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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
Plan B
Available OTC Effective until LH surge -Best within 3 days, can be used up to 5 days Effectiveness decreases with BMI\>25
26
Ella
Effective until LH peak -Effective up to 5 days after unprotected sex Prescription only Decrease efficacy in BMI\>30
27
Copper IUD as EC
Effective at anytime in cycle Not impacted by BMI Insert up to 5 days after unprotected sex
28
Hormone Replacement Therapy (HRT) Indications
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
Prescribing HRT
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
HRT contraindications
Breast cancer, CHD, VTE hx or high risk, liver disease, unexplained vaginal bleeding
31
Non-estrogen medications used in treatment of menopausal vasomotor symptoms
Antidepressants Black Cohosh Soy
32
Testosterone replacement indications
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
Testosterone Replacement Adverse Effects
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
Men on testosterone replacement should be screened for
prostate cancer
35
Black box warning for testosterone replacement therapy
Risk for MI, CVA, HF, depression, hostility, liver toxicity

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

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