gynecology Flashcards
DHEA
anabolic steroid
use: addison’s disease, adrenal insufficiency, cognitive disorders, depression, erectile dysfunction, immunostimulant, slowing and reversing aging, SLE, vaginal atrophy, menopausal flushes, osteoporosis, alzheimer’s sides, weight loss
how: increases estrogens, testosterone, decreases production of cortisol, possible effect on neurotransmitters
ci: breast cancer, endometriosis, hormone sensitive conditions, ovarian cancer, uterine cancer and fibroids
interactions: monitor closely when taking amiodarone, atorvastatin, buspirone, cortisone, diazepam, warfarin
se: acne, hirsutism, insomnia, hair loss, aggression, voice deepening
Estradiol
estrogen/progestin combination
Medroxyprogesterone
use: vulvar and vaginal atrophy, metastatic breast cancer, hypoestrogenism, osteoporosis, prostate cancer, post menopausal osteoporosis prophylaxis
ci: undiagnosed vaginal bleeding, thrombophlebitis or thromboembolic disorders, breast carcinoma except if being treated for metastatic disease, estrogen dependent tumors, porphyria, PREGNANCY X
interactions: may enhance the effects of hydrocortisone and prednisone when used together
se: weight changes, nausea, vomiting, depression, breast swelling, depression, rare is PE, DVT, breast and endometrial or ovarian cancers
Estriol
naturally occurring estrogen in the vaginal epithelium
mild endometrial proliferative effect
use: HRT post menopause, infertility due to cervical hostility, vaginal atrophy
how: naturally occurring estrogen
ci: pregnancy, thrombosis, estrogen dependent tumors, vaginal bleeding, history of undiagnosed manifestations of deterioration of otosclerosis during pregnancy or previous use of steroids
interactions: reduced efficacy may occur when used with activated charcoal, barbiturates, carbamazepine
se: breast swelling and pain, nausea, spotting, fluid retention, cervical hyper secretion
Conjugated estrogens
HRT, antineoplastic, antiosteoporotic
estrogen
use: atrophic vaginitis, female hypogonadism, osteoporosis, prostate cancer, abnormal uterine bleeding, breast cancer palliation
how: replaces endogenous estrogens, antiandrogenic effect is useful in prostate cancer
ci: blood coagulation disorders, angioedema, liver disease, history of breast cancer, stroke, MI, DVT, valvular disease, DM with vascular impairment, undiagnosed abnormal vaginal bleeding
interactions: metabolized partially by CYP450 34A, inhibitors of CYP34A like erythromycin, clarithromycin and grapefruit juice may increase levels and result in seed effects
se: abdominal pain, back pain, breast tenderness, headache, joint pain, pharyngitis, sinusitis, diarrhea
Estrone
Estrone is a naturally occurring steroidal estrogen
use: menopausal HRT, osteoporosis prophylaxis
ci: undiagnosed vaginal bleeding thrombophebitis, or thromboembolic disorders, breast cancer except in selected patients being treated for metastatic disease, estrogen dependent tumor, porphyria, PREGNANCY X
interactions: effects decreased by folic acid and anticonvulsants
se: gi upset, genitourinary changes, hematologic disorders, CV and CNS effects, endocrine and metabolic disorders, cholestatic jaundice, local skin reactions, chorea, contact lens intolerant, steeping of corneal curvature, PE, CARBOHYDRATE INTOLERANCE
Pregnenalone
precursor
memory enhancement, poorly documented adverse effects
Progesterone
hormone, progestin
use: prevention of estrogen induced endometrial hyperplasia, secondary physiologic amenorrhea, assisted reproduction for infertile women
ci: thrombophlebitis, cardiovascular disease, severe hepatic impairment, undiagnosed vaginal bleeding, incomplete abortion, hormone dependent carcinoma, pregnancy!
interactions: enhanced clearance of carbamazepine, phenobarbital, phytoin, may decrease warfarin efficacy
se: abdominal pain, weight change, amenorrhea, headache, breast tenderness, rare but serious DVT, PE, thrombophlebitis and osteoporosis
Levonoregestrel IUD
mirena
progestin IUD
use: menorrhagia, contraception
how: synthetic progestin inhibits ovulation by negative feedback mechanism on hypothalamus, leading to reduced secretion of FSH and LH
ci: pregnancy X, undiagnosed vaginal bleeding, severe arterial disease, liver adenoma, porphyria, after recent evacuation of hydratidiform mole, history of breast cancer, hepatic impairement
interaction: may inhibit cyclosporine metabolism
se: vaginal bleeding alterations, ectopic pregnancy, inter menstrual bleeding spotting, abdominal pain, ovarian cysts, acne, headache, breast discomfort, fluid retention, edema, changes in libido
medroxyprogesterone
Progestin hormone
use: contraception, endometriosis
ci: thromboembolic disorders, cerebral apoplexy, severe hepatic dysfunction, undiagnosed vaginal bleeding, incomplete abortion, hormone-dependent cancer, pregnancy x
interactions: aminoglutethimide and enzyme inducing drugs like carbamazepine, phenobarbital, phenytoin reduced efficacy
se: depression, fluid retention, fatigue, insomnia, dizziness, headache, nausea, breast tenderness, weight gain, loss anorexia, cholestatic jaundice, pain at injection side
Norelgestromin
monophonic contraceptive combo
progestin
use: contraception
ci: breast cancer, arterial thromboembolic disorders, DVT, PE, liver disease, liver tumors
se: headache, nausea, cramps, breast tenderness
Norgestimate
progestin and estrogen
use: contraception
ci: undiagnosed abnormal vaginal bleeding, history of current thrombophlebitis, or venous thromboembolic disorders, recent thromboembolic events, breast cancer, estrogen dependent tumors, hepatic impairment or disease, pregnancy x
se: gi upset, changes in appetite, fluid retention, edema, acne, melanoma, allergic, urticaria, depression, changes in libido, hair loss, hirsutism, fatigue, drowsiness or insomnia, fever, headache, serum lipid levels and LFTs
