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Female Repro Pharm > Hormone Contraception > Flashcards

Hormone Contraception Flashcards

1
Q

Menotropins

A

human menopausal gonadotropin, or hMG

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2
Q

Follicle stimulating hormone (3)

A

Follitropin alfa (rFSH alfa), Follitropin beta (rFSH beta), Urofollitropin (uFSH)

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3
Q

Leuteinizing hormone

A

Lutropin alfa

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4
Q

Human choriogonadotropin hormone

A

Choriogonadotropin alfa (rhCG)

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5
Q

Gonadotropin-releasing hormone analogs (6)

A
  • Leuprolide
    * You have to grow up to ride loop-rollercoasters
  • Goserelin, Histrelin, Nafarelin, Triptorelin, Gonadorelin (synthetic human GnRH)
    * Ellen was always very little
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6
Q

Gonadotropin-releasing hormone antagonists (3)

A

Cetrorelix, Degarelix, Ganirelix

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7
Q

Estrogens (4)

A

Conjugated estrogens (Premarin), Estradiol valerate, Ethinyl estradiol, Mestranol

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8
Q

Progestins (6)

A

Desogestrel/Etonogestrel, Drospinenone, Medroxyprogesterone, Norethindrone, Norgestimate, Norgestrel

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9
Q

Estrogen and Progesterone inhibitors and antagonists (4 classes)

A
  • Mifepristone
  • Selective estrogen receptor modulators (Raloxifene, Tamoxifen Toremifene)
  • Aromatase inhibitors (Anastrazole, Exemestane, Letrozole)
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10
Q

Which estrogen is commonly found in oral and implantable contraceptives?

A

Ethinyl estradiol

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11
Q

Which has more variation in oral and implantable contraceptives, estrogen or progesterone?

A

Progesterone

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12
Q

Why is Ethinyl estradiol so common?

A

Very potent; resistant to hepatic metabolism –> can give very low dose

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13
Q

Estrogen adverse effects

A

Nausea, breast tenderness, hyperpigmentation, increased migraines, cholestasis, gallbladder disease, HTN, Breast/Endometrial cancer(?)

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14
Q

Estrogen contraindications

A

Estrogen-dependent neoplasm, genital bleeding, liver disease, blood disorder, heavy smoker, CV disease, migraine with aura

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15
Q

Progesterone adverse effects

A

Breakthrough bleeding, Breast cancer, androgenic effects (weight gain, acne, hirsutism, low HDL)

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16
Q

When to give progestin-only contraceptive

A

Migraines, 35yo+ and smoker or obese, blood disorder, CV disease, HTN, SLE, high cholesterol

17
Q

Which progesterone is not androgenic?

A

Desogestrel, Norgestimate
Dropsirenone

Dees No Drops (your voice)

18
Q

Acne treatment

A

Desogestrel, Norgestimate, Dropsirenone

19
Q

Combination oral contraceptives MOA

A

Prevent ovulation (feedback inhibition)

  • suppressed GnRH/LH/FSH
  • absent LH surge
  • low endogenous steroids
20
Q

Progestin-only pills

A

Highly effective - thick cervical mucus, impaired implantation; only blocks 60% ovulations

21
Q

Benefits of Combination oral contraceptives

A

Estrogen - osteoporosis prevention, reduced cholesterol
Combination - reduce ovarian & colon cancer, ectopic pregnancy, breast disease, dysfunctional uterine bleeding/dysmenorrhea; improve PMS, hirsutism, acne

22
Q

Benefit of LARC

A

e. g. Mirena (Levonorgestrel)

- Rapid return to fertility after removal

23
Q

Implantable contraceptive

A

Etonogestrel (progestin)

24
Q

Depo-provera

A

Medroxyprogesterone acetate

  • IM or SQ every 3 mos
  • can take 6-12 mos for fertility to return
25
Q

Transdermal preparatoin

A

Ethinyl estradiol & Norelgestromin

26
Q

Vaginal contraceptive ring

A

Ethinyl estradiol & Etonogestrel
(NuvaRing)
- rapid return to fertility after removal

27
Q

Failure rate with typical and perfect use

  • COC
  • Progestin-only
  • Transdermal
  • Vaginal
A

Typical use: 9%

Perfect use: 0.3%

28
Q

Failure rate with typical and perfect use

  • IUD
  • Implant
  • Sterilization (female)
A

Typical use

  • IUD: 0.15-0.4%
  • Implant: 0.05%
  • Sterilization: 0.5%

Perfect use

  • IUD: 0.2-0.4%
  • Implant: 0.05%
  • Sterilization: 0.5%
29
Q

DDIs

A

Cytochrome P450 inducers

  • Phenytoin
  • Rifampin

Antibiotics (interfere with GI flora’s ability to increase bioavailability of estrogens)

30
Q

Pregnancy termination

A

Mifepristone
*“But I want my life to be pristine… wahh.”
- progesterone receptor antagonist
- used with Misoprostol (prostaglandin E1)
- 95% effective within 7 weeks
ADR: prolonged bleeding

31
Q

Morning after

A

Levonorgestrel

  • progesterone receptor antagonist
  • DOES NOT reverse pregnancy
  • No rx

Ulipristal acetate

  • progesterone receptor antagonist
  • may interfere with pregnancy
  • Rx required
32
Q

Time frame for most postcoital contraceptives

A

72 hours (for 99% effectiveness)

33
Q

Absolute contraindications of estrogen therapy

A
  • Thromboembolic disease
  • Undiagnosed abnormal genital bleeding
  • Potential for estrogen-dependent neoplasia
  • Impaired liver function
  • Possible pregnancy
34
Q

Selective Estrogen Receptor Modulators (SERMs)

A

Tamoxifen, Toremifene

  • competitive partial agonist inhibitors of estradiol
  • antagonist on breast; agonist at other tissues
  • Tx of ER+ breast cancer

Raloxifene

  • antagonist on endometrium and breast; agonist on lipids and bone
  • Prevent osteoporosis and breast cancer
35
Q

Aromatase inhibitors

A

Anastrazole, Letrozole, Exemestane

  • inhibit aromatase function (can’t produce estrone or estradiole)
  • Tx of breast cancer in postmenopausal women
  • DO NOT GIVE TO FERTILE WOMEN
36
Q

What do you NOT give to a fertile woman who has breast cancer?

A

Aromatase inhibitors (Anastrazole, Letrozole, Exemestane)

Female Repro Pharm (1 decks)

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