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Pharmacology II > Contraceptives > Flashcards

Contraceptives Flashcards

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1
Q

What are the three Estrogens used for oral contraceptives?

A

Ethinyl estradiol
Mestranol
Estradiol valerate

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2
Q

What is the MOA of Estrogens?

A

Influence gene transcription
Cycle control
Stabilize the endometrium
Minimizes irregular shedding

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3
Q

What effect(s) does estrogen have on the reproductive system?

A

Female Sexual Maturation
Endometrial Growth
Breast Tissue Stimulation

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4
Q

What effect(s) does estrogen have on the hematologic system?

A

Increased tendency for clotting

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5
Q

What effect(s) does estrogen have on the skin/mucosa?

A

Increased pigmentation
Increased skin collagen content/thickness
Maintenance of skin moisture

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6
Q

What effect(s) does estrogen have on the metabolic state of the body?

A

Increases HDL
Decreases LDL
Increases Triglycerides
Decreases bone re-absorption

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7
Q

What are some indications for estrogen use?

There are FIVE

A
  1. Contraception
  2. Menopausal hormone replacement therapy
  3. Endometriosis
  4. Dysfunctional Uterine Bleeding
  5. Prevention of osteoporosis
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8
Q

Estrogen is used to treat the _________ symptoms menopause

A

Vasomotor

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9
Q

T/F: Estrogen is used to treat osteoporosis

A

False

It is used to prevent it

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10
Q

What are contraindication for estrogen use?

There are FOUR

A
  1. Clotting Disorders
  2. Un-diagnosed abnormal genital bleeding (already went through menopause and bled again)
  3. Breast CA
  4. Pregnancy
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11
Q

What first generation progesterones are used as OCPs?

A
  1. Steroids (with similar activity to progesterone)
  2. Megestrol Acetate
  3. Medroxyprogesterone acetate
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12
Q

What second generation progesterones are used as OCPs?

A
  1. Norethindrone

2. Ethynodial

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13
Q

What third generation progesterones are used as OCPs?

A
  1. Norgestrel
  2. Levonorgestrel
  3. Desogestrel
  4. Norgestimate
  5. Dienogest
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14
Q

What is the nonsteriodal progesterone are used as OCPs?

A

Drospirenone

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15
Q

What is a Drospirenone derived from?

A

Spironolactone

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16
Q

What are the indications for Progesterone use?

A
  1. Secondary Amenorrhea (PMS)
  2. HRT
  3. Cervical Ripening (helps deliver babies)
  4. Infertility
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17
Q

T/F: Progesterones are metabolized by 3A4

A

True

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18
Q

What is the MOA of progesterones?

A

Directly modify RNA synthesis and influences gene transcription

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19
Q

What effects do progesterones have on the reproductive system?

A
  1. Determines onset of menstruation
  2. Changes endocervical gland secretion from watery to viscous
  3. Maintains pregnancy
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20
Q

How does the progesterone effect of changing endocervical secretion from watery to viscous prevent pregnancy?

A

Prevent sperm entry into the uterus

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21
Q

What effects does progesterone have on the metabolic system?

A
  1. Increases insulin secretion and resistance peripherally
  2. Increases Lipase activity
  3. May increase fat deposits
  4. Increased LDL
  5. Decreases HDL
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22
Q

What are indications for progesterone use?

A
  1. Contraception
  2. Post-menopausual HRT
  3. Dysfunctional Uterine Bleeding
  4. Pregnancy Maintenance
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23
Q

Should progesterone be used in a patient with a clotting disorder?

A

No

It is contraindicated as it increases the risk for clotting

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24
Q

Other than clotting disorders, what are 4 additional contraindications of progesterone use?

A
  1. Severe Migraines
  2. Unexplained vaginal bleeding
  3. Breast CA
  4. Active Liver Disease
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25
What are the ADRs associated with Estrogen use?
1. Nausea 2. Headache 3. Breast Tenderness
26
What are the ADRs associated with Progesterone use?
1. Acne 2. Hirsutism 3. Increased LDL 4. DVT 5. Vaginal Bleeding 6. Bone loss (specifically with DMPA)
27
T/F: Estrogen inhibits FSH release
True
28
_______ oral contraception involves taking 21 days of estrogen-progestin pills followed by 7 days of placebo pills
Monophasic
29
________ oral contraception involves taking varying concentrations of estrogen at different times during the cycle
Multiphasic
30
______ _____ oral contraception involves taking 84 active pills and 7 placebo pills.
Extended cycle
31
Estrogen doses vary from __ mcg to __ mcg
10 mcg to 50 mcg
32
What are the contraindications for OCP use? | Theres a lot
1. History of Stroke/Clot 2. Valvular Disease 3. Diabetes (with vascular involvement) 4. Migraine with Aura 5. Uncontrolled HTN 6. Breast CA 7. Liver Disease 8. Pregnancy
33
Should OCP be used in patient older than 35 who is smoking more than half a pack a day?
No
34
A patient is 5 weeks post-partum and currently breast-feeding, are OCP safe to start?
No | Contraindicated < 6 weeks post-partum
35
What ADRs are associated with OCP use?
1. Breakthrough Bleeding 2. Headache 3. Breast Tenderness 4. DVT (Clotting) 5. Nausea 6. Acne 7. Hirsutism
36
Nausea, Breast Tenderness, Cyclic Weight Gain, and Menorrhagia are all symptoms of what?
Excess Estrogen
37
Vasomotor symptoms, nervousness, and decreased libido are all symptoms of what?
Estrogen Deficiency
38
Increased appetite, bloating, constipation, acne, hirsutism, and oily skin are all symptoms of what?
Excess Progesterone
39
Late cycle breakthrough bleeding and menorrhagia are both symptoms of what?
Progesterone Deficiency
40
What drugs interact with OCPs?
1. Rifampin 2. Phenobarb, Phenytoin 3. Tetracycline 4. Penicillin
41
Does missing a dose of your OCP increase of decrease efficacy?
Decrease
42
T/F: If you forget to take your OCP on time however it is less than 24 hours it should NOT be taken
False | it can still be taken
43
When is an OCP dose considered to be missed?
Greater than 24 hrs since dose should have been taken
44
What estrogen and third generation progesterone compose the Ortho Evra Patch?
Ethinyl Estradiol | Norelgestromin
45
T/F: The clot risk with the ORtho Evra Patch is half that when compared to OCPs
False | Twice the risk
46
What first generation progesterone is used in Depo-Provera (DMPA)?
Medroxyprogesterone acetate
47
DMPA prevents ovulation for __ months
3
48
What is the most common ADR of DMPA?
Irregular Menstrual bleeding
49
What reversible ADR is with DMPA use?
Decreased Bone Mass Density | This will reverse when the drug is stopped
50
What estrogen and second generation progesterone are recommend for contraception in women with NO medical conditions?
Ethinyl Estradiol | Norethindrone
51
How long should you wear the Ortho Evra Patch?
3 weeks (then replace with new patch)
52
Is the Ortho Evra Patch more or less effective in patient with a BMI > 25
Less Effective There is a greater than 2x risk of unintended pregnancy
53
Etonogestrel and Ethinyl Estradiol are compound used in this IUD contraceptive device
Nuvaring
54
The Nuvaring should be left inplace for 3 weeks before being removed, when should a new one be place?
1 week after removal
55
What ADRs are seen with the Nuvaring?
Vaginal irritation, infection, secretions
56
Norethindrone is a ______ only pill
Progesterone
57
T/F: Norethindrone is safe in breast feeding and is often used post-partum
True
58
Implanted contraceptive devices such as the Nexplanon use ________
Etonogestrel
59
What is the major ADR of a Nexplanon (Etonogestrel)? What additional ADRs can be seen?
Irregular Bleeding ``` Headache Vaginitis Weight Gain Acne Breasr Pain ```
60
What are "back up" contraception methods?
1. Abstinence 2. Condom 3. Spermicide 4. Diaphragm 5. Cervical Cap 6. Sponges
61
Emergency contraception should be used within __ days of unprotected sex
5 days
62
This emergency contraception method uses Ethinyl Estradiol and Levonorgestrel
Yuzpe Method
63
What ADRs are seen with the Yuzpe Method
Nausea | Vomiting
64
How does Ulipristal Acetate (Ella) work?
Inhibits or delays ovulation
65
What ADRs are seen with Ulipristal Acetate (Ella)?
``` Headache Nausea Abdominal Pain Dysmenorrhea Fatigue Dizziness Acne ```
66
T/F: Ulipristal Acetate (Ella) can be purchased OTC
False
67
What progesterone is used in Plan B?
Levonorgestrel
68
What is the primary MOA of Plan B? Secondary?
Primary: Inhibits or delays ovulation Secondary: Prevents Fertilization
69
T/F: Plan B is effective if implantation has occurred
False
70
What ADRs are seen with Plan B?
``` Irregular Menses Nausea Abdominal Pain Fatigue Headache Dizziness Breast tenderness ```
71
T/F: Plan B is available OTC
True
72
What test should be obtained prior to administering or prescribing emergency contraception
Pregnancy Test
73
What is also known as the "Abortion Pill"?
Mifepristone (Korlym)
74
T/F: Mifepristone (Korlym) is metabolized by P450
True
75
What is a concerning condition to look for following an abortion using Mifepristone (Korlym)?
Sepsis
76
What is in place in NC that allows providers to refuse prescribing medication to induce or preforming abortions?
Conscience Clause

Pharmacology II (2 decks)

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