What type of epithelium lines the outer surface of the
ovaries?
[Simple/Stratified]
[squamous/cuboidal/columnar] epithelium
Simple cuboidal epithelium
What type of epithelium lines the uterus in the proliferative phase versus the secretory phase?
- Proliferative phase → [Simple/Stratified] [squamous/cuboidal/columnar] epithelium with _____ _____ glands
- Secretory phase → _____ glands
Proliferative phase → Simple columnar epithelium with long tubular glands
Secretory phase → Coiled glands
What types of epithelium line the endocervix and ectocervix?
- Endocervix → [Simple/Stratified] [squamous/cuboidal/columnar] epithelium
- Ectocervix → [Simple/Stratified] [squamous/cuboidal/columnar], [keratinized/nonkeratinized] epithelium
Endocervix → Simple columnar epithelium
Ectocervix → Stratified squamous, nonkeratinized epithelium
What type of epithelium lines the vagina?
[Simple/Stratified] [squamous/cuboidal/columnar],
[keratinized/nonkeratinized] epithelium
Stratified squamous, nonkeratinized epithelium
Which female reproductive structure is lined by ciliated simple columnar epithelium?
_____ _____
Fallopian tubes
What is the area of greatest risk for cervical cancer in the female reproductive tract?
______ zone. This involves the squamocolumnar junction, where the ______ meets the ______.
Transition zone. This involves the squamocolumnar junction, where the ectocervix meets the endocervix.
What type of epithelium lines the vulva?
[Simple/Stratified] [squamous/cuboidal/columnar] epithelium
Stratified squamous epithelium
This is the ______ zone (aka ______ junction) of the ______.
This is the transformation zone (aka squamocolumnar junction) of the cervix.
Which part of the autonomic nervous system mediates
erection of the penis?
[Sympathetic/Parasympathetic] nervous system
Parasympathetic nervous system
Which part of the autonomic nervous system mediates
emission during the male sexual response?
[Sympathetic/Parasympathetic] nervous system
Sympathetic nervous system
What spinal nerves are responsible for expulsion
during the male sexual response?
______ nerves
______ nerves
This is via the ______ nerve.
Visceral nerves
Somatic nerves
This is via the pudendal nerve.
How does norepinephrine exert an
antierectile effect on the penis?
Norepinephrine causes vascular smooth muscle
[contraction/relaxation] through ______ influx → [Vasodilation/Vasoconstriction]
Norepinephrine causes vascular smooth muscle contraction through Ca2+ influx → Vasoconstriction
(Think of an erection as requiring relaxation of penile smooth muscle so blood can fill the erectile tissue. Norepinephrine does the opposite.)
Name the drug class that acts on the nitric oxide
pathway to treat erectile dysfunction.
_____
inhibitors reduce _____ breakdown → Vascular smooth muscle
relaxation and vasodilation
PDE-5 inhibitors reduce cGMP breakdown → Vascular smooth muscle relaxation and vasodilation
How does nitric oxide mediate penile erection?
Nitric
oxide causes [contraction/relaxation] of vascular smooth muscle
through _____ production → Increased penile _____ flow
Nitric oxide causes relaxation of vascular smooth muscle through cGMP production → Increased penile blood flow
What ligament connects the ovaries
to the lateral pelvic wall?
_____
ligament of the ovaries. This is also called the _____ ligament.
Suspensory ligament of the ovaries. This is also called the infundibulopelvic ligament.
Which ligament contains the uterine vessels?
_____ ligament. This is also called the transverse _____ ligament.
Cardinal ligament. This is also called the transverse cervical ligament.
Which ligament contains the ovarian vessels?
_____ ligament
Infundibulopelvic ligament
What ligament connects the uterine horn to the
labia majora?
_____ ligament of the uterus
Round ligament of the uterus
What ligament connects the medial pole of the ovary
to the uterine horn?
_____ ligament
Ovarian ligament
What three structures are contained within the broad
ligament of the uterus?
_____ ligaments of
the uterus
_____ _____
_____
Round ligaments of the uterus
Fallopian tubes
Ovaries
The round ligament travels above which artery?
Artery of _____
Artery of Sampson
What are the three components of the broad ligament?
_____
_____
_____
Mesovarium
Mesometrium
Mesosalpinx
Which three structures are connected to
pelvic side wall through the broad
ligament?
_____
_____ _____
_____
Ovaries
Fallopian tubes
Uterus
What ligament connects the cervix to the side wall of the pelvis?
_____ ligament. This is also called the transverse _____ ligament.
Cardinal ligament. This is also called the transverse cervical ligament.
The ureter is at risk of injury
during ligation of which two vessels during
oophorectomy and hysterectomy?
Oophorectomy → [...] vessels
Hysterectomy → [...] vessels
Oophorectomy → Ovarian vessels
Hysterectomy → Uterine vessels
Why does ligation of ovarian vessels during
oophorectomy pose a risk to the ureter?
The ______ course of the ureter positions it near the ovarian vessels
The retroperitoneal course of the ureter positions it near the ovarian vessels
Which two structures of the uterus and ovaries are derivatives of
gubernaculum?
______ ligament
______ ligament of the uterus
Ovarian ligament
Round ligament of the uterus
Through which canal does the round ligament
of the uterus travel?
_____ canal
Inguinal canal
The absence of how many sexual characteristics is classified as
delayed puberty?
The absence of _____ sexual
characteristics. This is by age _____ in males and age _____ in females.
The absence of 2 sexual characteristics. This is by age 13 in males and age 14 in females.
What are the two main causes of delayed puberty?
[Hypergonadotropic/Hypogonadotropic]
[hypergonadism/hypogonadism]
[Hypergonadotropic/Hypogonadotropic] [hypergonadism/hypogonadism]
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
What are three causes of hypogonadotropic
hypogonadism?
Constitutional delay of g_____ and p_____
_____ syndrome
_____ _____ system lesions
Constitutional delay of growth and puberty
Kallmann
syndrome
Central nervous system lesions
Where does lobular carcinoma most commonly manifest in the breast?
_____ _____ _____ unit
Terminal duct lobular unit
What parts of the breast are affected in Paget
disease?
_____ ducts
_____ ducts
Lactiferous ducts
Major ducts
What two breast pathologies arise in the stroma?
_____
_____ tumor
Fibroadenomas
Phyllodes tumor
Name the most common location for ductal carcinoma in situ or ductal carcinoma in the breast.
_____ _____ _____ unit
Terminal duct lobular unit
Where in the breast do fibrocystic
changes manifest?
_____ _____ _____ unit
Terminal duct lobular unit
What is the most common location for a breast abscess or mastitis?
_____ ducts
_____ ducts
Lactiferous ducts
Major ducts
In preparation for ovulation, increased estrogen leads to increased GnRH receptor expression in which organ?
______ ______
Anterior pituitary
What causes LH to surge during ovulation?
______ causes the LH surge. This leads to the rupture of an
______ ______ and ovulation.
Estrogen causes the LH surge. This leads to the rupture of an ovarian follicle and ovulation.
What causes transient midcycle
ovulatory pain?
Fallopian tube
[contraction/relaxation] or follicular ______ → ______ irritation.
This can mimic ______.
This is known as Mittelschmerz.
Fallopian tube contraction or follicular rupture → Peritoneal irritation
This can mimic appendicitis.
This is known as Mittelschmerz.
Mittelschmerz is basically pain caused by ovulation itself.
At midcycle:
______ surge → follicle ______ → ovulation → follicular fluid/small amount of ______ released into peritoneal cavity → peritoneal ______ → sudden ______ pain
LH surge → follicle rupture→ ovulation → follicular fluid/small amount of blood released into peritoneal cavity → peritoneal irritation→ sudden pelvic pain
What hormone causes a woman's temperature to rise during ovulation?
_______
Progesterone
Pain during ovulation can mimic which medical emergency?
Acute _______
Acute appendicitis
How is typical ovulation pain described?
[Unilateral/Bilateral]
_______
Unilateral
Mild
What is the underlying physiologic mechanism of peripheral edema in
pregnancy?
______ due to increased blood volume →
[Increased/Decreased] capillary oncotic pressure → Peripheral edema
Hemodilution due to increased blood volume → Decreased capillary oncotic pressure → Peripheral edema
Which three transport proteins are secreted at higher levels during
pregnancy?
______ -binding globulin
______ ______ -binding globulin
______ -binding globulin
Cortisol-binding globulin
Sex hormone-binding globulin
Thyroxine-binding globulin
What physiologic change in pregnancy predisposes a patient to gastroesophageal reflux disease?
increased _______→ smooth muscle _______→ _______ lower esophageal sphincter (LES) tone → gastric contents reflux into esophagus → GERD
increased Progesterone → smooth muscle relaxation → decreased lower esophageal sphincter (LES) tone → gastric contents reflux into esophagus → GERD
What physiologic changes predispose to gallstones in pregnancy?
Gallbladder stasis caused by ______ and ______
Gallbladder stasis caused by estrogen and progesterone
↑ Estrogen → ↑ cholesterol secretion into bile → cholesterol-supersaturated bile
↑ Progesterone → smooth muscle relaxation → ↓ gallbladder contraction → gallbladder stasis
What musculoskeletal changes will be seen in the joints of pregnant
patients?
Increased ______ laxity
(This is to facilitate fetal ______)
Increased joint laxity
This is to facilitate fetal descent.
List three possible dermatologic changes in pregnancy that are caused
by hyperpigmentation.
Darkening of a______
M______
L______ ______
Darkening of areolae
Melasma (patches on face)
Linea nigra (black line going down abdomen)
List three possible dermatologic findings in pregnancy that are
caused by vascular changes.
Palmar e______
S______ ______
______
Palmar erythema
Spider angiomas
Varicosities
Describe the physiologic change in pregnancy that predisposes to
pyelonephritis.
Ureter and renal pelvis
[dilation/constriction] → [Increased/Decreased] urinary stasis →
Resultant infection
Ureter and renal pelvis dilation → Increased stasis → Resultant infection
How does the glomerular filtration rate change during
pregnancy?
[Vasodilation/Vasoconstriction] →
[Increased/Decreased] renal plasma flow → [Increased/Decreased]
glomerular filtration rate
Vasodilation → Increased renal plasma flow → Increased glomerular filtration rate
What are the three major mechanisms of increased cardiac output
during pregnancy?
[Increased/Decreased] heart rate (major
contributor)
[Increased/Decreased] systemic vascular
resistance
[Increased/Decreased] blood volume
Increased heart rate (major contributor)
Decreased systemic
vascular resistance
Increased blood volume
What physiologic respiratory change should be expected in
pregnancy?
Chronic [hyperventilation/hypoventilation]
helps to eliminate excess fetal ______
Chronic hyperventilation helps to eliminate excess fetal CO2
What is the pathophysiology of anemia in
pregnancy?
[Increased/Decreased] plasma
volume and [increased/decreased] red blood cell mass → Dilutional anemia
Increased plasma volume and increased red blood cell mass → Dilutional anemia
What is the purpose of the hypercoagulable state that occurs during
pregnancy?
The hypercoagulable state helps reduce _____
_____ at the time of delivery
blood loss
How do insulin resistance and
hypoglycemia affect a pregnant patient and her
child?
Insulin resistance and hypoglycemia → m_______ of
fat stores to reserve g_______ and a_______ a_______ for the fetus
Insulin resistance and hypoglycemia → Mobilization of fat stores to reserve glucose and amino acids for the fetus
What two processes occur during spermiogenesis?
Spermatids lose their _______ contents and gain an _______
_______ to form mature spermatozoa
Spermatids lose their cytoplasmic contents and gain an acrosomal cap to form mature spermatozoa
Where does spermatogenesis occur?
_____ _____
Seminiferous tubules
What kind of barrier must the spermatogonia cross
during the replication stage of spermatogenesis?
_____
junctions of the _____-_____ barrier
Tight junctions of the blood-testis barrier
When does spermatogenesis begin in a male?
_____
Puberty
Differentiation of sperm occurs via meiosis I and meiosis II. Which
sperm subtypes are involved in each?
Meiosis I → _____
_____ to _____ _____
Meiosis II → _____ _____ to _____
Meiosis I → Primary spermatocyte to secondary spermatocyte
Meiosis II → Secondary spermatocyte to spermatid
What is the genetic makeup of a spermatogonium?
It is
[diploid/haploid] with [...] single chromosomes and a sex of ______-______
It is diploid with 46 single chromosomes and a sex of X-Y
What is the genetic makeup of a primary spermatocyte?
It
is [diploid/haploid] with ______ single chromatids and a sex of
______-______ or ______-______
It is diploid with 23 single chromatids and a sex of X-X or Y-Y
What is the genetic makeup of a secondary spermatocyte?
It is [diploid/haploid] with ______ single chromatids and a sex
of ______-______ or ______-______
It is haploid with 23 single chromatids and a sex of X-X or Y-Y
What is the genetic makeup of a spermatid?
It is
[diploid/haploid] with ______ single chromatids and a sex of ______
or ______
It is haploid with 23 single chromatids and a sex of X or Y
What is the genetic makeup of a mature spermatozoon?
It
is [diploid/haploid] with ______ single chromatids and a sex of
______ or ______
It is haploid with 23 single chromatids and a sex of X or Y
What is the order of development of a spermatozoan from a
spermatogonium?
Spermatogonium → ______ ______ → ______
______ → ______→ Spermatozoan
Spermatogonium → Primary spermatocyte → Secondary spermatocyte → Spermatid → Spermatozoan
How long do mature spermatids take to develop?
______ months
2 months
In cystic fibrosis, what is the cause of
infertility?
Absent ______ ______. Sperm
tail ______ is preserved.
Absent vas deferens. Sperm tail mobility is preserved.
Name two agents that block the conversion of plasminogen into
plasmin.
A______ ______
T______ ______
Aminocaproic acid
Tranexamic acid
What two pharmacologic treatments can be used to reverse the effects of thrombolytics?
A______ ______
T______ ______
Aminocaproic acid
Tranexamic acid
What type of heparin has the highest risk for the development of
heparin-induced thrombocytopenia?
_______ heparin
unfractioned heparin
How does heparin affect the PTT?
It increases it
By what mechanism does heparin anticoagulate?
Activates
________ → Reduced action of factor ________ and factor ________
Activates antithrombin → Reduced action of factor IIa and factor Xa
Name 4 clinical uses for heparin.
Immediate _____ for _____ _____ syndrome
_____ _____
_____ _____ _____
_____ _____
Immediate anticoagulation for acute coronary syndrome
Myocardial Infarction
Direct Vein Thrombosis
Pulmonary Embolism
Name four adverse effects of heparin.
Heparin-induced _______
Type _______ renal tubular acidosis
O_______
B_______
Heparin-induced thrombocytopenia
Type 4 renal tubular acidosis
Osteoporosis
Bleeding
What is used to reverse heparin?
_____ _____
Protamine sulfate
Can heparin be used during pregnancy?
Yes
How does the mechanism of action of the LMWH and fondaparinux differ
compared to unfractionated heparin?
LMWHs preferentially
inhibit Factor ______ over Factor ______
Fondaparinux only acts on factor ______
LMWHs preferentially inhibit Factor Xa over Factor IIa
Fondaparinux only acts on factor Xa
Which type of heparin-induced thrombocytopenia causes a mild nonimmunologic decrease in
platelets and is asymptomatic and
transient?
Heparin-induced
thrombocytopenia type ________
Heparin-induced thrombocytopenia type 1
How is heparin-induced thrombocytopenia type 2
managed?
Stop ________ and start a different ________
stop heparin and start a different anticoagulant
What is the pathogenesis of heparin-induced thrombocytopenia
type 2?
Ig____ antibodies form against
heparin-bound ______ → ______ ______ → ______ + platelet
consumption/clearance → thrombocytopenia
IgG antibodies form against heparin-bound PF4→ platelet activation → thrombosis + platelet consumption/clearance → thrombocytopenia
When do heparin-induced thrombocytopenia types 1 and 2 occur in
relation to the timing of heparin administration?
Heparin-induced thrombocytopenia type 1 → Within _____ days
after heparin use
Heparin-induced thrombocytopenia type 2 → Within _____ to _____ days after heparin use
Heparin-induced thrombocytopenia type 1 → Within {{c1::2}} days after heparin use
Heparin-induced thrombocytopenia type 2 → Within {{c1::5}} to {{c1::10}} days after heparin use
Which hereditary thrombophilia can cause a diminished increase in PTT after standard heparin dosing?
______ ______ deficiency
Antithrombin III deficiency
What is the suffix used for low molecular weight heparin?
-parin
What is the mechanism of action of bivalirudin, dabigatran, and
argatroban?
______ inhibition of ______
Direct inhibition of thrombin
What reversal agent is available for bleeding caused by direct thrombin inhibitors?
A. Protamine sulfate
B. Idarucizumab
C. Andexanet
alfa
D. Tranexamic acid
B. Idarucizumab
A patient with dabigatran-associated hemorrhage requires urgent reversal. Which agent should be used?
A. Protamine sulfate
B. Idarucizumab
C. Andexanet
alfa
D. Tranexamic acid
B. Idarucizumab
Which of the direct thrombin inhibitors can be given orally?
D_______
Dabigatran
What agent is used to reverse direct factor Xa inhibitors?
A. Protamine sulfate
B. Idarucizumab
C. Andexanet
alfa
D. Tranexamic acid
C. Andexanet alfa
Which type of lab monitoring, if any, is required for direct thrombin inhibitors and direct factor Xa inhibitors?
You don't need to!!
What are three clinical indications for using direct thrombin
inhibitors?
V_____ _____
A_____ _____
_____ -induced _____
Venous thromboembolism
Atrial fibrillation
Heparin-induced thrombocytopenia
What are the common indications for the direct factor Xa
inhibitors?
Treatment and prophylaxis for _____ _____
_____ and _____ _____
Prophylaxis for _____ in patients with atrial fibrillation
Treatment and prophylaxis for Direct Vein Thrombosis and Pulmonary Embolism
Prophylaxis for stroke in patients with atrial fibrillation
What is the mechanism of action shared by clopidogrel,
prasugrel, ticagrelor, and ticlopidine?
Binds to _____ _____ receptors → Prevents _____/_____ expression
on platelet surfaces → Decreased platelet _____
Binds to ADP P2Y12 receptors → Prevents GpIIb/IIIa expression on platelet surfaces → Decreased platelet aggregation
How is ADP-induced expression of GpIIb/IIIa inhibited by drugs such
as clopidogrel, ticagrelor, and prasugrel?
Inhibition of ______ receptor
P2Y12
Which two antiplatelet agents inhibit phosphodiesterase to prevent cAMP hydrolysis, thus increasing cAMP levels within platelets?
_____
_____
Cilostazol
Dipyridamole
What is the effect of cilostazol and
dipyridamole on platelet activity?
They inhibit platelet _____ by increasing _____ levels
They inhibit platelet aggregation by increasing cAMP levels
Which isoform of the PDE enzyme is inhibited by cilostazol?
PDE-_____
PDE-3
Platelet-inhibiting agents such as cilostazol and dipyridamole are
used in the treatment of what medical condition?
I_____ _____
Intermittent claudication
Platelet-inhibiting agents such as cilostazol and dipyridamole are
used in the prevention of what two medical
conditions?
_____ _____ _____ or _____ (given with aspirin)
_____ _____ _____
Transient ischemic attack or stroke (given with aspirin)
Coronary stent restenosis
What are five adverse effects associated with
cilostazol and dipyridamole?
N______
_______ pain
H_______
Facial _______
H_______
Nausea
Abdominal pain
Headache
Facial flushing
Hypotension
A patient taking warfarin has a large intracranial bleed requiring
immediate reversal of warfarin to minimize further bleeding. What are
the two treatment options?
_____ _____ _____
_____ _____ _____
Prothrombin complex concentrate
Fresh frozen plasma
What is a complication of warfarin administration in the setting of
protein C or S deficiency?
Warfarin-induced _____ _____
Warfarin-induced skin necrosis
What is used to reverse the effects of warfarin slowly, and what
agent may be added for rapid effect?
Vitamin _____ will
reverse the effects of warfarin slowly
Adding _____ _____ _____ or _____ _____ _____ will reverse the effects of warfarin rapidly
Vitamin K will reverse the effects of warfarin slowly
Adding FFP or PCC will reverse the effects of warfarin rapidly
What is the mechanism of action of rivaroxaban,
apixaban, and edoxaban?
______ inhibition of factor ______
Direct inhibition of factor Xa
What is the mechanism of action shared by abciximab,
eptifibatide, and tirofiban?
Inhibits
_____/_____ on activated platelet surface → Decreased platelet _____
Inhibits GpIIb/IIIa on activated platelet surface → Decreased platelet aggregation
Which antiplatelet drug irreversibly blocks the COX enzyme, decreasing release of thromboxane A2?
_____
Aspirin
Which antiplatelet agent is associated with adverse effects including gastric ulcers, tinnitus, renal injury, and possible allergic reaction?
_____
Aspirin
Which two groups of antiplatelet therapy are used in acute
coronary syndrome and coronary stenting
and can also be used to decrease thrombotic stroke
incidence?
_____
_____ (P2Y12) receptor blocker
Aspirin
ADP (P2Y12) receptor blocker
Which group of antiplatelet agents are used in cardiac stress
testing, treatment of claudication, and prevention of stroke and
coronary stent restenosis?
____ inhibitors
PDE inhibitors
Which antiplatelet agents are used in the setting of unstable
angina and percutaneous coronary
intervention?
____/____ inhibitors
GpIIb/IIIa inhibitors
Which antiplatelet agent class is associated with TTP?
_____ receptor inhibitors
ADP receptor inhibitors
Which antiplatelet ADP receptor blocker is associated with risk for neutropenia?
_____
Ticlopidine
Which antiplatelet drug class is most heavily associated
with thrombocytopenia and
bleeding?
____/____ inhibitors
GpIIb/IIIa receptor blockers
Which antiplatelet drug class may cause flushing, hypotension, headache, abdominal pain, and nausea?
____ inhibitors
PDE inhibitors
Which antiplatelet agent is made from monoclonal antibody Fab
fragments?
____
Abciximab
Name two drugs that function as antiandrogens by interfering with
steroid synthesis.
____
____
Ketoconazole
Spironolactone
What two adverse effects are common to both ketoconazole and
spironolactone?
____
____
Gynecomastia
Amenorrhea
Ketoconazole and spironolactone can be used to decrease androgenic symptoms associated with ____ ____ ____.
polycystic ovarian syndrome
What hormone causes epiphyseal plate closure?
____
Estrogen
How would prescribing an adolescent exogenous testosterone affect his
adult height?
Exogenous testosterone → Premature closure
of ____ plates via estrogen conversion
epiphyseal
Name four ways testosterone affects male puberty.
Growth ____
____ of the voice
Increased l____
Closure of ____ plates
Growth spurt
Deepening of the voice
Increased libido
Closure of epiphyseal plates
What three medications will treat hirsutism in a patient with polycystic ovarian syndrome?
____
____
____
Spironolactone
Flutamide
Finasteride
What medication inhibits 5α-reductase conversion of testosterone to dihydrotestosterone?
____
Finasteride
What mechanism is responsible for finasteride being effective in the
management of benign prostatic hyperplasia?
Finasteride
is a ____-________ inhibitor → Decreased conversion of ____ to ____ →
Decreased prostatic growth
Finasteride is a 5α-reductase inhibitor → Decreased conversion of testosterone to dihydrotestosterone → Decreased prostatic growth
What are two adverse effects of finasteride therapy?
________
________ dysfunction
Gynecomastia
Sexual dysfunction
Finasteride can be used to treat ________ ________ ________ and male-pattern ________.
benign prostatic hyperplasia
baldness
Name three antiandrogenic drugs that function
by preventing androgens from binding to their
specific receptors.
________
________
________
Flutamide
Cyproterone
Spironolactone
What is the mechanism of action of flutamide and bicalutamide?
N_________ competitive ________ receptor antagonists
Nonsteroidal competitive androgen receptor anagonists
What condition is treated with flutamide, bicalutamide, apalutamide,
and enzalutamide?
_______ cancer
Prostate cancer
What medication may be used to induce ovulation in a patient with polycystic ovarian syndrome who wishes to become pregnant?
_______
clomiphene
How do LH and FSH levels change with the administration of
clomiphene?
LH levels _______. FSH levels _______. This
is going to cause decreased _______
LH levels increased. FSH levels increased. This is going to cause decreased GnRH
Describe the mechanism by which clomiphene acts on
the hypothalamus to
increase ovulation.
Binds to _______ receptors in the hypothalamus → Blocks
{positive/negative} feedback of LH and FSH → _______ release of LH and
FSH → Promotes ovulation
Binds to estrogen receptors in the hypothalamus → Blocks negative feedback of LH and FSH → increased release of LH and FSH → Promotes ovulation
What is the primary clinical use for
clomiphene?
I______ due to a______
Infertility due to anovulation
What are the major adverse effects of
clomiphene?
H_____ _____
Multiple
simultaneous _____
Ovarian _____
V_____ disturbances
Hot flashes
Multiple simultaneous pregnancies
Ovarian enlargement
Visual disturbances
Anastrozole, letrozole, and exemestane belong to what drug
class?
______ inhibitors
Aromatase inhibitors
(note the -trozole suffix, not universal but common)
What are aromatase inhibitors indicated for?
______
receptor-positive ______ cancer in ______ women
Estrogen receptor-positive breast cancer in postmenopausal women
What is the mechanism of action of the aromatase
inhibitors?
Inhibits ______ conversion of
______ to ______
Inhibits peripheral conversion of androgens to estrogen
How do aromatase inhibitors help in treating
estrogen receptor–positive breast cancer?
Blocks conversion of androstenedione to ______
and conversion of testosterone to ______ →
Lowers estrogen levels
Blocks conversion of androstenedione to estrone and conversion of testosterone to estradiol→ Lowers estrogen levels
What two hormones are decreased due to the antagonistic effect of goserelin and leuprolide?
_______
_______
FSH
LH
Continuous administration of leuprolide is used to
treat what conditions?
Uterine _______
E_______
_______ cancer
_______ puberty
Uterine fibroids
Endometriosis
Prostate cancer
Precocious puberty
Why do patients treated with leuprolide sometimes
experience a "tumor flare" during
treatment?
Temporarily acts as a _______ agonist before
[upregulating/downregulating] the receptor when given in a continuous fashion
Temporarily acts as a GnRH agonist before downregulating the receptor when given in a continuous fashion
Leuprolide is an analog of what hormone?
_______
GnRH
Is leuprolide given in a pulsatile or continuous fashion to treat
infertility?
In a _______ fashion. It
will act as a _______ agonist.
pulsatile
GrRH agonist
How does leuprolide work when given in continuous
versus pulsatile fashion?
Acts as a GnRH
[agonist/antagonist] when administered continuously
Acts as a GnRH [agonist/antagonist] when administered in a pulsatile manner
Acts as a GnRH antagonist when administered continuously
Acts as a GnRH agonist when administered in a pulsatile manner
What are three adverse hormonal effects of leuprolide?
Decreased ______
[Hypergonadism/Hypogonadism]
______ dysfunction
Decreased libido
Hypogonadism
Erectile dysfunction
What is the mechanism of action of danazol?
Partial ______ at ______ receptors
Partial agonist at androgen receptors
Name three adverse effects of danazol therapy related to its
androgenic effects.
A______
H______
M______
Acne
Hirsutism
Masculinization
What two medical conditions are treated with danazol?
E______
Hereditary ______
Endometriosis
Hereditary angioedema
Name an adverse neurologic effect of danazol.
Idiopathic
i______ h______
Idiopathic intracranial hypertension
What combination of antiprogestin and prostaglandin is used for
termination of pregnancy?
_______
_______
Misoprostol
Mifepristone
What is the mechanism of action of mifepristone and
ulipristal?
Competitively inhibit
progestins at ________ receptors
progesterone
Which SERM is used in breast cancer treatment and prevention?
________
Tamoxifen
What is the primary mechanism of action of tamoxifen?
Antagonist to the ______ receptor in the ______
Partial agonist in the ______ and ______
Antagonist to the estrogen receptor in the breast
Partial agonist in the bone and endometrium
What tumor marker would prompt you to use tamoxifen
in treating breast cancer?
The tumor must be ______
______ -positive
estrogen-receptor positive
Which three adverse effects are associated with
tamoxifen?
T______ events
H______ ______
Increased risk of e______ cancer
Thromboembolic events
Hot flashes
Increased risk of endometrial cancer
How do tamoxifen and raloxifene
modulate the effects of estrogen?
Binds to
_______ receptors → Blocks or stimulates _______ _______ in
_______-responsive cells
Binds to estrogen receptors → Blocks or stimulates gene expression in estrogen-responsive cells
How is the action of raloxifene different from that
of tamoxifen?
Tamoxifen is a partial
________ at the uterus.
Raloxifene is an {{c1::antagonist::agonist/antagonist}} at the uterus.
Tamoxifen is a partial agonist at the uterus.
Raloxifene is an antagonist at the uterus.
What is tamoxifen primarily used to treat?
_______ and/or _______ receptor-positive breast cancer
estrogen
progesterone
Raloxifene bc it is an estrogen agonist at the bone is used for _______
osteoporosis
How is raloxifene safer compared to tamoxifen?
Raloxifene does not
increase the risk of _______ cancer when compared to tamoxifen
endometrial
At what organ level do oral contraceptives influence the action of reproductive hormones?
_______
ovaries
What treatment is indicated for irregular menses?
_______ _______ _______ pills
Combined oral contraceptive pills
What is the mechanism of action by which combined oral
contraceptives prevent ovulation?
Inhibits _______ and _______→ Blocks _______ and _______ surges
Inhibits LH and FSH → Blocks estrogen and LH surges
What are the adverse
effects of combined contraceptives?
_______ menstrual bleeding
Breast _______
_______ adenomas
Venous _______
Breakthrough menstrual bleeding
Breast tenderness
Hepatic adenomas
Venous thromboembolism
Aside from preventing ovulation, how else do progestins prevent
pregnancy?
[Thickens/Thins] cervical mucus
Inhibits ______ proliferation
Thicken cervical mucus
Inhibit endometrial proliferation
What are three forms of combined contraception delivery?
P____
P____
Vaginal ____
Pills
Patch
Vaginal ring
What are the five contraindications of combined oral
contraception?
______ if over 35 years of age
Increased risk of ______ disease
M______
______ disease
______ cancer
Smoking if over 35 years of age
Increased risk of cardiovascular disease
Migraines
Liver disease
Breast cancer
What may make degarelix a better option than leuprolide for the
treatment of prostate cancer?
No tumor ______
No tumor flare
How does degarelix work?
_____ antagonist
GnRH antagonist
What are the two main adverse effects of degarelix?
H_____ ______
______
Hot flashes
Hepatotoxicity
What is degarelix typically used to treat?
_____ cancer
Prostate cancer
What are the four suffixes used for the following antineoplastic
drugs?
_____ for nitrosoureas
_____ for platinum compounds
_____ for anthracyclines
_____ for taxanes
-mustine
-platin
-rubicin
-taxel
Which class of alkylating agents might be used in the treatment of
brain tumors?
_____
Nitrosoureas
What is the major adverse effect associated with nitrosourea
alkylating chemotherapeutic agents?
_____ toxicity
CNS
Which alkylating agents can treat rheumatic disease, as
well as leukemias,
lymphomas, and
solid tumors?
_____ _____
Nitrogen mustards
Nitrogen mustards side effects: S_____, h_____ c_____, _____ cancer, and m_____
SIADH
hemorrhagic cystitis
bladder cancer
myelosuppression
Which two classes of alkylating agents require bioactivation by the
liver and act by cross-linking DNA?
_____ _____
_____
Nitrogen mustards
Nitrosoureas
Which alkylating agent is associated with adverse effects including
pulmonary toxicity, increased leukemia
risk, a disulfiram-like reaction, and
myelosuppression?
_____
Procarbazine
Procarbazine may be used to treat which 2 malignancies?
_____ _____
_____ tumors
Hodgkin lymphoma
Brain tumor
Procarbazine acts as a weak _____ inhibitor
MOA
Which class of antineoplastic drugs do cisplatin, carboplatin, and
oxaliplatin belong to?
_____ compounds
Platinum compounds
What is the mechanism of action of cisplatin, carboplatin, and oxaliplatin?
They _______-_______ _______
cross-link DNA
What are the two key common toxicities attributed to cisplatin and
carboplatin?
N_______
O_______
Nephrotoxicity
Ototoxicity
What is the treatment for choriocarcinoma?
M_______
Methotrexate
Which 2 antineoplastic agents interfere with nucleotide synthesis by
inhibiting thymidine synthesis?
M__________
___-_________
Methotrexate
5-fluorouracil
What is the mechanism of action of methotrexate?
Inhibits ______ ______
Inhibits dihydrofolate reductase
Which four cancers can methotrexate be used to treat?
L______
L______
C______
S______
Leukemias
Lymphomas
Choriocarcinomas
Sarcoma
Which agent can reverse the biological effects of methotrexate?
L______
Leucovorin
What enzyme is inhibited by 5-fluorouracil and its prodrug, capecitabine?
_____ _____
Thymidylate synthase
What are the four clinical uses for 5-fluorouracil?
C_____ cancer
P_____ cancer
_____ _____ carcinoma
A_____ _____
Colon cancer
Pancreatic cancer
Basal cell cancer
Actinic keratosis
5-fluorouracil side effects:
_______
_______-_______ erythrodysesthesia
myelosuppression
palmar-plantar
What medication can be given to enhance the effects
of 5-fluorouracil?
L______
Leucovorin
What is the prodrug for 5-fluorouracil?
C______
Capecitabine
Which pyrimidine analog is bioactivated to 5-FdUMP and inhibits
thymidylate synthase, causing a decrease in dTMP and DNA
synthesis?
___-_________
5-fluorouracil
What is the mechanism of action of cytarabine?
P_________ analog that acts as a DNA chain _________ to inhibit
DNA _________
Pyrimidine analog that acts as a DNA chain terminator to inhibit DNA polymerase
What two cancers are commonly treated with cytarabine?
_________
_________
Leukemias
Lymphomas
Name the major adverse effect of cytarabine, cladribine, and pentostatin.
______
Myelosuppression
What is the major adverse effect associated with
vinblastine?
______
Myelosuppression
What are the two major adverse effects of vincristine?
N______
C______
Neurotoxicity
Constipation
What is the key toxicity attributed to vincristine?
______ neuropathy
Peripheral neuropathy
Which class of microtubule inhibitors are used to
treat blood cancers and solid
tumors?
______ ______
Vinca alkaloids
Which two classes of antineoplastic agents interfere with cellular
division?
______ ______
______
Vinca alkaloids
Taxanes
Which class of microtubule inhibitors are used to
treat reproductive tumors?
______
Taxanes
What is the mechanism of action of taxanes?
H______ of
polymerized ______ in the ______ phase → Inhibition of mitotic
spindle ______
Hyperstabilization of polymerized mictrotubules in the M phase → Inhibition of mitotic spindle breakdown
Which class of microtubule inhibitors are associated with myelosuppression, neuropathy, and hypersensitivity?
______
Taxanes
Topoisomerase inhibitors used in cancer treatment all cause cell
cycle arrest at which phase?
____ phase
____ phase
S phase
G2 phase
What drugs inhibit eukaryotic topoisomerase II?
E______
T______
Etoposide
Teniposide
What is the mechanism of action of etoposide and teniposide?
Inhibits ______ ______ → Increased DNA ______ and cell cycle ______
Inhibits topoisomerase II → Increased DNA degradation and cell cycle arrest
Topoisomerase II normally acts by cutting and religating:
A. Single-stranded RNA
B. Double-stranded DNA
C. Single-stranded DNA
D. Double-stranded RNA
B. Double-stranded DNA
Etoposide and Teniposide can cause m______ and a______
myelosuppression and alopecia
Etoposide and Teniposide are commonly used to treat ______, ______, ______ cancer, and ______ cell lung cancers,
leukemia
lymphoma
testicular cancer
small cell lung cancers
What drugs inhibit eukaryotic topoisomerase I?
I______
T______
Irinotecan
Topotecan
Irinotecan and Topotecan can cause severe ______ and ______.
myelosuppression
diarrhea
What is the mechanism of action of irinotecan and topotecan?
Inhibits ______ ______ → Increased DNA ______ and cell cycle ______
Inhibits topoisomerase I → Increased DNA degradation and cell cycle arrest
Irinotecan and Topotecan are used to treat o______, c______ , and ______ cell lung cancers.
ovarian
colon
small cell lung cancers
What are the three main mechanisms of action of the
anthracyclines?
Generates ______ ______
Intercalates in ______
Inhibits ______ ______
Generates free radicals
Intercalates in
DNA
Inhibits topoisomerase II
Which 3 types of malignancies are commonly treated with
anthracyclines?
_____ tumors
_____
_____
Solid tumors
Leukemias
Lymphomas
Why might a patient receiving doxorubicin also concomitantly receive
dexrazoxane?
To prevent _____ _____
dilated cardiomyopathy
Which chemotherapeutic agents can cause dilated cardiomyopathy?
T_____
A_____
Trastuzumab
Anthracyclines
What drug is used to protect against cardiotoxic effects on
anthracycline neoplastics and what is its mechanism of action?
D______ → Acts as an i______ ______
Dexrazoxane → Acts as an iron chelator
What is the mechanism of action of bleomycin?
Induces ______ ______ formation → ______ in DNA strands
Induces free radical formation → breaks in DNA strands
Name 2 neoplasms commonly treated with bleomycin.
______ cancer
______ lymphoma
Testicular cancer
Hodgkin lymphoma
What 2 adverse effects are commonly associated with bleomycin?
P______ ______
Skin ______
Pulmonary Fibrosis
Skin hyperpigmentation
Bleomycin acts on stage _____ and stage _____ of the cell cycle
G2
M
What is the common key toxicity attributed to bleomycin and
busulfan?
Pulmonary ________
Pulmonary fibrosis
Imatinib, Dasatinib, Nilotinib are three small molecule inhibitors that target which molecular target?
_____-_____ tyrosine kinase
BCR-ABL
What is the typical suffix for the class of biologics that act as
tyrosine kinase inhibitors?
_____
-tinib
What is the treatment for chronic myelogenous leukemia?
Inhibitors of _____-_____ tyrosine kinase
BCR-ABL
What 2 monoclonal antibodies might be used to treat
metastatic colon cancer or head and neck
cancers by targeting EGFR?
C_____
P_____
Cetuximab
Panitumumab
Which cutaneous adverse effect occurs with cetuximab and panitumumab?
A. Alopecia
B. Rash
C. Vitiligo
D. Urticaria
B. Rash
What three anticancer small molecule inhibitors target EGFR?
E_____
G_____
A_____
Erlotinib
Gefitinib
Afatinib
What do ALK inhibitors and EGFR inhibitors treat?
_____-_____ _____ _____ cancer
Non-small cell lung cancer
What kind of cancer are ALK and EGFR oncogenes
associated with?
______ adenocarcinoma
Lung adenocarcinoma