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Reproductive pharmacology - Coggle Diagram
Reproductive pharmacology
leuprolide
for uterine fibrosis, endometriosis, precocious puberty, prostatic cancer, infertility
GnRH analog: with agonist properties (in pulsatile fashion); with antagonist properties (in continuous fashion
estrogen
for hypogonadism, ovarian failure, menstrual abnormalities, hormone replacement therapy in postmenopausal women
adverse: ↑risk of endometrial cancer, thrombi; contraindicated in ER+ breast cancer, history of DVT, tabacco use in women >35 years old
ethinyl estradiol, DES, mestranol
selective estrogen receptor modulators
tamoxifen
antagonist at breast; agonist at bone, uterus; risk of thrombi and endometrial cancer
for ER/PR + breast cancer
reloxifene
antagonist at breast, uterus; agonist at bone; risk of thrombi
for osteoporosis
clomiphene
antagonist at estrogen receptors in hypothalamus;
for infertility due to anovulation
aromatase inhibitors
inhibit peripheral conversion of androgen to estrogen
ER+ breast cancer
hormone replacement therapy
risk of endometrial cancer, cardiovascular risk
for relief or prevention of menopausal symptoms, osteoporosis
progestin
bind progesteron receptor; ↓growth and ↑vascularization of endometrium, thicken cervical mucus
for contraception(避妊), endometrial cancer, abnormal uterine bleeding
antiprogestin
competitive inhibitor of progestin
for termination of pregnancy, emergency contraception
combined contraception
estrogen, progestin: inhibitLH/FSH→no estrogen surge
progestin: thickening of cervical mucus→inhibit sperm entering; inhibit endometrial proliferation
progestin, ethinyl estradiol
contraindication: smokers>35 years old; patients with risk of cardiovascular disease; migraine, breast cancer, liver disease
copper intrauterine device
for long-acting reversible contraception, emergency contraception
risk of PID
produce local inflammatory reaction toxic to sperm and ova
tocolytics
for ↓ contraction frequency and allow time for administration of steroid or transfer to appropriate medical center with obsterical care
relax uterus; include terburaline, nifedipine, indomethacin
danazol
for endometriosis, hereditary angioedema
synthetic androgen that act as partial agonist at androgen receptors
testosterone, methyltestosterone
for hypogonadism, promoting development of 2° sex characteristic
agonist at androgen receptors
antiandrogens
flutamide: nonsteroidal competitive inhibitor at androgen receptor; for prostate carcinoma
ketoconazole: inhibit steroid synthesis
finasteride; 5αreductase inhibitor; for BPH and baldness
spironolactone: inhibit steroid binding
tamsulosin
for BPH
α₁-antagonist; inhibiting smooth muscle contraction
phosphodiesterase 5 inhibitors
for erectile dysfunction, pulmonary hypertension, BPH
inhibit PDE-5→↑cGMP→prolonged smooth muscle relaxation in response to NO→↑blood flow in corpus cavernosum of penis; ↓pulmonary vascular resistance
minoxidil
for androgenetic alopecia, severe refractory hypertension
direct arteriolar vasodilator