Week 7: Estrogens and Androgens, Adrenal Hormones, Drugs for Urologic Disorders

All of the following are clinical uses of Glucocorticoids EXCEPT:

a. Replacement therapy for Primary Adrenal Cortex Insufficiency (Addison's Disease)

b. Diagnosis of Cushing's Syndrome (a hypersecretion of glucocorticoids)

c. Relief of Inflammatory Symptoms (redness, swelling, heat, tenderness)

d. Treatment of Allergies - Bronchial Asthma - allergic rhinitis, drug/serum allergic reactions

e. all of the above ARE therapeutic uses for Adrenal Glucocorticoids

e. all of the above ARE therapeutic uses for Adrenal Glucocorticoids

1) Phosphodiesterase-5 (PDE5) is also distributed in the vascular arterial smooth muscle of the lungs.

2) Inhibition of PDE-5 has proven to be beneficial in treating Pulmonary Arterial Hypertension (PAH), decreasing pulmonary arterial resistance, decreasing the workload of the right ventricle and improving the symptoms of Right Sided Heart Failure.

a. both statements are true

b. first statement is false, and the second statement is true

c. first statement is true, and the second statement is false

d. both statements are false

a. both statements are true

This Mineralocorticoid drug is indicated for: binds to mineralocorticoid receptor and inhibits aldosterone function. Used as an adjunct in the management of chronic heart failure.

a. Fludrocortisone (Florinef)

b. Spironolactone (Aldactone)

c. Eplerenone (Inspira)

c. Eplerenone (Inspira)

This Mineralocorticoid drug is indicated for: MIneralocorticoid Replacement drug used primarily to replace the missing hormone aldosterone in various forms of adrenal insufficiency such as Addison's disease

a. Fludrocortisone (Florinef)

b. Spironolactone (Aldactone)

c. Eplerenone (Inspira)

a. Fludrocortisone (Florinef)

This Mineralocorticoid drug is indicated for: Potassium Sparring Diuretic: competes with aldosterone for mineralocorticoid receptors, and inhibits sodium reabsorption in the kidney and Potassium Secretion

a. Fludrocortisone (Florinef)

b. Spironolactone (Aldactone)

c. Eplerenone (Inspira)

b. Spironolactone (Aldactone)

True or False: Inhibiting the growth of the prostate and decreasing the risk to prostate cancer is a benefit of androgen therapy.

false

The 5-Alpha Reductase Inhibitors, Finasteride (Proscar) and Dutasteride (Avodart), treat BPH by inhibiting the conversion of ___________ to _____________, which causes the prostate to shrink and allow for an increased urine flow.

a. testosterone, dihydrotestosterone (DHT)

b. duhydrotestosterone (DHT), testosterone

a. testosterone, dihydrotestosterone (DHT)

True or False: The primary indications for estrogen therapy in post-menopausal women, are: VASOMOTOR INSTABILITY (hot flashes) and VAGINAL ATROPHY.

true

Which SERM drug that affects estrogen receptors has all of the following characteristics?

1. It is a pure anti-estrogen drug throughout the body. 

2. it has no estrogen agonist effects AT ALL. 

3. It is not a straight "SERM" drug as it does not modulate receptors and just antagonizes estrogen receptors throughout the body

4. indicated for the treatment of advanced metastatic breast cancers that have stopped responding to SERM & Aromatase Inhibitor treatment options. 

5. is a reversible inhibitor of the growth of tamoxifen- resistant, as well as estrogen sensitive breast cancers

6. It binds competitively to estrogen receptors with an affinity approximately 100 times greater than that of tamoxifen.

7. After initial loading dose injections, the eventual dose is 500mg injected IM once monthly.

a. Tamoxifen (Nolvadex)

b. Raloxfene (Evista)

c. Ospemifene (Osphena)

d. Fulvestrant Injection (Faslodex)

d. Fulvestrant Injection (Faslodex)

True or False: Estrogen Replacement Therapy (ERT) has been, and continues to be, very widely used for the prevention of post-menopausal osteoporosis.

false

#1. Progesterone only birth control contraception is not associated with the increased risks of DVT or heart disease that combination birth control pills containing both progesterone and estrogen are associated with.

#2. Progesterone, via negative feedback, suppresses the release of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), which are necessary for the LH surge and ovulation

a. both statements are true

b. first statement is true, second statement is false

c. first statement is false, second statement is true

d. both statements are true

a. both statements are true

This estrogen subcategory is the primary estrogen after menopause. Produced after the ovaries stop producing large amounts of estrogen. Primarily produced by the adrenal glands and fatty tissue.

a. estrone

b. estriol

c. estradiol

a. estrone

This estrogen subcategory is the main type of estrogen during pregnancy. Helps prepare the breasts for lactation. Primarily produced by the placenta.

a. estrone

b. estriol

c. estradiol

b. estriol

This estrogen subcategory is the most significant estrogen in reproductive-age women. Essential for the development of secondary sex characteristics and regulating the menstrual cycle. Primarily produced by the ovaries

a. estrone

b. estriol

c. estradiol

c. estradiol

Inhibition of Phosphodiesterase-5 (PDE-5) in the vascular smooth muscle of the corpus cavernosum leads to __________ in the second messenger, Guanasine Monophosphate (cGMP), which produces vascular smooth muscle _____________.

a. an increase, vasodilation

b. a decrease, vasodilation

c. an increase, vasoconstriction

d. a decrease, vasoconstriction

a. an increase, vasodilation

True or False: Osteoporosis is a commonly observed adverse effect associated with long-term corticosteroid therapy due to suppression of intestinal calcium absorption.

true

True or False: Cortisol levels are highest in the morning, promoting gluconeogenesis, to help you wake up and get ready for the day, and slowly decrease throughout the day.

true

True or False: The primary way ethinyl estradiol prevents pregnancy is by suppressing the hypothalamic-pituitary system, which in turn inhibits the release of gonadotropins (LH, and FSH). The absence of the mid-cycle LH surge prevents ovulation from occurring.

true

All of the following are therapeutic uses of progesterone/progestins EXCEPT:

a. contraception

b. treatment of dysmenorrhea

c. management and treatment of endometriosis and infertility

d. control of dysfunctional uterine bleeding

e. all of the above are therapeutic uses

e. all of the above are therapeutic uses

Regarding the pathophysiology of the mechanism of action for Veozah, which statement is false?

a. It is a nonhormonal prescription med used to reduce moderate to severe vasomotor symptoms (hot flashes and night sweats) from menopause.

b. Neurokinin B is a tachykinin neuropeptide in the hypothalamus that initiates puberty, regulates the menstrual cycle, & triggers menopause-related vasomotor symptoms.

c. During menopause, the lack of Estradiol (E2) results in increased expression of Neurokinin B leading to overstimulation of NKB neurons in the thermoregulatory center in the hypothalamus, which causes hotflashes.

d. The neurokinin 3 receptor is primarily located in the brain, with a wide distribution including the frontal cortex, amygdala, hippocampus, and hypothalamus

e. works by stimulating the activity of neurokinin B in the brain's temp-control center (hypothalamus), to restore normal body temperature regulation 

e. works by stimulating the activity of neurokinin B in the brain's temp-control center (hypothalamus), to restore normal body temperature regulation

All of the following are estrogen derivatives EXCEPT:

a. esterified estrogens (menest)

b. estradiol (estrace)

c. norethindrone (ortho-micronor)

d. premarin (conjugated estrogens)

e. raloxifene (evista)

f. both c and e

f. both c and e

All of the following are approved therapeutic uses of androgens EXCEPT:

a. Primary Hypogonadism (failure at the gonadal level)

b. Secondary hypogonadism (failure of the hypothalamus and/or anterior pituitary)

c. increase libido, treat sexual dysfunction in men and the symptoms of menopausal hot flashes in women

d. in individuals with human immunodeficiency virus infection or other chronic disease, testosterone can be used to treat chronic wasting

e. increase lean body mass, muscle strength, and endurance in athletes

e. increase lean body mass, muscle strength, and endurance in athletes

Which SERM drug that affects estrogen receptors has all of the following characteristics?

1. is an estrogen agonist/antagonist with tissue selective effects on the endometrium.

2. used to treat women with moderate to severe dyspareunia (painful intercourse) and moderate to severe vaginal dryness (a symptom of vulvar and vaginal atrophy) caused by menopause.

a. tamoxifen (nolvadex)

b. raloxifene (evista)

c. ospemifene (osphena)

d. fulvestrant injection (faslodex)

c. ospemifene (osphena)

All of the following are classified as glucocorticoid drugs EXCEPT

a. Hydrocortisone

b. Methylprednisolone (Medrol)

c. Fludrocortisone (Florinef)

d. Dexamethasone (Decadron)

c. Fludrocortisone (Florinef)

True or False: Aromatase is responsible for a key step in the biosynthesis of estrogens, pre-menopause, involved primarily with producing estrogen in the ovaries

true

All of the following are examples of progestins, utilized in contraception except:

a. Norethindrone

b. Norgestrel

c. Drospirenone

d. Medroxyprogesterone

e. ethinyl estradiol

f. Levonorgestrel

e. ethinyl estradiol

What androgen drug or anti-andogenic drug is a 5 alpha-Reductase Inhibitor indicated for Benign Prostatic Hyperplasia (BPH) & Male Pattern Baldness (MPB)?

a. androgel

b. Finasteride (proscar)

c. dutasteride (avodart)

d. bicalutamide (casodex)

b. Finasteride (proscar)

What androgen drug or anti-androgenic drug is a A PURE ANDROGEN RECEPTOR ANTAGONIST used in the prevention of prostate cancer

a. androgel

b. Finasteride (proscar)

c. dutasteride (avodart)

d. bicalutamide (casodex)

d. bicalutamide (casodex)

What androgen drug or anti-androgenic drug is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone

a. androgel

b. Finasteride (proscar)

c. dutasteride (avodart)

d. bicalutamide (casodex)

a. androgel

What androgen drug or anti-androgenic drug is a 5 alpha-Reductase Inhibitor indicated for Benign Prostatic Hyperplasia (BPH), but NOT Male Pattern Baldness (MPB)

a. androgel

b. Finasteride (proscar)

c. dutasteride (avodart)

d. bicalutamide (casodex)

c. dutasteride (avodart)

True or False: Acute Adrenal Insufficiency Syndrome (GI disturbances, fatigue, low BP, possible joint pain, headaches, fever) can occur with the ABRUPT discontinuation of corticosteroid therapy.

true

Phosphodiesterase-5 (PDE5) is a degratative enzyme found most prominently in the vascular smooth muscle in the___________________.

a. bladder

b. lungs

c. prostate gland

d. corpus cavernosum erectile tissue

e. All of the above

e. All of the above

All of the following combination birth control pills utilize ethinyl estradiol & norethindrone except:

a. Notrel

b. Yaz

c. Junel

d, Loestrin-Fe

b. Yaz

True or False: Glucocorticoids (cortisol) (hydrocortisone) promotes normal metabolism (gluconeogenesis, protein catabolism, lipolysis)

true

True or False: Glucocoricoids (cortisol) (hydrocortisone) decreases resistance to stress and the bodies ability to combat stress caused by infection, fright, trauma, bleeding...etc.

false

True or False: Glucocorticoids (cortisol) (hydrocortisone) decreases White Blood Cells, and compromises the body's ability to fight infections

true

True or False: Glucocorticoids (cortisol) (hydrocortisone) have Anti-Inflammatory Action - indirect inhibition of Phospholipase A2 - and a decrease in inflammatory Prostaglandin and Leukotriene production.

true

True or False: Glucocorticoids (cortisol) (hydrocortisone) Decreases blood pressure by decreasing the sensitivity of the vasculature to epinephrine and norepinephrine.

false

True or False: Glucocorticoids (cortisol) (hydrocortisone) reduces calcium absorption in the intestine, reduces bone formation, and favors development of osteoporosis.

true

Which SERM drug that affects estrogen receptors has all of the following characteristics?

1. has anti-estrogenic effects on hormone dependent cancer cells (positive effect) 

2. has pro-estrogenic effects  on bone cells (positive effect) 

3. has LITTLE to NO pro-estrogenic effects on the uterine endometrium  (positive effect)

4. indicated for the treatment and prevention of osteoporosis in postmenopausal women

5. Indicated for the reduction in the risk of invasive breast cancer in postmenopausal women with osteoporosis

6. Indicated for the reduction in the risk of invasive breast cancer  in postmenopausal women at high risk of invasive breast cancer.

a. Tamoxifen (Nolvadex) 

b. Raloxifene (Evista) 

c. Ospemifene (Osphena) 

d. Fulvestrant Injection (Faslodex)

b. Raloxifene (Evista)

True or False: Since Phosphodiesterase-5 (PDE5) is also associated with the smooth muscle of the prostate gland, Tadalafill (Cialis) can be, and is indicated for treating:

- the signs and symptoms of BPH alone,

- as well when Erectile Dysfunction (ED) & Benign Prostatic Hyperplasia (BPH) coexist together.

true

All of the following are Progesterone Only Pills "POPS" "Mini Pills" used in contraception birth control except:

a. Norethindrone

b. Drosperinone (Slynd)

c. Nortrel 7/7/7

d. Medroxyprogesterone (Depo-Provera)

c. Nortrel 7/7/7

All of the following are ADVERSE EFFECTS associated with ESTROGEN THERAPY EXCEPT:

a. Risk of thromboembolic events, myocardial infarction (from the increased clotting factors 2, 7, 9 & 10, increased platelet adhesiveness, decreased AT III)

b. Increased risk of breast cancer ( hormone dependent cancers)

c. Increased risk of endometrial cancer ( endometrial hyperplasia )

d. Nausea and breast tenderness

e. Nausea and breast tenderness

f. Postmenopausal uterine bleeding

g. All of the above are adverse effects associated with Estrogen therapy

g. All of the above are adverse effects associated with Estrogen therapy

In understanding the use of alpha receptor blockers to treat Benign Prostatic Hyperplasia (BPH), it is important to remember that _______________________ receptors are found in the prostate, and ______________________ receptors are found more so in vascular smooth muscle.

a. Alpha-1B, Alpha-1A

b. Alpha-1A, Alpha-1B

b. Alpha-1A, Alpha-1B

True or False: Cushing Syndrome like side effects are associated with long-term corticosteroid therapy.

true

All of the following are structural and physiological effects of estrogen EXCEPT:

a. Stimulate Endometrial / Uterine growth

b. Decrease hepatic synthesis of clotting factors 2,7,9,10,12

c. manage body temperature

d. Promote formation of secondary sex characteristics. 

e. Increase vaginal wall thickness

f. Reduce bone resorption and increase bone formation

b. Decrease hepatic synthesis of clotting factors 2,7,9,10,12

Choose the correct response:

Mifepristone, which _________________________________ is used in a regimen together with Misoprostol, which ______________________________ to end a pregnancy that is less than _________________________days in duration.

a. ---is a progesterone receptor agonist --- causes uterine relaxation ---120 days

b. ---is a progesterone receptor antagonist --- causes uterine contraction ---70 days

c. ---is a progesterone receptor agonist --- causes uterine contraction ---70 days

d. ---is a progesterone receptor antagonist --- causes uterine relaxation ---90 days

b. ---is a progesterone receptor antagonist --- causes uterine contraction ---70 days

Which alpha adrenergic blocker is indicated more for HTN (blocks Alpha-1B receptors more selectively)?

a. Doxazocin (Cardura)

b. Terazocin (Hytrin)

c. Prazocin (Minipress)

d. Tamsulosin (Flomax)

c. Prazocin (Minipress)

Which alpha adrenergic blocker is Indicated more for BPH ( blocks Alpha-1A receptors more selectively)?

a. Doxazocin (Cardura)

b. Terazocin (Hytrin)

c. Prazocin (Minipress)

d. Tamsulosin (Flomax)

d. Tamsulosin (Flomax)

Which alpha adrenergic blockers are Indicated for both HTN & BPH ( blocks both Alpha-1A & Alpha-1B receptors)?

a. Doxazocin (Cardura)

b. Terazocin (Hytrin)

c. Prazocin (Minipress)

d. Tamsulosin (Flomax)

a. Doxazocin (Cardura); b. Terazocin (Hytrin)

Which SERM drug that affects estrogen receptors has all of the following characteristics?

1. has anti-estrogenic effects on hormone dependent cancer cells (positive effect) 

2. has pro-estrogenic effects on bone cells ....preventing bone density loss. (positive effect) 

3. has pro-estrogenic effects on the uterine endometrium. predisposing the patient to uterine hyperplasia and uterine cancer. (negative effect) 

4. indicated primarily for the treatment of metastatic breast cancer or as adjuvant therapy following mastectomy or radiation for breast cancer.

a. Tamoxifen (Nolvadex) 

b. Raloxifene (Evista) 

c. Ospemifene (Osphena) 

d. Fulvestrant Injection (Faslodex)

a. Tamoxifen (Nolvadex)

Phosphodiesterase-5 (PDE5) Inhibitors ___________________ the hypotensive activity of Nitric Oxide (NO), and adminsitration of PDE5 Inhibitors in patients taking any form of organic nitrates (Nitroglycerin) is contraindicated.

a. lessen

b. potentiate

b. potentiate

All of the following are PHOSPHODIESTERASE-5 (PDE-5) INHIBITORS......EXCEPT:

a. Dutasteride (Avodart)

b. Sildenafil (Viagra)

c. Vardenafil (Levitra)

d. Avanafil (Stendra)

e. Tadalafil (Cialis)

a. Dutasteride (Avodart)

True or False: In order for the 5-Alpha Reductase Inhibitors to be effective, the prostate must be enlarged.

false