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Pharm Exam V > Gynecological Disorders/Contraception > Flashcards

Gynecological Disorders/Contraception Flashcards

1
Q

Primary gonadotropins and their roles?

A

FSH: follicle development

LH; later folicle development, gonadal steroid production and ovulation

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2
Q

Placental gonadotropin and function?

A

hCG: LH-like function during pregnancy and ovulation induction

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3
Q

What is menotropin?

A

Menotropin: human menopausal gonadotropin. FSH and LH recovered from urin of menopausal women and also for induction of ovulation

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4
Q

Name 4 GNRH agonists. Which are synthetic analogs and which synthetic versions of GNRH?

A

Gonadorelin: synthetic version

Synthetic analogs: Gosarelin acetate, Leuprolide, Nafarelin (nose spray)

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5
Q

What are the synthetic analogs good for?

A

Pulsatile: for stimulation of gnadotropic delayed puberty and ovulation induction

Continuous suppression: Breast and prostate cancer and dendometriosis** **(also polycystic ovary, ovarian hyperstimulation syndrome, and precocious puberty)

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6
Q

2 GNRH antagonists? Administration? Use?

A

Ganirelix: injection; endometriosis and preventing premature ovulation

Abarelix: also injection; prostate cancer

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7
Q

Name 2 antiestrogens.

A

Clomiphene

Danazol

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8
Q

Clomiphene:

MOA?

A

Clomiphene:

MOA: estrogen receptor antagonist; blocks estrogen mediated inhibition of FSH/LH release (inhibition of inhibition) resulting in increased FSH/LH secretion

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9
Q

Clomiphene:

  1. Indication?
  2. Potential for?
A

Clomiphene:

  1. indication: for infertility with extreme sensitivity to estrogenic inhibition of the hypothalamic-pituitary axis that results in follicles not maturing sufficiently because estrogen never get high enough to switch to positive feedback and induce the LH surge
  2. Potential for overstimulation of ovaries responsible for multiple pregnancies
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10
Q

Danazol:

  1. MOA?
  2. Indications?
A

Danazol:

  1. MOA: synthetic weak androgen that inhibits output of FSH/LH (weak inhibitor of estrogen)
  2. Indications: endometriosis, heavy menstruation, and fibrocystic disease
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11
Q

Danazol:

Adverse effects?

A

Danazol:

Adverse effects:

increased weight, bloating/fluid retention, acne, small breasts, increased muscle mass and hair, mood swings, deepening voice, and clitoral enlargement (explained by weak androgen activity)

Also GI upset, depression, and liver disease

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12
Q

Biological estrogens?

A

Biological estrogens

Estradiol

Estrone

Estriol

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13
Q

Synthetic estrogens?

Esterified estrogens?

A

Synthetic estrogens: Ethinyl estradiol (most potent) and Mestranol (oral combination only and converted to Ethinyl endogenously)

Esterified estrogens: E2 valerate and E2 cypionate (for hormone replacement therapy)

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14
Q

Sulfated esters?

A

Conjugated equine estrogens - oral hormone replacement therapy (comes from the urine of a pregnant mare!)

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15
Q

4 Progestin drugs?

What progestins do we need to recognize as progestins?

A

4 main:

Medroxyprogesterone acetate

Norethindrone

Levonorgestrel

Nargestrel

Also (sorrrrrry brittany!) norgestimate, gestodene, desogestrel, dropirenone, norlgestromin, and etongestrel

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16
Q

Medroxyprogesterone Acetate:

  1. Indication?
  2. Used with estrogen for what purpose?
  3. Progestin only _____. Androgen?
A

​Medroxyprogesterone Acetate:

  1. Indication: gonadotropin inhibition, dysmenorrhea, and uterine bleeding
  2. Used w/ estrogen in HRT to decrease unopposed estrogen effects
  3. Progestin only contraceptive; NO androgen effect
17
Q

Slight differences between noresthindrone, levonorgestrel, and nargestrel?

All have in common?

A

Noresthindrone: progestin only mini pill and implant

Levonorgestrel: progestin only implant or day after pill

Nargestrel: progestin only mini pill

ALL: taken in oral combination; effective gonadotropin inhibitor, and moderate androgen effects

18
Q

Hormone replacement therapy:

  1. Uses in menopause?
  2. What is taken for hysterectomy?
  3. What is taken if the uterus is present?
A

HRT:

  1. Menopause: hot flashes, night sweats
  2. Hysterectomy: estrogen alone
  3. Uterus: estrogen and progesterone: start with progesterone and LOW dose of E and after 2 years reduce E as much as possible
19
Q

Hormone Replacement Therapy:

  1. May also protect how?
  2. Who should not be on estrogen?
A

HRT

  1. May also protect from osteoporosis, decrease CVD in young women
  2. Older women with heart disease should not be on estrogen
20
Q

Adverse effects of progesterone?

A

Progesterone adverse effects:

Increased weight, depression, fatigue, hirsutism, change in libido, and oily skin

21
Q

Adverse effects of estrogen?

A

Estrogen adverse effects:

N/V, dysmenorrhea, endometrial hyperplasia, hyperpigmentation, migraine, increased weight, and edema

IMPORTANT:

Cholestasis

Breast and Endometrial cancer

Thromboembolic issues

22
Q

Contraindications of estrogen and progesterone?

A

Contraindications:

Estrogen dependent neoplasm

Undiagnosed uterine/genital bleeding

Thromboembolic disease

Liver disease

Hypertension/diabetes/hyperlipidemia

23
Q

Birth control:

Combinations with Ethinyl estradiol?

Combinations with Mestranol (estrogen synthetic)?

A

Birth control:

Combinations:

Ethinyl estradiol + norethindrone or norgestrel or ethynodiol diacetate

Mestranol + norethendrone or Ethynodiol diacetate

24
Q

Progestin only oral contraceptive?

  1. What could occur?
  2. Suited best for who?
A

Norethindrone: progestin only

  1. Frequent spotting, amenorrhea, and increased risk of ectopic pregnancy
  2. Suited for older women who smoke or women where estrogen is contraindicated
25
Q

Levonogestrel:

  1. Administration?
  2. How is it used in an emergency?
A

Levonogestrel:

  1. Implant or intrauterine
  2. Emergency oral; 2 doses 12 hours apart; N/V may occur. 98% effective if taken within 72 hours of sex
26
Q

What can be given transdermally?

  1. Less suceptible to?
  2. Less effective for?
A

Ethinyl estradiol + Norelgestromin:

  1. Less suceptible to interference of antibiotics
  2. Less effective in women over 198 lbs
27
Q

Contraceptive MOA?

Best inhibitor of ovulation? (in general - NOT specific drug)

A

MOA: steroid receptor mediated, inhibits LH/FSH secretion by negative feedback (inhibits GNRH pulses), depresses follicular development for ovulation (eliminate LH surge), depresses follicular synthesis of steroids, thickens cervical mucus, makes endometrium inhospitable, and alters motility/secretion of fallopian tubes

COMBINATION inhibitors are better at inhibiting ovulation than progesterone alone

28
Q

Other effects:

  1. CNS?
  2. Endocrine?
  3. Liver?
A

Other effects:

  1. CNS: behavioral/emotional
  2. Endocrine: increases cortical binding globulin, thyroxine binding globulin, aldosterone, and renin
  3. Liver: increases cholelithiasis and proteins
29
Q

Other effects:

  1. Changes in carbohydrate metabolism?
  2. Cardiovascular?
  3. Skin?
A

Other effects:

  1. CHO metabolism: reversible increase in insulin resistance
  2. CV: small increase in BP, CO, and HR
  3. Skin: increased pigmentation and sebum acne
30
Q

Adverse effects:

General considerations of all contraceptives?

A

Adverse effects:

General:

a. Cancer risk (use lowest estrogen possible)
b. Temporary infertility upon withdrawal

31
Q

Adverse effects:

Mild?

What should be done?

A

Adverse effects:

Mild: HA/N, edema, bleeding, absence of withdrawal bleeding

Change fomulation or possibly discontinue

32
Q

Adverse effects:

Moderate?

What should be done?

A

Adverse effects:

Moderate: breakthrough bleeding (expected with progesterone only; will decrease with biphasic or triphasic), increase weight, pigmentation (reversible), acne, and hirsutism

Change formula but may require discontinuance

33
Q

Adverse effects:

Severe?

What should be done?

A

Severe adverse effects:

a. Vascular disorders:

  • Venous thromboembolic disease of estrogen, MI
  • CV disease; worry about stoke and hypertension

b. GI disorders
* Cholestatic jaundice and hepatic adenoma
c. Depression

DISCONTINUE

34
Q

Contraindications of contraceptives?

A

Contraindications of contraceptives

Thrombophlebitis, thromboembolic disease, CV disorders

Estrogen dependent neoplasms, unidentified tract bleeding

Fibroid tumors

Diabetes, hypertension, migraines

Adolescents before epiphyseal closure

Pharm Exam V (6 decks)

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