1What is a drug in the rifamycin class that is po but not absorbed from the GI tract?
rifaximin
2What is the second line therapy in hepatic encephalopathy and also used for traveler's diarrhea?
rifaximin
3What are the 6 Rs of rifampin?
red or orange urine
RNA polymerase repression
rifampin amplifies the cytochrome p450 but rifabutin does not
rapid resistance developed if used alone
4Peripheral neuropathy is caused by which drug and what kind of deficiency? What is given to prevent this?
isoniazid
vitamin B6 deficiency
pyridoxine 25-50 mg po qd
5What is a major adverse effect of ethambutol?
optic neuropathy
6Which azole derivatives are for topical use?
clotrimazole
ketoconazole
miconazole
7What are the AE of amphotericin?
nephrotoxicity
arrhythmias
IV phlebitis
8Which antifungal has good penetration of the CNS?
fluconazole
9What is the drug of choice for invasive aspergillosis?
voriconazole
10Which drug is too toxic for IV use so instead it is used for oropharyngeal candidiasis (swish and swallow)?
nystatin
11What is the intensive phase treatment for TB?
2 months of rifampin plus isoniazid, pyrazinamide and ethambutol
12What is the continuation phase treatment for TB?
4 months of rifampin plus isoniazid
13What is the MOA for rifamycins?
inhibit DNA dependent RNA polymerase activity in bacterial cells
14What are the AE of rifampins?
elevated LFTs
rash
epigastric distress
anorexia
n/v/d
cramps
pseudomembraneous colitis
pancreatitis
15What is the box warning for rifampin?
discoloration of teeth, urine, sweat, sputum and tears
16What is the MOA of isoniazid?
inhibits the synthesis of mycolic acid leading to a disruption in the bacterial cell wall
17What is the box warning for isoniazid?
fetal hepatitis may occur within 3 months of treatment and many months after
18What should the patient be educated on when taking isoniazid?
s/s of hepatitis
19What are the CI of pyrazinamide?
severe hepatic damage
acute gout
photosensitivity
20What are the AE of pyrazinamide?
malaise
n/v
anorexia
arthralgia
myalgia
21What is the MOA of ethambutol?
impairs cell metabolism by inhibiting the synthesis of metabolites causing cell death
22What is a DDI w/ ethambutol?
BCG live vaccine
23What are the AE of ethambutol?
optic neuritis
gout/hyperuricemia
LFT abnormalitis
24What should be done monthly with ethambutol?
eye exams
25What is the clinical use for dapsone?
leprosy
26What is the MOA of dapsone?
inhibits bacterial synthesis of dihydrofolic acid via competition of PABA reduced nucleic acid
27What are the AE of dapsone?
methemoglobinemia
agranulocytosis
GI upset
peripheral neuropathy
28What are the CI of dapsone?
G6PD deficiency which must be checked prior to starting
29What is a DDI with dapsone?
trimethoprim
30What is clofazime and what is it used for
antimycobacterial agent used to treat leprosy
31What are the AE of clofazime?
skin discoloration
abdominal pain
diarrhea
32What are the polyenes?
amphotericin B
nystatin
33What is the method of action for polyenes (amphotericin B/nystatin)?
bind to ergosterol in the fungal cell membrane which forms pores that disrupts electrolyte balance
34What are the indications for amphotericin B?
severe systemic mycoses
bladder wash for fungal cystitis
intrathecally for fungal meningitis
35What are the indications for nystatin?
vaginal candidiasis
diaper rash
oropharyngeal candidias
36What are the DDI for polyenes?
aminoglycosides
37What are the AE of polyenes?
nephrotoxicity
IV phlebitis
hypokalemia
hypomagnesium
38What are the CI for polyenes?
renal or hepatic dysfuction
39What are the imidazole derivatives of azole?
clotrimazole
miconazole
ketoconazole
40What are the triazole deratives of the azole class?
fluconazole
itraconazole
voriconazole
41What is the MOA for the azoles?
inhibit fungal cytochrome p450 which decreases fungal synthesis of ergosterol leading to cell death
42What is a drug in the rifamycin class that is po but not absorbed from the GI tract?
rifaximin
43What are the indications for clotrimazole?
tinea infections
oropharyngeal candidiasis
vaginal candidiasis
44What are the indications for miconazole?
superficial fungal infections
oropharyngeal candidiasis
45What are the indications for ketoconazole?
psoriasis
hypercortisolism
fungal/tinea infections
46What is a box warning for ketoconazole?
hepatoxicity
47What are the DDI for ketoconazole?
CYP3A4
48What are the indications for fluconazole?
cryptococcal meningitis
candidiasis
coccidiodomycosis
histoplasmosis
blastomycosis
49Does fluconazole have a broad or narrow spectrum of efficacy?
broad
50What are the DDIs with fluconazole?
CYP450 inhibitors
QTc prolongating drugs
51WHat are the AE of fluconazole?
increased LFTs
QTc prolongation
52What are the indications for voriconazole?
candidiasis
invasive aspergillosis
53What are the CI/DDI with voriconazole?
CYP3A4 substrates
hepatic or renal dysfunction
54What are the AE of variconazole?
increased LFTs
55What are the indications for itraconazole?
dermatophytosis (onychomycosis)
56What is a DDI with itraconazole?
CYP450 inhibitors
57What are the AE of itraconazole?
increased LFTs and QTc prolongation
58What are the CI of itraconazole?
pregnancy
breastfeeding
patients with ventricular dysfunction or history of heart failure
59What is the box warning with voriconazole?
negative ionotropic effects with IV administration (must d/c with signs of HF)
QTc prolongation
vtach
torsade de pointes
cardic arrest
60What drug falls under the allylamine derative class?
terbinafine
61What are the indications for terbinafine?
dermatophytosis
tinea infections
62What are the CI of terbinafine?
impaired liver function
SLE
63What are the AE of terbinafine?
headache
hepatotoxicity
dysgeusia
GI upset
64What are the drugs in the echinocandins class
caspofungin (IV)
micafugin (IV)
anidulafungin (IV)
65What are the indications for echinocandins?
invasive aspergillosis
invasive candidiasis
66Are echinocandins broad or narrow spectrum efficacy?
broad
67What are the AE of anidulafungin?
increased alk phos
68What are the AE of micafungin?
thrombocytopenia
phlebitis
69What is a pyridine derivative?
ciclopirox
70What are the indications for ciclopirox?
tinea versicolor
dermatophytosis
seb derm
71Which drug falls under the benzofuran class?
griseofulvin
72What are the indicications for benzofurans (griseofulvin)?
oral treatment for tinea infections
73What are the CI for griseofulvin?
porphyria
hepatic failure
pregancy
breastfeeding
74What are the AE of griseofulvin?
disulfiram-like reaction
hepatotoxicity
75What are the antimetabolites?
flucytosine
76What are the indications for flucytosine?
monotherapy: GU candidiasis infections not covered by alternative drugs
in combination with amphotericin B for systemic fungal infections
77What are the box warnings for antimetabolites (flucytosine)?
caution in patients with renal impairment
78What are the protozoal infections
amebiasis
giardiasis
trichomonas
toxoplasmosis
cryptosporidiosis
trypanosomiasis
leisumaniasis
79What is the treatment for amebiasis?
metronidazole or tinidazole (not effective against cysts)
80What are the treatment for cysts/abscesses caused by amebiasis?
paromomycin
nitazoxanide
81how is amebiasis transmited?
fecal-oral route
82What is an AE associated with pyrimethamine?
stevens-johnson syndrome
83How is giardiasis spread?
fecally contaminated water or food
84What is the treatment for trichomonas?
metronidazole
tinedazole
85How is trichomonas transmitted?
sexually
86What is the treatment for toxoplasmosis?
self limited unless the patient is immunocompromised or pregnant
87How is cryptosporidiosis spread?
contaminated water supplies
88What is the treatment for cryptosporidiosis?
syptomatic care (oral rehydration or antimotility agents)
antiparasitic therapy
89How is trypanosomiasis transmitted?
bloodsucking tsetse flies
90How is leishmaniasis transmitted?
sandflies
91What is the MOA of metronidazole and tinidazole?
creates free radicals which causes DNA strands to break leading to cell death
92What are the therapeutic uses for metronidazole?
amebiasis
giardia
trichomonas
anaerobic infections
C. diff
gardnerella vaginalis
93What are the DDI with metronidazole?
alcohol
vitamin K antagonists
94What are the AE of metronidazole?
disulfiram like reactions
95What are the s/s of disulfiram-like reaction?
flushing
tachycardia
hyperventilation
n/v
96What are the indications for tinidazole?
amebiasis
trichomoniasis
97What are the CI for tinidazole?
pregnancy
breast feeding
carcinogenic in animals
98What are the DDI of tinidazole?
alcohol
VKA
99What is the MOA or nitazoxanide?
inhibits growth of sporozoites and oocysts of cryptosporidium and trophozoites of giardia which interferes with pyruvate
100What are the therapeutic uses for nitaazoxanide?
cryptosporidum parvum
giardia lamblia
101What are the AE of nitazoxanide?
n/v/d
abdominal cramps
heartburn
102What are the treatments helminth infections?
albendazole
mebendazole
ivermectin
praziquantes
103What drugs fall into the benzimidazole class?
albendazole
mebendazole
104What is the MOA of albendazole and mebendazole?
inhibit microtubule polymerization which results in
blockage of glucose uptake which inhibits the formation of helminth microtubules in suscpetible adult intestine-dwelling heminths
causes degeneration of cytoplasmic microtubule in intestinal and tegmental cells of intestinal helminths
105What are the therapeutic uses for albendazole and mebendazole?
roundworm
tapeworm
hook warm
pinworm
fluke
whip worm
thrichinosis
106What are the AE of benzimidazole?
headache
abnormal LFT
107What is the MOA of ivermectin?
binds glutamate-gated CI ion channels in ivertebrate nerve and muscles cells leading to paralysis causing parasite death
108What are the therapeutic uses for ivermectin?
onchocerciasis
stronglyoidiasis
hook worms
109What is the MOA of praziquantes?
increase cell membrane permeability to calcium
110What are the therapeutic uses of praziquantes?
schistosomiasis
111What is malaria cause by?
parasite plasmodium
112What are the treatment options for malaria?
hyoxy/chloroquine phosphate
primaquine
113What are the therapeutic uses for hyoxy/chloroquine phosphate?
amebiasis
malaria
prophylaxis
114What are the CI of hydroxy/chloroquine phosphate?
retinal or visual changes
psorasis
porphyria
115What are the DDIs with avalen?
QTc prolongating agents
116What are the AE of avalen?
retinopathy
117What is the MOA of primaquine?
disrupts plasmodium mitochondria
118What are the therapeutic uses for primaquine?
malaria treatment
prophylaxis
119What are the CI for primaquine?
G6PD deficiency
lefamulin
120What are the DDIs with primaquine?
BB
121What is the box warning associated with mefloquine?
neuospychiatric reactions
122What is the MOA of pyrimethamine?
folic acid antagonist
123What is an AE associated with pyrimethamine?
stevens-johnson syndrome
124What drugs can be used to coccioidomycosis?
amphotericin B or fluconazole
125What is used to treat oral candidiasis?
nystatin swish and swallow
126what are the treatment options for esophageal candidiasis?
fluconazole
amphotericin B
caspofungin
127what is the treatment for cryptococcal meningitis?
amphotericin B followed by flucytosine/fluconazole then fluconazole for life
128What is the treatment for histoplasmosis?
liposomal amphotericin B x 2 weeks then itraconazole for 1 year
129What is the treatment for toxoplasmic encephalitis?
pyrimethamine plus sulfadiazine and leucovorin or TMP/SMZ
130What is the treatment for isosporiasis?
bactrim
131What is the treatment for mycobacterium avium complex?
clarithromycin plus ethambutol
add rifabutin if patient has advance disease
132What is the treatment for salmonella enterocolitis or bacterimia?
ciprofloxacin
133What are the treatment options for campyobacter enterocolitis?
cipro
azithromycin
134What is the treatment for shigella enterocolitis?
cipro
135What is the treatment for pneumocystiti jirovecii pneumonia?
bactrim
sometimes glucocorticoids
136What are the treatment options for mucocutaneous herpes simplex?
acyclovir
famciclovir
valacyclovir
137What is the primary treatment for varicella zoster?
acyclovir
138What are the treatment options for cytomegalovirus?
ganciclovir
foscarnet
cidofovir
139What is the treatment for cytomegalovirus esophagitis or colitis?
ganciclovir
140What is the first line treatment for C. diff?
oral fidaxomicin
141What is teh first line treatment options for an overall healthy patient with no comorbities?
amoxicillin
doxy
142What are the treatment options for a patient with comorbidities or risk factors for resistant pathogens with CAP?
amoxicillin-clavulanate/cefuroxime/cefpodoxime
plus azithromycin/clarithromycin/doxy
OR a monotherapy with a respiratory floroquinolone
143What are the treatment options for a patient with HAP that does not have a high risk for mortality and no risk factors for MRSA?
cefepime
zosyn
levofloxacin
144What are the treatment options for patient with a high risk of a MRSA infection with HAP?
combo therapy with linezolid or vancolycin plus zosyn, cefepime, levo/cipro or aztreonam
145HAP patients with a high risk for mortality or patients with structural lung disease are treated with?
vancomycin/linezolid plus zosyn/cefepime/or a floroquinolone
146What is the treatment for VAP?
aztreonam/imipenem/cefepime/zosyn plus vanc/linezolid plus fluoroquinolone/aminglycoside/polymyxin
147What is used to treat aspiration pneumonia?
unasyn
carbapenem
clinadmycin
148What is the treatment for scabies?
permethrin 5% lotion
149What is the MOA of permethrin?
inhibition of voltage-gated sodium channels which causes delay repolarization of neuron leading to paralysis and death of the mite
150What is the alternative treatment for scabies and its MOA?
lindane 1% lotion
blocks gaba channels which causes neurotoxicity in the mite
151What is the first line treatment for lyme disease?
doxycyline
152What is the first line treatment for lyme disease in a pregnant or nursing patient?
amoxicillin
153What are the three essential nutrients for hematopoietic machinary?
iron
vitamin B12
folic acid
154What is a deficiency in oxygen carrying erythrocytes?
anemia
155What is a deficiency of platelets int he blood?
thrombocytopenia
156What is the presence of abnormally few neutrophils in the blood leading to increased suseptibility to infection?
neutropenia
157What are the symptoms of severe anemia?
fainting
chest pain
angina
heart attack
158Which iron product is used to treat anemia of CKD who are being treated with erythropoietin?
ferrous sulfate
159Which iron product is used to treat microcytic hypochromic anemia? Used when oral administration is infeasible or ineffective?
iron dextran complex
160What is important to remember with iron dextran complex?
need test dose and must monitor for anaphylaxis
161Which iron product is used to treat iron deficiency anemia in patients with dialysis and non dialysis dependent CKD?
iron sucrose
162Which iron product has a lower incidence of anaphlyaxis in comparison with other parenteral iron products?
iron sucrose
163Oral iron therapy is indicated in
all patients with iron deficiency anemia
164What are the oral iron therapy options?
ferrous sulfate
ferrous fumarate
ferrous gluconate
165What are the AE of iron oral therapy?
nausea
constipation
black discoloration of stool
166How long should you continue therapy after the anemia has resolved with oral therapy?
3 months in order to build iron stores
167What are the indication for parenteral iron therapy?
malabsorption
nonadherance, contraindications or intolerance to oral iron therapy
168What are the parenteral iron therapy options?
iron dextran
iron sucrose
ferric gluconate complex
ferumoxytol
169What are the AE of parenteral iron therapy?
thrombophlebitis
myalgia
arthralgia
headaches
anaphylaxis
170DDI with ferrous salts?
antacids or calcium
cefdinir
floroquinolones
tetracyclines
levothyroxine
171AE of ferrous salts?
constipation
GI discomfort
dark stools
172What is used to treat acute iron toxicity?
deferoxamine
activated charcoal
173What is used to treat megaloblastic macrocytic anemia?
vitamin B12
174What drugs are used to treat vitamin B12 deficiency?
cyanocobalamin
hydroxocobalamin
175What can happen with long term use of vitamin B12?
neurologic syndrome
176What are some foods high in B12?
meat
fish
shellfish
poultry
eggs
milk
177Folic acid deficiency causes what kind of anemia?
megaloblastic macrocytic
178Who is at risk for folic acid deficiency?
alcohol dependent
liver disease
patients on MTX, TMP, pyrimethamine and phenytoin
malabsorption
patients on hemodialysis
179Who has high requirements for folic acid?
pregnant women
people with hemolytic anemia
180What is the dietary reference intake?
400 mcg/day
181What is the dietary reference for pregnant women?
600 mcg/d
182What is the dietary reference for breastfeeding women?
500 mcg/d
183What is the dosing for folic acid?
1 mg po qd
184What are the AE associated with folic acid?
none
185What are the hematopoetic growth factors?
erythropoietin
granulocyte colony stimylating factor
granulocyte- macrophage colony stimulating factor
186What are the severe box warnings associated with epoetin alfa and darbepoetin?
CKD patients at greater risk for death, serious adverse CV reactions and stroke
shortened overall survival rate or increased risk of tumor progression in cancer patients
perisurgery causing increased risk of DVT
187Whats the MOA of G-CSF meds?
stimulate G-CSF receptors expressed on mature neutrophils and their progenitors
188What is G-CSF used for?
neutropenia
189What are the AE of G-CSF meds?
bone pain
splenic rupture
190What are the classifications of chemotherapeutic agents?
alkylating agents
antimetabolites
topoisomerase inhibitors
antibiotics
mitotic inhibitors
protein kinase inhibitors
191What is the MOA of anthracyclines?
block DNA and RNA synthesis through direct steroic inhibition as well as by inhibiting topoisomerase II
also cause production of oxygen free radicals
192What are the SE of anthracyclines?
cardiac toxicity
193How can you prevent cardiac toxicity with anthracyclines?
dependent on dose and can be avoided by keeping doses below a certain lifetime dose
can adminster dexrazoxane to decrease free radical formation
194What is an antitumor antibody MOA?
inhibit DNA dependent RNA polymerase imparing DNA and RNA synthesis
195What are the AE of antitmor antibodies?
bone marrow suppression
196What is the MOA of of antitumor antibiotics?
binds to DNA and triggers the formation of oxygen free radicals
197What are the AE of antitumor antibiotics?
pulmonary fibrosis
198What is the MOA of alkylating agents?
damage DNA via the cross-linking of DNA strands
199What are the AE of busulfan (alkylating agent)?
pulmonary fibrosis
bone marrow supression
200What are the AE of cyclophosphamide (alkylating agent)?
hemorrhagic cystitis
bone marrow supression
201What are the AE of the akylating agents that are platinum analogues?
nephrotoxicity
ototoxicity
202What is often given with MTX (antifolate) in order to minimize bone marrow suppresion?
leucovorin
203What are the AE of MTX?
myelosupression
mucositis
hepatoxicity
204What are the AE of oxazaphosphorines?
bladder toxicity: hemorrhagic cystitis, bladder carcinoma
205What are the comon AE of chemotherapy?
GI
n/v
alopecia
stomatitis
blood/myelosuppresion
sex
CNS
cardiovascular
respiratory
urologic
206What agents cause GI issues?
alkylating agents
antifolates
pyrimidine antagonists
antibiotics
anthracyclines
207What chemotherapeutic agent causes severe n/v?
cisplatin
208What is the most effective treatment for chemo induced n/v?
ondansetron (5HT3 receptro antagonists)
209Which drug/antiemetic class is saved for severe n/v?
aprepitant (neurokinin receptor antagonists)
210What are the CI for dopamine receptor antagonists?
intestinal obstruction
prolactin dependent tumors
parkinson disease
211What are the CI for seratonin receptor antagonists?
severe liver dz
prolonged QT interval
212What are the CI for anticholinergic agents and antihistamines?
tachyarrhythmias
HF
urinary retention
BPH
glaucoma
pyloric stenosis
213Which is a glucocorticoid used for most n/v?
dexamethasone
214What are the AE of dexamethasone?
cushing syndrome
hyperglycemia
215Which agents cause the most significant hair loss?
cyclophosphamide (alkylating agent)
dactinomycin (antitumor antibody)
216All chemotherapy drugs can cause
stomatitis
217If a patient on chemotherapy presents with a neutrophil count of less than 10^9/L with fever what should you treaten them with?
granulocyte colony stimulating factor or granculocytes-macrophage colony stimulating factor
218Which chemo agents can cause damage to sexual organs?
alkylating agents
219What chemo agents can induce peripheral neuropathy?
platinum based medications
220Which chemo agents cause issues with the respiratory system?
bleomycin (antitumor antibiotic)
busulfan (alkylating agent)
221What are the major anticoagulants?
heparin
enoxaprin
fondaparinux
rivaroxban
apixaban
dabigatran
warfarin
222Which drugs work directly on Factor Xa?
rivaroxaban
apixaban
edoxaban
223Which drug amplifies antithrombin III which inhibits factor Xa?
fondaparinux
224Which drugs amplifies antihrombin III which blocks thrombin (factor IIa)?
unfractioned heparin
225Which drugs work directly on thrombin?
dabigatran
226What is the MOA of unfractionated heparin?
inactivates factor IX,X, XI and XII and thrombin
inhibits conversion of fibrinogen to fibrin
227What is low dose unfractionated heparin used for?
DVT prophylaxis
peri and post op
immobility
228What is high dose unfractionated heparin used for?
A fib
DVT, acute arteria thrombosis, PE
ACS/myocardial infarct
mechanical heart valve replacement
VTE prophylaxis for patients on hemodialysis or heart lung machine
229What is the antidote for unfractionate heparin and LMWH?
protamine sulfate
230What is the box warning for unfractionated heparin?
epidural or spinal hematomas
231What is a major AE of unfractionated heparin? How is it monitored?
thrombocytopenia
baseline platelets established and platelets continuously monitored
232What is a low molecular weight heparin?
enoxaparin
233What is the MOA of enoxaparin?
amplifies antithrombin III which inhibits factor Xa which increases inhibition rate of clotting proteases
234How does LMHW compare to unfractionated heparin?
higher bioavailability and longer half life
235What is enoxaparin used for?
prophylaxis/treatment for DVT
prolonged immobility
ACS
236Does LMWH need to be renally adjusted?
yes
237What is the MOA of direct thrombin inhibitors?
directly inhibit thrombin
238Which drug is a sythetic heparin?
fondaparinux
239What are the uses of fondaparinux?
afib
venous thromboembolism
HIT
240What are the therapeutic uses for direct thrombin inhibitors?
PCI
NSTEMI
HIT
241A CHAD2VAS2C score over what would indicate treatment with OAC?
2 or greater
242What is the MOA of warfarin?
decrease hepatic synthesis of vitamin K dependent clotting factors
243Where in the clotting cascade does warfarin work?
factors II, VII, IX, X, protein C and protein S
244What is warfarin indicated for?
afib
VTE
cardiac valve replacement
lupus anticoag
245What can you administer for rapid reversal of warfarin effect?
FPP
PCC
246What is an AE of warfarin?
skin necrosis
247How do you manage warfarin induced skin necrosis?
d/c warfarin
administer IV vitamin K, unfractionated heparin and PCC or FFP
248What are some cautions with warfarin?
hemorrhage
tissue necrosis
HIT
hepatic impairment
249What are the major drugs that interact with warfarin?
azoles
amiodarone
bactrim
fluoroquinolones
alcohol
macrolides
250What are the indications for apixaban AND dabigatran?
stroke prevention
prevention of VTE after joint replacement
tx and prevention of DVT/PE
251Apixaban dose must be adjusted if 2 out of the 3 are met:
SCr > 1.5
80 or older
weight is 60 or less
252What is the MOA of apixaban?
inhibit factor Xa which reduces thrombin generation and subsequent thrombus formation
253What is the box warning associated with all anticoagulants?
spinal or epidural hematoma
254What is the reversal agent for apixaban and rivaroxaban?
andexanet alfa
PCC-4
255What is the MOA for dabigatran?
direct inhibitor of thrombin
256What are the AE of dabigatran?
gastritis
257Idarucizumab is the reversal agent for?
dapigatran
258Rivaroxaban has similar indications as dabigatran and apixaban but what are its additional indications?
prevention of VTE in hospitalized medically ill
prevention of major CV events in patients with CAD/PAD
259What is the MOA of rivaroxaban?
inhibits factor Xa which reduces thrombin generation and subsequent thrombus formation
260What are the major classes of hormonal therapy?
estrogens
selective estrogen receptor modulators
progestins
androgens
261Which hormone is synthesized and secreted by the anterior pituitary gland and triggers ovulation? In men it stimulates testicular leydig cells to synthesize testosterone
luteinizing hormones
262Which hormone is synthesized and secreted by the anterior pituitary gland and stimulates the maturation of germ cells in both men and women?
follicle stimulating hormones
263Which hormone is synthesized and released from gonadotropic neurons in the hypothalamus. Pulsating secretion stimulates the release of LH and FSH
human chorionic gonadotropin
264Where does estrogen work?
hypothalamus to supress the release of GnRH
pituitary gland to supress the release of gonadotropins
265What are the three different types of estrogens?
estrone
estradiol
estriol
266What drugs are estrogens?
estradiol
ethinyl estradiol
estrone sulfate
267What is the MOA of estrogens?
act via alpha estogen receptor and beta estrogen receptor
decrease release of GnRH
decrease LH and FSH
268What are some CI for estrogen?
unusual vaginal bleeding
breast cancer
uterine cancer
blood clots in legs or lungs
bleeding disorder
stroke/heart attack
liver problems
pregnancy
hypertiglyceridemia
insulin dependent DM
lupus
acute pancreatitis
vasculitis
after herpes gestationis
269What are the box warnings for estrogen?
endometiral cancer
CVD
breast cancer
dementia
smoking
270What drugs are selective estrogen receptor modulator?
tamoxifen
raloxifene
271What are the indications for tamoxifen?
premenopausal estrogen resptor positive breast cancer
vaginal atrophy
prostate cancer
prevention of gynecomastia
272What is the MOA of tamoxifen?
competative antagonists on the estrogen receptors of the breast to decrease breast cancer cell growth
273Tamoxiflen is also an agonists for estrogen receptors on which tissues?
bone tissue- inhibits osteoclasts
endometrium and myometrium- increases proliferation
274What are the AE of tamoxifen?
hot flashes
vaginal discharge
amenorrhea
menstrual changes
275What is the box warning associated with tamoxifen?
stroke
PE
high risk for cancer and women with DCIS
276What are the CI for tamoxifen?
preganancy
undiagnosed vaginal bleeding
277What are the uses for raloxifene?
prphylaxis of breast cancer in high risk patients
osteoporosis
278what is the MOA of raloxifene?
competative antagonist on estrogen receptors in the following tissues:
breast- decrease breast cancer cell growth
endometrium and myometrium- decrease proliferation
279Raloxifene is on agonist on the estrogen receptor in which tissue type?
bone tissue- inhibits osteoclasts
280What are the AE of raloxifene?
hot flashes
flu syndrome
crams/muscle spasms
arthralgia
infections
281What are the box warnings associated with raloxifene?
increased risk of DVT/PE
stroke
282What are the CI of raloxifene?
pregnancy/lactation
active history of thromboembolic events
283What class is clomephene?
antiestrogens
284What is the MOA of clomiphene?
blocks hypothalamic estrogen receptors inhibiting negative feedback and increasing release of FSH and LH to trigger ovulation
285What are the AE associated with clomiphene?
ovarian hyperstimulation
increased incidence of multiple births
ovarian cysts
hot flashed
blurred vision
286What are the steroidal aromatase inhibitors?
exemestane
287What are the nonsteroidal aromatase inhibitors?
anastrozole
letrozole
288What is the MOA of aromatase inhibitors?
inhibits aromatase which decreases conversion of androstenedione to estrone, decreased conversion of testosterone to estradial leading to decreased tumor growth
289What are the uses for aromatase inhibitors?
post menopausal estrogen receptor positive breast cancer
290What specifically is letrozole used for?
ovulation induction
291What are the AE of aromatase inhibitors?
hot flashes
vaginal dryness
myalgia or arthralgia
292What are the CI of aromatase inhibitors?
women who are or may become pregnant
premonpausal women
293What is a warning for aromatase inhibitors?
risk of osteoporosis with long term use
294What must be taken with progestins in order to lower the chance of getting endometrial cancer in women who still have a uterus?
estrogens
295What is the MOA of progestins?
inhibits GnRH and LH secretion- no ovulation
inhibits endometrial proliferation- prevents implantation of the embryo
changes cervical mucous and impairs fallopian tube peristalsis
inhibits follicular maturation
296Which drugs are int he pregnanes class?
medroxyprogesterone acetate
megestrol acetate
297What are the uses for pregnanes?
monopause hormone therapy
contraception
assisted reproductive technology
depot MPA
298What are the box warnings associated with pregnanes?
bone mineral density loss (inj only)
CV risk
breast cancer
dementia risk