Gyn Meds and treatments

Question 1

Estrogen s/e

Answer 1

Weight gain
Nausea
Breast tenderness
Headache
Endometrial hyperplasia or cancer

Question 2

progesterone s/e

Answer 2

Acne
Depression
Hypertension

Question 3

Non-hormonal treatments for menopausal hot flashes

Answer 3

Desvenlafaxine
Venlafaxine (good choice if depression, anxiety, fatigue, or isolation coexist)

Clonidine - good choice if BP control needed; S/E: dry mouth, constipation, drowsiness

Gabapentin - good choice if insomnia, restless leg syndrome, seizure disorder, neuropathy, chronic pain coexist

Question 4

Copper IUD

Answer 4

Inhibits sperm motility
Inhibits migration of the egg
Causes damage to the egg itself
Can be left in place for up to 10 years

Most effective emergency contraception, can place up to five days after sex

Question 5

Levonorgestrel IUD (Mirena)

Answer 5

Causes thickening of cervical mucus
Inhibits sperm motility
Inhibits migration of the egg
Left in place up to five years

Question 6

Contraindications to IUD placement

Answer 6

Current uterine infection
Non-pregnancy or desire for pregnancy in near future
Severe uterine distortion - bicornuate uterus, cervical stenosis, fibroids distorting urterine cavity
Uterine bleeding not worked up
Copper allergy or Wilson disease
Breast cancer should avoid Levonorgestrel IUD

Question 7

OCPs

Answer 7

MOA:
Inhibit follicle development
Inhibit ovulation
Alter cervical mucus
Prevent fertilization
Alter the endometrium

S/E:
N, bloating, HA, increased risk of thormbosis

Absolute contraindications:
Pregnancy
Hx of DVT, PE, or inherited thrombophilia (Factor V Leiden)
Hx estrogen dependent tumor
Hx stroke or CAD
Poorly controlled htn
Smokers over 35
Hepatic disease/neoplasm - adenoma, cancer, hepatitis, cirrhosis
Abnl vaginal bleeding of unknown etiology
Migraine with aura, neurologic sxs or vascular involvement (increased risk of stroke)

Question 8

Drugs reducing the effectiveness of OCPs

Answer 8

antiepileptics: 
Phenobarbital
Phenytoin
Carbamazepine
topiramate
oxcarbazepine
primidone

Abx: - rifampin, griseofulvin

St John’s wort

Induce CYP450

Question 9

Progestin only contraceptives

Answer 9

OCP
IM depo-medroxyprogesterone (Depo-Provera) q3mo
Progesin implant - lasts 3 years

MOA: thickening of cervical mucus

S/E:
Breakthrough bleeding
Weight gain - depo 3-5 lbs water retention
+/- osteoporosis - limit depo to less than 2 yrs of use

Question 10

Transdermal patch contraceptive

Answer 10

Combination of estrogen and progesterone

change q1 wk x3, without 1 wk

Question 11

Intravaginal ring (NuvaRing)

Answer 11

Releases estrogen and progesterone continuously for three weeks

Change monthly

Question 12

Emergency contraception

Answer 12

Ethinyl estradiol/levonogestrel combo pill
- high dose estrogen -> more s/e

Levonorgestrel (plan B)

• prevents ovulation
• inhibits fertilization - disrupts fallopian tube motility and thickens cervical mucus

Copper IUD

Antiprogestins
-Ulipristol - selective progesterone receptor modulator - delays ovulation for up to 5 days
Mifeprestone (RU-486) - progesterone receptor antagonist - low dose - emergency contraception
-high dose - abortion

Question 13

Drugs associated with gynecomastia

Answer 13

STACKED

Spironolactone
THC
Alcohol - chronic use
Cimetidine
Ketoconazole
Estrogens
Digoxin