Section #4 Men and Women

- Hormone Replacement Therapy - Menopausal Hormone Therapy - Estrogen-Progestin Therapy - Estrogen Replacement Therapy

Estring releases only __ µg/day of estradiol and it's only for treating vaginal symptoms such as atrophic vaginitis.

7.5

The typical first-year failure rate of DMPA approaches its failure rate with consistent and correct use: __

0.3%

Lo Loestrin Fe and Lo Minastrin Fe (chewable tablets) contain only __ µg of ethinyl estradiol

Methylprednisolone should only be given after __ weeks of gestation, and only to women who do not have symptom relief with other treatments

Most women do not return quickly to full fertility after Depo-Provera. Ranges from 4 to 36 months, with an average of ~__ months.

Adults 19-50 years old—____ mg/day + 600 IU vitamin D to prevent osteoporosis

1000

The 2014 recommendations from The Institute of Medicine (IOM) is a total daily elemental calcium intake of _____ mg for all adults 19-50 years old, including pregnant and lactating women

1000

The 2014 recommendations from The Institute of Medicine (IOM) is a total daily elemental calcium intake of ___ mg for men 51-70 years old, and ___ mg for women >50 years old and men >70 years old.

1000; 1200

Get ___ to ____ mg/day of calcium from food or from supplements taken with food. Calcium helps bind ____ in the gut and decreases the amount that gets into the urine.

1000; 1200; oxalate

Make sure patients count energy "shots" such as 5-Hour Energy or Spike Double Shot. They contain ___ to ___ mg of caffeine per bottle

100; 350

PMS Treatment: __ mg/day Vitamin B6 (____)

100; pyridoxine

Evidence supports the use of vitamin B6 (pyridoxine) __ to __ mg every 8 hours, and doxylamine (Unisom SleepTabs) __ mg at bedtime and ___ mg each in the morning and afternoon for morning sickness

10; 25; 25; 12.5

Menopause is diagnosed after __ months of amenorrhea.

Adults 51 to 70 years old—____ mg/day + 600 IU vitamin D to prevent osteoporosis

1200

Adults >71 years of age—____ mg/day + 800 IU vitamin D to prevent osteoporosis

1200

PMS Treatment: ___mg elemental calcium/day

1200

Plan B is a progestin-only emergency contraceptive that consists of two doses (taken __ hours apart up to 72 hours after unprotected sex) of one ___ mg levonorgestrel oral tablet.

12; .75

Children 9 to 18 years old—___ mg/day + 600 IU vitamin D* to prevent osteoporosis

1300

After the ring is inserted, it releases a continuous low dose of hormones equivalent to ~__ µg of oral ethinyl estradiol

Infertility occurs in ~__% of couples

Adults on corticosteroids—____ mg/day Ca to prevent osteoporosis

1500

Osteoporosis affects as many as __% of women around the age of 50 years and up to __% of women over the age of 80 years. It also affects men, although not to the same extent as women

15; 70

In June 2013, the FDA allowed the OTC sale of levonorgestrel-based emergency contraception Plan B One-Step to all women of child-bearing age, including those under age ___. The OTC status would allow anyone (male or female) to purchase the product

The half-life of tadalafil is distinctly different, at __ hours.

Research on Europe's version of Plan B has found that the pill doesn't work in women who weigh more than ___ pounds and loses effectiveness at ___ pounds

176; 166

There's no harm in trying soy for most women, but advise not going over __ or __ servings a day and avoiding soy supplements in women with _____ receptor-positive breast cancer

1; 2; estrogen

Less than __% of the drugs in the 2015 PDR are specifically listed as safe to use during pregnancy (Category A). Drugs that are ____ absorbed must contain a pregnancy subsection in their label

1; systemically

Creatinine doses over __ gm/day are potentially harmful to the kidneys

PMS Treatment: 100 mg/day Spironolactone for __ week(s) prior to menses

DMPA users may have a __ to __-pound weight gain the first year

2- to 5

The scores reflect the number of standard deviations above (+ scores) or below (- scores) the control database. • The WHO has defined osteoporosis as a T-score at or < -__. Normal results are a T-score at or >-__.

2.5; 1.0

A low-estrogen oral contraceptive (__ µg of ethinyl estradiol) remains an appropriate treatment for peri-menopausal women who seek relief of menopausal symptoms

For menstrual migraines WITHOUT aura, use an extended-cycle OC with __ mcg of estrogen or less, but ONLY for otherwise healthy women under 35 who don't smoke.

Replacement therapy is generally indicated if the level is < ___ ng/dl AND evidence of symptoms such as loss of libido, fatigue, hot flushes, depression, mood swings and decreased ability to concentrate.

200

Pregnant and lactating women—_____ mg/day to prevent osteoporosis

2000

Some patients may require _____ IU of vitamin D daily to reach desirable serum levels

2000

"Low-dose" agents—Alesse, Levlite, Lessina and Loestrin 1/20 contain __ µg of ethinyl estradiol and ___ µg levonorgestrel, a third less than the dose in Levlen or Nordette

20; 100

Do not using ethinyl estradiol doses over __ mcg, or d_____ or desogestrel in women at risk for thrombosis due to smoking, age over 35, etc

20; drospirenone

For most women, start with __ mcg ethinyl estradiol plus an older ____ (levonorgestrel, norethindrone, etc). These have a good balance of safety and efficacy

20; progestin

The CDC advises postpartum women not to use combined hormonal contraceptives during the first __ days after delivery because of a high risk for ______.

21; venous thromboembolism (VTE)

Loestrin 24 Fe, Yaz, and Ocella are __-day cycle contraceptives

Teriparatide (Forteo) therapy is indicated for no more than __ months.

In general, one should wait __ hours after taking these drugs (__ hours after Cialis) before taking nitrates

24 ; 48

Only about __% of North Americans produce equol from soy...with a higher percentage among those of ____ or Hispanic descent.

40; Asian

When two or more pills in a row are missed, take one as soon as possible, throw out any other missed pills, then take the remaining pills at the usual time. Recommend backup for __ days

Caffeine doses over ___ to ___ mg/day can cause problems such as insomnia, stomach upset, tachycardia, nervousness, and diuresis

250; 300

It's not practical to test women to see if they produce equol. Instead, advise those who want to try soy to consume about __ servings a day of soy milk, tofu, etc, for __ months to see if it helps

2; 3

Use an emergency contraceptive (EC) if miss __ or more combo OC pills, AND have had unprotected sex in the previous __ days

2; 5

Estradiol Vaginal Rings (Estring, Femring) provide a __-month supply of estradiol.

If the ring is expelled, it can be washed off and reinserted. If the ring has been out for more than __ hours, use back-up contraception

Only __ in 1000 women using OCPs will become pregnant in a year of perfectly consistent use, i.e., taking 1 pill at the same time every day

Skyla is the second low-dose levonorgestrel-releasing intrauterine system. It lasts for __ years or until removed

Cost ~$50 for one Depo-Provera injection that lasts __ months

3 (11-13 weeks)

The NAMS recommended duration of combined estrogen-progestogen HT is __ to __ years

3 to 5

5-ARIs improve symptoms by shrinking enlarged prostates in men, but often take __ to __ months or longer to work. Therefore, many practitioners prescribe a(n) ____ to offer more rapid relief by relaxing prostatic smooth muscle.

3 to 6; α-blocker

Pregnant women take an average of __-__ prescription drugs during pregnancy

3-5

The FDA performed a systematic review of long-term bisphosphonate efficacy and concluded that there was little benefit of use beyond __-__ years.

3-5

Before menopause, the average woman produces ___ µg of testosterone daily, but this decreases substantially after menopause.

300

Testosterone levels normally range from ___ to ____ ng/dl

300; 1000

Many experts recommend a daily intake of 800-2000 IU of vitamin D and target serum levels of 25-OH-D between __ and __ ng/mL for postmenopausal women

30; 60

With 11.6 million people using them (__% of contraceptive using women), oral contraceptive pills (OCPs) are the most common contraceptive method used by American women

Teriparatide (Forteo) is a recombinant daily injectable version of the first __ amino acids on the amino-terminal portion of the ___ molecule.

34; PTH

PMS Treatment: ___ mg/day elemental magnesium

360

Lilly, who makes Humatrope, restricts the drug to boys predicted to be shorter than 5'__" as adults and 4'__" in girls

3; 11

Most patients should stop zoledronic treatment after __ years, and their physician should review the need for continuation of therapy __ years later

3; 3

Each patch should be worn continuously for 7 days before being replaced with a new patch on the same day of the week. The regimen should be followed for __ weeks, with no patch being applied in the ____ week.

3; 4th

The ring stays in place for __ week(s) and is replaced each ____ following menstruation

3; month

GH generally produces about 1.5 to 2.8 inches of growth after __ year(s) of use and costs more than $20,000 per year of use.

Tadalafil (Cialis) is also marketed as Adcirca in a __ mg tablet for pulmonary hypertension

Instead of the usual 7-day hormone free interval, Natazia has __ estrogen-only tabs plus __ inert tabs.

4; 2

The duration of action of sildenafil, avanafil, and vardenafil is about ___ hours, while the duration of action of tadalafil is about __ hours

4; 36

USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.__to 0.__ mg (400 - 800 µg) of folic acid.

4; 8

The estrogen in Quartette increases at specific points and provides __ short light periods a year. _____ decreases over time, which might help encourage patient adherence.

4; Breakthrough bleeding

About 50% of patients with a first kidney stone will have another within __ years without any treatment.

Calcitonin is an option for women with osteoporosis who are more than __ years beyond menopause.

HT is approved by the US FDA for alleviation of vasomotor symptoms for Perimenopausal or postmenopausal women aged __ to __; women aged __ to __; women with premature or early menopause

50 to 59; 60 to 79

Femring provides either __ or ___ µg/day of estradiol. This higher dose makes it useful for hot flashes.

50; 100

For abortions, Low-dose MTX (__ mg/m2) injection is followed by intravaginal misoprostol (___ µg) 3 to 7 days later

50; 800

The estimated lifetime risk of osteoporotic fracture is as high as __%, especially in white and Asian women. 20% of fractures involve the proximal ___.

50; femur

ED occurs in an estimated __% of men aged 40 to 70

Weight loss and exercise are important for women who are overweight. Just a __% to __% weight loss can decrease androgen levels and return menstrual function

5; 10

Estrogen graduated—Estrostep is the first graduated estrogen (20 µg ethinyl estradiol for __days, __ µg for 7 days and __ µg for 9 days) with 1 mg _____ dose remaining constant.

5; 30; 35; norethindrone

In 2013, the FDA warned that clinicians should not administer magnesium sulfate to pregnant women for the off-label use of stopping preterm labor for more than __ to __ days, lest the treatment lead to low ____ levels and ____ abnormalities in the fetus

5; 7; calcium bone

Wait __ days after stopping long-acting nitrates before starting ED drugs. Some prescribers feel that ED drugs should not be given at all to those who have taken nitrates in the past few ___.

5; months

Also need to wait __ months after use of 5-ARIs before giving blood.

Fewer problems should be reported with Implanon because it involves implanting only one rod rather than __ with Norplant, and it is inserted less deep in the skin

Once a fertilized egg is implanted and pregnancy occurs—usually about __ days after an egg is fertilized—emergency contraception has no effect.

The 2014 IOM recommendations is a daily vitamin D intake of ___ IU for men and women up to 70 years old and ___ IU for those >70 years old

600; 800

The new Practice Bulletin states that HT should not be discontinued at age __ years, because some women have hot flushes longer

In randomized trials, vitamin B6 and doxylamine has been associated with a __% reduction in nausea and vomiting, and ACOG therefore recommends it as first-line therapy for nausea and vomiting in pregnancy.

A good rule of thumb to estimate the ED incidence is the same percentage as your age past 40, e.g., 70% of men in their __s, 80% of men in their __s, etc

70; 80

Overall, progestin-only contraceptives prevent ovulation in __-__% of cycles, however, the clinical effectiveness ranges __-__%.

70—80; 96—98

After using an EC, resume OC pack or start a new one, and use a backup contraceptive for __ days after levonorgestrel (Plan B One-Step,) or __ days after ulipristal (Ella)

7; 14

BPH is identified through biopsy in up to __% of men > 60 years of age

Calcium stones, especially calcium oxalate stones, account for about __% of kidney stones.

Nausea and vomiting of pregnancy affects ~__% of pregnant women

The average American consumes < __ mg of calcium per day

800

Tt takes only ___ mg of caffeine to fail a National Collegiate Athletic Association (NCAA) drug test

800

The efficacy of all 4 agents is similar, with about __% of men stating that these agents produce an improvement in erections and about __% of men finding that they are able to have intercourse successfully

80; 75

Seasonale is a 91-day regimen taken daily as __ active tablets followed by __ inactive tablets, so the client has only one period every __ months (one period a "season").

84; 7; 3

For the first 3 to 6 months with Mirena, women have increased days of spotting and bleeding, but later, that monthly blood loss is reduced by up to __% without affecting endogenous ____ levels

90; estrogen

A large percentage of men taking these agents experience "_____" symptoms like hot flushes, gynecomastia or osteoporosis

andropause

The adrenal gland continues to produce _____, which is converted to estrone and estradiol in body fat and in muscle and skin cells.

androstenedione

PCOS is characterized by a____, hyper____, and ____ resistance.

anovulation; androgenemia; insulin

When infertility is related to _____ or ____ phase defects, hormonal manipulation is often successful. These agents are often used with in-vitro fertilization procedures

anovulation; luteal

Drugs for Anovulatory Dysfunction/Hyperprolactinemia are ____ agonists that block the release of prolactin

dopamine

Phytoestrogens generally act as weak estrogens, but may also have _____ effects. The dosage and purity of commercial phytoestrogens and their possible adverse effects are unknown

antiestrogenic

Currently, the FDA uses five risk categories -- from __, the least problematic, to __, the most dangerous -- to rank the safety of prescription drugs during pregnancy

A; X

vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) are/are not bioequivalent and should/ should not be considered interchangeable.

are not; should not

Too much androgen: Increased ____, weight gain, acne, oily skin, hirsutism, decreased ___, increased breast ___, breast tenderness, increased ___ cholesterol, decreased ___ cholesterol.

appetite; libido; size; LDL; HDL

Prostaglandins are an alternative to _____ or oxytocin in the treatment of post-partum ______

ergonovine; hemorrhage

Denosumab (Prolia) is also used to increase bone mass in women who are receiving adjuvant a_____ inhibitor therapy for breast cancer or in men who are receiving _____ deprivation therapy for nonmetastatic prostate cancer.

aromatase; androgen

PDE-5 Inhibitors allow an erection to occur naturally when a man is ____. They do not directly cause an erection.

aroused

FDA Contraindications for Menopausal Hormone Therapy: Active or recent ____ thromboembolic disease (angina, myocardial infarction)

arterial

Vitamin C (____ acid) and vinegar (____ acid) will aid the absorption of calcium

ascorbic; acetic

____ is the weakest of the three main forms of estrogen, made in the body from other ____ (E3)

Estriol; estrogens

____ is the estrogen of pregnancy. It is the principal estrogen produced by the _____

Estriol; placenta

Natazia has a unique four-phase dosing regimen, the ____ dose steps down and ____ dose steps up during the cycle, to help avoid breakthrough bleeding

estradiol; dienogest

Endogenous estrogens include ____, ____, ____

estradiol; estrone; estriol

Theoretically, the body produces high levels of ____ during pregnancy to protect estrogen-sensitive tissues from the ____-inducing effects of other estrogens

estriol; cancer

A black box warning to Depo-Provera states that prolonged use may result in the loss of ___ ____ ____ (BMD). This is due to lower estradiol levels, leading to increased ____ resorption

bone mineral density; bone

A progestin is not needed with Estring because little ____ is absorbed

estrogen

The __-score compares you to a standard database of young at peak bone mass (35-year old) Caucasian women, whereas the __-score compares you to a database of women your age.

T; Z

Elderly and _____ (the darker the skin, the less production of vitamin D from sunlight) are especially vulnerable.

African-Americans;

Bisphosphonates include ______ (Fosfamax), _____ (Actonate, Atelvia), _____ (Boniva), ______ (Zometa, Reclast)

Alendronate;Risedronate; Ibandronate;Zoledronate

_____ will reduce the number of stones in patients with gout or too much uric acid in their urine

Allopurinol

___-1-receptors improve symptoms relatively quickly and are involved in _____ of smooth muscle and are abundant in the vascular smooth muscled as well as the prostate and ____ neck

Alpha; contraction; bladder

______ are often pushed by trainers. But there's no evidence that they improve performance or that they increase lean body weight any more than ordinary food

Amino acids

___ ____, synthetic derivatives of testosterone, have been used illicitly and are Schedule III controlled substances as well

Anabolic steroids

Topical forms of testosterone: "Patches" (____), Gels (AndroGel 1.62%, Testim, Fortesta, Bio-T Gel, Vogelxo)

Androderm

Testosterone is administered via several dosage forms for _____ Replacement Therapy (ART), hypo____ and "andropause" in men

Androgen; gonadism

Raloxifene (Evista) is a SERM that is a selective agonist for some estrogen receptors (___) and an antagonist for others (____ and ____).

bone; breast and uterus

______ medications are utilized to manage the blood pressure in preeclampsia

Antihypertensive

_____ prevents vasoconstriction and pathological blood coagulation in the ____ that causes preeclampsia

Aspirin; placenta

____ (Stendra) has a slightly faster onset of action than the other PDE-5 inhibitors (15 minutes vs. 30 minutes a duration of ~__hours and may have fewer side effects

Avanafil; 5

____ is applied to the underarm, like deodorant

Axiron

The possibility of severe and sometimes incapacitating ___, ___, and/or ____ (musculoskeletal) pain exists in patients taking bisphosphonates

bone; joint; muscle

Many of the class __, __—and even __—agents are used in pregnancy.

B, C, D

The primary risk of folic acid supplementation is masking of ____ deficiency by treating the anemia while neurological damage proceeds, but ___ deficiency is uncommon in young women

B-12; B-12

Uterine Relaxants include ___ agonists, ____ sulfate injection, ___ channel blockers, ______ inhibitors, hydroxyprogesterone caproate

B-2; magnesium; calcium; prostaglandin

But, estriol seems to be no different from other estrogen in terms of increasing ____ cancer risk

breast

FDA Contraindications for Menopausal Hormone Therapy: Current, past or suspected ___ cancer

breast

Contraindications for Estrogens: Estrogen-responsive ____ cancer or any ____-dependent neoplasia

breast; estrogen

Testosterone is also given as Striant ____ muco-adhesive system

buccal

Bioidentical preparations include Estriol; ____ (bioestrogen); ____ (triestrogen)

Biest; Triest

____ are the first-line drugs for treating postmenopausal women with osteoporosis

Bisphosphonates

_____ can prevent vertebral and non-vertebral fractures in postmenopausal women with osteoporosis.

Bisphosphonates

Tadalafil (Cialis) was approved for ____ in 2011

BPH

The most authoritative reference for teratogenic and fetotoxic effects is Drugs in Pregnancy and Lactation by ____

Briggs

Dopamine Agonist Agents include _____ (Parlodel), _____ (Dostinex)

Bromocriptine; Cabergoline

Given the information available at approval, most medications (~2/3) are assigned to Pregnancy Category __

Legit Uses of Anabolic Agents: ____ catabolism

Corticosteroid

_____ is promoted to increase muscle mass, but it increases size by causing water retention, not adding muscle.

Creatine

Prior to 1985, growth hormone (GH) was derived from human cadavers, however, the use of human derived GH was stopped due to contamination of the product with _____ virus

Creutzfeldt-Jakob

The skin on the ____ tends to be thicker and is less likely to become irritated by the patch and leads to better absorption. The patches should not be applied to the ____

buttocks; breast

Management of Dysfunctional Uterine Bleeding (DUB)- administer high doses of ____

estrogen

Testosterone is converted to ____ in the body

estrogen

Adequate daily consumption of ____ ___ before and during early pregnancy has been shown to significantly reduce the risk for NTDs such as spina bifida.

folic acid

Induction of ovulation is generally accomplished in 2 steps: 1) _____ stimulation with FSH and/or LH

follicular

____ influence the growth, differentiation and function of many target tissues, including the female and male _____ systems such as mammary gland, uterus, ovaries, testes, and prostate

Estrogens; reproductive

Bio-identical hormones include those agents that occur in the normal human physiological biosynthesis: - _____ (E1) - _____ (E2) - _____ (E3) - _____ (not "progestins" like medroxyprogesterone that are synthetic)

Estrone; estradiol; estriol; progesterone

_____ is a weaker estrogen produced both in the ovaries and in ___ tissue from other hormones, and the main estrogen found in women after menopause (E1)

Estrone; fat

C____ and g____ have shown some efficacy but are not FDA-approved for treating menopausal symptoms

Clonidine; gabapentin

We do not suggest the use of MHT as ____ prophylaxis based on the available data

CVD

____ is not a first-line drug for postmenopausal osteoporosis treatment, as its fracture efficacy is not strong and its BMD effects are less than those of other agents

Calcitonin

____ (Miacalcin, Fortical) is a polypeptide hormone that inhibits postmenopausal bone resorption by inhibiting _____ function

Calcitonin; osteoclast

____ ___ IV should be kept at bedside in case of respiratory depression from magnesium sulfate use

Calcium gluconate

No Risk—safe to use

Category A

No evidence of risk

Category B

Risk cannot be ruled out—use only if there are no alternatives and the benefits of use are greater than the risks

Category C

Evidence of risk—avoid use if possible. Use only if benefits of use are much greater than the potential risks

Category D

Contraindication—never use

Category X

PMS Treatment: ____ (Vitex agnus-castus) seems to improve breast tenderness, constipation, and mood, but not ____

Chasteberry; bloating

Drospirenone may increase/ decrease potassium levels and may be associated with less/ more weight gain than other agents

increase; less

The primary adverse effects are the ___ and _____ effects

GI; esophageal

Broad-spectrum antibiotics (penicillins, tetracyclines, erythromycin) can reduce _____ bacteria that help ____ absorption, but this usually affects only a very small number of women

GI; estrogen

Calcium supplements are generally well tolerated, but GI effects such as constipation, intestinal bloating and excess gas are frequently reported, particularly with calcium ______

carbonate

Side Effects of Progestins: increased/ decreased BP

increased

____ changes and clinical symptoms occur over a period leading up to and immediately following menopause; this period is frequently termed the _____ or perimenopause but is increasingly referred to as the menopausal _____

Hormonal; climacteric; transition

Some observational studies suggest that people who drink _____ have a higher risk of fractures. But this is debatable since it's more likely that people who drink those consume less milk and therefore get less ____.

carbonated beverages; calcium

Calcium supplements may increase risk of ____ events. Sources disagree

cardiac

Ergocalciferol (vitamin D2) is much more/ less potent and has a longer/ shorter duration of action than cholecalciferol.

less; shorter

Still, for all women except smokers over age 35, the risk for death from _____ disease resulting from pregnancy exceeds the risk posed by OCP use

cardiovascular

In June 2014, the FDA started requiring manufacturers to include a general warning in the drug labeling of all approved testosterone products about the risk of blood clots (___ and ___) in the veins.

DVTs and PE

___ products are still the preferred source of calcium, but supplements and calcium-fortified foods are also beneficial.

Dairy

_____ (Prolia) injected subcutaneously once every __ months can reduce the risk of vertebral and nonvertebral fractures in women with postmenopausal osteoporosis

Denosumab; 6

____ (Prolia) is the first ____ Ligand inhibitor. It keeps the protein RANKL from activating its receptor on osteoclasts.

Denosumab; RANK

Oxytocin (Pitocin) promotes milk ___ ("galactokinetic" effect) and establishes maternal ____

letdown; behavior

The most used test for bone density is the DEXA (___ ____ X-ray Absorptiometry) Scan. The bone density of the area scanned is reported as a __-score and a __-score.

Dual Energy; T; Z

_____ is the leading cause of recurrent short-term school absence in adolescent girls and a common problem of women or reproductive age

Dysmenorrhea

____ is a low-dose (20 µg ethinyl estradiol/90 µg levonorgestrel) pill designed to be taken daily for years with no hormone-free intervals to completely suppress _____, resulting in no period and significant control of premenstrual symptoms

Lybrel; ovulation

____ ____ helps prevent seizures in women with preeclampsia. It slows neuromuscular conduction and depresses CNS _____ without significant effects on blood pressure

Magnesium sulfate; irritability

Climara Pro is a once-a-week patch that contains l____ and estradiol

levonorgestrel

In 2011, the FDA approved _____ (hydroxyprogesterone caproate) injection to reduce the risk of preterm delivery before 37 weeks of pregnancy

Makena

In 2011, the FDA approved ____ (hydroxyprogesterone caproate) injection to reduce the risk of preterm delivery before ___weeks of pregnancy, in pregnant women with a history of at least one spontaneous preterm birth.

Makena; 37

ED is associated with age, ______ disease, d____, smoking, alcohol, p______, obesity and _____ injuries

cardiovascular; diabetes; prostatectomy; spinal cord

Liletta continuouslyreleases _____ for up to 3 years

levonorgestrel

____ secrete acid that dissolves minerals out of bone, leaving a rubbery cartilage scaffolding that, under normal conditions, is slowly ____

Osteoclasts; recalcified

Bisphosphonates can cause _____ of the Mandible

Osteonecrosis

The risk for VTE is greater for those containing desogestrel and drospirenone when compared with ____.

levonorgestrel

____ (Paxil 10 - 20 mg/day, controlled release 12.5 - 25 mg/day) is a non-hormonal med for menopausal symptoms which may cause headache, nausea, insomnia, drowsiness, or sexual dysfunction.

Paroxetine

____ are best for women who smoke, because smoking speeds up the ___ metabolism of estrogen.

Patches; hepatic

In addition in discerning the difference in blue and green some men with _____ problems temporarily lose their vision after taking these agents. It blocks a(n) ____ found in the retina

cardiovascular; enzyme

Mirena is an (IUD) intrauterine system that releases a low dose of _____ into the lining of the uterus that lasts for __ years or until removed

levonorgestrel; 5

For FBD, also consider role of supplemental vitamin __, and decreased ____ and sodium intake. (Limit vitamin to 400 IU or less per day.)

E; caffeine

___ may be a treatment option for a few years of early postmenopause.

ET/EPT

_____ (Vaniqa) cream can help with unwanted facial hair (hirsutism)

Eflornithine

____ estrogen is the natural estrogen hormone in the body

Endogenous

Contraindications for Estrogens: ____ cancer

Endometrial

Clinical Uses of Progestins: - E____ - Premenstrual ___ and tension ("PMS") - "Chemical ____ "

Endometriosis; edema; castration

Adverse Effects of Anabolic Agents: _____ heart and increase plasma ____ leading to hypertension, thromboembolic disorders, arrhythmias and M.I. (Due partially to extreme decreases of ___ cholesterol)

Enlarged; lipids; HDL

____ ___ is defined by NIH as follows: "The persistent inability of a man to achieve and/or maintain a(n) _____ adequate to allow for satisfactory sexual intercourse

Erectile dysfunction (ED); erection

___ is the main estrogen made by women's ovaries before menopause (also described as 17-beta and E2)

Estradiol

_____, synthesized from testosterone via the aromatase pathway, may also be implicated in initiating hyperplasia in the prostatic stroma and epithelium.

Estradiol

FDA is exploring methods to better study medication safety in pregnancy: The Medication ____ in ____ ____ Evaluation Program (MEPREP).

Exposure; Pregnancy Risk

If 3 or 4 cycles of an oral drug fail to result in a pregnancy, or the woman is of advanced fertility age, injection of ____ can be tried.

FSH/LH

____ (Proscar) is a 5-ARI that may cause ____ (hair growth)

Finasteride; Hypertrichosis

All alpha blockers can cause IFIS (Intraoperative ____ ____Syndrome). This condition makes ___ surgery more risky and reduces the outcome. Possibly results in permanent effects

Floppy Iris; cataract

Ibandronate has not been shown to reduce the risk of _____ fractures

nonvertebral

_____ has long been thought to be effective for treatment of symptoms of pregnancy-associated nausea and vomiting with acceptable side effects and no evidence of adverse effect on pregnancy outcome.

Ginger

Gonadotropin Releasing Hormone and Luteinizing Hormone-Releasing Hormone Agonists prevent the pulsed release of ____ from the hypothalamus, blocking the release of FSH and ___

GnRH; LH

GnRH agonists include ____ acetate implant (Zoladex), ______ acetate (Lupron Depot), ___ acetate (Synarel nasal spray)

Goserelin; Leuprolide; Nafarelin

_____ occurs with 5-ARIs at a rate higher (0.5-1%) than any other drug, including spironolactone (Aldactone)

Gynecomastia

___ antagonists and proton pump inhibitors (PPIs) may ↓ absorption of calcium due to ↓ ___.

H2; acidity

__RT or __RT (____ with or without progestin) is the most effective treatment for the menopausal symptom

H; E; estrogen

Side Effects of Progestins: May decrease ___ cholesterol (or when used with estrogen, offset estrogen's beneficial effect of increasing ___)

HDL; HDL

Level C recommendation ("based primarily on consensus and expert opinion"): Individualize the decision to continue __

Adverse Effects of SERMS: ____ and ____ cramps are most common

Hot flashes; leg

____ affect from 50% to 82% of US women who experience natural menopause, and 10% to 40% report vaginal ____

Hot flushes; atrophy

Testosterone is a Schedule ___ controlled substance

III

Heavier women should discuss ___ _____ with their provider

IUD insertion

Management of Dysfunctional Uterine Bleeding (DUB)- rule out organic causes and stabilize with ____

IV fluids

____ is a problem in a few of those taking 5-ARIs In 2012, the FDA required revised labeling warning of potential ____ side effects that can last even after patients stop taking the drugs

Impotency; sexual

_____ (Indocin) and other NSAIDs have anti-prostaglandin effects

Indomethacin

The primary contraceptive effect of exogenous progestins in progestin-only pills (Ovrette, Micronor, NorQD, Plan B One Step) involves the suppression of the midcycle surge of ___

Induction of ovulation is generally accomplished in 2 steps: 2) Stimulate ___ surge and induce final ____ maturation and ovulation

LH; follicular

In males, hCG mimics ____ and helps restore and maintain _____ production in the testes.

LH; testosterone

Although most medications and immunizations are safe for nursing mothers and infants, physicians should consult the National Institutes of Health online database, ____, when considering medications for nursing mothers

LactMed

Too little progestin: ____ breakthrough bleeding

Late

Adverse Effects of Anabolic Agents: ____ tumors and peliosis ____

Liver; hepatitis

Level A: ____ estrogen therapy is advised for isolated atrophic vaginal symptoms.

Local

____ (Depo-Provera) Injection is for contraception and also for the management of pain associated with ____ in two dosage strengths: 150-mg and 104 mg of DMPA

Medroxyprogesterone; endometriosis

____ (Glucophage) can be used to improve ____ sensitivity and therefore reduce androgen levels. This improves menstrual frequency and ovulation, allowing some women to get pregnant

Metformin; insulin

____ (Flagyl) has been known to be carcinogenic in rats and mutagenic in bacteria, but is classed as pregnancy category __ since these problems have not been shown to occur in humans

Metronidazole; B

_____, plant compounds that are converted to estrogens in the gut, are widely promoted as "natural" substitutes for estrogen in hormone replacement therapy (HRT) and for osteoporosis

Phytoestrogens

Management of Dysfunctional Uterine Bleeding (DUB)- Other therapies include ____ and cyclic medroxyprogesterone (Provera)

NSAIDs

Nasal application: ____ nasal gel

Natesto

During parturition, there is an increase in concentration of oxytocin in _____ fluid, and oxytocin acting within the brain plays a major role in establishing maternal behavior.

cerebrospinal

_____ alpha-1-adrenergic blockers—_____ (Hytrin), _____ (Cardura)—originally approved for hypertension, have been used for several years to increase urine flow and decrease prostatic hyperplasia

Non-selective; terazosin; doxazosin

Use of Viagra in Women? FDA Approved/ Not Approved

Not Approved

Sildenafil (Viagra) is ___ in the UK

OTC

The FDA does not categorize ___ drugs but requires them to carry at least this standard warning, "If pregnant or breast-feeding, ask a health care professional before use."

OTC

Both vitamin B6 and doxylamine are available ___ in the U.S. and have shown no evidence of ____

OTC; teratogenicity

PMS Treatment: _____—may initially make symptoms worse

Oral contraceptives

____ build new bone

Osteoblasts

____ is the uterotonic agent of choice

Oxytocin

St. John's Wort induces the cytochrome ____ hepatic microsomal system, specifically the CYP3A4 isoenzyme resulting in a ____ in the effectiveness of oral contraceptives.

P-450; decrease

_____ is the most common endocrine problem in young females with approximately 15% of women developing it during their reproductive years.

PCOS

The AUA recommends that ___ inhibitors be offered as the first-line therapy for ED unless contraindicated. All should be used with caution with nitrates

PDE-5

____ stimulates bone density by stimulating new bone growth. It _____ the normal rate of bone formation, with a ↓ in _____ fractures of 66%.

PTH; doubles; spinal

_____, also known as osteitis deformans, is a nonmalignant disease involving accelerated bone _____ followed by deposition of dense, chaotic, and ineffectively mineralized bone ____.

Paget's disease; resorption; matrix

Drugs for Anovulatory Dysfunction/Hyperprolactinemia are also used in the management of ____ Disease

Parkinson's

Bromocriptine (Parlodel) is an older agent used more for _____ than for prolactin-secreting pituitary ____

Parkinson's; adenomas

The new final rule requires the use of three subsections in the labeling titled "____," "____" and "Females and Males of Reproductive Potential"

Pregnancy; Lactation

____ Vaginal Cream is approved for dyspareunia

Premarin

Most studies find that estrogens do not increase the risk of ____ cancer

cervical

____ and excessive sexual stimulation, more common in geriatric males, are generally the effect of excessive testosterone dosage

Priapism

____ alone increases breast cancer risk, and _____ poses no benefit (except improved sexual satisfaction), but comes with multiple risks

Progestin; testosterone

_____, e.g., dinoprostone (Cervidil vaginal insert, Prepidil gel) and misoprostol (Cytotec) stimulate ____ motility and are also used as ____ and for cervical ______

Prostaglandins; uterine; abortifacients; ripening

____ cancer as a secondary malignancy or prostatic _____ can develop during prolonged therapy with testosterone and are more likely to occur in elderly male patients.

Prostate; hypertrophy

Gonadotropin Secretion Stimulants are Drugs Used for Assisted ______

Reproduction

____ is the primary antibiotic that induces OC metabolism

Rifampin

PMS Treatment: SSRIs and ____

SNRIs

ACOG: there is more evidence to support nonhormonal alternatives such as ___ and SNRIs for management of vasomotor symptoms. In addition, the document updates newer agents that combine SERMs and ____ to reduce negative side effects.

SSRIs; estrogen

____differs from Seasonale in that it incorporates 7 tablets of low-dose _____ rather than placebo tablets in an effort to limit bloating, hormonal fluctuations, and breakthrough bleeding

Seasonique; estrogen

_____ (Viagra) is a PDE-5 inhibitor also marketed as Revatio 20 mg for ______ hypertension

Sildenafil; pulmonary

Growth Hormone: _____, rh-GH (Genotropin, Humatrope, Norditropin, Nutropin, Saizen, Omnitrope)

Somatropin

_____ (Aldactone) is used to treat androgen excess. It helps decrease hirsutism and may be added when OCs alone aren't enough. It should not be used during ____

Spironolactone; pregnancy

____ 10 or 20 mg is sometimes called the "weekend drug" since Cialis is longer acting than Viagra and Levitra, up to __ hours activity

Tadalafil; 36

Selective α-1a Blockers include ___ (Flomax), _____ (Uroxatral), Silodosin (Rapaflo)

Tamsulosin, Alfuzosin

_____ (Forteo) was approved November 2002 to treat (not _____) osteoporosis in postmenopausal women and in men with idiopathic or hypo____ osteoporosis

Teriparatide;prevent; gonadal

____, the primary androgen found in the body, is synthesized by cells in the testis, ovary, and adrenal cortex.

Testosterone

Bio-identical hormones include those agents that occur in the normal human physiological biosynthesis: - T_____ - Dehydroepiandrosterone (DHEA) - P_____ - A_____

Testosterone; pregnenolone; androstenedionen

After a whole lot of fuss and study, the Agency for Healthcare Research and Quality (AHRQ) issued a report in 2014 that finds no consistent correlation between vitamin D and health outcomes such as _____ disease, all-cause ____, several types of ___, or ____ health.

cardiovascular; mortality; cancer; bone

Ortho-Evra, Xulane patch contains n____ and ethinyl estradiol

norelgestromin

CombiPatch is a thin matrix patch containing estradiol and n____. The patch is changed twice a week

norethindrone

Evidence-based medicine does/ does not support an association between estrogens used for HRT and breast cancer incidence.

does not

In 2013, the Centers for Disease Control and Prevention (CDC) launched the TRxeating for ____ initiative as a key step toward safer use of medication during pregnancy

Two

Mifepristone (Mifeprex) aka RU-486 and Korly is a derivative of _____

norethindrone

____ (ella) is a prescription emergency contraceptive for use up to __ hours following unprotected sexual intercourse or contraceptive failure

Ulipristal; 120 (5 days)

APC induces decreased factor __ activity

FDA required labeling for all drospirenone-containing products state that they may be linked to a 3 times higher risk for ____ than pills with other types of progestins, such as levonorgestrel

VTE

Like estrogens, ____ can occur with SERMS, especially during the first few months of therapy. This can lead to stroke

VTEs

____ (Levitra, Staxyn--orodispersable formulation) is similar to Viagra in length of action, about __- __ hours

Vardenafil; 4-8

_____ (Effexor-ER 37.5 - 75 mg/day) is a non-hormonal med which is associated with dry mouth, nausea, constipation, and sleeplessness

Venlafaxine

Can Health Care Practitioners Have a "Conscientious Objection" to Contraceptives?

YES

The mechanisms of action of EC containing a combination of estrogen and progestin, known as the ____ regimen (4-5 regular OC tablets), and those of the _____ regimen continue to be controversial, especially over the possibility that these regimens might act by interfering with _____ of the fertilized ovum

Yuzpe; levonorgestrel; implantation

Estradiol Transdermal "Patches" (e.g., Estraderm, Vivelle-Dot, Climara, Alora, CombiPatch, FemPatch, Menostar, Minivelle) should be applied to the clean, dry skin of the lower ____ or buttocks.

abdomen

It is true that L-methylfolate is slightly better ____ than folic acid. But, so far there's no proof that this makes a clinical difference

absorbed

Optimum absorption occurs when calcium is taken with meals due to increased ____ content of stomach.

acid

When androgens are given to women, virilization, manifested by ___, growth of facial hair, enlarged ___, ____ breast size, and deepening of the voice, can occur. If treatment is discontinued when these symptoms first appear, they usually do/ do not subside.

acne; clitoris; reduced ; do not

In men and postmenopausal women the principal source of estrogen is ____ tissue, where estrone is synthesized from dehydroepiandrosterone secreted by the ____ cortex

adipose; adrenal

"natural" and "bioidentical" are/ are not presently mutually exclusive terms

are

As men ___, testosterone levels decrease. They can also decrease with use of certain drugs, e.g., long-term use of extended-release ___, may lower testosterone levels

age; opiates

Generic _____ is usually first-line treatment of osteoporosis because of its broad spectrum of anti-_____ efficacy and low cost

alendronate; fracture

Patients at increased risk for fracture should start ____ or other bone-protective treatment at the onset of _____ therapy

alendronate; glucocorticoid

ONJ has been associated with some/all of the bisphosphonates that are in common use.

all

Testosterone can cause ____ resembling male pattern baldness

alopecia

Finasteride is teratogenic, so contraindicated in females with ____, but may be used off-label in _____ women,

alopecia; postmenopausal

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ____ containing antacids

aluminum

Androgens have a(n) ____ effect vs. adrenocorticoid steroids which have a(n) ____ effect

anabolic; catabolic

To off-set many of these side effects, such as gynecomastia and low sex drive, many body-builders and "week-end warriors" are turning to anti-estrogens such as ______ (Arimidex) since one of the side effects of having too much testosterone is high estrogen levels

anastrozole

Chemical castration results in decreased testosterone and ____ levels. Termed: "____ ____ Therapy."

androgen; Androgen Depravation

Combined contraceptives block ____ production and may therefore reduce hirsutism and ____

androgen; acne

Danazol (Danocrine), a(n) _____, is effective in the treatment of pelvic pain associated with _____, but adverse effects such as acne, hirsutism and baldness, often limit its use

androgen; endometriosis

In the world of performance enhancing drugs, hCG is increasingly used in combination with various anabolic _____ steroid (AAS) cycles.

androgenic

Saw palmetto berries contain a large number of compounds which appear to have an anti____ effect by inhibiting the enzyme 5-alpha-reductase.

androgenic

FDA is investigating the use of estrogens combined with ____ and states that they have never been proven safe and effective

androgens

Some postmenopausal women take estrogens combined with ____ (testosterone), e.g., Estratest, Syntest or ____ alone (e.g., Androderm) to prevent _____and increase energy and libido.

androgens; testosterone; osteoporosis

The origin Paget's disease is unknown, and it is frequently ____

asymptomatic

Most postpartum hemorrhages are caused by uterine ____ and occur in the immediate postpartum period.

atony

Floppy iris syndrome can occur years after an alpha-blocker is stopped due to _____ of the iris.

atrophy

Adverse Effects of Anabolic Agents: Testicular ____, sterility, acne and _____

atrophy; gynecomastia

Women who have symptomatic vaginal ___ (dyspareunia, atrophic vaginitis) benefit from physiologic estrogen add-back either systemically with oral or ____ therapy or ____ with vaginal treatments (creams or rings).

atrophy; transdermal;topically

The most common side effects reported include ___ pain, pain in the ____, musculoskeletal pain, high ____ levels, and urinary bladder infections.

back; extremities; cholesterol

Merck also markets Finasteride under the trade name Propecia for male _____

baldness

Nexplanon is essentially identical to Implanon except Nexplanon has 15 mg of ____ ___added to the core, so it is detectable by X-ray. It also has a pre-loaded applicator for easier ____

barium sulphate; insertion

Duavee is the first to combine conjugated estrogens with _____, an estrogen agonist/antagonist that substitutes for a progestin

bazedoxifene

Duavee is a combination of conjugated estrogens and the estrogen agonist/antagonist SERM _____ approved for women with a uterus for the treatment of _____ symptoms associated with menopause

bazedoxifene; vasomotor

Obstructive symptoms associated with enlargement of the prostate gland- difficulty in _____ or ___ a urinary stream

beginning; maintaining

It will take years and large studies to determine if _____ hormones are safer, but many women say they feel much better on them.

bioidentical

Too little evidence supports benefit of compounded ____ hormones, phytoestrogens, _____ remedies, or exercise

bioidentical; herbal

Denosumab is not a _____

bisphosphonate

Calcitonin is generally reserved for use in patients who cannot tolerate _____ or hormone therapy

bisphosphonates

Denosumab (Prolia) may be an effective alternative for patients who have not responded to _____ or cannot tolerate them

bisphosphonates

Weekly or monthly doses of oral _____ are as effective as daily doses in increasing bone mineral density and are better tolerated

bisphosphonates

Pharmacotherapies shown to lower the risk for vertebral fracture (and for hip fracture in some cases) include b____, d____, ____ hormone peptides, and r___.

bisphosphonates; denosumab; parathyroid; raloxifene

When administered in the early stages of pregnancy (within first 7 weeks—49 days), Mifepristone (Mifeprex) has an abortifacient effect by causing detachment of the ____, which decreases human ____ _____ (hCG) production

blastocyst; chorionic gonadotropin

Contraindications for Estrogens: undiagnosed abnormal vaginal ____

bleeding

Side Effects of Progestins: Headache, ____, mood changes

bloating

β-2 agonists can cause increased ____ ___ and _____

blood glucose; tachycardia

In the early 1990s, researchers discovered that the same properties of thalidomide that restrict ___ ___ growth and resulted in the stunted limbs, were useful in treating a number of medical disorders, including some cancerous tumors, like multiple ____, Crohn's disease and multiple ____, and it was approved for some of those uses

blood vessel; myeloma; sclerosis

The main reasons for treating symptoms of the menopausal transition and actual menopause are as follows: - To preserve ____ - To lower the risk of disease - To improve quality of life

bone

Public Citizen's Health Research Group has recommended that patients not take teriparatide since it has led to ___ cancer in laboratory animals.

bone (osteosarcoma)

Legit Uses of Anabolic Agents: Increase muscle mass in _____.

cachexia

Postmenopausal women may benefit from c____, e_____, and hormone replacement therapy

calcitriol; etidronate

Magnesium sulfate works as an intracellular ___ antagonist

calcium

Thiazides help reduce ____ excretion

calcium

Oxytocin (Pitocin) activates the phospholipase C-inositol pathway and increases intracellular ____ levels, stimulating _____ in myometrial smooth muscle

calcium; contractions

2013 FDA advisory panel recommends removal of Calcitonin due to a lack of efficacy and an association with ____.

cancer

5-ARIs could mask prostate ____ by falsely lowering prostate specific antigen (PSA) levels by interference with the assay. Studies have shown that finasteride ↓ PSA by ~ 40%

cancer

Another Citracal product, Citracal Plus Heart Health, also contains more calcium ____ than calcium citrate.

carbonate

Mirena is designed for use for women who have already had ____

children

Skyla is aimed at younger women who have not had _____

children

The most common form of vitamin D is vitamin D-3, _____. Vitamin D2 is _____

cholecalciferol; ergocalciferol

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ______ (Questran)

cholestyramine

Step 2 is accomplished with human ____ ____ (Ovidrel, Pregnyl, Novarel), ____ (Cetrotide) and _____ (Antagon)

chorionic gonadotropin [hCG]; cetrorelix; ganirelix

Calcium ___ is reported to be better absorbed and to cause less GI upset (gas and bloating). Is the drug of choice for patients with achlorhydria, chronic antacid use or on acid suppression therapy, i.e., H-2 antagonists or PPIs

citrate

Many clinicians prefer calcium ____ because it can be taken with or without food, while calcium ____ must be taken with food for optimal absorption

citrate; carbonate

A new Citracal product contained not only calcium ____, but also calcium ____. Citracal Plus Bone Density Builder actually contains more calcium ____ per tablet than calcium citrate (240 mg vs. 60 mg)

citrate; carbonate; carbonate

According to The Medical Letter, October 31, 2011, in women with ovulatory failure or those who have unexplained infertility with normal estradiol and gonadotropin levels, oral c____ or l____ would be a reasonable first approach to ovulation induction

clomiphene; letrozole

Step 1 is accomplished with _____ (Clomid, Serophene), _____ (Repronex, Menopur), [urofollitropin] (Bravelle), _____ (Gonal-f, Follistim AQ).

clomiphene; menotropins; follitropin

Level B: "Common sense lifestyle solutions" are layering ____, lowering room temperature, and consuming ___ drinks.

clothing; cool

HT is relatively contraindicated in blood ___, ____, breast cancer

clots; stroke

Estrogen influences hemostasis by increasing the levels of _____ factors (VII, VIII, X, fibrinogen) and ____, lowering antithrombin III and protein __ levels, and altering ____ (APC) resistance

clotting; plasminogen; S; activated protein C

Limit soft drinks, especially ___. They contain _____ acid, which may increase the risk of stones

colas; phosphoric

Drug interactions and non-_____ is more likely to reduce the effectiveness of the low-dose preparations and ________ is more common

compliance; breakthrough bleeding

With a ____ regimen, many clients have a bit of unpredictable breakthrough bleeding during the first six months of treatment, but by the end of the first year are free of bleeding

continuous

Note that the higher doses used for ____ may be associated with VTE, e.g., Ortho-Evra, Yaz.

contraception

Clinical Uses of Progestins: Combined with estrogens in oral ____ and used alone for contraception orally as "___ pill" and injection as Depo-Provera.

contraceptives; mini

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ______, e.g., prednisone

corticosteroids

Mifepristone is also approved as Korlym which also acts as a ____ receptor blocker indicated to control _____ secondary to hypercortisolism in adult patients with endogenous ____ syndrome who have type 2 diabetes mellitus or glucose intolerance

cortisol; hyperglycemia; Cushing's

hCG is also used for c____ in young males.

cryptorchidism

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ______ (Sandimmune)

cyclosporine

For women taking estrogen-only therapy, however, avoiding treatment does/ does not appear to have been a good decision, he argued

does not

Low-strength Cialis (2.5 and 5 mg) is approved for ____ use.

daily

Withdrawal of bisphosphonate treatment is associated with increases/ decreases in bone mineral density (BMD) and bone turnover after 2 to 3 years for ____ and 1 to 2 years for ____ and risedronate

decreases; alendronate; ibandronate

Testosterone is given parenterally in regular and ___-release (depot) dosage forms, e.g., DepAndro, Depotest, Duratest, Delatestryl, Testo-LA, Aveed.

delayed

NuvaRing, contains etonogestrel (the active metabolite of _____) and ____ estradiol, is a flexible, transparent vaginal contraceptive ring.

desogestrel; ethinyl

Bromocriptine was approved in 2010 for ____ as Cycloset

diabetes

Natazia also contains a new progestin called ____ which has anti-androgenic effects like drospirenone (Yaz), but without the risk of _____

dienogest; hyperkalemia

Testosterone is converted to the active ____ (DHT)

dihydrotestosterone

The development and enlargement of the prostate gland is dependent on the androgen, 5-α-_____.

dihydrotestosterone (DHT)

5-α-Reductase Inhibitors (5-ARIs) inhibit 5-α-reductase, the enzyme that catalyzes conversion of testosterone to _____, which is required for development and maintenance of prostatic ____

dihydrotestosterone; hyperplasia

Calcium supplements must be ____ before they can be absorbed. Even when dissolved, absorption is incomplete, usually averaging ~ __% to __%. It requires adequate vitamin D and varies with age, increasing/decreasing after puberty.

dissolved; 20; 30; decreasing

Best calcium to take in ____ doses, e.g., 500 mg three times a day if taking 1500 mg/day. ___ mg at one dose is maximum that can be absorbed

divided; 500

Women on Depo-Provera do/ do not have a monthly period

do not

Levetiracetam (Keppra) and Valproate ____ compromise OC efficacy

don't

Heavy menstrual bleeding (HMB) or menorrhagia occurs in 9% to 14% of women and is characterized by the need to use ___ sanitary protection, menstrual flow that soaks through 1 or more sanitary pads/tampons per ____, and the need to change sanitary protection during the ____.

double; hour; night

For every standard deviation below normal, the risk for fracture ___ or ___

doubles or triples

Obstructive symptoms associated with enlargement of the prostate gland- post-micturitional ____

dribbling

The FDA has approved the use of ____ (Avodart) together with ____ (Flomax) as Jalyn for treatment of BPH. The combination works more quickly than a 5-alpha-reductase inhibitor alone and more effectively than an alpha-1-blocker alone.

dutasteride; tamsulosin

Up to 90% of young women report _____, which is a leading cause of school and work absenteeism among women. If left untreated, menorrhagia can cause ____

dysmenorrhea; anemia

In 2013, the FDA approved ospemifene (Osphena) for treating moderate to severe _____ in postmenopausal women.

dyspareunia

Irritative symptoms associated with enlargement of the prostate gland- d____

dysuria

Magnesium sulfate can cause pulmonary ____ and respiratory _____ in the mother

edema; depression

Preeclampsia and eclampsia, a pregnancy-specific condition in ~8% of pregnancies, consists of hypertension with ____, _____, or both.

edema; proteinuria

Emergency contraceptives are LESS _____...cause MORE menstrual _____...and can cost MORE

effective; irregularities

Obstructive symptoms associated with enlargement of the prostate gland- inability to completely ___ the bladder

empty

Bazedoxifene reduces the risk for _____ hyperplasia

endometrial

Combined contraceptives lower risk of ____, ____, and ____ cancer

endometrial; colorectal; ovarian

Other actions of progestins include alterations in the _____ that can impair implantation and an increase in cervical ____ viscosity which inhibits sperm migration into the uterus

endometrium; mucus

Bisphosphonates decrease levels of vascular ______ growth factor, possibly leading to fewer new blood _____ in bone marrow

endothelial; vessels

Caffeine is used as a stimulant, and it MAY increase ____ and time to ____

endurance; exhaustion

Among the off-label uses for Viagra: Building ____, especially for athletes who compete at ___ altitudes, by delivering ____, nutrients and performance-enhancing drugs to muscles more efficiently

endurance; high; oxygen

Estrogen Agents include Conjugated estrogens ____ or "CEE" (Premarin); synthetic conjugated estrogens, A (____) and B (____); _____ (E-2)

equine; Cenestin; Enjuvia; Estradiol

Estrogens for atrophic vaginitis can be applied topically, e.g., conjugated estrogens ____ (Premarin Vaginal Cream), ____ (Vagifem tablets, Estring)

equine; estradiol

It MIGHT be because only SOME women can convert the soy isoflavone "daidzein" to "____"...a metabolite with estrogenic activity

equol

Ospemifene is a novel selective ____ ____ modulator (SERM) that makes vaginal tissue thicker and less fragile, resulting in a reduction in pain with sexual intercourse

estrogen receptor

According to a study at Yale, thousands of women may have died unnecessarily in the last decade because of the widespread rejection of ___ therapy, even for those aged 50 to 69 who have had a _____

estrogen; hysterectomy

If bleeding continues beyond 3 months, increase the ____ dose if a woman is taking less than 30 mcg, or change the ____ if she is on a 30 mcg or higher pill.

estrogen; progestin

Level A ("good or consistent scientific evidence"): Systemic HT, with just ____ or estrogen plus ___, is the most effective approach for treating vasomotor symptoms

estrogen; progestin

Quartette is a 91-day oral regimen during which the dose of ____ increases at 3 distinct points during the first 84 days and the amount of _____ remains consistent, followed by 7 days of 10 μg ____ ____.

estrogen; progestin; ethinyl estradiol

A small portion of DHT is converted to ____, thus explaining some of the "feminization" properties (gynecomastia, testicular atrophy) in males who use excessive amounts of _____ or testosterone-related products such as androstenedione

estrogen; testosterone

Tetrahydrogestrinone (THG)—this supplement agent surfaced a few years ago as an "abused" drug amongst athletes. It is not a(n) ____, but has ____-like chemical structure. This is now a Rx drug

estrogen; testosterone

Adverse effects of GnRH agonists and LHRH agonists are secondary to the hypo_____ state and include hot flushes, vaginal ____, decreased ____ and a loss of trabecular bone mass during therapy

estrogenic; dryness; libido

Progestins and ____ have similar chemical structure

estrogens

Prior to the WHI, _____ were considered first-line therapy in treating osteoporosis. Current recommendations, however, are to use alternative therapies if the only reason for HRT is for ______

estrogens; osteoporosis

Progestins are used in combination with ____ in women who have a uterus to decrease the risk of uterine endometrial hyperplasia and cancer by retarding the _____ of the endometrial cells by reducing the number of ____ receptors in the uterus.

estrogens; proliferation; estrogen

GnRHa and LHRH also result in suppression or down regulation of ____ and ____ and consequent suppression of ovarian and testicular steroidogeneses, pro ducting a chemical _____ or pseudo menopause

estrogens; testosterone;oophorectomy

Estrogen Agents include Estropipate or ____ (Ogen, Ortho-est); ______ (DES)

estrone; Diethylstilbestrol

After menopause, ____ becomes the predominant endogenous estrogen in women's bodies even though the ovaries continue to produce small amounts of ____, as do the secondary hormone-production sites

estrone; estradiol

The addition of an ethinyl group at the 17 position, ______ (EE), makes the molecule more potent and highly orally active.

ethinylestradiol

Other Bisphosphonates (Not approved for osteoporosis; used for Paget's disease and hypercalcemia of malignancy) include _____ (Didronel), _____ (Aredia), ____ (Skelid)

etidronate; pamidronate; tiludronate

Implanon, Nexplanon is matchstick-sized contraceptive containing the progestin _____ that is inserted in a woman's upper arm for as long as 3 years

etonogestrel

A(n) ____-cycle OC such as Seasonale provides a more consistent hormone suppression compared to ____ OC

extended; monthly

All bisphosphonates are poorly absorbed (~1%) from the GIT in a ____ state and even more poorly in the presence of ____. The absorbed drug is distributed primarily to the ___ and persists for years

fasting; food

Since estrogens and progestins are ___-soluble, the patch is less effective in women weighing over 198 pounds or __ Kg.

fat; 90

Estrogens and progestins are __-soluble. Therefore, in ___ women, they may not be as effective, resulting in unwanted pregnancy.

fat; obese

In 2010, the FDA issued a warning regarding an increased risk of atypical _____ fracture in patients treated with bisphosphonates used for osteoporosis

femoral;

Ella is used off-label for uterine ____

fibroids

Even so, metronidazole should be used during the ___ trimester only when there are no alternatives.

first

The role of ____ in osteoporosis is not clear and is rarely used today

fluoride

SSRIs, such as ____ (Prozac, Sarafem), sertraline (Zoloft), _____ (Paxil) are approved for PMDD

fluoxetine; paroxetine

Many will experience adverse effects from magnesium sulfate, especially _____ and respiratory ____

flushing; depression

Beyaz and Safrtl are combined with ____ to reduce risk for ____ defects

folate; neural tube

Obstructive symptoms associated with enlargement of the prostate gland- decrease in ____ of the urinary stream

force

In the U.S., folic acid is obtained from three sources: ____ foods, ready-to-eat ____, and supplements

fortified; cereals

Osteoporosis and low bone density are associated with a risk of ____ (and resulting morbidity and mortality) as a result of even minimally traumatic events

fracture

If bisphosphonates are discontinued, fracture risk should be re-evaluated after every new ___, or after __ years if no new fracture occurs.

fracture; 2

Denosumab (Prolia) has a role in prevention of skeletal-related events (such as pathologic ____, _____ compression or radiation to bone) in patients with bone metastases from solid tumors

fracture; spinal cord

Hormone replacement therapy (HRT) has been shown to protect against ____, as well as to alleviate climacteric symptoms related to ____.

fractures; menopause

Irritative symptoms associated with enlargement of the prostate gland- increased ____ during the day and at night

frequency

Adverse Effects of Estrogens: increased risk of ____ stones

gall

Some problems may not show up until later ____, e.g., DES

generations

5-ARIs are teratogenic; women of childbearing age should use ____ when handling these tablets since they can be absorbed through the ___

gloves; skin

Disruption of the regular menstrual cycle secondary to testosterone-induced suppression of _____ secretion can lead to amenorrhea or oligomenorrhea

gonadotropin

Male clients can experience feminization during prolonged therapy with testosterone, which is believed to result from inhibition of _____ secretion and conversion of androgens to ____

gonadotropin; estrogens

During the menopausal transition, physiologic changes in responsiveness to ______ and their secretions occur, with wide variations in _____ levels

gonadotropins; hormone

The Medical Letter, November 10, 2003, reviewed this new approval and concluded: "At a cost of more than $20,000 per year, somatropin can increase the height of short children without ___ ___ deficiency who can tolerate __-__ injections a week for years. To date there is no definite evidence that somatropin causes serious, irreversible adverse effects, but it has never been used in as large a population of children as this indication permits."

growth hormone; 6-7

GH is used for treating ____ failure due to growth hormone deficiency (GHD), chronic ____ disease, or ____'s syndrome and for treating cachexia and AIDS ____

growth; renal; Turner; wasting

NO then activates the enzyme ____ cyclase, which results in ↑ levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation of the corpus ____ and allowing inflow of blood.

guanylate; cavernosum

Consider "hidden" caffeine: g___, ___ nuts, coffee beans, and ___ leaves. They'll be listed as ingredients, but not counted in the caffeine content.

guarana; cola; mate

These effects include breast soreness and _____. Feminizing effects are generally reversible/irreversiblein men

gynecomastia; reversible

Approximately ____ of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use

half

The most common side effects of PDE-5 Inhibitors include h_____, f____, ____ congestion, i_____, dyspepsia, visual disturbances such as color perception (___ and ___), _____ loss, amnesia, opthalmic problems

headache; flushing; nasal; indigestion; blue and green; hearing

Patients using testosterone should seek medical attention immediately if symptoms of a _____ or ____ are present, such as chest pain, shortness of breath or trouble breathing, weakness in one part or one side of the body, or slurred speech

heart attack; stroke

Women who use oral contraceptives have a significantly lower rate of death from any cause, including ____ disease and all ____, compared with women who have never used the products

heart; cancers

FDA required prescribing information for GnRH agonists warns about the potential risk for ___ disease and _____ in these men.

heart; diabetes

Creatine may help with brief, ___-intensity exercise, such as sprinting, power lifting, etc. But it isn't going to make you the next Mr. or Ms. Olympia.

high

Although all progestins (as well as pregnancy) increase the risk for blood clots, the 3rd and 4th generation progestins have a lower/ higher risk of venous thrombosis than 2nd generation progestins (levonorgestrel).

higher

Ortho Evra causes a lower/higher risk of venous thromboembolism (VTE), than women using birth control pills.

higher

The rate of unintended pregnancy in the U.S. is much lower/ higher than in other developed nations

higher

Contraceptives containing drospirenone or cyproterone acetate may be most effective for treatment of ____, but all combined contraceptives appear to be similarly effective against ____

hirsutism; acne

Side Effects of Progestins: Androgenic effects—____ (facial hair) and ____

hirsutism; alopecia

The most risky time to miss pills is just before or after a _____ interval.

hormone-free

If two or more pills are missed in the last week before a ____ interval, finish the active pills, then start a new pack the next day. Or, use a backup contraceptive until they have taken active pills for __ days

hormone-free; 7

Women who are "equol producers" seem to have modestly fewer ____ or night sweats per day than non-producers

hot flashes

Proponents claim that bioidentical hormones are safer and better tolerated than Premarin, Provera, and other non-____ hormones.

human

Clinical Uses of Progestins: Menstrual disorders (____menorrhea, ___menorrhea, and ___menorrhea) and abnormal uterine bleeding

hyper; a; dys

If the "morning sickness" is severe, it is known as ____ ____, and often requires hospitalization.

hyperemesis gravidarum

Caution since prostaglandins can cause uterine _____ and rupture.

hyperstimulation

The most common contraindications of oral contraceptives include ___, smoking over age __, history of ____ disease or venous thromboembolism, and current or history of breast cancer

hypertension; 35; cardiovascular

Methimazole (Tapazole) and propylthiouracil (PTU) used for ______ are category D, but are generally used during pregnancy since failure to treat could have grave consequences to the mother and the fetus

hyperthyroidism (Graves' disease)

For men with true male ____, the benefits outweigh the potential risks associated with testosterone therapy, but for many overweight sedentary men, a healthy lifestyle with regular exercise and reduced caloric intake is the wiser choice

hypogonadism

Diethylstilbestrol (DES) was later found that there is a link to ____ (urethra ends somewhere along the penis or close to the scrotum, rather than at the tip) in male offspring too.

hypospadias

Due to additive ______ effects, clients taking _____ (nitroglycerin, isosorbide dinitrate—Isordil or isosorbide mononitrate—ISMO, Imdur) should not use PDE-5 Inhibitors due to a drop in blood pressure

hypotensive; nitrates

GnRH agonists and LHRH agonists are used in women to treat various problems such as PMS, primary _____ amenorrhea, endometriosis, uterine ____ and benign ___ disease (FBD)

hypothalamic; fibroid(s); breast

Once bound to the receptor, progestins slow the frequency of release of gonadotropin releasing hormone (GnRH) from the _____ and blunt the pre-ovulatory LH surge, thereby preventing follicular maturation and ovulation

hypothalamus

IV administration of _____ (Boniva, and generics) every 3 months or _____ acid (Reclast, and generics) once a year are other alternatives.

ibandronate; zoledronic

The data suggest that emergency contraceptives are unlikely to act by interfering with ______, although the possibility has not been completely excluded

implantation

Viagra offsets _____, which can be a side-effect of testosterone injections

impotence

Increase/ decrease the progestin dose if bleeding persists with a progestin-only or multiphasic OC.

increase

Tri-phasic oral contraceptives have increasing/decreasing amounts of progestin with each 7 tablets

increasing

Denosumab (Prolia) labeled _____ is more limited (i.e., for patients at high risk of fracture related to osteoporosis; not indicated solely for _____ of osteoporosis)

indication; prevention;

Denosumab (Prolia) has fewer labeled ____ (compared with alendronate, risedronate, and zoledronic acid that are also indicated for the treatment of ____ in men, _____-induced osteoporosis, and Paget's disease).

indications; osteoporosis; glucocorticoid

Denosumab (Prolia) has a greater risk of being associated with the occurrence of serious _____

infections

Warn patients who do not want to become pregnant that they may no longer be _____ once starting these treatments. Make sure they realize that ____ ____takes on new importance

infertile; birth control

Either clomiphene or letrozole may be combined with intrauterine _____ to increase the likelihood of conception, particularly in couples with oligospermia

insemination

Too little fluid exacerbates an already constricted ____ volume and leads to further end-organ ____

intravascular; ischemia

Loestrin 24 Fe (norethindrone acetate/ethinyl estradiol and ferrous fumarate) provides 24 days of active hormonal therapy with four days of __ containing placebo pills

iron

Tylenol (acetaminophen), for example, carries this warning and is/ is not generally considered safe to take during pregnancy

Labels on aspirin, naproxen sodium (Aleve) and ibuprofen (Advil, Motrin) advise against use during the ___ trimester because they may harm the fetus or cause complications during _____.

last; delivery

Denosumab (Prolia) is administered more/ less frequently (compared with alendronate, ibandronate, and risedronate)

less

The dose of HRT is more/less than for contraception

less

ACOG has concluded that there is/ is no scientific evidence to support claims of increased efficacy or safety for individualized estrogen or progesterone regimens prepared by compounding pharmacies

is no

When one active pill is late or missed at any time in the cycle, take it as soon as it's remembered, then continue the remaining pills at the usual time. There is/ is no need to use backup contraception.

is no

The Medical Letter, May 31, 2010: There is/ is no acceptable evidence that bioidentical hormones are safe and effective. Patients should/ should not be discouraged from taking them.

is no; should

Compared with placebo or no intervention, the use of combination contraceptives is/is not associated with weight gain

is not

The pill, a drug called NorLevo, comes with a warning label about weight. A dose increase of levonorgestrel is/ is not proven to be a solution for this problem.

is not

Viagra is/ is not banned by Major League Baseball and other professional leagues

is not

hCG is/ is not approved for weight loss

is not

Necrotic, nonhealing lesions of the ___ have also been reported after tooth extraction and other dental procedures, in some women taking _____ and other "antiresorptive drugs."

jaw; bisphosphonates

Bromocriptine (Parlodel) is still sometimes used to suppress ____ in women who choose not to breast-feed following delivery, although this indication has been ____

lactation; removed

Treatment with testosterone has been shown to improve ____ profiles and ____ resistance and increase the time to ST _____ during stress testing.

lipid; insulin; depression

Contraindications for Estrogens: Known ___ dysfunction or disease

liver

FDA Contraindications for Menopausal Hormone Therapy: active ____ disease

liver

Oral estrogens have their "first-pass" through the ___ before they get into the general circulation while estrogen from the patches goes directly into the ____ and do not go through the liver

liver; blood

Cabergoline (Dostinex) has a shorter/longer action and more convenient dosing regimen that bromocriptine

longer

FDA changed the labeling in the PI for the bisphosphonates to suggest stopping the bisphosphonate 3 to 5 years in patients with __ fracture risk. They may need to continue if they have a ____ fracture risk

low; high

Oxytocin (Pitocin) is used as continuous __-dose infusion or _____ delivery

low; pulsatile

Level A: Healthcare providers should individualize care and use the ____ effective dose for the ___ duration.

lowest; shortest

Level B: Nonestrogen water-based or silicone-based ____ and moisturizers may alleviate ___

lubricants; pain

PMS is a common cyclic disorder of young and middle-age women and is characterized by emotional and physical symptoms that consistently occur during the ____ phase of the menstrual cycle

luteal

Progesterone is secreted from the corpus luteum in response to ____ hormone

luteinizing

Progestins blunt ____ hormone release, and estrogens suppress _____ hormone . Both ultimately inhibit maturation and release of the dominant ovule

luteinizing (LH); follicle-stimulating (FSH)

Another 1/3 is due to a ____ infertility factor. The remaining third is unexplained

male

Finasteride is on the World Anti-Doping list because it can be used as a(n) _____ agent to conceal _____ drugs

masking; performance-enhancing

Progesterone-only contraceptives, such as oral _____ (Provera), are generally considered first-line drugs for treatment.

medroxyprogesterone

Previous studies have had mixed results with soy's effects on _____ symptoms. Some show a modest benefit, while others show no benefit at all

menopausal

In 2012, Natazia was approved for the treatment of heavy menstrual bleeding (HMB). This is the first oral contraceptive indicated for the treatment of HMB or _____

menorrhagia

Progestins are used to treat a____, abnormal uterine ____, preterm birth, or as a c____.

menorrhea; bleeding; contraceptive

The amount of the estrogens in the body varies over the course of the ____ cycle

menstrual

Combined oral contraceptives can help regulate ____ cycles in women who don't want to get pregnant. OCs also tend to decrease ____ levels.

menstrual; androgen

Prolactin affects the ____ cycle and _____ production, thus have effectiveness in treating menstrual and fertility problems, galactorrhea, and prolactinomas

menstrual; breast milk

Risk factors for dysmenorrhea include nulliparity, heavy ____ flow, s____, and d_____

menstrual; smoking; depression

PCOS causes _____ irregularities and excessive androgen (_____) levels which leads to infertility, obesity, acne, and hirsutism

menstrual; testosterone

In 2013, in DSM-5, PMDD is officially moved to the main body of DSM-5, thus making it a _____illness

mental

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ______ (Rheumatrex)

methotrexate

The combination of _____ and misoprostol (Cytotec) is off-label, but about 90% effective up to ___ days for inducing abortions

methotrexate; 49

Orally administered testosterone is not absorbed well unless it is ____, which then renders it ____, e.g., methyltestosterone

methylated; hepatotoxic

L-____ is being promoted by some manufacturers as a more active form of folic acid

methylfolate

Hormonal contraceptives may also be of benefit in preventing menstrual ____, treating pelvic pain caused by _____, and treating bleeding from uterine ____

migraines; endometriosis; fibroids

Successful reproduction in mammals demands that mothers become attached to and ____ their offspring immediately after birth.

nourish

The progestin-only "mini-pill" formulations are generally used when there are contraindications to estrogens, such as for ____ mothers and women that do not tolerate _____. Brand names include Micronor and NOR-Q.D.

nursing; estrogen

Diethylstilbestrol (DES) was used extensively in the 50s and 60s to prevent _____

miscarriages

Mifepristone (Mifeprex) is usually administered in conjunction with _____ given up to 72 hours later.

misoprostol (Cytotec)

The Medical Letter: There is no convincing evidence that multiphasic OCs are superior to ____ OC's, or vice-versa. There is no evidence that they cause fewer adverse effects or improve ____ control

monophasic; cycle

Femring provides more/ less estradiol than Estring.

Level A: Low-dose and ultra-low systemic doses of estrogen have a more/less favorable adverse effect profile than standard doses.

CCBs relax the ____ by blocking calcium channels

myometrium

High doses can lead to n____ and renal insufficiency. Calcium ____ is less likely to cause stone formation

nephrocalcinosis; citrate

PDE-5 Inhibitors were originally associated with NAION (non-arteritic anterior ischemic optic neuropathy), a rare condition that can cause permanent vision loss in one or both eyes. This condition occurs when the optic ____ is starved of blood. At risk groups are diabetics and people with _____. In 2009, it was reported that these products did/ did not cause ophthalmic problems as manifested by changes in electroretinography (ERG) and other retinal function parameters during 6 months of daily use of tadalafil, sildenafil citrate, or placebo

nerve; hypertension; did not

Calcium channel blockers, e.g., _____ (Procardia) are used off-label as a _____ and for treating severe menstrual cramps because _____ is necessary for muscle contraction

nifedipine; tocolytic; calcium

The physiologic mechanism of erection of the penis involves release of ____ ___ in the corpus cavernosum during sexual stimulation.

nitric oxide (NO)

_____ females do not manifest such nurturing behavior.

non-lactating

Unfortunately, HRT has a number of adverse effects and many patients are _______

noncompliant

Alpha-blockers are used ____ in women to improve symptoms due to bladder ____ obstruction. This obstruction can cause urinary difficulties, similar to those seen in men with BPH

off-label; outlet

Women thinking of using DMPA need to be carefully counseled about initial increases in spotting and bleeding and eventual _____ or amenorrhea

oligomenorrhea

ED can be ____ and/or _____ in nature

organic; psychogenic

In 2013, the FDA approved ____ (Osphena) for treating dyspareunia in postmenopausal women

ospemifene

Teriparatide (Forteo) is the first FDA approved treatment for osteoporosis that stimulates _____ that leads to new bone formation (____ effect). Older drugs work to stop or slow bone loss.

osteoblasts; anabolic

Lack of estrogen after menopause is associated with rapid bone loss due to increased _____ activity and bone _____

osteoclast; resorption

Bisphosphonates inhibit the activity of _____ and decrease bone turnover and _____ ("Anti-resorptive agents").

osteoclasts; resorption

The middle group between -2.5 and -1.0 is defined as having _____

osteopenia

Estrogens are helpful for ____, but are no longer recommended solely for prevention

osteoporosis

HT is NOT approved by the FDA as a treatment for _____ in Perimenopausal or postmenopausal women aged 50 to 59; women aged 60 to 79; women with premature or early menopause

osteoporosis

Teriparatide (Forteo) is best offered to postmenopausal women with _____ who are at high risk for fracture.

osteoporosis

Young women treated with GnRH agonists for endometriosis may never achieve peak bone mineral density BMD, increasing their risk for _____ later in life

osteoporosis

Raloxifene (Evista) is a SERM approved for ____ prevention and treatment of ___ cancer

osteoporosis; breast

Postmenopausal women with _____ who have an inadequate dietary intake of calcium and vitamin D should take calcium and vitamin D ____ to reduce their risk of fractures

osteoporosis; supplements

Recent studies with combined oral contraceptives show a decrease in ____ cancer, as well as colorectal cancer

ovarian

Estradiol (E-2) is naturally occurring in the human body, secreted by the ____. However, estradiol is low potency when given orally

ovaries

Progesterone is naturally produced by the ____, and it softens the ___ lining into a spongy bed that holds a fertilized egg

ovaries; uterus

Clinicians should be cautious about ordering testosterone measurements in younger ____ men who feel that they are not as muscular as they should be or in middle-aged to older men who simply do not "feel right" and want to feel ____.

overweight; younger

Combination oral contraceptives prevent ____ by basically making your body "think" it is pregnant and stopping the ovary from releasing an egg.

ovulation

The evidence strongly supports disruption of _____ as a mechanism of action

ovulation

About 1/3 of infertility is due to problems with ____ or an anatomic abnormality of the ____ tube or ____, such as scarring, adhesions or endometriosis

ovulation; fallopian; peritoneum

The data also suggest that emergency contraceptives are ineffective after _____. Women and clinicians who consider implantation or later events to be the beginning of pregnancy should be aware that emergency contraceptives are likely non____ by this definition of pregnancy

ovulation; nonabortive

Clomiphene (Clomid) is used to stimulate ___ in women trying to get pregnant. It's given either alone or with ______.

ovulation;metformin

Limit high-___ foods (black tea, chocolate, etc.) and limiting sodium to ____ mg/day to reduce calcium in the urine.

oxalate; 2300

Potassium citrate increases urinary ____ to help prevent calcium from forming crystals.

Calcitonin may also be given to reduce ____ from bone metastases and osteoporosis

pain

Typical signs and symptoms of osteonecrosis of the jaw include p__, s_____, infection, or poor healing of the ___, _____ of the teeth, numbness or a feeling of _____ in the jaw, and _____ of exposed bone.

pain; swelling; gums; loosening; heaviness; drainage

Because of the high cost, _____ hormone peptides should be used only for patients at very high risk, especially for vertebral fractures.

parathyroid

Teriparatide (Forteo), the 1-34 sequence of _____ hormone, has been shown to reduce the risk of vertebral and nonvertebral fractures, but it must be injected ____ and it is expensive.

parathyroid; daily

Level A: The only nonhormonal therapy approved to treat vasomotor symptoms is ____, and to treat dyspareunia is ____

paroxetine; ospemifene

For women refractory to this combination therapy, a ____, e.g., Phenergan, Compazine; ____ (Reglan); or _____(Zofran) can each be tried successively

phenothiazine; metoclopramide; ondansetron

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: ______ (Dilantin)

phenytoin

Viagra might help women with certain types of sexual dysfunction—those with ____ problems, but not _____ problems. But there is conflicting data and no company has sought regulatory approval in the U.

physical; psychological

Plants such as soy and red clover contain physiologically active _____, but these are not identical to endogenous estrogens.

phytoestrogens

Endogenous human growth hormone (hGH) is produced in the _____ gland

pituitary

GnRH agonists and LHRH agonists desensitize _____ LHRH receptors and inhibit ___ and ___ secretion

pituitary; LH ; FSH

The primary action of the combination products is to suppress the hypothalamic-____ system, decreasing the secretion of _____-releasing hormone (GnRH).

pituitary; gonadotropin

Testosterone is also being studied as a male birth control drug. This is due to the negative feedback from the ____ to the ___ to decrease natural production of sperm

pituitary; testes

According to the October 2011 issue of Natural Medicines Comprehensive Database, two NIH-sponsored studies suggest that saw palmetto is no more effective than ____.

placebo

Preeclampsia is related to defective _____, that as a result, inadequate perfusion and placental ____ lead to endothelial dysfunction, with ____ and clotting system activation.

placentation;ischemia; platelet

The risk of venous blood clots is already included in the labeling of testosterone products as a possible consequence of _____, but because there have been postmarket reports of venous blood clots unrelated to ____, FDA is requiring this change

polycythemia; polycythemia

The SERM raloxifene (Evista) is most often considered for ____ women with low bone mass or younger postmenopausal women with _____

postmenopausal; osteoporosis

The combination of conjugated estrogens and bazedoxifene is indicated only for _____ women who still have a _____.

postmenopausal; uterus

Add ____ citrate or a ____ if diet isn't enough, especially for patients with recurrent calcium stones.

potassium; thiazide

The VTE risk with hormonal contraceptives is still lower than the risk with ____: 5 - 20 clots/10,000 and 40 - 65/10,000 women postpartum

pregnancy

Contraindications for Estrogens: Known or suspected ____

pregnancy (Pregnancy category X)

Women with pre-existing medical conditions, such as asthma or high blood pressure, may need to continue to use prescription drugs to treat those conditions during ____ and ____

pregnancy and breastfeeding

The main reasons for treating symptoms of the menopausal transition and actual menopause are as follows: - To provide relief of vasomotor symptoms - To reduce the risk of unwanted ____ - To avoid the _____ of menstrual cycles

pregnancy; irregularity

Emergency contraception is similarly safe in both adolescents and adults, and safer than _____. Repeated use is/ is not riskier

pregnancy; is not

To avoid possible teratogens, the woman must know she is ____. This is not always the case

pregnant

DMPA can be administered at any time in a woman's cycle when she is not ____, if she uses __ days of back-up method following injection.

pregnant; 7

If a woman is already ____, the pill has no effect. It works by preventing ovulation or ____ of an egg

pregnant; fertilization

In 2011, the FDA warned that injectable terbutaline should not be used to prevent ____ labor or to treat it beyond __ to __ hours because of a potential for cardiac problems or death

preterm; 48 to 72

Systemic estrogen products are government approved in the U.S. and Canada for ____, but not _____, of postmenopausal osteoporosis

prevention; treatment

With increased APC resistance, this inhibition is not in effect and the coagulation cascade proceeds. The net effect is a _____ effect.

procoagulant

At the cellular level, progestins diffuse freely into target cells and bind to the ____ receptor.

progesterone

Mifepristone (Mifeprex) is a ____ receptor antagonist which is vital to sustaining pregnancy

progesterone

PMS Treatment: Natural _____—has been tried, but recent data suggests little benefit

progesterone

Use of combined contraceptives containing both estrogen and _____ is associated with a lower risk for the development of many types of cancer

progesterone

ella is a ____ agonist/antagonist whose likely main effect is to inhibit or delay ovulation

progesterone

Endometrial cancer risk is increased if estrogen is used without a _____

progestin

Femring will need a ___ to prevent endometrial hyperplasia.

progestin

In women, may co-administer a _____ or birth control pills to protect against ___ loss and hot flashes

progestin; bone

Level B conclusions ("limited or inconsistent scientific evidence"): Data do not support use of ____ alone, testosterone, compounded bioidentical hormones, phytoestrogens, ____ supplements, and ____ modifications.

progestin; herbal; lifestyle

Drugs used in the treatment of endometriosis include: - p_____ - D_____ -_____ agonists

progestins; Danazol; GnRH

In 2005, the FDA clarified the definition of "anabolic steroid" to include THG, p_____ and steroid precursors such as ______ ("Andro")

prohormones; androstenedione

Hyperprolactinemia is a condition in which excessive amounts of ____ enter the bloodstream due to benign tumors of the _____ gland

prolactin; pituitary gland

The administration of progesterone to women with adequate estrogen production transforms the uterus from a ____ to a ____ phase

proliferative; secretory

. Testosterone does not "cause" ____ cancer, but it does "feed" it.

prostate

GnRH agonists and LHRH agonists are used in men to treat ____ cancer and for "chemical _____."

prostate; castration

Estrogen patches like those used by menopausal women could benefit men with advanced ____ cancer. Estrogen reduces ____ levels, but giving the hormone orally causes _____ toxicity

prostate; testosterone;cardiovascular

The anti-HIV antiretroviral ______ inhibitors decrease the level of estrogen in patients receiving hormonal replacement therapy or oral contraceptive agents

protease

Excessive fluid administration can result in ______ edema, ascites and ____overload,

pulmonary; cardiopulmonary

In April 2013, the FDA approved the combination of doxylamine and _____ (Diclegis) to treat pregnant women with N&V who have not adequately responded to dietary and lifestyle changes

pyridoxine

Extraskeletal risks and benefits are important when considering _____ therapy.

raloxifene

The SERM _____ (Evista) is approved for both prevention and treatment of osteoporosis

raloxifene

One way drug manufacturers learn about the safety of medications is through pregnancy ____ -- studies that enroll pregnant women after they've begun taking a drug but before the ____ of the baby

registries; birth

α-1-Adrenergic Blockers can cause smooth muscles in the bladder neck and prostate to relax/contract, thereby reducing pressure on the ____ and improving urine flow rate.

relax; urethra

PDE-5 Inhibitors have no direct _____ effect, but enhance the effect of NO by inhibiting 5 phosphodiesterase enzyme—PDE5, which is responsible for _____ of cGMP in the corpus cavernous

relaxant; degradation

Health professionals should encourage use of cholecalciferol (D3) over ergocalciferol (D2) in all patients without severe ____ failure, either as a general supplement or as a treatment for vitamin D deficiency.

renal

PDE-5 Inhibitors may also inhibit other phosphodiesterase enzymes, such as PDE-6, found in the____. The degree of _____ of the three agents on these enzymes explains the differences in side effects

retina; selectivity

Prescriber's Letter, December 2014, states: bone loss is often ____ upon stopping and there's no proof of an increased risk of ____.

reversible; fractures

The "Pregnancy" and "Lactation" subsections will also include three subheadings: "____ summary," "_____ considerations" and "data.

risk; clinical

Adverse Effects of Anabolic Agents: Behavioral and personality changes (aggressive behavior)—"___ ___"

roid rage

No drug -- prescription or OTC -- has been proven absolutely ___ when you are pregnant

safe

Also available is calcitonin-____ nasal spray. It often causes severe nasal irritation, e.g., r____, e____ as well as nausea and flushing

salmon; rhinitis; epistaxis

In patients with osteoporosis, however, the enzyme attacks the ____ and permanently destroys the bone.

scaffolding

Endogenous progesterone is responsible for inducing _____ activity in the endometrium of the estrogen-primed uterus in preparation for the _____ of a fertilized egg and for the maintenance of _____

secretory; implantation; pregnancy

The goals of preeclampsia treatment are to prevent ____, lower blood pressure and to avoid maternal end-___ damage, and ____ delivery.

seizures; organ; expedite

Magnesium sulfate is FDA-approved to prevent ____ in preeclampsia and to control ____ in eclampsia, but not as a _____.

seizures; seizures; tocolytic

The prostate is responsible for the production of ____ fluid in men. With age, the gland enlarges and may become _____

seminal; cancerous

With a ____ regimen, predictable withdrawal bleeding occurs in many clients, and often persists for several years or longer.

sequential

Testosterone improves ____function, bone mineral density and increasing free-__ mass and strength

sexual; fat

A study of 7500 women in the St. Louis area showed that more women got pregnant while using ___-acting methods such as pills, patches and vaginal rings than those using ___-term contraception methods such as IUDs, medroxyprogesterone injection and skin implants

short; long

In 2012, the American College of Obstetricians and Gynecologists (ACOG) said the pill should/ should not be available OTC

should

Anticonvulsants Carbamazepine (Tegretol), Phenytoin (Dilantin), Phenobarbital ____ compromise OC Efficacy

significantly

Estrogens also contribute to shaping the ____ and bringing about the pubertal growth spurt of the ___ bones and its culmination by fusion of the ____

skeleton; long; epiphyses

For women who don't benefit from __ or can't take it, consider other options...estrogen, paroxetine, venlafaxine, clonidine, etc

soy

Most bioidentical hormones are derivatives of ___ or ___ extracts, chemically modified to be structurally identical to endogenous hormones.

soy; plant

Drospirenone is a _____ analogue that may be preferred by women who experience water retention associated with their menstrual cycle.

spironolactone

Too little estrogen: Early or mid-cycle breakthrough bleeding, increased ____, hypo_____

spotting; menorrhea

A few medications are labeled Pregnancy Category X, e.g., s___, e____, and p_____ medications Tegison and Soriatane. _____ (Accutane) is probably the most notorious

statins; estrogens; psoriasis; Isotretinoin

Another use of magnesium sulfate, given by paramedic's en-route, is to help prevent complications from ischemic ____.

stroke

Do not use combined OCs for women who have migraine WITH AURA due to a possible increased risk of ____. Use a progestin-only contraceptive instead

stroke

It has now been found that even though slow-release sodium fluoride does seem to increase BMD, the type of bone architecture is not ____

strong

Denosumab (Prolia) is an every six month (twice a year) _____ injection administered by a health care professional.

subcutaneous

Calcitonin has been available in parenteral form (Calcimar) for ____ or _____ injection for some time, but lagged in popularity because of its high cost and because clients are adverse to injecting themselves.

subcutaneous or intramuscular

Denosumab (Prolia) is administered ____ (compared with zoledronic acid that is administered ____).

subcutaneously; intravenously

.We only have 3 ways of boosting our blood levels of vitamin D: - Increasing ___ exposure - Intake of vitamin-D rich ____ - Taking vitamin D ______

sun; foods; supplements

There is no evidence that women with an adequate dietary intake of calcium and vitamin D benefit from taking _____, but an adequate intake of _____ may be difficult to achieve by diet alone.

supplements; vitamin D

Denosumab (Prolia) causes significant _____ of bone turnover and this may contribute to the occurrence of _____ of the jaw, atypical ____, and delayed fracture healing

suppression;osteonecrosis; fractures

Professional society guidelines recommend testosterone therapy for patients with _____ testosterone deficiency.

symptomatic

Level A: Thromboembolic disease and breast cancer are risks for combined ____ HT

systemic

There is some ____ absorption of topical estrogens

systemic

Side effects of Forteo include dizziness and ____ following injection. It usually subsides after the first few doses

tachycardia

Many of these anti-estrogens such as _____ (Nolvadex) and ____ (Aromasin) are used in breast cancer treatment

tamoxifen; exemestane

Adverse Effects of Estrogens: breast ____ or enlargement and edema

tenderness

Too much estrogen: Nausea, bloating, breast _____, increased _____, melasma, headache

tenderness; blood pressure

Too much progestin: Breast _____, headache, fatigue, changes in ____

tenderness; mood

β-2 agonists: _____ (Brethine) are used via IV infusion and continued for ~__ hours after contractions cease

terbutaline; 12

For women taking antiresorptive drugs (except ___), achieving an adequate intake of both calcium and vitamin D will often require taking a supplement

teriparatide

As such, hCG is commonly used during and after steroid cycles to maintain and restore ____ size as well as normal ____ production.

testicular; testosterone

5-α-reductase metabolizes _____ to DHT in the prostate gland, which causes enlargement

testosterone

Progesterone is derived from_____, so progestins have androgenic effects.

testosterone

The ovaries continue making small amounts of ______, which can be converted to estradiol

testosterone

prescribing _____ therapy to women is ill-advised in most situations. Authors of the guideline suggest that the benefit of possibly improved sexual function doesn't outweigh the many unknowns about side effects.

testosterone

When AAS are put into a male body, the body's natural negative-feedback loops cause the body to shut down its own production of _____via shutdown of the ___-____-gonadal axis

testosterone;hypothalamic-pituitary

if hCG is used for too long and in too high of a dose, the resulting rise in natural _____ will eventually inhibit its own production via negative feedback on the ____ and pituitary.

testosterone;hypothalamus

Note on _____: This drug was developed in the 1950s in Germany and used without a prescription as a sleeping pill and for "morning sickness." It was found to cause serious birth defects and it is the principal reason U.S. drug laws are so strict and it was not approved

thalidomide

Contraindications for Estrogens: Active (within the past year) ____ disease (VTE) or ____ ____ (PE)

thromboembolic; pulmonary embolism

Adverse Effects of Estrogens: increased risk of venous _____

thromboembolism (VTE)

The WHI study demonstrated that the major risks of hormone therapy (HT; estrogen and progestin) are venous _____ and ____ cancer

thromboembolism; breast

According to a small observational conjugated equine estrogens (CEEs) showed an association with increased risk for venous ____ and possibly myocardial ____, when compared with oral estradiol.

thrombosis; infarction,

Drugs that Deplete Calcium or Can Contribute to Osteoporosis: _____ hormone in excessive doses

thyroid

Clinical Uses of Progestins: reduce premature births (____)

tocolytic

Terbutaline is not FDA approved as a ____, but is used "off-label.

tocolytic

Uterine Relaxants manage pre-term labor ("_____") Preterm birth is defined as occurring before ___ weeks of gestation

tocolytic; 37

Denosumab (Prolia) may be effective and/or better ___ in some patients who have failed or can't tolerate other ____.

tolerated; therapies

Lysteda tablets (____ acid), (also available as Cyklokapron for bleeding disorders) works by stabilizing a ____ that helps blood to clot

tranexamic; protein

An ACOG Committee Opinion from April 2013 found that ____ delivery is safer than oral administration of HT.

transdermal

To prevent kidney stones, drink ____ 8-oz glasses of liquid/day, or enough to produce ≥ __ L/day of urine

twelve; 2

PMDD is characterized by depressed or labile mood, anxiety, irritability, anger and other symptoms, limited to ___week(s) before menses.

two

Up to ___ of patients with hip fracture never regain their pre-fracture activity status; in fact __ in five dies during the following year.

two-thirds; 1

Failure to adhere to dosing guidelines can result in severe esophageal ______

ulcerations

:The osteosarcoma data is based on an 18 month animal study at very high doses from birth. It is likely/ unlikely to occur in humans at normal doses given when osteoporosis occurs

unlikely

The client must then remain ____ after bisphosphonates and wait ___ minutes (for Fosamax and Actonel; __ minutes with Boniva) before eating or drinking anything—even juice can significantly reduce its absorption.

upright; 30; 60

Alpha-blockers can help increase urine flow by relaxing the bladder neck and ___

urethra

Irritative symptoms associated with enlargement of the prostate gland- _____ and ____ incontinence

urgency and urge

Estradiol Vaginal Tableta (Vagifem) are commonly used for atrophic vaginitis and ____ symptoms, not for ____ effects.

urinary; systemic

Oxytocin (Pitocin) induces labor and stops ____ bleeding postpartum

uterine

Uterotonic Drugs stimulate ____ motility ("oxytocic") to induce labor and provide ____ ripening and to decrease post-partum ____

uterine; cervical; hemorrhage

Endometriosis occurs when tissue that is supposed to line the ____ starts growing elsewhere in the body—on the ovaries, fallopian tubes, the bladder and elsewhere

uterus

The same events that affect the ____ and mammary gland at the time of birth also affect the brain.

uterus

Progesterone increases basal body temperature, causes histologic changes in _____ tissues, inhibits uterine ____, inhibits ____ secretion, stimulates ____ alveolar gland tissues, and precipitates withdrawal bleeding in the presence of ____

vaginal; contractions; pituitary; mammary; estrogen

Diethylstilbestrol (DES) was removed from the human market in 1971 since it was associated with second and third generation ____ cancer, birth defects and _____ in females.

vaginal; infertility

The oral contraceptive Natazia (estradiol ____/dienogest) was recently also approved for the treatment of heavy menstrual bleeding (HMB)

valerate

Four-phasic (Natazia) is the first OC to contain 17-β estradiol (estradiol ____) instead of ethinyl ____, the synthetic estrogen in most OCs

valerate; estradiol

A patient complaining of ED is a good opportunity to assess for carotid, coronary, renal, etc. _____ problems

vascular

Magnesium sulfate is a _____ to increase blood flow to the brain and blocks ____ that overloads cells in the brain when blood flow is reduced

vasodilator; calcium

Level A: SSRIs, SNRIs, clonidine, and gabapentin relieve ____ symptoms and are alternatives to HT.

vasomotor

Use a low estrogen OC with almost continuous estrogen dosing (Lo Loestrin Fe, etc) for women with ____ symptoms or poor cycle control

vasomotor

Clinical Uses of Estrogens: - HRT for menopause and ____ symptoms - C______ - Atrophic _____ - D_____

vasomotor; contraception; vaginitis; dyspareunia

Calcitonin is not recommended for treating bone pain, except bone pain from acute ____ compression fractures.

vertebral

The SERM raloxifene (Evista) prevents bone loss and reduces the risk of ____ fractures, but its effectiveness in reducing other fractures is uncertain

vertebral

Estrogen receptor agonists can increase bone mineral density and reduce the risk of ____ fractures. They have not been shown to reduce the risk of ______ fractures

vertebral; nonvertebral

Merck warned Canadian women that NuvaRing should not be used by women who have had migraine headaches with ____ problems or constant stomach pain caused by _____ dysfunction

vision; pancreatic

Tadalafil (Cialis) has the lowest effects on the phototransduction pathway of the ____, thus the lowest incidence of ____ side effects, of any of the three agents due to its less selectivity for PDE-6.

visual; retina

The Selenium and Vitamin E Cancer Prevention Trial (SELECT) originally found no reduction in prostate cancer risk associated with either selenium or vitamin E. A follow-up study by Klein and colleagues conclude that dietary supplementation with _____ significantly INCREASED the risk of prostate cancer among healthy men.

vitamin E

Dyspareunia is _____ atrophy leading to pain during sexual intercourse

vulvovaginal

According to the medical definition, pregnancy doesn't being until a fertilized egg implants itself into the ____of the uterus

wall

If given orally bisphosphonates must be used as follows: To be taken with plain ___ first thing in the morning on a full/empty stomach.

water; empty

Once affixed, the patch offers regular transdermal delivery of the hormones for 1 ____

week

Legit Uses of Anabolic Agents: ____ and anemia- due to _____ effect

weight loss; erythropoietic

After 3 years of ____ acid treatment, the benefits on BMD density persist for at least another __ years after discontinuation.

zoledronic; 3

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Section #4 Men and Women

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