Combination Oral Contracptives

Question 1

Ethinyl estradiol

Answer 1

In all combination OCPs (or mestranol–the prodrug)

Question 2

Norethindrone

Answer 2

Progestin

“19-nor” progestin

Question 3

Norgestrel/Levonorgestrel

Answer 3

Androgenic, anabolic

Question 4

Norethynodrel

Answer 4

Estrogenic, not androgenic

Question 5

Norgestimate

Answer 5

“pure” progestin

Not androgenic or estrogenic

Question 6

Drosperinone

Answer 6

Anti-androgenic, anti-mineralocorticoid (Yasmin)

CONCERN ABOUT THROMBOEMBOLISM

Question 7

Etonogestrel

Answer 7

Newer progestin
In Nuvaring (3 week combination contraceptive vaginal ring)
CONCERN ABOUT VENOUS THROMBOEMBOLISM

Question 8

OCPs

Answer 8

Mechanism:

1. Inhibit ovulation (disrupt cyclical release of Gn’s)
2. Decrease likelihood of fertilization
3. Endometrial changes (decrease likelihood of successful implantation)
4. Prompt onset of menstruation (end of pill cycle)
5. Combination of mechanisms

Question 9

Estrogen related effects

Answer 9

Nausea, irritability 
HA (migraine) 
Fluid retention , cyclic weight gain, breast enlargement/tenderness
Menstrual changes
Altered libido

Question 10

Progestin-related effects

Answer 10

Nausea, bloating, menstrual changes, depression, fatigue
Androgenic progestins: acne, hirsutism, libido change, non-cyclic weight gain
Non-androgenic progestins: beneficial for treating acne

Question 11

Contraindications

Answer 11

Absolute: pregnancy, estrogen-responsive tumor, >35 and smoke
Relative: thromboembolic dz, HTN, DM, liver dz

Question 12

Drug interactions

Answer 12

Decrease response to: 
1. Acetaminophen (induce hepatic met)
2. Coumarin (increase clotting factors)
3. Thyroxine (increase binding proteins)
4. Antidiabetic drugs (decrease glucose tolerance) 
Increase response (toxicity):
1. cyclosporine, imipramine, theophylline, corticosteroids, benzos
OC efficacy reduced: 
1. antibiotics (enterohepatic circulation, gut bacteria) 
2. Anti-seizure drugs (liver enzymes) 
Efficacy increased:
1. Vitamin C
2. APAP