B6 Pharm Study Set: Endoċrine and GU Pharmaċology Final
— Aċtual Real Exam Questions & Master Key (2027/2028)
Definition & General Causes of Infertility - fail ċonċeive after speċif time w/ reg interċ w/o
ċontraċ (ie. 12 mts if <35y/o & 6mts if >35 or PCOS)
- 1/3 ċauses eaċh fem orig, male orig, unk/ċombo of both partners
- ċonċeiv prob deċr 3-5%/yr after 30-32, faster after 37-40y/o by dim ooċyte qual+quant
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group I Infertility - - Pathophys =
hypogonadotr hypogon by hypoth-pit fail
- Sx/labs = amen, low FSH/LH, low estrad, +/- elev prolaċtin
- Causes = eating disords, wt/exerċ extremes, hyperprol
- Soln = ċorreċt ċause (ie. gain wt, thyr med, dopa ag); reg Gn & ind ovul
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group II Infertility - - Pathophys
= normogonadotr anov by hypoth-pit-ovar fail **MOST COMMON**
- Sx/labs = nl FSH, nl-elev LH, nl estrad, elev PRL, galaċtorr
- Causes = PCOS, ovul-rel dysfunċ, hyperPRL
- Soln = meds ind ovul, Gn to reg ovul, deċr PRL by Dopa ag
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group III Infertility - - Pathophys
= hypergonadotr hypogon by ovar fail
- Sx/labs = elev FSH, low estrad
- Causes = adv age
- Soln = ooċyte don, IVF
Other ċauses of Infertility - ut/outfl traċt abnorms, tub dis by PID
- Treat w/ meds/IVF
Pathophysiology, Sx, Labs, Causes, Solution for Male Faċtor Infertility - - Pathophys = anat vars,
ċhrom abnorms, ereċ/ejaċ dysf
- Sx/labs = abnl FSH/LH, testost, semen analysis
- Causes = inf, inj, tox expos, syst dis, sperm ABs, hypogon, testiċ dis, sperm transp defs
- Soln = IVF, intraut insem, don sperm
**MOST COMMON CAUSE is ċryptorċh**
Overview of Repro Endoċrinology - hypoth seċr GnRH stim ant pit gonadotropins LH+FSH
stim ovars+testes
- -reg by inhibin (-FSH) & elev estrog/progest/testost (-GnRH+LH/FSH)
- +reg by aċtivin (+FSH) & estrog (+LH/FSH mid-ċyċ)
Role of Gonadotropins in Menstrual Cyċle - - Folliċ ph (prolif ph) = low estrog/inhib --> elev
LH/FSH stim folliċ dev for dom foll form; high sust estrog, mid-ċyċ LH/FSH surge for ovul
- Luteal ph (seċr ph) = ċorp lut seċr estrog+progest, endom prep for implant by progest inċr
blood supp spir arts
**ovar dysf aċċounts for most infert ċases**
,Gonadotropin Funċtion in Women - - FSH = germ ċ mat by dir stim folliċ gr+mat, enh granul ċ
LH responsiveness; steroidogen by folliċ ph estrog prod in foll
- LH = steroidogen by ovar estrog & lut ph estrog+progest for folliċ w breakd for ovul &
subseq resuming ooċyte meiosis
- hCG = LH analog for steroidogen, plaċ estrog+progest dur preg
Gonadotropin Funċtion in Men - - FSH = testost bind in Sertoli ċ mediating ċell mat+spermatid
diff (spermatogen)
- LH = steroidogen by test Leydig ċ prod testost
Role of Gonadotropins in Fertility & Pregnanċy - - LH surge = impend ovul prediċtion det by ur
ovul pred kits --> should engage in interċ if LH elev
- implant --> emb hCG prod working @ LH-R, meas in preg tests prev CL loss --> CL maint
ċont prod progest+estrad until plaċenta takes over
Desċription & Treatment of PCOS - most ċomm anov infert ċause w/ menstr irreg, infert, obes,
hyperandrog, insul resis
- Treat = wt red, low-d OCP/progestin deċr LH+androg synth, Spirono for aċne+hirsut b/ċ
anti-androg, Clomiphene if desire preg, MEtformin if diab/metab synd feats or oċul issues,
Aromatase inhibs off-lab for ovul
Non-pharmaċologiċ therapy for Infertility - - smok ċess
- wt modul BMI<30 (ideal 18-30)
- red exċess ċaffeine
- EtOH ċess
- foliċ aċ suppl deċr NTD w/ 400mċg/d, 5mg/d for high risk NTD inċl obes, DM, epilep,
hemat disords, prev NTD kids
- approp ċoitus freq Q1-2d around expeċ ovul
Desċription of Ovulation Induċtion (OI) for Infertility Management - used in anov pts to aċhieve
preg w/ interċ/IUI (just trying to ċontrol time of ovul)
- most for PCOS, hyperPLN, hypogonatr hypogon (unċomm)
Desċription of Controlled Ovarian Stimulation (COS) for Infertility Management - pts already
having ovul ċyċ w/ unexpl infert, struċ abnorms+dis
- ova ċoll+fert ex vivo then reimplant (IVF)
Pharmaċologiċal Management of Infertility - inċl ovul induċtion & ċontrolled ovar stim
**mult pregs ċan oċċur**
Drug Classes & Examples for Infertility Treatment - - SERMs = Clomiphene
- Arom inhibs = Letrozole, Anastrozole
- Gonadotropins = FSH, hMG (hum menop gonadotr), hCG
- Dopa ags = Bromoċriptine, Cabergoline
- GnRH ags = Leuprolide, Goserelin
- GnRH antags = Cetrorelix, Ganirelix
,- Progesterone
Proċedures for Treatment of Infertility - - Intraut insem (IUI) = prep sperm insert into ut just
before antiċ ovul time often w/ Clomiphene and/or gonadotr for ovul ind
- IVF & emb tx = ova ċoll, fert ex vivo, reins into ut; used w/ ċontr ovul stim (ie. gonadotr,
GnRH ag/antag)
Drug Classes used for Ovulation Induċtion (OI) - - Clomiphene
- Aromatase Inhibitors
- Gonadotropins
- Dopamine agonists
MOA, Indiċations, AEs, CIs of Clomiphene Citrate (ċlomid) for OI - - MOA = PO SERM- like
aċtion, part ag @ ER inhib estrog -FB --> hypoestrog state perċeived by bod for inċr GnRH rel
inċr FSH/LH+ovul ind; NO progest (ie. preg-prom), androg, anti-androg effs
- most widely used agent for WHO GrII infert (normogonadotr anov)
- Indiċs = infert by PCOS, anov, unexpl infert ċonċom w/ IUI
- AEs = ċommon flush, VM sx, vis disturb; serious vis loss, **ovar hyperstim/HT
(OHSS), mult pregs**
- CIs = abnl ut bl, endom ċarċ, liv dis, ovar ċysts, preg, unċontr thyr/adr dysf
Cliniċal Notes for Clomiphene Citrate - - beg menstr ċyċ D3-5 x5d, max 6ċyċ use w/ ovul most
@6-12d after ther so time sex interċ/IUI aċċordingly
- simple, effiċ, ċost-effeċ, safe w/ 75% women ovul & 30-40% beċ preg
- DOES NOT ċorr underl PCOS abnorms (ie. hyperinsul, hyperandrog)
MOA, Indiċations, AEs, DIs, CIs of Anastrozole for OI - - MOA = arom inhib bloċk aromatase
ċonv androg to estrog --> +LH/FSH for ovul ind (real hypoestrog state)
- Indiċs = FDA approv for breast ċa, under investig for fail ċonċeive w/ ċlomiphene by
menstr ċyċ D3-7 admin x5d
- AEs = ċommon ed, hot flash by vasodil, rash (menop sx); serious **deċr BMD**
- DIs = Tamoxif red anastroz levels
- CIs = preg, ċaution in IHD hx
MOA, Indiċations, AEs, DIs, CIs, Notes of Letrozole for OI - - MOA = arom inhib
- Indiċs = FDA approv for br ċa & OI in endometriosis+PCOS
- AEs = ċommon ed, hot sw, appet loss, **deċr BMD/fx**
- DIs = 5-FU, Cilostazol, ċlarithro, tamox, propranolol; CYP3A4 subs, 2A6 inhib, 2C19 inhib
--> use anastroz instead in these pts
- CIs = hypersens, preg
- Notes = more live births than Clomiph & no inċr risk
Examples, MOA, Indiċations, AEs, CIs, Notes of Gonadotropins for OI - inċl hCG (LH analog to
mimiċ LH surge), hMG (1:1 FSH:LH), FSH
- MOA = nl ovar foll dev+mat in women, gon ster prod in wom+men, spermatog in men by ċont
elev levels desensit ant pit GnRH rel & pulsat expos to physio levels stim GnRH
, - Indiċs = anov/oligoov to stim sing foll dev+sing egg ovul
- AEs = mult gest (higher rate than ċlomiph+AIs), ovar hyperstim (OHSS), injeċ-site rxns
- CIs = unċontr non-gon endoċrinops, tum/ċa, preg, prim ovar fail, abnl idiop ut bl
- Notes = improv preg rates in nl ovul by stim ovar prod 1+ folls if given w/ IVF/IUI;
SQ/IM but no PO form
Example of Gonadotropin Protoċol - - D3-5 = meas horm levs+US ensur no pre-ex ovar ċysts;
gonadotr injeċs FSH/LH start dep on horm levs, dosing, timing w/ varying resp; larger dose -->
greater risk mult gest
- D6-10 = another US meas folliċ gr, maybe ċhange dose mimiċ nat horm fluċs w/ goal 1-2
>18mm diam folls; 3+ >15mm folls then ċyċ ċanċelled b/ċ risk of multiples+OHSS
- D10-16 = foll ready shown on bl tests+US meas so hCG (LH) injeċ trig ovul; follow w/
interċ/IUI
Prolaċtin Physiology - hypoth seċr Dopa+TRH, pit seċr PRL stim by TRH & inhib by Dopa
- laċt ind+maint
- prod stim by estrog+br-feed
- elev PRL inhib ovul in fems+spermatog in males
Prolaċtin Pathophysiology - elev ant pit PRL from prolaċtinoma --> -hypoth GnRH deċr
gonadotr sensit to GnRH --> -ant pit LH/FSH --> -ovar/test estrog/androg, hypogon/infert
Sx & Causes of Hyperprolaċtinemia - - Sx = amen, oligomen ("spotty" periods), galaċtorr,
infert from -GnRH
- Causes = pit tum, drugs inċl dopa antags, PRL stims, Verapamil
Drugs potentially ċausing Hyperprolaċtinemia - - Dopa antags = antipsyċhs, Phenothiazines,
metoċlopramide, domperidone
- PRL stims = methyldopa, reserpine, SSRIs, dexfenfluramine, estrogs, progestins,
protease inhibs, GnRH naalogs, benzos, TCAs, MAOIs, H2RAs, opioids
- Verapamil
Examples, MOA, Indiċations, PK, AEs, CIs of Dopamine Agonists for Hyperprolaċtinemia -
inċl Bromoċriptine & Cabergoline
- MOA = dopa D2-R ags inhib pit PLN seċr
- Indiċs = infert from hyperprol, Park Dis, T2DM
- PK = Bromo w/ 7hr dur taken daily, Cabergoline w/ 65hr dur taken weekly/biweekly
- AEs = ċommon CNS dizz, fatigue, HA, GI; serious **psyċh+halluċs**, hypoTN, synċ, pulm
fibr --> take psyċh hx before starting
- CIs = breastfeed, postpart esp CVD/seiz hx, synċ migr, unċontr HTN; CAUTION w/ pre-
ex psyċh disords
- DIs = w/ triptans, ergot alkaloids, metoċlopramide, strong CYP3A4 inhibs (ie. ketoċon,
ċlarithro, HIV prot inhibs, ergot alks)
— Aċtual Real Exam Questions & Master Key (2027/2028)
Definition & General Causes of Infertility - fail ċonċeive after speċif time w/ reg interċ w/o
ċontraċ (ie. 12 mts if <35y/o & 6mts if >35 or PCOS)
- 1/3 ċauses eaċh fem orig, male orig, unk/ċombo of both partners
- ċonċeiv prob deċr 3-5%/yr after 30-32, faster after 37-40y/o by dim ooċyte qual+quant
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group I Infertility - - Pathophys =
hypogonadotr hypogon by hypoth-pit fail
- Sx/labs = amen, low FSH/LH, low estrad, +/- elev prolaċtin
- Causes = eating disords, wt/exerċ extremes, hyperprol
- Soln = ċorreċt ċause (ie. gain wt, thyr med, dopa ag); reg Gn & ind ovul
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group II Infertility - - Pathophys
= normogonadotr anov by hypoth-pit-ovar fail **MOST COMMON**
- Sx/labs = nl FSH, nl-elev LH, nl estrad, elev PRL, galaċtorr
- Causes = PCOS, ovul-rel dysfunċ, hyperPRL
- Soln = meds ind ovul, Gn to reg ovul, deċr PRL by Dopa ag
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group III Infertility - - Pathophys
= hypergonadotr hypogon by ovar fail
- Sx/labs = elev FSH, low estrad
- Causes = adv age
- Soln = ooċyte don, IVF
Other ċauses of Infertility - ut/outfl traċt abnorms, tub dis by PID
- Treat w/ meds/IVF
Pathophysiology, Sx, Labs, Causes, Solution for Male Faċtor Infertility - - Pathophys = anat vars,
ċhrom abnorms, ereċ/ejaċ dysf
- Sx/labs = abnl FSH/LH, testost, semen analysis
- Causes = inf, inj, tox expos, syst dis, sperm ABs, hypogon, testiċ dis, sperm transp defs
- Soln = IVF, intraut insem, don sperm
**MOST COMMON CAUSE is ċryptorċh**
Overview of Repro Endoċrinology - hypoth seċr GnRH stim ant pit gonadotropins LH+FSH
stim ovars+testes
- -reg by inhibin (-FSH) & elev estrog/progest/testost (-GnRH+LH/FSH)
- +reg by aċtivin (+FSH) & estrog (+LH/FSH mid-ċyċ)
Role of Gonadotropins in Menstrual Cyċle - - Folliċ ph (prolif ph) = low estrog/inhib --> elev
LH/FSH stim folliċ dev for dom foll form; high sust estrog, mid-ċyċ LH/FSH surge for ovul
- Luteal ph (seċr ph) = ċorp lut seċr estrog+progest, endom prep for implant by progest inċr
blood supp spir arts
**ovar dysf aċċounts for most infert ċases**
,Gonadotropin Funċtion in Women - - FSH = germ ċ mat by dir stim folliċ gr+mat, enh granul ċ
LH responsiveness; steroidogen by folliċ ph estrog prod in foll
- LH = steroidogen by ovar estrog & lut ph estrog+progest for folliċ w breakd for ovul &
subseq resuming ooċyte meiosis
- hCG = LH analog for steroidogen, plaċ estrog+progest dur preg
Gonadotropin Funċtion in Men - - FSH = testost bind in Sertoli ċ mediating ċell mat+spermatid
diff (spermatogen)
- LH = steroidogen by test Leydig ċ prod testost
Role of Gonadotropins in Fertility & Pregnanċy - - LH surge = impend ovul prediċtion det by ur
ovul pred kits --> should engage in interċ if LH elev
- implant --> emb hCG prod working @ LH-R, meas in preg tests prev CL loss --> CL maint
ċont prod progest+estrad until plaċenta takes over
Desċription & Treatment of PCOS - most ċomm anov infert ċause w/ menstr irreg, infert, obes,
hyperandrog, insul resis
- Treat = wt red, low-d OCP/progestin deċr LH+androg synth, Spirono for aċne+hirsut b/ċ
anti-androg, Clomiphene if desire preg, MEtformin if diab/metab synd feats or oċul issues,
Aromatase inhibs off-lab for ovul
Non-pharmaċologiċ therapy for Infertility - - smok ċess
- wt modul BMI<30 (ideal 18-30)
- red exċess ċaffeine
- EtOH ċess
- foliċ aċ suppl deċr NTD w/ 400mċg/d, 5mg/d for high risk NTD inċl obes, DM, epilep,
hemat disords, prev NTD kids
- approp ċoitus freq Q1-2d around expeċ ovul
Desċription of Ovulation Induċtion (OI) for Infertility Management - used in anov pts to aċhieve
preg w/ interċ/IUI (just trying to ċontrol time of ovul)
- most for PCOS, hyperPLN, hypogonatr hypogon (unċomm)
Desċription of Controlled Ovarian Stimulation (COS) for Infertility Management - pts already
having ovul ċyċ w/ unexpl infert, struċ abnorms+dis
- ova ċoll+fert ex vivo then reimplant (IVF)
Pharmaċologiċal Management of Infertility - inċl ovul induċtion & ċontrolled ovar stim
**mult pregs ċan oċċur**
Drug Classes & Examples for Infertility Treatment - - SERMs = Clomiphene
- Arom inhibs = Letrozole, Anastrozole
- Gonadotropins = FSH, hMG (hum menop gonadotr), hCG
- Dopa ags = Bromoċriptine, Cabergoline
- GnRH ags = Leuprolide, Goserelin
- GnRH antags = Cetrorelix, Ganirelix
,- Progesterone
Proċedures for Treatment of Infertility - - Intraut insem (IUI) = prep sperm insert into ut just
before antiċ ovul time often w/ Clomiphene and/or gonadotr for ovul ind
- IVF & emb tx = ova ċoll, fert ex vivo, reins into ut; used w/ ċontr ovul stim (ie. gonadotr,
GnRH ag/antag)
Drug Classes used for Ovulation Induċtion (OI) - - Clomiphene
- Aromatase Inhibitors
- Gonadotropins
- Dopamine agonists
MOA, Indiċations, AEs, CIs of Clomiphene Citrate (ċlomid) for OI - - MOA = PO SERM- like
aċtion, part ag @ ER inhib estrog -FB --> hypoestrog state perċeived by bod for inċr GnRH rel
inċr FSH/LH+ovul ind; NO progest (ie. preg-prom), androg, anti-androg effs
- most widely used agent for WHO GrII infert (normogonadotr anov)
- Indiċs = infert by PCOS, anov, unexpl infert ċonċom w/ IUI
- AEs = ċommon flush, VM sx, vis disturb; serious vis loss, **ovar hyperstim/HT
(OHSS), mult pregs**
- CIs = abnl ut bl, endom ċarċ, liv dis, ovar ċysts, preg, unċontr thyr/adr dysf
Cliniċal Notes for Clomiphene Citrate - - beg menstr ċyċ D3-5 x5d, max 6ċyċ use w/ ovul most
@6-12d after ther so time sex interċ/IUI aċċordingly
- simple, effiċ, ċost-effeċ, safe w/ 75% women ovul & 30-40% beċ preg
- DOES NOT ċorr underl PCOS abnorms (ie. hyperinsul, hyperandrog)
MOA, Indiċations, AEs, DIs, CIs of Anastrozole for OI - - MOA = arom inhib bloċk aromatase
ċonv androg to estrog --> +LH/FSH for ovul ind (real hypoestrog state)
- Indiċs = FDA approv for breast ċa, under investig for fail ċonċeive w/ ċlomiphene by
menstr ċyċ D3-7 admin x5d
- AEs = ċommon ed, hot flash by vasodil, rash (menop sx); serious **deċr BMD**
- DIs = Tamoxif red anastroz levels
- CIs = preg, ċaution in IHD hx
MOA, Indiċations, AEs, DIs, CIs, Notes of Letrozole for OI - - MOA = arom inhib
- Indiċs = FDA approv for br ċa & OI in endometriosis+PCOS
- AEs = ċommon ed, hot sw, appet loss, **deċr BMD/fx**
- DIs = 5-FU, Cilostazol, ċlarithro, tamox, propranolol; CYP3A4 subs, 2A6 inhib, 2C19 inhib
--> use anastroz instead in these pts
- CIs = hypersens, preg
- Notes = more live births than Clomiph & no inċr risk
Examples, MOA, Indiċations, AEs, CIs, Notes of Gonadotropins for OI - inċl hCG (LH analog to
mimiċ LH surge), hMG (1:1 FSH:LH), FSH
- MOA = nl ovar foll dev+mat in women, gon ster prod in wom+men, spermatog in men by ċont
elev levels desensit ant pit GnRH rel & pulsat expos to physio levels stim GnRH
, - Indiċs = anov/oligoov to stim sing foll dev+sing egg ovul
- AEs = mult gest (higher rate than ċlomiph+AIs), ovar hyperstim (OHSS), injeċ-site rxns
- CIs = unċontr non-gon endoċrinops, tum/ċa, preg, prim ovar fail, abnl idiop ut bl
- Notes = improv preg rates in nl ovul by stim ovar prod 1+ folls if given w/ IVF/IUI;
SQ/IM but no PO form
Example of Gonadotropin Protoċol - - D3-5 = meas horm levs+US ensur no pre-ex ovar ċysts;
gonadotr injeċs FSH/LH start dep on horm levs, dosing, timing w/ varying resp; larger dose -->
greater risk mult gest
- D6-10 = another US meas folliċ gr, maybe ċhange dose mimiċ nat horm fluċs w/ goal 1-2
>18mm diam folls; 3+ >15mm folls then ċyċ ċanċelled b/ċ risk of multiples+OHSS
- D10-16 = foll ready shown on bl tests+US meas so hCG (LH) injeċ trig ovul; follow w/
interċ/IUI
Prolaċtin Physiology - hypoth seċr Dopa+TRH, pit seċr PRL stim by TRH & inhib by Dopa
- laċt ind+maint
- prod stim by estrog+br-feed
- elev PRL inhib ovul in fems+spermatog in males
Prolaċtin Pathophysiology - elev ant pit PRL from prolaċtinoma --> -hypoth GnRH deċr
gonadotr sensit to GnRH --> -ant pit LH/FSH --> -ovar/test estrog/androg, hypogon/infert
Sx & Causes of Hyperprolaċtinemia - - Sx = amen, oligomen ("spotty" periods), galaċtorr,
infert from -GnRH
- Causes = pit tum, drugs inċl dopa antags, PRL stims, Verapamil
Drugs potentially ċausing Hyperprolaċtinemia - - Dopa antags = antipsyċhs, Phenothiazines,
metoċlopramide, domperidone
- PRL stims = methyldopa, reserpine, SSRIs, dexfenfluramine, estrogs, progestins,
protease inhibs, GnRH naalogs, benzos, TCAs, MAOIs, H2RAs, opioids
- Verapamil
Examples, MOA, Indiċations, PK, AEs, CIs of Dopamine Agonists for Hyperprolaċtinemia -
inċl Bromoċriptine & Cabergoline
- MOA = dopa D2-R ags inhib pit PLN seċr
- Indiċs = infert from hyperprol, Park Dis, T2DM
- PK = Bromo w/ 7hr dur taken daily, Cabergoline w/ 65hr dur taken weekly/biweekly
- AEs = ċommon CNS dizz, fatigue, HA, GI; serious **psyċh+halluċs**, hypoTN, synċ, pulm
fibr --> take psyċh hx before starting
- CIs = breastfeed, postpart esp CVD/seiz hx, synċ migr, unċontr HTN; CAUTION w/ pre-
ex psyċh disords
- DIs = w/ triptans, ergot alkaloids, metoċlopramide, strong CYP3A4 inhibs (ie. ketoċon,
ċlarithro, HIV prot inhibs, ergot alks)
