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NP Adv Pharm_S21 > 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 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 y Migraine with aura Uncontrolled HTN Undiagnosed vaginal bleeding

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6
Q

Estrogen adverse effects

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

Progestin adverse effects

A
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9
Q

Androgenic adverse effects

A

Acne

Weight gain

Hirsutism

Fatigue

Depression

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10
Q

Progestin only contraceptive options

A

Nexplanon implant DMPA injection IUD - Mirena, Skyla, Lilletta

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11
Q

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

A

monophasic

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12
Q

Transdermal contraceptive patch - adverse effects

A

Greater incidence of venous throboembolism Not indicated for weight > 198lbs

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13
Q

Depo Provera risks/side effects

A

Bleeding irregularities Delayed return of fertility Weight gain Decrease in bone mineral density

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14
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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15
Q

Progestin-only contraceptives - adverse effects

A

Spotting Amenorrhea Irregular menstruation Ectopic pregnancy - increased risks

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16
Q

Paragard IUD MOA

A

MOA: copper toxic to sperm, prevents implantation

17
Q

Paragard benefits/side effects

A

Benefits: nonhormonal Side effects: increased menstrual flow and dysmenorrhea

18
Q

Emergency Contraception Options

A

Plan B Ella Paragard

19
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

20
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

21
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

22
Q

HRT contraindications

A

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

23
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

24
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

25
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)

26
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

27
Q

Men on testosterone replacement should be screened for

A

prostate cancer

28
Q

Non-estrogen medications used in treatment of menopausal vasomotor symptoms

A

Antidepressants Black Cohosh Soy

NP Adv Pharm_S21 (25 decks)

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