntamox
Term
fomrestane
Definition
operates simliar to exemstanebut no logne rused ue to poro oral bioavailbliyt.
Term
anastrozole
Definition
type II reversible nonsteroid aromatasei nbhitor.
Term
anastrozole indications
Definition
potmenopausal women with lcoalized er positive breast cancer, firstl ine treatmetn ofllowing tamox
Term
anstrozole sideefect
Definition
hot flashes
Term
letrozole,
Definition
just like anastrozole
Term
aromatase inbhitiors only useful in postmenopausal woman
Definition
useful sa an alaternative for to esterogen selectives,
Term
danazol
Definition
weak androgen. inbhiitor of gonadal funciton i nthe treatemtn of endometriosis,

adverseefewfcts causel imited use.
Term
danazol
Definition
Term
-relin drugs
Definition
gnrh analgos
Term
gnrh analog fucntion
Definition
stimualte gnrh receptors, cause intial flare decreasing lh and fsh secretion supresisng steeroidigeness
Term
gnrh agaonist indication
Definition
advances prodstate cancer, endometriosis, and advanced bread cancer.
Term
gnrh agonists adverse effects
Definition
fetal harm, hypoestrogenism
Term
gnrh antagonists
Definition
do not transiently icnrese sex hormones, avoiding intial flare.
Term
all -lix drugs
Definition
gnrh antagonist
Term
abarelix
Definition
used for prostate cancer
Term
degarelix
Definition
treats rpostatecancer
Term
cetrorelix and ganirelix
Definition
inhibion of premature lh surges in women withovarianstimaultion can asl obe used for endometriosis
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