Female Fertility & Contraception Flashcards
Mention uses of ethinyl estradiol
- OCPs
- Replacement therpy:
a. 1ry hypogonadism
b. Postmenopausal: dec menophasal symptoms & osteroporosis, cardioprotective
Adverse effects of synthetic estrogen
Nausea, breast tenderness, weight gain, endometrial hyperplasia, inc risk of endometrial & bc, HTN & thromboembolism
In male: dec libido, gynecomastia, impotence, feminization
Mention uses of norgesterol
- Hormonal contrac (main use)
- Dysmenorrhea (inhibit ovulation)
- Endometriosis (long-lasting ovarian suppression)
Mention adverse effects of progestins
Irregular bleeding followed by amenorrhea, weight gain, edema, depression, HTN, low HDL, hirsutism & acne
Mention ovulation-inducing agents
- Clomiphene
- HCG
- Human menopausal G: menotropins, urofallitropin
- Gonadorelin sc pulses
- Bromocriptine in hyperprolactinemia
Describe MOA & routes of ergot alkaloids
Mixed partial agonist effects at a-adrenoreceptors & 5HT receptors
Oral, IM, intramyometrial CI IV
Mention uses of ergot alkaloids with respect FGS
- Prevent/control postpartum Hge
- After C-section or instrumental delivery to prevent uterine atony
- Sub involuted uterus
Mention adverse effects of ergot alkaloids
- NVA
- Inc BP, seizures
- Vasospasm, palpitations (transient chest pains, coronary arterial spasm)
- Reduce milk secretion if used for longer period postpartum
Mention CIs of ergot alkaloids
During pregnancy, HTN, cardiac patients
Copmpare oral preparations of contraceptives
Combined estrogen & progesterone (most effective)
Progesterone only (minipill) less reliable but no risk of thromboembolism
Mention indications of parenteral progesterone preparations
- Contraception
- Regulation of menstrual cycle
Mention adverse effects & CIs of
Minor: NV, headache, breast tenderness, edema
Intermediate: bleeding (low dose), amenorrhea (high dose), acne, hirstutism, skin pigmentation
Major: 1. CVS: thromboembolism, pulmonary embolism, HTN, stroke, MI
2. Carcinogenic: breast & endometrial
3. Cholecystitis
4. Depression
Describe drug interaction of hormonal cotracep
Enzyme inducers dec efficacy leading to pregnancy
Describe MOA, uses & AEs of clomiphene
-Partial agonist estrohen acts centrally, blocks central estrogen receptors in hypo preventing feedback inhibition of estrogen on FSHRH & LHRH, stimulate ovulation & corpus luteum formatio
-Used in female infertility due to ovulation disorders
-AEs hot flushed, multiple pregnancies, overstimulation of ovaries
Describe MOA, uses & AEs of tamoxiphen
-SERM partial agonist acting peripherally, inhibit estrogen action on breast (antagonist), preserves bone mineral density & inc endometrial cancer risk (agonist)
-Used in ttt of hormone sensitive bc
AEs: hot flushes, vaginal discharges, menstrual irregularities
Describe MOA, uses & AEs of raloxifene
-SERM as estrogen on bone but not on breast or uterus (no risk of cancer)
-ttt of osteoporosis
-AEs: hot flashed, legcramps, sweating, CI : history of venous TE
MOA & use of mifepristone
-Competitive inhibitor of progesterone & glucocorticoid receptors
-Therapeutic abortion
Mention uses and AEs of Leuprolide
GnRH analog
-Uses
1. SC pulses to inc gonadotrophins amd stimulate ovulation in infertility
2. Continuous to inhibit gonadotrophins in cancer prostate endometriosis and IVF
-AEs:
1. Headache, hot flushes, depression
2. Vaginal dryness, dec libido, ovarian cyst
3. Osteoporosis
Mention uses of genirelix
GnRH antagonist
1. Controlled ovarian hyper-stimulation (inhibit LH surge)
2. Advanced prostatic cancer
Mention thepeutic uses of hCG
Its action is similar to LH:
1. Infertility, IVF
2. Undescended testes
3. 1ry or 2ry amenorrhea due to lack of gonadotrophins
List adverse effects of gonadotrophins
- Hyperstimulation syndrome; enlarged ovary, ascites, hemoperitoneum
- Multiple births
- Spontaneous abortions
- Gymecomastia in males
