Contraceptives Flashcards
What is the only estrogen used in combination OC?
ethinyl estradiol
The menstrual cycle consists of what phases?
- follicular = preovulatory
- ovulatory
- luteal = postovulatory
This is a 10 amino acid peptide produced by neurons in the hypothalamus.
GnRH
GnRH is secreted into the portal circulation and deliver to ther?
anterior pituitary
The binding of GnRH to its receptor leads to the biosynthesis and release of?
LH = leutinizing hormone FSH = follicle stimulating hormone
Describe the difference between monophasic, biphasic, triphasic, four-phasic..
Mono= fixed dose of estrogen/progestin BI= the progestin dose changes twice Tri= one or both change 3 times four= estradiol valerate/ dienogest
This is a prodrug estrogen.
Mestranol
What does enterohepatic recirculation involve?
1, sulfate and glucuronide conjugation
2. biliary secretion into intestine
3. bacterial enzymes allows reabsorption of estrogens
Disruption of this will decrease contraceptive effectiveness.
This progestin has aldosterone antagonist activity.
Drospirenone
Describe the estrogen receptors.
- Located on separate genes
- In the nucleus, receptor dimerization.
- Estrogen response elements in promoter act on ligand transcription factor.
Describe the progesterone receptors.
- single gene
What is the most common GI adverse effect and how can it be minimized?
Nausea.
After dinner or bedtime
What dermatologic effects are seen?
Chloasma, Acne, hirsutism
What are the cardiovascular effects?
Hypertension - Estrogen stimulates RAAS
MI/stroke - >35yrs or >15cigs/day
Thromboembolic - estrogen promotes clotting factors, decreases antithrombin III
Progestin desogestrel - increase nonfatal venous thrombosis
What are the warning signs?
A - abdominal pain C - chest pain H - headaches E - eye problems S - severe leg pain
What effect is seen with metabolic?
Decreased glucose tolerance
Increased LDL plasma triglycerides
Beneficial effects of oral contraceptives?
decrease endometrial cancer, ovarian cancer, acne
Effect of OC and antibiotics?
Antibiotics kill off bacterial enzymes needed to cleave sulfate and glucuronide conjugates.
What is the topical transdermal system?
Ortho evra
ethinyl estradiol + norelgestromin
Thromboembolism
What is the vaginal ring?
Nuvaring
ethinyl estradiol + etonogestrel
What are progestin only preparations used for?
women with contraindications or lactating and want contraception
What are the mechanisms of progestin only?
Increase viscosity of cervical mucous
inhibit sperm mitigation
inhospitable environment for implantation
What are the progestin only tablets?
Micronor
Norethindrone
What is the IM injection given every 3 months?
Depo-Provera
Medroxyprogesterone
Lead to bone loss, risk of osteoporosis
This progestin only product is a rod placed under the skin.
implanon
etonogestrel
What are the intrauterine devices? what is the problem with them?
Paraguard (copper)
Mirena (levonorgestrel)
Introduce bacteria genital tract cause PID.
What are the emergency contraceptives?
Plan B - levonorgestrel
Ella - Unipristal
Next choice - levonorgestrel
