Estrogen and Progestin Inhibitors Flashcards

1
Q

What are different routes of admin of Birth control (“type”)

A
Oral pill
Injectable
Implantable
Intrauterine Device
Transdermal
Vaginal Ring
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2
Q

Why can you never give Estrogen alone?

A

Endometrial effects?***

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3
Q

What hormones are given with different routes?

A
Oral pill- E+P or P
Injectable- E+P or P
Implantable- P
Intrauterine Device- P or Copper
Transdermal -E+P
Vaginal Ring- E+P
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4
Q

What is the MOA of Hormonal Birrth Control

A

Supress LH and FSH surge
Alter Cervical mucous
Alter Endometrium
In general envt. less favorable for implantation

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5
Q

What is the most common dosing strategy in Oral birth ontrol pills?

A

21 active tablets

7 inert tablets

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6
Q

What can be done to decrease Side effects from Hormonal birth control?

A

Alter dosing strategy to more closely mirror their natural cycle.

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7
Q

What is the most common form of injectable BC?

A

Medroxyprogesterone (Depo-provera)

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8
Q

What is the strategy for Plan B Emergency Birth control?

A

Within 72 hrs post sexual intercourse (unfavorable envt for ovulation)

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9
Q

What hormone is used for Plan B Emergency Birth control?

A

Levonorgestrel

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10
Q

What defines “perfect use” of Emergency contraception?

A

Take drug at same time each day with the same meal, not missing any doses, etc.

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11
Q

What are the adverse effects of Hormonal Contraceptives?
Mild
Mod
Severe

A

Mild: Nausea, Breast Pain, Edema, BT bleeding(estrogen), Withdrawl bleed failure, serum protein changes

Mod: BT bleeding(progestin)
Weight Gain
Inc Skin pigmentation
Acne
Hirsuitism
Vaginal infections
Amenorrhea
Severe:
Thromboembolus
MI
Cholestasis
Depression
Cancer
Cerebrovascular Disease
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12
Q

When would you not prescribe hormonal BC?

A
Cancer(use progestin only pill)
Thromboembolic Disorders
Liver disease
History of CVD
Smokers older than 35yo
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13
Q

What are the Drug interactions with Contraceptives?

A

HIV agents, anticonvulsants, and St. Johns wort inc. hormone metabolism
Antibiotics lower contraceptive effectiveness.

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14
Q

What is the MOA of Clomiphene?

A

A partial agonist of estrogen. blocks estrogen negative feedback.

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15
Q

What are the AA of Clomiphene?

A

Multiple Births
HOT FLASHES
Ovary enlargement
Blurred vision

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16
Q

Wy does a partial agonist decrease action on Estrogen?

A

Net action is less bc it displaces a stronger agonist.

17
Q

When is clomiphene given?

A

Follicular phase. Increase in LH and FSH

Remove the drug before the Luteal phase

18
Q

What is the MOA of the SERMS?

A

They act differentlydepending on the tissue they are in

19
Q
What are the actions of SERMS in different tissues?
BONE
ENDOMETRIUM
PITUITARY
BREAST
A

BONE: supress resorption
ENDOMETRIUM: proliferation
PITUITARY: hot flashes
BREAST: inhibit proliferation

20
Q

What are the actions of Tamoxifen?

A

Antagonist: breast/ H-P-G axis

Partial agonist endometrium

21
Q

What are the AA of Tamoxifen?

A

Endometrial Cancer, Hot flashes, N/V

22
Q

What are the actions of Raloxifen?

A

Antagonist: breast/ H-P-G axis
Partial agonist endometrium (less)
Same as tamoxifen with less of an effect on endometrium.
Hot flashes are worse though

23
Q

What is the MOA of Danazol?

A

Inhibit gonadal function

24
Q

What is the use of Danazol?

A

Endometriosis, Breast fibrocystic disease

25
Q

What are the AA of Danazol?

A

Weight Gain, Edema, oily skin, acne,hirsuitism, HOT FLASHES

26
Q

What are teh types of Anti Progesterones?

A

Abortifacents

Emergency contraceptives

27
Q

What is an example of an abortifacent?

A

Mifeprestone (used first as anti-rogesterone)

Used in combo with misoPROSTol-uterine contractions

28
Q

What is the MOA ofUlipristal?

A

Partial Agonist of Progesterone.

29
Q

What is the MOA of Anti progesterones?

A

Inhibit progesterone Receptors
Uterine Contractions
Lining of uterus is Shed
Opens cervix