Exam 5- Reproductive Flashcards
contraceptives mechanism of action
estrogen and progesterone provide negative feedback which prevents secretion of LH and FSH
most common combination=
ethinyl estradiol and synthetic progestin
called “CHCs” Combined Hormonal Contraceptives
we don’t use estrogens alone bc
they increase the risk of endometrial and ovarian cancer
progestin only contraceptives
=minipills or POPs
=25% of all preps
-slightly less efficacy and increased risk for breakthrough bleeding
-reduced risk for thromboembolic disease vs. CHC
-taken daily, no placebo
-prevent ovulation and thicken mucus to hinder sperm
new preps are ___
extended doses
-no reduction in efficacy but increased risk for breakthrough bleeding
mild adverse effects of hormonal contraceptives
mastalgia
nausea
headache
moderate adverse effects of hormonal contraceptives
hyperpigmentation
edema
weight gain
severe adverse effects of hormonal contraceptives
-IN HIGH RISK WOMEN ONLY:
coagulation… emboli and thrombotic stroke
(from estrogen)
coronary heart disease
- depression
-migraine with aura
-cholestatic jaundice and gallbladder dysfunction
cancer risks with hormonal contraception
- no strong evidence for increased risk of breast cancer with hormonal contraception, but may want to avoid inwoven with a history
- want to avoid with active cancer
routes of administration with highest and lowest risks for side effects
highest= patches, depots lowest= vaginal rings
drospirenone
=progestin component of a number of combination hormonal contraceptives
=”yaz”
-blockade of mineralocorticoid and androgen receptors
-lower occurrence of acne, PMDD, hirsutism and weight gain
-increased risk for venous thromboembolism
missing a pill..
effective suppression of ovulation will persist if up to three active pills are missed in a row
(not the case with progestin-only)
antibiotics with contraception
may impair absorption by messing with GI flora
enzyme inducers and contraceptives
may increase estrogen metabolism via CYP450
RU-486
=ABORTION PILL
=luteolytic drug (creates a destructive environment for egg)
-progesterone and glucocorticoid receptor antagonist
-administered with prostaglandin to terminate early pregnancy (within 7 wks)
-can have SEVERE effects
Plan B
=high dose levonorgestrel
=synthetic progestin
-functions the same way as an oral contraceptive but at a higher dose
(controversy= it may also prevent implantation of a fertilized egg)
drugs that promote ovulation goal=
increase gonadotropin secretion in an ideal pattern
three fertility drugs
- clomiphene= SERM that blocks negative feedback
- gonadorelin=synthetic GnRH
- gonadotropins= analogs of LH and or FSH
menopause tx types
- conjugated estrogens
2. estrogen plus progestin
effects of combined progestin and estrogen HRT in postmenopausal women
- increased risk of CHD, venous thrombosis, and breast cancer
- reduced osteoporosis, hot flashes, and incidence of colorectal cancer
effects of estrogen HRT in postmenopausal women
increased risk of venous thrombosis and stroke, as well as endometrial cancer
-breast cancer or heart disease was not significant
current recommendation for post menopausal symptoms
- HRT still indicated for women experiencing severe vasomotor symptoms
- only administer for 3-5yrs
- local application for vaginal/urinary symptoms
- NOT first line tx for osteoporosis
alternatives to HRT for postmenopausal symptoms of
osteoporosis
mood disturbances
increased LDL
osteoporosis = bispohosphonates
mood disturbances = anti-depressants/mood stabilizers
increased LDL = statins
BPH treatment types
- alpha1 andrenergic receptor agonists
2. 5alpha-reductase inhibitors
alpha1 andrenergic receptor agonists
=relaxes prostate and uretral smooth muscle
tamsulosin=selective for prostate sm muscles
dixazosin= nonselective … hypotension
5alpha-reductase inhibitors
= (-) testosteron to DHT
dutasteride
-take a long time to work and may not work in all men
erectile dysfunction treatment mechanism
inhibit PDE-5 which metabolizes cGMP to GMP and stops erection
erectile dysfunction drug list
sildenafil
vardenafil
avanafil
tadalafil (claims to be longer lasting)
erectile dysfunction drugs side effects
hypotension never use with nitrates (additive effects) headaches facial flushing visual effects
