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| 8155155661 | Progestins: MOA? | 1. Thickening cervical mucus to prevent sperm penetration 2. Slowing tubal motility and delaying sperm transport 3. Inducing endometrial atrophy (endometrium may become too thin) 4. Blocking the LH surge, which inhibits ovulation (IM Medroxyprogesterone is very effective) | 0 | |
| 8155201014 | Estrogens: Uses? | 1. Suppress FSH release from the pituitary (which may assist in preventing the LH surge and ovulation) 2. Produces state in endometrium that is not receptive to implantation 3. Stabilize endometrial lining (primary role) 4. Provide cycle control | 1 | |
| 8155229539 | Estrogen contraceptives? | Ethinyl estradiol Mestranol (Estradiol Valerate) | 2 | |
| 8155235962 | Progestin + Estrogen contraceptives? | *Norgestrel (implants)* *Levonorgestrel (IUD)* *Norelgestromin (patch)* *Etonogestrel (vaginal ring)* Norethindrone | 3 | |
| 8155258941 | Progestin-only Preparations? | Medroxyprogesterone (IM injection, lasts 3 months) Etonogestrel (4 cm long implant lasts 3 years) Norethindrone (Mirconor, oral) | 4 | |
| 8155284632 | Monophasic tx? | Fixed amount of estrogen and progestin for 21 days | 5 | |
| 8155291770 | Biphasic & triphasic tx? | Provide 2 or 3 different pills containing varying amounts of active ingredients | 6 | |
| 8155308806 | How do the amount of hormones vary throughout 21-day period for oral contraceptives? | Amount of progestin is increased while estrogen stays the same | 7 | |
| 8158409576 | "Slide 8 is very important" |  | 8 | |
| 8155323831 | Combined Oral Contraceptives: CV side effects- when are they contraindicated? | Women > 35 yoa who smoke > 15 cigarettes/ day | 9 | |
| 8155354767 | Women who is 36 and smokes 16 cigarettes/ day wants to use oral contraceptive. What should you Rx her? | Progestin-only preparations: Medroxyprogesterone (IM injection) Etonogestrel (Implant) Norethindrone (Oral) | 10 | |
| 8155377514 | Oral contraceptives: How do they increase risk of venous thromboembolism? | Estrogen increases hepatic production of factor VII, X, and fibrinogen in coagulation cascade *No risk seen w/ progestin-only preparations! | 11 | |
| 8155413425 | Oral contraceptives: Androgenic activity side effects? | Hirsutism & acne (from norethindrone) Anti-aldosterone & anti-androgenic effects (from Drosperinone) | 12 | |
| 8155452195 | Norethindrone: Side effects? | Hirsutism & acne | 13 | |
| 8155452196 | Oral contraceptive that causes Hirsutism & acne? | Norethindrone | 14 | |
| 8155473824 | Drosperinone: Side effects? | Anti-aldosterone & anti-androgenic effects | 15 | |
| 8155478523 | Oral contraceptive that has anti-aldosterone & anti-androgenic effects? | Drosperinone | 16 | |
| 8155495447 | Oral contraceptive effect on cancer? | 50% decrease in incidence of endometrial cancer due to progestin opposing estrogen-induced proliferation | 17 | |
| 8155503443 | Progestin-only contraceptives: Side effects? | 1. Irregular, unpredictable spotting and bleeding 2. Headache 3. Decreased HDL and increased LDL | 18 | |
| 8158061478 | Type of contraceptives that cause irregular, unpredictable spotting and bleeding? | Progestin-only contraceptives | 19 | |
| 8158080239 | How is tx w/ contraceptives usually begun? | Estrogen (less for lighter women, more for heavier women) *choice is also influenced by specific 19-nor progestin, which may have andronergic activity | 20 | |
| 8158132765 | Transdermal patch: Contains what? | Ethinyl estradiol & norelgestromin | 21 | |
| 8158149381 | Transdermal patch: Why may it result in higher levels of estrogen? | Transdermal system avoids first-pass metabolism *this is effective in pts < 90 kg. | 22 | |
| 8158161511 | Vaginal ring: What does it contain? | Ethinyl estradiol & Etonogestrel | 23 | |
| 8158408392 | Vaginal ring: Common complaints? | Discomfort & expulsion of the ring | 24 | |
| 8154982197 | Which of the following is an estrogen that is used in most combined hormonal contraceptives? (A) Clomiphene (B) Estrone (C) Ethinyl estradiol (D) Diethylstilbestrol (DES) (E) Norgestrel | (C) Ethinyl estradiol | 25 | |
| 8158408393 | Concerns Re: Postpartum Use of Hormonal Contraceptives? | Mother's hypercoagulability & effects on lactation *In first 21 days postpartum (when risk of thrombosis is higher), estrogen-containing hormonal contraceptives should be avoided *Those who are breastfeeding avoid CHCs for first 42 days postpartum in those w/ risk factors for VTE and for 30 days in those w/o risk factors | 26 | |
| 8158408394 | Postcoital contraceptives: Use? | Prevent pregnancy if administered w/in 72 hours after unprotected sex | 27 | |
| 8158408395 | Postcoital contraceptives: Combinations? | 1. Progestin (L-norgestrel) 2. Estrogen 3. Estrogen & progestin | 28 | |
| 8158408396 | Levonorgestrel (Plan B): When should you take it? | First dose = w/in 72 hours of unprotected sex Second dose = 12 hour later | 29 | |
| 8158408397 | What are 2 safe (and effective) emergency contraceptives? | 1. Levonorgestrel 2. Norgestrel | 30 | |
| 8154992966 | 50-year-old woman with a positive mammogram undergoes lumpectomy and a small carcinoma is removed. Biochemical analysis of the cancer reveals the presence of estrogen and progesterone receptors. After this procedure, she will probably receive which of the following drugs? (A) Danazol (B) Flutamide (C) Leuprolide (D) Mifepristone (E) Tamoxifen | (E) Tamoxifen Tamoxifen has proved useful in adjunctive therapy of breast cancer; the drug decreases the rate of recurrence of cancer. | 31 | |
| 8154999237 | A young woman complains of abdominal pain at the time of menstruation. Careful evaluation indicates the presence of significant endometrial deposits on the pelvic peritoneum. Which of the following is the most appropriate medical therapy for this patient? (A) Flutamide, orally (B) Medroxyprogesterone acetate by intramuscular injection (C) Norgestrel as an IUD (D) Oxandrolone by intramuscular injection (E) Raloxifene orally | (B) Medroxyprogesterone acetate by intramuscular injection In endometriosis, suppression of ovarian function and production of gonadal steroids are useful. Intramuscular injection of relatively large doses of medroxyprogesterone provides 3 mo of an ovarian suppressive effect because of inhibition of pituitary production of gonadotropins | 32 | |
| 8155004510 | Which of the following is a unique property of SERMs? (A) Act as agonists in some tissues and antagonists in other tissues (B) Activate a unique plasma membrane-bound receptor (C) Have both estrogenic and progestational agonist activity (D) Inhibit the aromatase enzyme required for estrogen synthesis (E) Produce estrogenic effects without binding to estrogen receptors | (A) Act as agonists in some tissues and antagonists in other tissues | 33 | |
| 8155009397 | A 52-year-old postmenopausal patient has evidence of low bone mineral density. She and her physician are considering therapy with raloxifene or a combination of conjugated estrogens and medroxyprogesterone acetate. Which of the following patient characteristics is most likely to lead them to select raloxifene? (A) Previous hysterectomy (B) Recurrent vaginitis (C) Rheumatoid arthritis (D) Strong family history of breast cancer (E) Troublesome hot flushes | (D) Strong family history of breast cancer SERMs such as tamoxifen and raloxifene exhibit tissuespecific estrogenic and antiestrogenic effects | 34 | |
| 8155037678 | A recently married 38-year-old woman who recently recovered from a pulmonary embolism is seeking a prescription for contraception. Which of the following would be contraindicated? A) combination (estrogen + progestin) oral contraceptive pills B) depo medroxyprogesterone acetate C) implanon implant D) levonorgestrel releasing IUD E) progestin-only mini pill | A) combination (estrogen + progestin) oral contraceptive pills Contraceptives containing estrogen are contraindicated in patients with a history of thromboembolic disorders. | 35 | |
| 8155048838 | A 38-year-old woman with a 20 year of cigarette smoking (1/2 pack per day) is seeking a prescription for contraception. Which of the following would have the greatest contraindication for use in this patient? A) depo medroxyprogesterone B) implanon implant C) levonorgestrel releasing IUD D) transdermal patch | D) transdermal patch Available transdermal contraceptive patches release both synthetic estrogen and progestin hormones. Estrogen hormones are considered contraindicated for women who smoke due to increased risk for thromboembolism. | 36 | |
| 8155054822 | A 21-year-old recently married woman with a history of cigarette smoking is seeking contraceptive therapy. When discussing her long-term plans, she indicates that she does not wish to become pregnant for at least the next 5 years. After discussing the available therapeutic options, you both decide that the "best choice" for her current needs is a reversible form of contraception that is highly efficacious, and also has a very long duration of action (>1 year). Which therapeutic option for contraception seems most appropriate for this patient? A) combination oral contraceptive pills B) implanon implant C) medroxyprogesterone s.c. injection D) progestin-only mini pills E) transdermal contraceptive patch F) tubal ligation | B) implanon implant These implants contain a progestin, and once implanted provide continuous contraception for up to 3 years. | 37 | |
| 8155066022 | A 23-year-old woman is prescribed a progestin-only mini pill for contraception. Which advice would you consider most appropriate before writing her prescription? A) It is imperative that progestin mini pills be taken at the same time each day B) These pills can help with acne C) These pills are potent suppressors of ovulation, and have a 2 week grace period before pregnancy is likely to occur if a pill is missed. D) Taking these pills for more than a year in duration frequently results in sterility. | A) It is imperative that progestin mini pills be taken at the same time each day A major contributor to the contraceptive efficacy of POPs is their effect to thicken cervical mucus. The change in cervical mucus takes place 2-4 hours after the first dose of POPs. However, after 24 hours, cervical mucus drastically thins, allowing sperm to easily penetrate. Therefore, it is imperative that POPs be taken at the same time each day. | 38 | |
| 8155073296 | A 32-year-old woman with early-stage ER+ breast cancer requires treatment. You elect to start therapy with a selective estrogen receptor modulator that exerts its effect by binding to and inhibiting the estrogen receptor expressed in breast tumor cells. Which medication will you prescribe for this purpose? A) diethylstilbestrol B) finasteride C) mestranol D) mifepristone E) tamoxifen | E) tamoxifen Tomoxifen is a SERM. Due to the presence of different subtypes of estrogen receptors (alpha vs beta) expressed in different tissues, and differerences in signal transduction, the effects of SERMs are highly "tissue dependent". Treatment of her condition is an FDA approved indication for tomoxifen. | 39 | |
| 8155081269 | A 21-year-old woman arrives in your clinic 14 days after being the victim of a sexual assault, and requests treatment to prevent an unwanted pregnancy. After further discussion and lab tests, you agree to write a prescription for a medication that is FDA approved for someone in her situation. Which medication would you write a prescription for? A) clomiphene B) fluoxymesterone C) mefepristone + misoprostol D) raloxifene | C) mefepristone + misoprostol Mifepristone is a receptor antagonist for both glucocorticoid & progesterone receptors that is FDA approved for termination of pregnancy (used in combination with misoprostol) over the first 70 days of pregnancy. | 40 |
