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# System prepended metadata

title: Pharm Block Ib

---

# 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**
  * ![](https://i.imgur.com/I2TovCC.jpg)
  * 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