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Pharmacology II > Contraceptives > Flashcards

Contraceptives Flashcards

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
Q

What are the ADRs associated with Estrogen use?

A
  1. Nausea
  2. Headache
  3. Breast Tenderness
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26
Q

What are the ADRs associated with Progesterone use?

A
  1. Acne
  2. Hirsutism
  3. Increased LDL
  4. DVT
  5. Vaginal Bleeding
  6. Bone loss (specifically with DMPA)
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27
Q

T/F: Estrogen inhibits FSH release

A

True

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28
Q

_______ oral contraception involves taking 21 days of estrogen-progestin pills followed by 7 days of placebo pills

A

Monophasic

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29
Q

________ oral contraception involves taking varying concentrations of estrogen at different times during the cycle

A

Multiphasic

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30
Q

______ _____ oral contraception involves taking 84 active pills and 7 placebo pills.

A

Extended cycle

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31
Q

Estrogen doses vary from __ mcg to __ mcg

A

10 mcg to 50 mcg

32
Q

What are the contraindications for OCP use?

Theres a lot

A
  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
Q

Should OCP be used in patient older than 35 who is smoking more than half a pack a day?

A

No

34
Q

A patient is 5 weeks post-partum and currently breast-feeding, are OCP safe to start?

A

No

Contraindicated < 6 weeks post-partum

35
Q

What ADRs are associated with OCP use?

A
  1. Breakthrough Bleeding
  2. Headache
  3. Breast Tenderness
  4. DVT (Clotting)
  5. Nausea
  6. Acne
  7. Hirsutism
36
Q

Nausea, Breast Tenderness, Cyclic Weight Gain, and Menorrhagia are all symptoms of what?

A

Excess Estrogen

37
Q

Vasomotor symptoms, nervousness, and decreased libido are all symptoms of what?

A

Estrogen Deficiency

38
Q

Increased appetite, bloating, constipation, acne, hirsutism, and oily skin are all symptoms of what?

A

Excess Progesterone

39
Q

Late cycle breakthrough bleeding and menorrhagia are both symptoms of what?

A

Progesterone Deficiency

40
Q

What drugs interact with OCPs?

A
  1. Rifampin
  2. Phenobarb, Phenytoin
  3. Tetracycline
  4. Penicillin
41
Q

Does missing a dose of your OCP increase of decrease efficacy?

A

Decrease

42
Q

T/F: If you forget to take your OCP on time however it is less than 24 hours it should NOT be taken

A

False

it can still be taken

43
Q

When is an OCP dose considered to be missed?

A

Greater than 24 hrs since dose should have been taken

44
Q

What estrogen and third generation progesterone compose the Ortho Evra Patch?

A

Ethinyl Estradiol

Norelgestromin

45
Q

T/F: The clot risk with the ORtho Evra Patch is half that when compared to OCPs

A

False

Twice the risk

46
Q

What first generation progesterone is used in Depo-Provera (DMPA)?

A

Medroxyprogesterone acetate

47
Q

DMPA prevents ovulation for __ months

A

3

48
Q

What is the most common ADR of DMPA?

A

Irregular Menstrual bleeding

49
Q

What reversible ADR is with DMPA use?

A

Decreased Bone Mass Density

This will reverse when the drug is stopped

50
Q

What estrogen and second generation progesterone are recommend for contraception in women with NO medical conditions?

A

Ethinyl Estradiol

Norethindrone

51
Q

How long should you wear the Ortho Evra Patch?

A

3 weeks (then replace with new patch)

52
Q

Is the Ortho Evra Patch more or less effective in patient with a BMI > 25

A

Less Effective

There is a greater than 2x risk of unintended pregnancy

53
Q

Etonogestrel and Ethinyl Estradiol are compound used in this IUD contraceptive device

A

Nuvaring

54
Q

The Nuvaring should be left inplace for 3 weeks before being removed, when should a new one be place?

A

1 week after removal

55
Q

What ADRs are seen with the Nuvaring?

A

Vaginal irritation, infection, secretions

56
Q

Norethindrone is a ______ only pill

A

Progesterone

57
Q

T/F: Norethindrone is safe in breast feeding and is often used post-partum

A

True

58
Q

Implanted contraceptive devices such as the Nexplanon use ________

A

Etonogestrel

59
Q

What is the major ADR of a Nexplanon (Etonogestrel)?

What additional ADRs can be seen?

A

Irregular Bleeding

Headache
Vaginitis
Weight Gain
Acne
Breasr Pain
60
Q

What are “back up” contraception methods?

A
  1. Abstinence
  2. Condom
  3. Spermicide
  4. Diaphragm
  5. Cervical Cap
  6. Sponges
61
Q

Emergency contraception should be used within __ days of unprotected sex

A

5 days

62
Q

This emergency contraception method uses Ethinyl Estradiol and Levonorgestrel

A

Yuzpe Method

63
Q

What ADRs are seen with the Yuzpe Method

A

Nausea

Vomiting

64
Q

How does Ulipristal Acetate (Ella) work?

A

Inhibits or delays ovulation

65
Q

What ADRs are seen with Ulipristal Acetate (Ella)?

A 
Headache
Nausea
Abdominal Pain
Dysmenorrhea
Fatigue
Dizziness
Acne
66
Q

T/F: Ulipristal Acetate (Ella) can be purchased OTC

A

False

67
Q

What progesterone is used in Plan B?

A

Levonorgestrel

68
Q

What is the primary MOA of Plan B?

Secondary?

A

Primary: Inhibits or delays ovulation

Secondary: Prevents Fertilization

69
Q

T/F: Plan B is effective if implantation has occurred

A

False

70
Q

What ADRs are seen with Plan B?

A 
Irregular Menses 
Nausea
Abdominal Pain 
Fatigue 
Headache 
Dizziness
Breast tenderness
71
Q

T/F: Plan B is available OTC

A

True

72
Q

What test should be obtained prior to administering or prescribing emergency contraception

A

Pregnancy Test

73
Q

What is also known as the “Abortion Pill”?

A

Mifepristone (Korlym)

74
Q

T/F: Mifepristone (Korlym) is metabolized by P450

A

True

75
Q

What is a concerning condition to look for following an abortion using Mifepristone (Korlym)?

A

Sepsis

76
Q

What is in place in NC that allows providers to refuse prescribing medication to induce or preforming abortions?

A

Conscience Clause

Pharmacology II (2 decks)

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