Endometriosis Pharmacology

  1. What pharmacological options can decrease FSH/LH productions thereby decreasing estrogen production?
    • Oral contraceptives
    • GnRH analogues
    • Progestin
  2. Estradiol stimulates the production of _____
    Prostaglandin (PGE2, PGF2 alpha)
  3. Agents of GnRH agonists for the treatment of endometriosis agonists:
    • Leuprolide acetate (injectable)
    • Nafarelin acetate (intranasal)
    • Goserelin acetate (SubQ implant)
  4. Which GnRH agonist is injectable?
    Leuprolide (aka Lupron)
  5. Which GnRH agonist is intranasal?
    Nafarelin (synarel)
  6. Which GnRH agonist is subQ implant?
    Goserelin (Zoladex)
  7. GnRH agonists would have what effect on LH and FSH compared to GnRH Antagonists?
    Agonists would have “flare” of LH and FSH initially, but then afterwards LH and FSH downregulation and desensitization occurs vs Antagonist would have no LH or FSH production at all
  8. What are the three most common symptoms of GnRH agonists use?
    • Hot flushes
    • Vaginal dryness
    • Insomnia
  9. Medical oophorectomy is produced via use of _____
    Chronic use of GnRH agonists
  10. Drug-induced bone demineralization and osteoporosis is also a concern with use of _____
    GnRH agonists.
  11. What could chronic GnRH agonist use lead to?
    Medical oophorectomy (menopausal symptoms)
  12. What is the primary advantage of GnRH agonists over danazol?
    • better pt compliance
    • Most patients find the side effects of GnRH agonists more tolerable (no androgenic manifestations)
  13. What is the benefit of “Add Back” therapy with GnRH agonist use?
    Add-back medication will reduce or eliminate the vasomotor symptoms and vaginal atrophy and also diminish or overcome the demineralization of bone without affecting the inhibition of growth of endometriosis
  14. T/F: add back therapy should be initiated when patient is first put on GnRH agonist to enhance its effects
    False; add back therapy is recommended in combination with CHRONIC GnRH agonist regiments to eliminate the vasomotor sxs and vaginal atrophy and bone loss
  15. What are the drugs used in add back therapy?
    Progestin (norethindrone) or a combined estrogen/progestin
  16. What is danazol?
    A synthetic androgen that induces amenorrhoeic state with higher incidence of adverse effects as therapy for endometriosisa
  17. What is the MOA of danazol?
    Inhibition of gonadotropin production(FSH/LH production) via feedback inhibition of pituitary-ovarian axis
  18. Which of the endometriosis treatment would have androgenic manifestations as side effects?
  19. What are the side effects of danazol use?
    • Oily skin
    • Weight gain
    • Voice deepening
    • Hair growth
    • Hypoestrogenic features such as emotional lability, hot flashes, vaginal dryness and reversible breast atrophy
  20. When might Danazols side effects disappear?
    With cessation of drug therapy, except for maybe voice deepening might persists
Card Set
Endometriosis Pharmacology
Endo Exam 4