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Pharmacology > Contraceptives, Menstration, Hormones, Lactation > Flashcards

Contraceptives, Menstration, Hormones, Lactation Flashcards

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
Q

What are the contraindications for IUDs?

A

abnormal/distorted uterine cavity
PID
postpartum endometritis
uterine malignancy

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26
Q

If a patient has Wilson disease, what type of IUD do they get?

A

COPPER only, (paragard)

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27
Q

What is emergency contraception used for?

A

to prevent pregnancy after known intercourse

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28
Q

What is the name of emergency contraceptions (2)?

A

Levonorgestrel

Ulipristal Acetate

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29
Q

What drug’s MOA inludes inhibition of ovulation/fertilization by thickening the cervical mucosa (altering the endometrium to inhibit implantation)

A

Levonorgestrel

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30
Q

Which emergency contraceptive is a progesterone receptor agonist/antagonist, preventing it from binding, delaying follicular rupture

A

Ulipristal acetate (ella)

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31
Q

what is the treatment of choice for dysmenorrhea?

A

NSAIDs - decreases uterine contractions and reduces menstrual blood flow

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32
Q

True or false: DO NOT use estrogen alone if intact uterus

A

True - always add a progestin

33
Q

Patient presents with amenorrhea and menopause symptoms. She does NOT have a uterus. Which patch is ok?

A

ethinyl estradiol patch (estrogen only)

34
Q

MOA of medroxyprogesterone

A

derivative of progesterone; transforms proliferative into secretory endometrium, INDUCING WITHDRAWAL BLEEDING IN SECONDARY AMENORRHEA

35
Q

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?

A

Bromocriptine

36
Q

This treatment is a dopamine 2 receptor agonist, inhibiting prolactin secretions

A

Bromocriptine

37
Q

AE Bromocriptine?

A

hypotension, constipation, nausea, anorexia, Raynauds

38
Q

Which hormonal replacement’s MOA is inhibition of plasminogen activation

A

Tranexamic acid

39
Q

Which hormone replacement therapy is often used in patients with PCOS-related amenorrhea and anovulatory bleeding?

A

Clomiphene

40
Q

What are 1st line for prevention of osteoporosis?

A

bisphosphates (add Ca and Vit D)

41
Q

what is the treatment of choice for dysmenorrhea?

A

NSAIDs (release of prostaglandins cause uterine contractions and pain)

42
Q

What do you NEVER use alone in treatment for menopause if the patient has an intact uterus?

43
Q

What is the MOA of medroxyprogesterone

A

induces withdrawal bleeding in secondary amenorrhea (derivative of progesterone)

44
Q

For those who cannot take hormonal therapy, what are some other options?

A

Antidepressants
Clonidine
Gabapentin
Phytoestrogens

45
Q

What type of birth control to use with a person who is 37, smoker, hypertension, and suffers from migraines?

A

Progestin-only

46
Q

Long term use of COC have an association with benign tumors of what origin?

47
Q

which Contraceptive has antiandrogenic AND antimineralocorticoid activity; including a spironolactone analog

A

Drospirenone (Yasmin, yaz)

48
Q

Yaz or Yasmin is commonly chosen if patient is producing too much ______, but CAUTION for low _____

A

androgen; K

49
Q

The transdermal (patch) type of OC is

A

ortho-evra (estrogen + progestin)

50
Q

weight over ____ kg increase failure rates of ortho-evra

51
Q

which has more estrogen exposure; ortho-evra patch or COC?

A

ortho-evra (35 mg)

52
Q

how long can the NuvaRing stay in the vagina?

A

3 weeks (followed by 7 days period)

53
Q

what’s the maximum amount of time that the nuvaring can be OUTSIDE the vagina to still work? (some people remove it during sex)

54
Q

what is the injectable (IM/SubQ) form of contraception?

A

Depo Provera (progestin-only)

55
Q

how often does the depo provera need to be administered?

A

every 3 months

56
Q

what is an advantage of Depo Provera?

A

it’s estrogen-free; great choice when estrogen is contraindicated

57
Q

The Depo shot has a black box warning that reads:

A

loss of bone mineral density, NOT RECOMMENDED FOR LONG TERM USE

58
Q

What is the component of IUDs?

A

Levornorgestrel - progestin only (or copper if Paragard)

59
Q

MOA of intrauterine devices (IUD)

A

causes inflammatory response that interferes with implantation, and with sperm transport/fertilization (copper paragard prevents implantation)

60
Q

how is implanon and nexplanon administered?

A

under the skin of inner upper arm

61
Q

MOA implanon?

A

increases viscosity of cervical mucous, altering endometrium and inhibiting ovulation

62
Q

What is the major contraindication to ParaGard

A

Wilson disease

63
Q

what are some common adverse effects of nexplanon/implanon?

A

abdominal cramping
uterine bleeding
expulsion of device
(less common: ectopic pregnancy, embedded device, uterine perforation)

64
Q

T or F: emergency contraception is more effective the earlier it’s used after unprotected sex

65
Q

How does Levonorgestrel prevent pregnancy as an emergency contraceptive?

A

alters the tubal transport, thickens cervical mucus (alteration of endometrium = inhibits implantation)

66
Q

What are the 2 types of emergency contraception?

A

Levonorgestrel

Ulipristal acetate

67
Q

what is the MOA of ulipristal acetate?

A

progesterone receptor antagonist (delays follicular rupture if taken before ovulation)

68
Q

True or False: ALL teratogens are completely contraindicated during pregnancy

A

FALSE - sometimes the benefits outweigh the risks

69
Q

What problems can benzodiazepines, lamotrigine, topiramate case?

A

oral cleft

70
Q

Paroxetine is considered a teratogen because it can cause _____

A

cardiac septal anomalies

71
Q

Pseudoephedrine is a teratogen as it can cause _____

A

gastroschisis

72
Q

absolute risk VS relative risk

A

absolute risk = actual risk of person getting the malformation

relative risk = risk compared to control & general population

73
Q

how to avoid neural tube defect during pregnancy?

A

take 0.4-0.8 mg folic acid daily starting 1 month before pregnancy through first 2-3 months

74
Q

Drugs are least likely to transfer into breast milk if they have these characteristics

A 
High protein point
high molecular weight
short 1/2 life
no active metabolites
well tolerated by kids
75
Q

1st line for treating n/v in pregnancy

A

pyridoxine + doxylamine

76
Q

how to treat pain in pregnancy

A

Acetaminophen (APAP)

77
Q

How to treat UTI in pregnancy?

A

cephalexin, cefpodoxime, amoxicillin clav

78
Q

when discontinuing hormone therapy, over what period of time do you taper?

A

3-6 months (reduces risk of symptom return)

Pharmacology (12 decks)

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