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Pharmacology > Hormonal Contraception > Flashcards

Hormonal Contraception Flashcards

1
Q

What two types of hormonal contraception are there?

A

Combined- Estrogen/Progestin

Progrestin Only

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2
Q

MOA of combination contraceptives:

A
  • *Suppression of mid-cycle gonadotropin (FSH, LH) secretion, thereby inhibiting ovulation
  • Development of endometrial atrophy=unreceptive to implantation
  • Production of viscous mucous to impede sperm transport
  • Possible effect on secretion and peristalsis within the fallopian tube interfering with ovum and sperm transport
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3
Q

What does the 7 day off period common with contraceptive cause?

A

Removal of estrogen/progestin causes sloughing of the endometrium and menses

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4
Q

Why is menstruation lighter with hormonal contraceptive?

A

Progestin throughout the cycle inhibits proliferative growth of the menses

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5
Q

The 3 types of combination oral contraceptives include:

A

Monophasic, biphasic, and triphasic

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6
Q

What is monophasic combination oral contraceptives?

A

Fixed amount of estrogen and progestin throughout cycle

Some people may have less AE

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7
Q

What is biphasic combination oral contraceptives?

A

Progestin/estrogen rate is lower in 1st half of the cycle, then increases estrogen (some contain not progestin during 2nd half of cycle)

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8
Q

What is triphasic combination oral contraceptives?

A

Estrogen/progestin ratio varies throughout the cycle

Can mimic natural cycle

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9
Q

Most common form of estrogen used in combination oral contraceptions:

A

Ethinyl estradiol

mestranol is also used, prodrug of ethinyl estradiol

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10
Q

Standard estrogen dose vs low dose=

A

Standard= 30-35mcg
Low dose= 20mcg
(Mestranol 50mcg=ethinyl estradiol 35mcg)

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11
Q

What AE may low dose oral contraceptives causes?

A

Breakthrough bleeding

Decreased efficacy in obese patients (high Vd)

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12
Q

Why is estrogen always used in combination with progestin?

A

Unopposed estrogen promotes endometrial growth and may lead to endometrial cancer

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13
Q

The goal of dosing progestin in combined oral contraceptives is to limit:

A

Androgen activity unnecessary for contraception

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14
Q

Which adverse effects does androgen activity cause?

A

Acne and hirsutism

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15
Q

An antiandrogenic progestin is_____ and what are its SE good/bad?

A

Drospirenone (derived from spironolactone)
Antimineralcorticoid properties so can causes hyperkalemia
May causes less water retention, breast tenderness, and acne

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16
Q

Examples of mild combination oral contraceptive effects include:

A

Nausea, breast tenderness, breakthrough bleeding, edema, headache

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17
Q

Examples of moderate combination oral contraceptive effects include:

A

Breakthrough bleeding, weight gain, increased skin pigmentation, acne, hirsutism, amenorrhea

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18
Q

Examples of severe combination oral contraceptive effects include:

A

Vascular d/o, GI d/o(gallstones, infection), depression, cancer

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19
Q

What patient s/s may require a decreased estrogen dose?

A

Breast tenderness
Weight gain
Nausea
HA

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20
Q

What patient s/s may require a increased estrogen dose?

A

Breakthrough bleeding
Amenorrhea
Acne (also decrease androgen potency)

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21
Q

What patient s/s may warrant switching to a less potent progestin?

A 
Breast tenderness 
Weight gain
Depression
Moodiness, irritability 
HA
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22
Q

What patient s/s may warrant switching to a more potent progestin

A

Breakthrough bleeding

Severe menstrual cramps

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23
Q

Potential benefits of combination contraceptives include:

A 
Dec. ovarian cancer
Dec. endometrial cancer
Dec. benign breast cancer 
Dec. PID (pelvic inflamm. disease)
Dec. Iron deficiency anemia 
Dec. ectopic pregnancy 
Dec. dysmenorrhea
Dec. menorrhagia
Contraception
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24
Q

Potential harms of combination oral contraceptives include:

A

DVT/PE
Relative CI in women >35 who smoke d/t increased risk of thrombotic CV events
Increased risk of breast cancer- more likely to worse cancer than be the cause of cancer

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25
Q

Which drugs can cause induction of metabolism of combination oral contraceptive and what does that mean?

A 
Reduction of contraceptive effectiveness- use another method
Rifampin
Phenytoin
Primidone
Carbamazine 
Phenobarbital
Griseofulvin
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26
Q

Which drugs can be potentiated by combination OC’s?

A 
May need less of these meds
Diazepam(Valium)
Chlordiazepoxide (Librium)
Theophylline
Tricycle antidepressants 
Corticosteroids/cortisone
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27
Q

How do cyclic, extended-cycle, and continuous administration of OCs differ?

A

Cyclic: monthly withdrawal bleeding
Extended cycle: withdrawal bleeding once every 4months or so
Continuous: no withdrawal bleeding

28
Q

What are the commonly used estrogen and progestins used in combination OC’s?

A

Ethinyl Estradiol

Levonorgestrel, norgestrel, norethindrone, norgestimate, desogestrel, ethyndiol, drospirone

29
Q

Which are two commonly used progestin only contraceptives?

A

Norethindrone and Norgestrel

30
Q

Progestin only pills are slightly _____ effective than combination OC’s.

A

less

31
Q

What is one common AE of progestin only pills?

A

breakthrough bleeding

32
Q

Who may the use of progestin-only pills be recommended for?

A 
Breastfeeding mothers (estrogen decreases milk supply)
Patients who should avoid estrogen: PMH of SLE, sickle cell, CV, VTE, migraines)
33
Q

Ortho Evra (norelgestromin/EE):

A

Transdermal patch

Combination therapy

34
Q

How is Ortho Evra administered?

A

Each patch lasts 7 days (3patches/cycle)

1 week off for withdrawal bleed or continuous administration

35
Q

What type of absorption does Ortho Evra have?

A

Excellent absorption: highly lipophillic

36
Q

What type of hormone release does Ortho Evra have?

A

Continuous sustained release, avoids peaks/troughs

Delivers 20mcg EE and 150mcg norelgestromin each day (low dose)

37
Q

AE of the transdermal patch:

A

skin irritation

38
Q

MOA of the Nuva Ring:

A 
Combined therapy (etonogestrel/EE)
Hormone release into vagina and absorbed through the vaginal epithelium 
Continuous sustained release of hormones (avoidance of peaks/troughs)
39
Q

Dosing for the Nuva Ring:

A

15mcg EE and 120mcg etonogestrel/day (low dose)

40
Q

How is the Nuva Ring administered?

A

Inserted into the vagina and left in place for 3wks
1wk of withdrawal bleeding
One size, can be placed anywhere in the vagina

41
Q

What type of contraceptive is the Depo Provera shot?

A

Progestin only (medroxyprogesterone)

42
Q

How is Depo Provera administered?

A

IM or SubQ

43
Q

Advantages of Depo Provera:

A

No daily adherence necessary, shot lasts 3 months, hight efficacy

44
Q

AE of Depo Provera:

A

Increased bleeding

45
Q

The Implanon is what type of contraceptive?

A

Progestin only (etonogestrel)

46
Q

How long does Implanon provide contraception for?

A

3years
Slow release of 60mcg of etonogestrel/day
Immediately reversible

47
Q

AE of the Implanon implant:

A

Irregular bleeding

48
Q

What type of contraception is the Mirena?

A

Progestin releasing IUD (levonorgestrel)

Releases 14-20mcg of levonorgestrel/day

49
Q

How does the Mirena work?

A

Local endometrial effect
Inhibits sperm transport and fertilization of the ova
Possible prevention of implantation

50
Q

How long can the Mirena prevent pregnancy for?

A

5years

51
Q

Warning associated with the Mirena include:

A

ectopic pregnancy, intrauterine pregnancy, sepsis, amenorrhea or irregular bleeding

52
Q

Plan B is generally two high doses or one high dose of:

A

Levonorgestrol

53
Q

How does Plan B work?

A

Interferes with ovulation, fertilization, transport of egg, and implantation

54
Q

When is Plan B most effective but up to hour many hours after intercourse can it be used?

A

72hrs (75-80% effective)

up to 120hrs

55
Q

Once ______ has occurred Plan B is ineffective.

A

implantation

56
Q

AE of Plan B:

A

N/V

57
Q

What are other emergency contraceptive options, other than Plan B, that are available with Rx?

A 
High dose levonorgestrel/EE 
Copper IUD(can insert up to 5 days after intercourse)
58
Q

Patients who have acne should be recommended what formula of OC?

A

High Estrogen

Lower androgen potency

59
Q

Patients with breakthrough bleeding should be recommended what formula of OC?

A

Higher Estrogen
Higher Progestin
Lower Androgen

60
Q

Patients with absent/light menstrual flow should be recommended what formula of OC?

A

High Estrogen

Lower Progestin

61
Q

Patients with depression should be recommended what formula of OC?

A

Lower Progestin

62
Q

Patients with moodiness or irritability should be recommended what formula of OC?

A

Lower Progestin

63
Q

Patients with headaches should be recommended what formula of OC?

A

Lower Estrogen

Lower Progestin

64
Q

Patients with breast soreness should be recommended what formula of OC?

A

Lower Estrogen

Lower Progestin

65
Q

Patients with weight gain should be recommended what formula of OC?

A

Lower Estrogen

Lower Progestin

66
Q

Patients with severe menstrual cramps should be recommended what formula of OC?

A

Higher Progestin

67
Q

Patients who have endometriosis or need endometriosis prevention should be recommended what formula?

A

Lower Estrogen
High Progestin
Higher Androgen

Pharmacology (48 decks)

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