Contraceptives

Question 1

What is the only estrogen used in combination OC?

Answer 1

ethinyl estradiol

Question 2

The menstrual cycle consists of what phases?

Answer 2

1. follicular = preovulatory
2. ovulatory
3. luteal = postovulatory

Question 3

This is a 10 amino acid peptide produced by neurons in the hypothalamus.

Answer 3

GnRH

Question 4

GnRH is secreted into the portal circulation and deliver to ther?

Answer 4

anterior pituitary

Question 5

The binding of GnRH to its receptor leads to the biosynthesis and release of?

Answer 5

LH = leutinizing hormone
FSH = follicle stimulating hormone

Question 6

Describe the difference between monophasic, biphasic, triphasic, four-phasic..

Answer 6

Mono= fixed dose of estrogen/progestin
BI= the progestin dose changes twice
Tri= one or both change 3 times
four= estradiol valerate/ dienogest

Question 7

This is a prodrug estrogen.

Answer 7

Mestranol

Question 8

What does enterohepatic recirculation involve?

Answer 8

1, sulfate and glucuronide conjugation
2. biliary secretion into intestine
3. bacterial enzymes allows reabsorption of estrogens
Disruption of this will decrease contraceptive effectiveness.

Question 9

This progestin has aldosterone antagonist activity.

Answer 9

Drospirenone

Question 10

Describe the estrogen receptors.

Answer 10

1. Located on separate genes
2. In the nucleus, receptor dimerization.
3. Estrogen response elements in promoter act on ligand transcription factor.

Question 11

Describe the progesterone receptors.

Answer 11

1. single gene

Question 12

What is the most common GI adverse effect and how can it be minimized?

Answer 12

Nausea.

After dinner or bedtime

Question 13

What dermatologic effects are seen?

Answer 13

Chloasma, Acne, hirsutism

Question 14

What are the cardiovascular effects?

Answer 14

Hypertension - Estrogen stimulates RAAS
MI/stroke - >35yrs or >15cigs/day
Thromboembolic - estrogen promotes clotting factors, decreases antithrombin III
Progestin desogestrel - increase nonfatal venous thrombosis

Question 15

What are the warning signs?

Answer 15

A - abdominal pain
C - chest pain
H - headaches
E - eye problems
S - severe leg pain

Question 16

What effect is seen with metabolic?

Answer 16

Decreased glucose tolerance

Increased LDL plasma triglycerides

Question 17

Beneficial effects of oral contraceptives?

Answer 17

decrease endometrial cancer, ovarian cancer, acne

Question 18

Effect of OC and antibiotics?

Answer 18

Antibiotics kill off bacterial enzymes needed to cleave sulfate and glucuronide conjugates.

Question 19

What is the topical transdermal system?

Answer 19

Ortho evra
ethinyl estradiol + norelgestromin
Thromboembolism

Question 20

What is the vaginal ring?

Answer 20

Nuvaring

ethinyl estradiol + etonogestrel

Question 21

What are progestin only preparations used for?

Answer 21

women with contraindications or lactating and want contraception

Question 22

What are the mechanisms of progestin only?

Answer 22

Increase viscosity of cervical mucous
inhibit sperm mitigation
inhospitable environment for implantation

Question 23

What are the progestin only tablets?

Answer 23

Micronor

Norethindrone

Question 24

What is the IM injection given every 3 months?

Answer 24

Depo-Provera
Medroxyprogesterone
Lead to bone loss, risk of osteoporosis

Question 25

This progestin only product is a rod placed under the skin.

Answer 25

implanon

etonogestrel

Question 26

What are the intrauterine devices? what is the problem with them?

Answer 26

Paraguard (copper)
Mirena (levonorgestrel)
Introduce bacteria genital tract cause PID.

Question 27

What are the emergency contraceptives?

Answer 27

Plan B - levonorgestrel
Ella - Unipristal
Next choice - levonorgestrel