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Pharmacology > Contraceptives, Menstration, Hormones, Lactation > Flashcards

Contraceptives, Menstration, Hormones, Lactation Flashcards

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1
Q

what are some of the benefits of COMBINATION oral contraceptives

A

reduce risk of endometrial and ovarian cancer

  • prevents ovarian cysts
  • relieves PMS, benign breast disease, endometriosis
  • acne control
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2
Q

What is the efficacy of PERFECT use of oral contraceptives?

A

98%

80% with typical use

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3
Q

What type of contraceptive should a 40 year old smoker with hypertension and hx migraines use?

A

Progestin only

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4
Q

When is estrogen CONTRAINDICATED in contraceptive use?

A 
smoker >35 years old
HTN
migraine headaches w/ aura
-venous thromboembolism
-gallbladder disease
-hepatic tumors
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5
Q

in what kind of tumors is oral contraceptives contraindicated?

A

hepatic

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6
Q

Patient presents wanting to begin oral contraceptives, she is 42 years old and has a history of DVT. What kind of OC do you consider?

A

Progestin-only!

estrogen contraindicated

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7
Q

common adverse effects of oral contraceptives?

A 
headache
n/v
nostalgia
weight gain
breakthrough bleeding/spotting
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8
Q

what 2 options do you have regarding management of AEs w/ oral contraceptives?

A
  • adjust the amount of estrogen/progestin

- use lower dose combo

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9
Q

are progestin-only pills more effective than combo or estrogen pills?

A

NO - less effective

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10
Q

When using Progestin-only pills, missing a dose can yield a higher risk for contraceptive failure. What is the time frame for missing a dose?

A

3 hours = missed dose

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11
Q

why would you prescribe a woman with hx thromboembolism progestin-only?

A

lower risk of thromboembolism

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12
Q

which type of oral contraceptive is ok for breastfeeding?

A

progestin-only; start 6 weeks postpartum

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13
Q

estrogen is metabolized by which CYP system?

A

CYP450-3A4

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14
Q

Drospirenone (COC) has a spironolactone analog; how does this affect the body?

A

can affect sodium and water imbalance in body

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15
Q

Which type of patient would you prescribe Drospirenone to?

A

a patient who produces too much androgen, because it is an antiandrogenic drug.

CAUTION if low K

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16
Q

What is the advantage of a NON-oral hormonal contraceptive?

A

does not need to be taken every day and are just as effective

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17
Q

What is the transdermal type of non-oral hormonal contraceptive? How long does it last?

A

Ortho-Evra (estrogen + progestin)

replace patch every week

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18
Q

What is the transvaginal type of non-oral contraceptive? How long does it last?

A

NuvaRing (estrogen + estronogestrel)

lasts 3 weeks, out for 1 week, repeat.

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19
Q

What is the non-oral hormonal contraceptive? How long does it last?

A

Depo-Provera (progestin only)

every 3 months

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20
Q

The black box warning for this reads: causes loss of bone mineral density, reversible with D/C - not recommended for long term use

A

Depo-Provera (progestin only)

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21
Q

What is the delayed return to fertility time frame for Depo-Provera?

A

10-12 months

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22
Q

What type of contraceptive includes: Mirena, Skyla, ParaGard?

A

Intrauterine IUDs

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23
Q

What is the MOA for intrauterine IUDs?

A

causes inflammatory response that interferes with implantation, and/or interferes with sperm transport and fertilization

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24
Q

What are the names of the implantable contraceptive devices?

A

Implanon & Nexplanon

-inserted under skin of upper arm

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25
What are the contraindications for IUDs?
abnormal/distorted uterine cavity PID postpartum endometritis uterine malignancy
26
If a patient has Wilson disease, what type of IUD do they get?
COPPER only, (paragard)
27
What is emergency contraception used for?
to prevent pregnancy after known intercourse
28
What is the name of emergency contraceptions (2)?
Levonorgestrel | Ulipristal Acetate
29
What drug's MOA inludes inhibition of ovulation/fertilization by thickening the cervical mucosa (altering the endometrium to inhibit implantation)
Levonorgestrel
30
Which emergency contraceptive is a progesterone receptor agonist/antagonist, preventing it from binding, delaying follicular rupture
Ulipristal acetate (ella)
31
what is the treatment of choice for dysmenorrhea?
NSAIDs - decreases uterine contractions and reduces menstrual blood flow
32
True or false: DO NOT use estrogen alone if intact uterus
True - always add a progestin
33
Patient presents with amenorrhea and menopause symptoms. She does NOT have a uterus. Which patch is ok?
ethinyl estradiol patch (estrogen only)
34
MOA of medroxyprogesterone
derivative of progesterone; transforms proliferative into secretory endometrium, INDUCING WITHDRAWAL BLEEDING IN SECONDARY AMENORRHEA
35
A menopausal patient presents with amenorrhea, and has a history of hyperprolactinemia. What is the best hormone treatment, which can restore ovulation in 90% of people?
Bromocriptine
36
This treatment is a dopamine 2 receptor agonist, inhibiting prolactin secretions
Bromocriptine
37
AE Bromocriptine?
hypotension, constipation, nausea, anorexia, Raynauds
38
Which hormonal replacement's MOA is inhibition of plasminogen activation
Tranexamic acid
39
Which hormone replacement therapy is often used in patients with PCOS-related amenorrhea and anovulatory bleeding?
Clomiphene
40
What are 1st line for prevention of osteoporosis?
bisphosphates (add Ca and Vit D)
41
what is the treatment of choice for dysmenorrhea?
NSAIDs (release of prostaglandins cause uterine contractions and pain)
42
What do you NEVER use alone in treatment for menopause if the patient has an intact uterus?
ESTROGEN
43
What is the MOA of medroxyprogesterone
induces withdrawal bleeding in secondary amenorrhea (derivative of progesterone)
44
For those who cannot take hormonal therapy, what are some other options?
Antidepressants Clonidine Gabapentin Phytoestrogens
45
What type of birth control to use with a person who is 37, smoker, hypertension, and suffers from migraines?
Progestin-only
46
Long term use of COC have an association with benign tumors of what origin?
hepatic
47
which Contraceptive has antiandrogenic AND antimineralocorticoid activity; including a spironolactone analog
Drospirenone (Yasmin, yaz)
48
Yaz or Yasmin is commonly chosen if patient is producing too much ______, but CAUTION for low _____
androgen; K
49
The transdermal (patch) type of OC is
ortho-evra (estrogen + progestin)
50
weight over ____ kg increase failure rates of ortho-evra
90
51
which has more estrogen exposure; ortho-evra patch or COC?
ortho-evra (35 mg)
52
how long can the NuvaRing stay in the vagina?
3 weeks (followed by 7 days period)
53
what's the maximum amount of time that the nuvaring can be OUTSIDE the vagina to still work? (some people remove it during sex)
3 hours
54
what is the injectable (IM/SubQ) form of contraception?
Depo Provera (progestin-only)
55
how often does the depo provera need to be administered?
every 3 months
56
what is an advantage of Depo Provera?
it's estrogen-free; great choice when estrogen is contraindicated
57
The Depo shot has a black box warning that reads:
loss of bone mineral density, NOT RECOMMENDED FOR LONG TERM USE
58
What is the component of IUDs?
Levornorgestrel - progestin only (or copper if Paragard)
59
MOA of intrauterine devices (IUD)
causes inflammatory response that interferes with implantation, and with sperm transport/fertilization (copper paragard prevents implantation)
60
how is implanon and nexplanon administered?
under the skin of inner upper arm
61
MOA implanon?
increases viscosity of cervical mucous, altering endometrium and inhibiting ovulation
62
What is the major contraindication to ParaGard
Wilson disease
63
what are some common adverse effects of nexplanon/implanon?
abdominal cramping uterine bleeding expulsion of device (less common: ectopic pregnancy, embedded device, uterine perforation)
64
T or F: emergency contraception is more effective the earlier it's used after unprotected sex
True
65
How does Levonorgestrel prevent pregnancy as an emergency contraceptive?
alters the tubal transport, thickens cervical mucus (alteration of endometrium = inhibits implantation)
66
What are the 2 types of emergency contraception?
Levonorgestrel | Ulipristal acetate
67
what is the MOA of ulipristal acetate?
progesterone receptor antagonist (delays follicular rupture if taken before ovulation)
68
True or False: ALL teratogens are completely contraindicated during pregnancy
FALSE - sometimes the benefits outweigh the risks
69
What problems can benzodiazepines, lamotrigine, topiramate case?
oral cleft
70
Paroxetine is considered a teratogen because it can cause _____
cardiac septal anomalies
71
Pseudoephedrine is a teratogen as it can cause _____
gastroschisis
72
absolute risk VS relative risk
absolute risk = actual risk of person getting the malformation relative risk = risk compared to control & general population
73
how to avoid neural tube defect during pregnancy?
take 0.4-0.8 mg folic acid daily starting 1 month before pregnancy through first 2-3 months
74
Drugs are least likely to transfer into breast milk if they have these characteristics
``` High protein point high molecular weight short 1/2 life no active metabolites well tolerated by kids ```
75
1st line for treating n/v in pregnancy
pyridoxine + doxylamine
76
how to treat pain in pregnancy
Acetaminophen (APAP)
77
How to treat UTI in pregnancy?
cephalexin, cefpodoxime, amoxicillin clav
78
when discontinuing hormone therapy, over what period of time do you taper?
3-6 months (reduces risk of symptom return)

Pharmacology (12 decks)

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