GU/Repro Flashcards
Exam2
Estrogen/progestin contraceptive- MOA?
Suppresses FSH/LH -> inhibits ovulation
Mimics hormone changes of pregnancy -> prevents pituitary gland from stimulating ovaries -> thinning/increase in cervical mucus
Progesterone contraceptive- MOA?
Suppresses LH -> inhibits ovulation
Thickens cervical mucus -> slows transport of sperm
Endometrial atrophy -> inhibits implantation of egg
What drug is a progestin-only contraception?
Levonorgestrel (oral)
Medroxyprogesterone (injection)
What drug class is levonorgestrel?
Progestin-only contraceptive (plan B- emergency contraception)
Must be taken within 3 days
Lower efficacy for BMI > 30
Progestin only pills- MOA/info?
Suppresses ovulation
Thickens cervical mucus- slows sperm
Thin endometrium- prevents egg implantation
Safe for breastfeeding
Safe for smoker/CAD risk
Less effective than combo
Adherence schedule more strict
(Progestin-only oral contraceptive)
What drug is a non-oral hormonal contraceptive- injection?
Medroxyprogesterone (progestin only)
What drug type is medroxyprogesterone?
Progestin only injection - every 3 months
Contraindicated for pts w/ depression d/t CNS affect -> exacerbate depression
What drug type is ethinyl estradiol?
Non-oral hormonal contraceptive- patch
What drug is a non-oral hormonal contraceptive in patch/ring form?
Ethinyl estradiol
Ethinyl estradiol- use?
Patch: used weekly x3weeks, 1 week off to bleed
Higher systemic estrogen exposure
Contraindicated for those w/ clotting risk d/t increased risk of DVT
Ring: insert monthly, in for 3weeks, out for 1
Store in fridge
Adverse effects of combo hormonal contraceptives?
Thrombosis
Contraindicated for age > 35 who smoke d/t risk of cardiovascular events
Contraindications for estrogen-containing contraaceptives?
History of thrombosis (stroke, heart attack, PE/DVT)
Migraine with aura
Combo oral contraceptives- side effects?
Initiation: 7 active pills at same time/day
Estrogen- decreased milk supply
Increased risk of thrombophlebitis, cardiovascular events
(Ethinyl estradiol)
Drug interactions with hormonal contraceptives?
Decrease efficacy:
Antibiotics
Anticonvulsants
Drospirenone- risk of increased K+
What lab can be used to determine BPH?
PSA- serum prostate-specific antigen
If this is increased, sign of BPH
What drug class is tamsulosin?
Alpha-blocker
What drug is an alpha-blocker?
Tamsulosin
(can’t be used with tubes- capsules only)
Tamsulosin- indication?
BPH- first line for moderate to severe symptoms
(Alpha blocker)
Tamsulosin- MOA?
Dilation of urethra
Inhibits alpha1 adrenergic receptors -> relaxes smooth muscles in prostate & bladder neck ->
reduces bladder outlet obstruction
Improves urinary flow
(Alpha blocker)
Tamsulosin- side effects?
Floppy iris syndrome w/ cataract surgery- notify op. doc prior to eye surgery
Retrograde ejaculation
Dizziness
Rebound HTN w/ abrupt d/c
Take at night to avoid first does hypotension
Take 30min after a meal (prevents sticking to food)
Contraindicated w/ strong CYP3A4 inhibitor
Caution w/ PDE-5 inhibitor d/t additive hypotensive effects (sildenafil / tadalafil)
(Alpha blocker)
What drug is a 5-alpha reductase inhibitor?
Finasteride
What drug class is finasteride?
5-Alpha reductase inhibitors
Finasteride- indications?
BPH- decreases prostate size
Finasteride- MOA?
Inhibits 5 alpha-reductase enzymes conversion of testosterone to DHT -> decreases prostate size
Can take >6months to work- can be taken with alpha blockers (tamsulosin) to bridge
(DHT leads to hyperplasia)
(5 Alpha-reductase inhibitor)
Finasteride- side effects?
Sexual dysfunction- Sx decrease over time
Gynecomastia
Contraindicated for bladder obstruction w/o increased prostate size
Contraindicated for pregnancy/child-bearing age- Hazardous med- women shouldn’t handle this med w/o PPE-
Teratogenic and can be absorbed through skin
What is ED?
Persistent inability to achieve / sustain erection
Nitric oxide release impaired -> decreased vasodilation -> decreased blood flow
What drugs are first-line treatment for ED?
PDE-5 inhibitors
(Sildenafil)
What drug is a PDE-5i?
Sildenafil
What drug class is sildenafil in?
PDE-5i
Sildenafil- indication?
ED- first-line
(PDE-5i)
Sildenafil- MOA?
Inhibits PDE5-i -> increases nitric oxide prod. -> vasodilation of smooth muscle -> increased blood flow -> prolonged erection
(doesn’t initiate or cause an erection)
(PDE-5i)
Sildenafil- side effects?
Impaired color discrimination (blue vision)
Hypotension
Priapism (prolonged painful erection)
Transient hearing loss
Tadalafil lasts longer
Contraindicated w/ nitrates d/t severe hypotension
(PDE-5i)
Ulipristal- indication?
Emergency contraception up to 5 days after unprotected sex -any weight
Req. Rx
What is a non-oral hormonal contraception IUD?
Levonorgestrel IUD (Mirena)
Must be replaced every 3-8years
What are two emergency contraceptives?
Levonorgestrel (plan B)- within 3days, BMI limit, OTC
Ulipristal acetate- within 5days, no BMI limit, Rx
