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pharm summer 1 > Contraceptives > Flashcards

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
Q

oral contraceptive progestin MOA:

A
  • primary contaceptive
  • prevents LH surge (no ovum release)
  • thickens cervical mucus
  • decrease tubal motility
  • thin endometrium
26
Q

oral contraceptives contraindications:

A
  • 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
Q

OC drug interactions:

A
  • all reduce efficacy
  • rifampin
  • phenobarb
  • carbamazepine
  • phenytoin
28
Q

antibiotic interactions with OC:

A
  • tetracyclines and PCNs reduce ethanol estradiol concentration
  • ampicillin may cause breakthrough bleeding
29
Q

OC adverse effects:

A

-breakthrough bleeding

30
Q

estrogen OC adverse effects:

A
  • HA
  • breast tenderness
  • DVT, Clot
  • nausea
31
Q

progesterone androgenic OC adverse effects:

A
  • acne

- hirsutism

32
Q

Excess estrogen symptoms:

A

N, breast tenderness, HA, fluid rendition weight gain, dysmenorrhea , menorrhagia, uterine fibroid growth

33
Q

estrogen deficiency symptoms:

A

-vasomotor symptoms, nervousness, decreased libido, early cycle BTB, amenorrhea

34
Q

excess progestin symptoms

A

-inc appetite, wt. gain, bloating, constipation, depression, fatigue, irritability, acne, oily skin, hirsutism

35
Q

progestin deficiency symptoms:

A

-dysmenorrhea, menorrhagia, late cycle BTB

36
Q

Ortho evra patch

A

norelgestromin and ethanol estadiol

-increased clot risk over OC

37
Q

patch directions

A
  • new patch weekly x3 weeks, no patch week 4
  • dont cut, dose dump
  • less effective in heavier patients over 90 kg
38
Q

Nuvaring

A

-Etonogestrel + EE

insert vaginally, 3 weeks in, 1 week off

39
Q

nuvaring side effects:

A

irritation, infection, secretion

40
Q

Progestin only pills

A
  • 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
Q

Depo-provera

A
  • 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
Q

Depo-provera ADRs

A
  • irreg menstrual bleeding, breast tenderness, wt gain, depression
  • decrease BMD (make sure pt gets calcium and vit D
43
Q

implants

A
  • etonogestrel

- reversible

44
Q

impact side effects:

A
  • irregular bleeding

- HA, vaginitis, wt gain, acne, breast and ab pain

45
Q

Emergency contraceptive

A
  • yuzpe method
  • levonorgesterol
  • ulipristal
  • mifepristone
  • Cu-IUD
  • use within 5 days of unprotected intercourse
46
Q

yuzpe method side affects

A

N, V

47
Q

ulipristal acetate:

A

-selective progesterone modulator

48
Q

ulipristal acetate MOA:

A

delays or inhibits ovulation

49
Q

ulipristal ADRs:

A

HA, N, ab pain, dysmenorrhea, fatigue, dizziness, acne

50
Q

Levonorgestrel MOA:

A
  • inhibits/delays ovulation

- prevents fertilization

51
Q

levonorgestrel side effects:

A

-irregular menses, N, ab pain, fatigue, dizziness, breast tenderness

52
Q

what do you have tom do before emergency contraception?

A

prego test

53
Q

Mifepristone MOA:

A

progesterone and cortisol receptor antagonist

  • abortion pill
  • watch for sepsis
54
Q

how is mifepristone metabolized

A

p450

pharm summer 1 (4 decks)

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