Contraceptives Flashcards

1
Q

Estrogen MOA:

A
  • transcription factor
  • directly modifies mRNA synthesis
  • influences gene transcription
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2
Q

Estrogen reproductive effects:

A

-sexulan maturation, endometrial growth, breast tissue stimulation

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3
Q

How does estrogen increase clotting tendency?

A

increases levels of vit. K

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4
Q

Estrogen effects on skin?

A
  • inc. pigment
  • inc. colagen/ thickness
  • skin moisture
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5
Q

Estrogen metabolic effects:

A
  • dec. bone resorption
  • inc. HDL
  • Dec. LDL
  • inc. trigs
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6
Q

Estrogen indications:

A
  • Contraception
  • menopausal hormone replacement therapy (vasomotor symptoms or vulvovaginal atrophy)
  • endometriosis tx
  • dysfunctional uterine bleeding
  • osteoporosis prevention
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7
Q

Estrogen contra:

A
  • undiagnosed genital bleeding
  • breast cancer or chance of
  • DVT or PE or hx of
  • clotting disorders
  • liver disease
  • protein C, S or antithrombin deficiency
  • prego
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8
Q

how is progesterone metabolized?

A

3A4

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9
Q

how does progesterone interact with ketoconazole?

A

its inhibited by it

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10
Q

Progesterone warnings:

A

DVT, PE, CVA, AMI, dementia, breast ca.

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11
Q

Progesterone indications:

A

secondary amenorrhea, DUB, PMS, HRT, cervical ripening, Mastodynia, endometrial hyperplasia, infertility, anovulatory bleeding

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12
Q

First Gen Progestins:

A
  • steroids with similar activity to progesterone
  • Megestrol acetate
  • medroxyprogesterone acetate (proverà)
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13
Q

2nd gen progestins:

A
  • norethindrone
  • ethynodial
  • have some androgenic effects
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14
Q

3rd gen progestins

A
  • Norgestrel, Levonorgestrel
  • Desogestrel
  • Norgestimate
  • Dienogest
  • oral or injectable
  • less androgenic
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15
Q

non steroidal progestins:

A
  • Derived from spironolactone

- Drospirenone

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16
Q

Progestins MOA:

A
  • directly modify RNA synthesis

- influence gene transcription

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17
Q

reproductive effects of progestins:

A
  • feedback loop with FSH and LH
  • decline determines onset of menstruation
  • changes endocervical gland secretions from watery to viscous (reducing sperm entry into uterus)
  • maintains pregnancy
  • mild sedative
  • inc body temp with preovulatory surge
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18
Q

progestins metabolic effects:

A
  • inc insulin secretion and peripheral insulin resistance
  • inc lipase activity
  • inc LDL, dec HDL
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19
Q

Indic of progestins:

A
  • contraception
  • post-menopause HRT
  • dysfunctional uterine bleed
  • pregnancy maintenance
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20
Q

progestins contra:

A
  • DVT, PE
  • severe migraine
  • unexplained vag bleed
  • breast Ca
  • liver disease
  • CV risk
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21
Q

Progestin ADRs:

A
  • Acne
  • hirutism
  • inc LDL
  • insulin resistance
  • DVT (esp. 3rd gen)
  • vag bleeding
  • bone loss
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22
Q

Oral contraceptive Estrogens:

A
  • Ethinyl estradiol
  • Mestranol
  • Estradiol valerate
23
Q

Oral contraceptive Progestins:

A
  • Medroxyprogesterone
  • norethindrone
  • levonorethindrone
  • ethynodiol acetate
  • desogestrol
  • drospirenone
  • norgestimate
  • dienogest
24
Q

Oral contraceptive estrogen MOA:

A
  • cycle control
  • contraceptive activity
  • stabilize endometrium
  • minimizes irregular shedding
  • inhibits FSH release
  • potentiates LH surge inhibition
25
oral contraceptive progestin MOA:
- primary contaceptive - prevents LH surge (no ovum release) - thickens cervical mucus - decrease tubal motility - thin endometrium
26
oral contraceptives contraindications:
- clot disorders - diabetes - migraine with aura - uncontrolled HTN - surgery with prolonged immobilization - thrombogenic mutations - breast Ca - liver dz - age 35+ and smoker - pregnant - breastfeeding
27
OC drug interactions:
- all reduce efficacy - rifampin - phenobarb - carbamazepine - phenytoin
28
antibiotic interactions with OC:
- tetracyclines and PCNs reduce ethanol estradiol concentration - ampicillin may cause breakthrough bleeding
29
OC adverse effects:
-breakthrough bleeding
30
estrogen OC adverse effects:
- HA - breast tenderness - DVT, Clot - nausea
31
progesterone androgenic OC adverse effects:
- acne | - hirsutism
32
Excess estrogen symptoms:
N, breast tenderness, HA, fluid rendition weight gain, dysmenorrhea , menorrhagia, uterine fibroid growth
33
estrogen deficiency symptoms:
-vasomotor symptoms, nervousness, decreased libido, early cycle BTB, amenorrhea
34
excess progestin symptoms
-inc appetite, wt. gain, bloating, constipation, depression, fatigue, irritability, acne, oily skin, hirsutism
35
progestin deficiency symptoms:
-dysmenorrhea, menorrhagia, late cycle BTB
36
Ortho evra patch
norelgestromin and ethanol estadiol | -increased clot risk over OC
37
patch directions
- new patch weekly x3 weeks, no patch week 4 - dont cut, dose dump - less effective in heavier patients over 90 kg
38
Nuvaring
-Etonogestrel + EE | insert vaginally, 3 weeks in, 1 week off
39
nuvaring side effects:
irritation, infection, secretion
40
Progestin only pills
- norethindrone - start any time in cycle. within first 5 days, no backup needed - used postpartum - ok with breast feeding - need to take on time, within 3 hrs
41
Depo-provera
- medroxyprogesterone acetate injection - long acting, no ovulation for 3 months - repeat dose at 12 weeks - sasfest 30 days after delivery min breast feeding women
42
Depo-provera ADRs
- irreg menstrual bleeding, breast tenderness, wt gain, depression - decrease BMD (make sure pt gets calcium and vit D
43
implants
- etonogestrel | - reversible
44
impact side effects:
- irregular bleeding | - HA, vaginitis, wt gain, acne, breast and ab pain
45
Emergency contraceptive
- yuzpe method - levonorgesterol - ulipristal - mifepristone - Cu-IUD - use within 5 days of unprotected intercourse
46
yuzpe method side affects
N, V
47
ulipristal acetate:
-selective progesterone modulator
48
ulipristal acetate MOA:
delays or inhibits ovulation
49
ulipristal ADRs:
HA, N, ab pain, dysmenorrhea, fatigue, dizziness, acne
50
Levonorgestrel MOA:
- inhibits/delays ovulation | - prevents fertilization
51
levonorgestrel side effects:
-irregular menses, N, ab pain, fatigue, dizziness, breast tenderness
52
what do you have tom do before emergency contraception?
prego test
53
Mifepristone MOA:
progesterone and cortisol receptor antagonist - abortion pill - watch for sepsis
54
how is mifepristone metabolized
p450