Female Reproduction Flashcards
Premarin
- Conjugated estrogens
- Alters gene transcription
- Vaginal bleeding, breast tenderness, increased DVT risk, increased risk of atherosclerosis & CAD, increased risk of uterine or breast CA
I: prevention & tx of osteoporosis & post-menopausal sx (hot flashes, vaginal dryness, itching)
Oral & topical creams
Progesterone should be added to estrogen HRT in any woman who still has a uterus
Drospirenone
Progestin
“4th generation gonane” (closer to natural progresterone)
Spironolactone analogue
Alters gene transcription
Anti-mineralocorticoid properties, counteracts estrogen-stimulated activity of renin-angiotensin-aldosterone system, not androgenic
Reduced water retention & bloating
I: contraception, secondary amenorrhea, DUB, endometriosis, palliative tx of endometrial CA/ renal cell carcinoma / breast CA / prostate CA, PMDD
PO (pill), IM
Closer to natural progesterone vs. other OCP
CI: hepatic failure, renal or adrenal insufficiency
Monitor for hyperkalemia
Medroxy-progesterone
(Provera)
class Moa
Synthetic progesterone
Alters gene transcription
Inhibits follicular development, prevents ovulation
Medroxy-progesterone
(Provera)
Side effects
Increased LDL:HDL, increased DVT risk
Breast tenderness, increased facial hair, decreased scalp hair, difficulty falling/remaining asleep, Abd pain, dysuria, anxiety, HA, N/V, cervicitis, reduced bone density
High dose for breast CA tx: weight gain, worsening DM & edema (esp. face)
BPH tx: reduced libido, impotence, reduced ejaculate volume, chemical castration (w/in 3 days)
Extremely high doses (CA): adrenal suppression, interference w/ carbohydrate metabolism (but doesn’t cause diabetes)
Delayed return of fertility: 9-10 months after last injection
Medroxy-progesterone
(Provera)
Characterisitics
I: Contraceptive, HRT, DUB, endometriosis tx, chemical castration of males
PO, IM (Depo – every 3 months)
Progestin added to prevent endometrial hyperplasia/CA
CI: Pregnancy (birth defects), prior Hx DVT, Hx breast/ovarian/uterine CA
Black box warning: don’t use drug for longer than 2 years unless no other viable method for contraception
Reduces risk of endometrial CA by up to 80%!
Ulipristal acetate
Ella
Selective progesterone receptor modulator (SPRM)
Delays/inhibits ovulation, inhibits follicle rupture
I: Emergency contraception
Must be given w/in 120 hours (5 days)
Prevents 60% expected pregnancies
Mifepristone
Mifeprex
Class
MOA
Synthetic steroid
Progestin antagonist w/ partial agonist activity – blockage of progesterone receptors = decline in HCG (= decline in progesterone in corpus luteum)
endometrial degeneration, cervical softening/dilation, prostaglandin release, increase in sensitivity of myometrium to prostaglandins
Mifepristone
Mifeprex
Side effects
Abd pain, uterine cramping, vaginal bleeding/spotting (9-16 days)
Less common: N/V/D, dizziness, fatigue, fever
Mifepristone
(Mifeprex)
Characteristics
I: Abortifacient in first 2 months of pregnancy (85% effective), Emergency contraceptive in smaller doses, induction of labor (can be combined w/ oxytocin)
Often used as abortifacient w/ Misoprostol (Cytotec) = prostaglandin E1 analog
CI: IUD, ectopic pregnancy, known hemorrhagic disorder, anticoagulation therapy, long-term prednisone therapy
Clomiphene
Clomid
Class
Moa
Selective estrogen receptor modulators (SERMs)
Binds estrogen-R sites in brain, interferes w/ normal negative feedback of estrogen on GnRH = increased GnRH increased LH, FSH, ovulation stimulation
Clomiphene
Clomid
Side effects
characteristics
Vaginal dryness, vaginal bleeding, breast tenderness, anxiety, hot flashes
Multiple births
PO
Potential CI: liver disease, breast CA, uterine CA
