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Adv Pharm Faculty Page (Smoller/Bose) > Contraceptives/HRT/Testosterone > Flashcards

Contraceptives/HRT/Testosterone Flashcards

1
Q

Main groups of hormonal contraceptives (2 groups)

A

Estrogen-progestin contraceptives

Progestin-only contraceptive

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2
Q

Estrogen-progestin contraceptives - MOA

A

Estrogens: suppress FSH release, stabilize the endometrial lining, provide cycle control

Progestins: block the LH surge = no ovulation, thicken cervical mucus delay sperm transport, induce endometrial atrophy/inhibit endometrial proliferation

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3
Q

Estrogen-progestin contraceptives - indications

A

Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded, Dysmenorrhea Endometriosis, PCOS Acne, PMS/PMDD

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4
Q

Estrogen-progestin contraceptives - cautions

A

breastfeeding - may decrease milk supply, HLD, DM with complications, prolonged immobility/long leg cast (clot), migraine without aura over the age of 35

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5
Q

Estrogen-progestin contraceptives - contraindications

A

Thromboembolic disease, CAD, Active liver disease, Breast cancer, Smoker over 35 yo, Migraine with aura, Uncontrolled HTN, Undiagnosed vaginal bleeding

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6
Q

Estrogen adverse effects (Excess and deficiency)

A
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7
Q

High doses of estrogen-progestin contraceptives increases the risk of

A

Breast cancer, stroke, MI, DVT

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8
Q

Estrogen/progestin contraceptive counseling

A

How/when to start

Whether or not a back up method is needed

Common side effects and how to avoid Dangerous side effects

No protection against STIs

Follow-up visit

For pills: strategies to remember to take and what to do if a dose is missed

ACHES

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9
Q

Continuous dosing of estrogen-progestin ocps is possible with which formulation?

A

monophasic

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10
Q

Transdermal contraceptive patch - adverse effects

A

Greater incidence of venous throboembolism (black box warning_

-60% more estrogen exposure than OC

Not indicated for weight > 198lbs

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11
Q

Progestin adverse effects (excess and deficiency)

A
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12
Q

Androgenic adverse effects

A

Acne

Weight gain

Hirsutism

Fatigue

Depression

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13
Q

Progestin only contraceptive options

A

Minipill

Nexplanon implant

DMPA injection - Depo-Provera

IUD - Mirena, Skyla, Lilletta

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14
Q

Depo Provera risks/side effects

A

Bleeding irregularities

Delayed return of fertility (up to 6-18 months)

-don’t use more than 2 yrs

Weight gain

Decrease in bone mineral density

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15
Q

Progestin-only contraceptives - MOA

A

Inhibition of ovulation- suppression of midcycle peaks of LH & FSH

Thickened, decreased cervical mucous

Thinner, atrophic endometrium

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16
Q

Progestin-only contraceptives - adverse effects

A

Spotting

Amenorrhea

Irregular menstruation

Ectopic pregnancy - increased risks

17
Q

Paragard IUD MOA

A

MOA: copper toxic to sperm, prevents implantation

18
Q

Paragard benefits/side effects

A

Benefits: nonhormonal, use for up to 10 years

Side effects: increased menstrual flow and dysmenorrhea

19
Q

MOA for Mirena

A

Progestin releasing IUD

  • Impairs sperm motility and function
  • Inhibits conception
  • Thickens cervical mucus
  • Endometrium atrophy
  • Impaired tubal motility
20
Q

Progestin IUD benefits and adverse effects

A

Benefits:

Acts locally (systemic effects rare), lighter periods, no weight gain

Adverse effects:

Irregular cycle 3-6 months

21
Q

Contraindications to IUD placement

A

Current PID/cervicitis or PID within the last 3 months

Nulliparity or remote hx of PID (>3 mos) is not a contraindication

22
Q

Emergency Contraception Options

A

Plan B

Ella

Paragard

23
Q

Emergency Contraception MOA

A

Suppresses Ovulation (if taken prior to LH surge)

Prevent fertilization of an ovulated egg

Copper IUD: may also prevent implantation

No impact if already pregnant

24
Q

Yuzpe Method

A

Can be used with any combined or progestin only OC

Not as effect as other EC methods

Can have significant nausea

25
Q

Plan B

A

Available OTC

Effective until LH surge

-Best within 3 days, can be used up to 5 days

Effectiveness decreases with BMI>25

26
Q

Ella

A

Effective until LH peak

-Effective up to 5 days after unprotected sex

Prescription only

Decrease efficacy in BMI>30

27
Q

Copper IUD as EC

A

Effective at anytime in cycle

Not impacted by BMI

Insert up to 5 days after unprotected sex

28
Q

Hormone Replacement Therapy (HRT) Indications

A

Menopausal vasomotor symptoms

Vaginal atrphy - vaginal preparations

Added benefits: –increased bone density however decreased bone density is not an indication to start HRT –decreases risk of colon cancer

29
Q

Prescribing HRT

A

Use lowest dose for shortest duration possible

Less risky in younger women

Vaginal preparation less risky than oral/transdermal

In people with an intact uterus both estrogen and progesterone must be used - unopposed estrogen in those with a uterus increases risk for endometrial cancer

30
Q

HRT contraindications

A

Breast cancer, CHD, VTE hx or high risk, liver disease, unexplained vaginal bleeding

31
Q

Non-estrogen medications used in treatment of menopausal vasomotor symptoms

A

Antidepressants

Black Cohosh

Soy

32
Q

Testosterone replacement indications

A

Primary – disorders of the testes, Low serum testosterone and elevated LH/FSH

Congenital: Klinefelter syndrome, cryptorchidism

Acquired: mumps, radiation, chemo, medications, trauma, testicular torsion

Secondary – disorders of the hypothalamus/pituitary Low serum testosterone and normal or low LH/FSH

Congenital syndromes causing GnRH deficiency

Acquired: Tumors, eating disorders, post-androgen abuse, DM, Infiltrative diseases, head trauma, Drug use (marijuana, anabolic steroids, opioids)

33
Q

Testosterone Replacement Adverse Effects

A

Acne, Gynecomastia, Edema, Increased risk of CV disease, Increased risk of prostate cancer, Lower HDL, elevated triglycerides, Increased homocysteine, Male pattern baldness, Mood changes, Increased risk of sleep apnea

34
Q

Men on testosterone replacement should be screened for

A

prostate cancer

35
Q

Black box warning for testosterone replacement therapy

A

Risk for MI, CVA, HF, depression, hostility, liver toxicity

Adv Pharm Faculty Page (Smoller/Bose) (32 decks)

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