Gynecological Rx Flashcards
DHEA
class: anabolic steroid
moa: inc production of estrogens and testosterone; dec prod of cortisol
clinical use: Addison’s adrenal insuff; cognitive disorders, depression, ED; vaginal atrophy; menopausal hot flashes; osteoporosis, alzheimersl SLE
AE: acne, hirsuitism, hair loss, aggression, voice deepening
interactions: monitor closely with amiodarone, warfarin, atorvo, buspar, cortison, diaze
CI: breast CA, endometriosis; hormone sensitive conditions; uterine cancer; uterine fibroids
Estradiol
class: medroxyprogesterone
moa: bioidentical (E2)
clinical use: vulvar and vaginal atrophy in menopause; metastatic breast CA; hypoestrogenism; osteoporosis; prostate CA; prophylactically for post-meno osteoporosis
AE: breast swelling, weight changes, N/V; rare thromboembolism
interactions: enhance hydrocortizone & prenisolone when used together
CI: un-dx vaginal bleeding, embolic disorders; breast carcinoma; pregnancy X
Estriol
class: naturally occuring estrogen (E3)
moa: induces normalization of vaginal epithelium
clinical use: menopausal HRT; infertility due to cervical hostility; menopausal atrophic vaginitis
AE: breast tension or pain, nausea, spotting; fluid retentiog or cervical hypersecretion
interactions:
CI: pregnancy, thrombosis, estrogen-sens tumors; vag bleeding
Pregnenolone
precursor of steroid hormones
Used for memory enhancement
Progesterone
class: progestin hormone
moa: main hormone secrected by the corpus luteum; Induces secretory changes of the endometrium; promotes mammary gland development; relaxes uterus and maintains pregnancy
clinical use: prevention of estrogen-induced endometrial hyperplasia; secondary physiological amenorrhea; assists reproduction for infertile women
AE: abdominal pain, weight change, amenorrhea. breast tenderness, rare but series DVT, PE
interactions: same same, may decrease Warfarin
CI: thrombophlebitis, severe hepatic impairment, incomplete abortion, breast cancer, known or suspected preg
Human chorionic gonadotropin
hormone
Estrogen, conjugated
class: estrogen
moa: synthetic compound that bind estrogen receptors (more strongly than physiological)
clinical use: atrophic vagintis; female hypogonadism; osteoporosis; prostate CA; AUB, breast cancer palliation
AE: abdominal and back pain, breast tenderness, HA
interactions: CYP450 3A4
CI: same as the other estrogens (clots, un-dx vag bleeding; active or hx of breast CA)
Estrone
class: estrogen
moa: naturally occurring steroidal estrogen (E1)
clinical use: menopausal HRT; osteoporosis prophylaxis
AE: GI disturbances; GU changes; eye changes; pulmonary thromboem; carbohydrate intolerance
interactions: decreases anticonvulsants and folic acid
CI: same as all the other estrogens but pregnancy X
Levonorgestrel IUD
class: Progestin IUD; Mirena (contraceptive)
moa: synthetic progestin; inhibits ovulation by neg feedback leading to reduced secretions of FSH/LH
clinical use: Pregnancy prevention; menorrhagia
AE: vag bleeding alterations; ectopic preg nancy; ovarian cysts; acne
interactions: may inhibit cyclosporine metabolism
CI: pregnancy X
Medroxyprogesterone acetate
DepoProvera
class: prgestin hormone
moa: no estrogenic effects; converts the proliferative phase of the cycle to the secretory
clinical use: contraception; endometriosis
AE: depression, fluid retention, chostatic jaundice, hormone stuff; weight gain; injection site irritation
interactions: extra caution when administering carbamazepine, phenobarb, phenytoin
CI: pregnancy X; same as other hormone ones in this section
Norelgestromin/ethinyl estradiol patch
class: progestin (monophasic contraceptive combo)
moa: inhibits gonadotropin secretion from the pituitary
clinical use: contraception
AE: HA, nausea, menstrual cramps, breast sx’s
interactions:
CI: same as other hormonal b/c s
Norgestimate/ethinyl estradiol oral
norgestimATE = oral pill
class: progestin + estrogen (contraceptive)
moa: inhibits secreion of growth hormone from pituitary
clinical use: contraception
AE: breast reactions, nausea, HA, skin changes, dysmenorrhea
interactions:
CI: same as other hormonal b/c; pregnancy X
Norethindrone
contraceptive
Drospirenone/ethinyl estradiol
Yas/Yasmin
MOA: inhibition of ovulation. K+ sparing
Used for: contraception, acne, PMDD
AE: Reports of up to *****sevenfold risk of developing thromboembolism
*Potassium levels should be checked after 2 weeks of use
Megestrol acetate
