# Pharm Block Ib
## Anti-progestins
* e.g. mifeprostone and ulipristal
* Mifeprostone
* Tx: terminate pregnancy, w/ misoprostol (PGE1 analog)
* Ulipristal
* Emergency contraception

## Aromatase inhibitor
* Tx: 停經婦女的ER(+) breast cancer
* Aromatase: androstenedione => estrone, testosterone => estradiol
* e.g.anastrozole, letrozole, exemestane

## 5α-reductase inhibitor
* Finasteride
* Tx: BPH and male-pattern baldness

## 17α-hydroxylase and cholesterol desmolase inhibitor
* ketoconazole and spironolactone
* Side effects: amenorrhea (females) and gynecomastia (males)

## Androgen receptor antagonist
* Flutamide
* Tx: prostate cancer

## Estrogen receptors antagonist
* **Clomiphene**
* blocks negative feedback
* Tx: infertility (PCOS)
* **Tamoxifen**
* antagonist at breast
* agonist at bone and uterus (=> **emdometrial cancer**)
* **Raloxifene**
* antagonist at breast and uterus
* agonist at bone (inhibits resorption, Tx: osteoporosis)

## GnRH receptor agonist
* **Leuprolide**
* 
* Tx: prostate carcinoma
* side effects:
* decreased libido, erectile dysfunction, and hypogonadism
* nausea and vomitting
* Goserelin

## Arteriolar vasodilator
* Minoxidil
* Tx: male-pattern baldness and severe refractory hypertension
* Hydralazine
* Side effects: reflex tachycardia, peripheral edema

## PDE-5 inhibitors
* increased blood flow in the corpus cavernosum of the penis
* inhibition of PDE-5 results in increased cGMP, causing smooth muscle relaxation in response to NO
* Side effects: headache, flushing, dyspepsia, and cyanopia (blue-tinted vision)
* Tadalafil
* Tx: BPH

## α receptor antagonist
* Tamsulosin
* Selective α1A/D receptor antagonist
* Tx: BPH
* Terazosin
* non-selective α1 receptor antagonist
* Tx: 有高血壓的BPH (α1B antagonist)

## β2-agonists
* Terbutaline and ritodrine
* relax uterus
* activates PKA, dephosphorylating Myosin Light Chain Kinase (MLCK)

## Synthetic androgen
* Side effects:
* increased LDL, decreased HDL
* testosterone => prematurt closure of epiphyseal plates
* higher hematocrit
* **Danazol**
* partial agonist of AR
* Tx:
* endometriosis
* hereditary angioedema
* side effect:
* pseudotumor cerebri: ICP increased, weight gain, edema, acne, hirsutism, and masculinization (androgenic effects)
* decreased HDL and
* hepato-toxicity

## Estrogen analog
* Side effects:
* endometrial cancer (沒有同時給progesterone的時候)
* hypercoagulable
* Ethinyl estradiol, DES, and mestranol

## Progestins
* levonorgestrel, etonogestrel, and megestrol

## CCB
* Nifedipine
* tocolytic宮縮抑制劑

## NSAID
* Indomethacin
* tocolytic

## Miscellaneous
* Withdrawal bleeding: progestin challenge
* A lack of estrogen no longer supports the growth of endometrium, leading to sloughing.
* excludes anatomic defects (e.g. Asherman syndrome) and chronic anovulation without estrogen