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Pharmacology > Hormonal Contraceptives > Flashcards

Hormonal Contraceptives Flashcards

1
Q

Hormonal contraceptive formulations?

A

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

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2
Q

HC I?

A

Oral contraception, dysfunctional uterine bleeding

  • Endometriosis
  • Mittelschmerz
  • Dys- or hyper-menorrhea
  • Polycystic ovarian syndrome
  • Acne
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3
Q

HC advantages?

A
  • High efficacy
  • Reversible
  • Decrease menstrual flow, dysmenorrhoea, I cramps PMS, PID and ectopic pregnancy, ovarian and endometrial cancer
  • Predictability of menses
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4
Q

HC disadvantages?

A
  • ­ incidence of

– VTE

– Myocardial infarction

– Cerebrovascular accidents

  • ­ risk of

– Breast and cervical cancer

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5
Q

HC CI?

A
  1. Pregnancy
  2. Thromboembolic
  3. CVD
  4. Breast Cancer
  5. Gall stones
  6. Lactation
  7. Migraine
  8. Porphyria
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6
Q

HC Cautions?

A
  1. Liver disease
  2. Diabetes
  3. Asthma
  4. Migraine
  5. Seizure disorders
  6. Breastfeeding
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7
Q

Effects of COC?

A
    • Ovulation
  2. Thicker and less copious cervical mucus
  3. Enlargement of breasts, suppresses lactation
  4. Decrease anti-thrombin III
  5. Euphoria affect
  6. Decrease rate bone
  7. Increase HDL and decrease LDL
  8. Increase cardiac output
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8
Q

A/E of COC?

NOT LIFE threatening

A
  1. Alleviated by change in formula
  2. Nausea, mastalgia, oedema
  3. Breakthrough bleeding, weight gain, change in libido, headache, migraine, acne
  4. Vaginal yeast infections, depression
  5. Chloasma
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9
Q

A/E of COC?
LIFE threatening

A
  • 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

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10
Q

COC DI?

A
  1. Antibiotics
    – Alteration of gut flora (interrupts EH recirculation)
  2. Laxatives
    – Malabsorption of COCs
  3. Anticoagulants
    – Use of OC not recommended
  4. Antidiabetic therapy
    – May ­ glucose levels
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11
Q

Drugs affecting levels of COC?

A
  • Penicillins
  • Tetracyclines
  • Cephalosporins
  • Erythromycin
  • Sulfonamides
  • Chloramphenicol
  • Clindamycin
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12
Q

Progestin-only preparations(4)?

A

Preparations include:

POPs

– Progestin-only pill (POP)

– Long-acting injectables

– Subdermal implants

– Progestin-releasing intrauterine systems

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13
Q

POP cervical mucus effects

A

Norethisterone or levonorgestrel → alters cervical mucous

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14
Q

POP MOA?

A

*Decrease sperm penetrability of cervical mucous

  • Decrease receptivity of endometrium to implantation
  • Suppress ovulation (not necessarily inhibit)
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15
Q

POP Uses?

A
  • Thromboembolism

– Lactation

– 4-6 weeks prior to major elective surgery

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16
Q

POP Disadvantages?

A

– Functional ovarian cysts more common

– Less reliable

– If > 3hr delay ® EC

– Enzyme inducers decrease efficacy

17
Q

Drugs affecting levels of COC and POP?

A

*Anticonvulsants (enzyme inducers)

  • Rifampicin

cantifungal

  • Griseofulvin medication]
  • Nevirapine
  • Protease inhibitors
18
Q

POP CI?

A
  • Undiagnosed abnormal uterine bleeding
  • Breast cancer
  • Malabsorption syndrome
  • Liver disease
19
Q

POP A/E?

A
  • Irregular menses
  • Breakthrough bleeding
  • Weight gain
  • Headache
  • Acne
  • Greasy hair
  • Dizziness
  • Nausea
20
Q

IM preparations(2)

A
  1. Depot medroxyprogestero ne acetate (DMPA)
    – Every 12 wks
    – Weight gain more significant than NE
  2. Norethisterone enanthate

-every 8 weeks
– Preferred in diabetics

21
Q

IM advantages?

A
  1. Minimal patient involvement
  2. 4-6 weeks prior to surgery
  3. Not associated with VTE or CVD
  4. Useful in epilepsy and mental retardation
22
Q

IM disadvantages?

A
  1. Disrupt menstrual bleeding, weight gain, headaches, mood changes
  2. Fertility delayed, amenorrhoea
  3. Decreased libido
23
Q

IM uses?

A
  1. Chronic illness
  2. Improve painful and heavy periods
  3. Elective surgery
  4. Epileptics
  5. Fibroids

6.Fe-def anamia

24
Q

IM CI/

A
  • Hepatic disease
  • Undiagnosed vaginal bleeding
  • Migraine with focal aura
  • Severe arterial disease
  • Sex-steroid dependent cancer
25
Q

Implants?

-MOA
-Combinations
-Admin
-S/E

A

Single biodegradable rod

  • (levonorgestrel or etonogestrel)
  • Prevent LH surge
  • Placed subdermally between biceps and triceps in nondominant arm

Side effects- irregular bleeding, headaches, visual disturbances

26
Q

Vaginal Ring?

-Combination
-Admin
-A/E

A

-Combination:
* Etonorgestrel and EE

-Admin:
* Insert by user

-A/E:
foreign body sensation, expulsion of ring, headache

27
Q

Emergency contraceptions?

A

Option A: Yuzpe method
-2 doses COC (ethinyl estradiol + norgestrel / levonorgestrel)

“Option B” -Levonorgestrel
* Orally, active progestin

Pharmacology (44 decks)

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