USMLE STEP 1 FIRST AID: REPRODUCTIVE PHARMACOLOGY
UPDATED STUDY GUIDE QUESTIONS AND CORRECT ANSWERS
Leuprolide -- MOA GnRH analog --
Agonist with pulsatile fashion
Antagonist with continuous use (downregulates
GnRH receptor in pituitary --> Decrease FSH and
LH)
Leuprolide -- Use Infertility (pulsatile)
Prostate cancer (continous with flutamide)
Uterine fibroids (continuous)
Precocious puberty (continuous)
FIRST LINE for women w/ severe or refractory
endometriosis-related pain (continuous)
(inhibits GnrH --> decrease FSH/LH --> decrease
estrogen. the endometrium needs estrogen to
grow (proliferate), so decrease in estrogen -->
shrinking of abnormal endometrial tissue)
Leuprolide -- Toxicity Nausea
Vomiting
Osteoporosis
Pseudomenopause (night sweats, hot flashes)
Estrogens-- Names Ethinyl estradiol, DES, Mestranol
,Estrogens-- MOA Bind estrogen receptors
Estrogens-- Use 1) Hypogonadism
2) Ovarian failure
3) Menstrual abnormalities
4) Hormone replacement therapy (post
menopausal women)
5) Androgen dependent prostate cancer (men)
Estrogens-- AE 1) Endometrial cancer (when given w/o
progesterone)
2) Bleeding in postmenopausal women
3) Clear cell adenocarcinoma of vagina (DES in
utero)
4) Thrombi
5) Pancreatitis
6) Cholestatic jaundice
7) Ischemic colitis
8) Invasive breast and ovarian cancer
Contraindication for estrogen ER+ breast cancer
therapy DVT history
Name the SERMs Clomiphene
Tamoxifen
Raloxifene
, Selective Estrogen Receptor Antagonist at estrogen receptors in
Modulators-- SERMs: Clomiphene-- hypothalamus
MOA Prevent normal feedback inhibition--> increases
AP release of LH and FSH--> ovulation
Selective Estrogen Receptor Treats anovulation in PCOS
Modulators-- SERMs: Clomiphene--
Use
Selective Estrogen Receptor Hot flashes
Modulators-- SERMs: Clomiphene-- Ovarian enlargement
Toxicity Multiple simultaneous pregnancies
Visual disturbances
Selective Estrogen Receptor Antagonist on breast tissue
Modulators-- SERMs: Tamoxifen-- Agonist-- bone, uterus
MOA
Selective Estrogen Receptor Treat and prevent recurrence of ER/PR+ breast
Modulators-- SERMs: Tamoxifen-- cancer
Use
Selective Estrogen Receptor Endometrial cancer, thromboembolism
Modulators-- SERMs: Tamoxifen--
Toxicity
UPDATED STUDY GUIDE QUESTIONS AND CORRECT ANSWERS
Leuprolide -- MOA GnRH analog --
Agonist with pulsatile fashion
Antagonist with continuous use (downregulates
GnRH receptor in pituitary --> Decrease FSH and
LH)
Leuprolide -- Use Infertility (pulsatile)
Prostate cancer (continous with flutamide)
Uterine fibroids (continuous)
Precocious puberty (continuous)
FIRST LINE for women w/ severe or refractory
endometriosis-related pain (continuous)
(inhibits GnrH --> decrease FSH/LH --> decrease
estrogen. the endometrium needs estrogen to
grow (proliferate), so decrease in estrogen -->
shrinking of abnormal endometrial tissue)
Leuprolide -- Toxicity Nausea
Vomiting
Osteoporosis
Pseudomenopause (night sweats, hot flashes)
Estrogens-- Names Ethinyl estradiol, DES, Mestranol
,Estrogens-- MOA Bind estrogen receptors
Estrogens-- Use 1) Hypogonadism
2) Ovarian failure
3) Menstrual abnormalities
4) Hormone replacement therapy (post
menopausal women)
5) Androgen dependent prostate cancer (men)
Estrogens-- AE 1) Endometrial cancer (when given w/o
progesterone)
2) Bleeding in postmenopausal women
3) Clear cell adenocarcinoma of vagina (DES in
utero)
4) Thrombi
5) Pancreatitis
6) Cholestatic jaundice
7) Ischemic colitis
8) Invasive breast and ovarian cancer
Contraindication for estrogen ER+ breast cancer
therapy DVT history
Name the SERMs Clomiphene
Tamoxifen
Raloxifene
, Selective Estrogen Receptor Antagonist at estrogen receptors in
Modulators-- SERMs: Clomiphene-- hypothalamus
MOA Prevent normal feedback inhibition--> increases
AP release of LH and FSH--> ovulation
Selective Estrogen Receptor Treats anovulation in PCOS
Modulators-- SERMs: Clomiphene--
Use
Selective Estrogen Receptor Hot flashes
Modulators-- SERMs: Clomiphene-- Ovarian enlargement
Toxicity Multiple simultaneous pregnancies
Visual disturbances
Selective Estrogen Receptor Antagonist on breast tissue
Modulators-- SERMs: Tamoxifen-- Agonist-- bone, uterus
MOA
Selective Estrogen Receptor Treat and prevent recurrence of ER/PR+ breast
Modulators-- SERMs: Tamoxifen-- cancer
Use
Selective Estrogen Receptor Endometrial cancer, thromboembolism
Modulators-- SERMs: Tamoxifen--
Toxicity
