Hormonal Contraceptives Flashcards
Hormonal contraceptive formulations?
Low-dose
– 15-35 µg ethinyl estradiol + progestin
High-dose
– 50 µg ethinyl estradiol + progestin
– Not recommended for regular contraceptive use
- Formulations Mimic cyclic pattern of
– Used for endometriosis
– Monophasic – fixed dose endogenous hormone secretion
– Phasic
– Levonorgestrel, norethisterone, norgestrel
HC I?
Oral contraception, dysfunctional uterine bleeding
- Endometriosis
- Mittelschmerz
- Dys- or hyper-menorrhea
- Polycystic ovarian syndrome
- Acne
HC advantages?
- High efficacy
- Reversible
- Decrease menstrual flow, dysmenorrhoea, I cramps PMS, PID and ectopic pregnancy, ovarian and endometrial cancer
- Predictability of menses
HC disadvantages?
- incidence of
– VTE
– Myocardial infarction
– Cerebrovascular accidents
- risk of
– Breast and cervical cancer
HC CI?
- Pregnancy
- Thromboembolic
- CVD
- Breast Cancer
- Gall stones
- Lactation
- Migraine
- Porphyria
HC Cautions?
- Liver disease
- Diabetes
- Asthma
- Migraine
- Seizure disorders
- Breastfeeding
Effects of COC?
- Ovulation
- Thicker and less copious cervical mucus
- Enlargement of breasts, suppresses lactation
- Decrease anti-thrombin III
- Euphoria affect
- Decrease rate bone
- Increase HDL and decrease LDL
- Increase cardiac output
A/E of COC?
NOT LIFE threatening
- Alleviated by change in formula
- Nausea, mastalgia, oedema
- Breakthrough bleeding, weight gain, change in libido, headache, migraine, acne
- Vaginal yeast infections, depression
- Chloasma
A/E of COC?
LIFE threatening
- Cerebrovascular disease
- Cholestatic jaundice
- incidence of thromboembolic disease
– Especially in women with a history of DVT, smokers, diabetes, hypertension
- risk of myocardial infarction
– Obese, diabetes, preeclampsia, hypertension and smoker
COC DI?
- Antibiotics
– Alteration of gut flora (interrupts EH recirculation) - Laxatives
– Malabsorption of COCs - Anticoagulants
– Use of OC not recommended - Antidiabetic therapy
– May glucose levels
Drugs affecting levels of COC?
- Penicillins
- Tetracyclines
- Cephalosporins
- Erythromycin
- Sulfonamides
- Chloramphenicol
- Clindamycin
Progestin-only preparations(4)?
Preparations include:
POPs
– Progestin-only pill (POP)
– Long-acting injectables
– Subdermal implants
– Progestin-releasing intrauterine systems
POP cervical mucus effects
Norethisterone or levonorgestrel → alters cervical mucous
POP MOA?
*Decrease sperm penetrability of cervical mucous
- Decrease receptivity of endometrium to implantation
- Suppress ovulation (not necessarily inhibit)
POP Uses?
- Thromboembolism
– Lactation
– 4-6 weeks prior to major elective surgery
POP Disadvantages?
– Functional ovarian cysts more common
– Less reliable
– If > 3hr delay ® EC
– Enzyme inducers decrease efficacy
Drugs affecting levels of COC and POP?
*Anticonvulsants (enzyme inducers)
- Rifampicin
cantifungal
- Griseofulvin medication]
- Nevirapine
- Protease inhibitors
POP CI?
- Undiagnosed abnormal uterine bleeding
- Breast cancer
- Malabsorption syndrome
- Liver disease
POP A/E?
- Irregular menses
- Breakthrough bleeding
- Weight gain
- Headache
- Acne
- Greasy hair
- Dizziness
- Nausea
IM preparations(2)
- Depot medroxyprogestero ne acetate (DMPA)
– Every 12 wks
– Weight gain more significant than NE - Norethisterone enanthate
-every 8 weeks
– Preferred in diabetics
IM advantages?
- Minimal patient involvement
- 4-6 weeks prior to surgery
- Not associated with VTE or CVD
- Useful in epilepsy and mental retardation
IM disadvantages?
- Disrupt menstrual bleeding, weight gain, headaches, mood changes
- Fertility delayed, amenorrhoea
- Decreased libido
IM uses?
- Chronic illness
- Improve painful and heavy periods
- Elective surgery
- Epileptics
- Fibroids
6.Fe-def anamia
IM CI/
- Hepatic disease
- Undiagnosed vaginal bleeding
- Migraine with focal aura
- Severe arterial disease
- Sex-steroid dependent cancer
