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PHARM 443 : Sex Ed/MSK > Lecture 2/3 > Flashcards

Lecture 2/3 Flashcards

Contraceptive 2

1
Q

What is the MOA of estrogen ?

A

Secreted because of FSH
prevents follicular development and ovulation

Increase endometrium lining

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2
Q

What is the MOA of progestin ?

A

inhibits ovulation
Thickens cervical mucus ( les sperm transport)
Slows the tubal transport
maintains the lining and highly part of the luteal phase

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3
Q

Which of the following estrogens in CHC products is a synthetic version of the estrogen produced by the human fetal liver?

A

Estetrol (E4)

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4
Q

What is the primary advantage of ethinyl estradiol (EE) over other forms of estrogen in CHC products?

A

Longer half-life and increased potency

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5
Q

What are the estrogen made by the body ?

A

estrone 1
estradiol 2
Estriol 3
Esterol 4

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6
Q

Which estrogen is released bythe placenta during pregnancy ?

A

E3

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7
Q

Where and when is Estrone 1 made ?

A

ovaries, after menopause

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8
Q

What is special regarding the 3rd progestin?

A

less andregenic, same progestin, estrogenic effect

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9
Q

What are the non-contraceptive benefits of combined hormonal contraceptives?

A

improve cycle control
inhibits ovulation
lower risk of colorectal cancer
good effect on bone mineral density

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10
Q

Which hormones has a procoagulant effect ?

A

Estrogen and dose- dependent

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11
Q

What are the risks that increases VTE while being on CHC ?

A

in the 1st year
thrombophilia
older, age, obesity, recent surgery
6 weeks after delivery

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12
Q

What are the risks that increases MI or Stroke while being on CHC?

A

doses more than 50 ug EE
smoking, >35 years old
hypertension

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13
Q

What is the connection between breast cancer and CHC ?

A

None , unknown

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14
Q

What are the effect of CHC to BP ?

A

Increases BP

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15
Q

How can CHC be linked to diabetes ?

A

progestin can compete with insulin receptors

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16
Q

Name 1st gen progestin ?

A

norethindrone,
ethynodiol

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17
Q

Name 2nd gen CHC ?

A

norgestrel,
levonorgestrel

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18
Q

Name 3rd gen CHC ?

A

desogestrel,
norgestimate,
norelgestromin,
etonorgestrel

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19
Q

What are the the risks of combined hormonal contraceptives.

A

VTE , MI, Breast Cancer
BP, Diabetes, TG, gallbladder and migraines

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20
Q

Name 4th gen CHC ?

A

Drospirenone

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21
Q

which of the CHC has the lower androgenic activities ?

A

3rd gen CHC
desogestrel,
norgestimate,
norelgestromin,
etonorgestrel

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22
Q

Which of the CHC has the most progesterone and androgenic ?

A

2nd gen CHC
norgestrel,
levonorgestrel

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23
Q

What are contraindications to CHC ?

A

major one : >35 years + smoking
breastfeeding

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24
Q

What are the contraindications for drospirenone ?

A

renal or liver failure, adrenal disease, drugs that
increase K+ levels (ie ACE inhibitors, spironolactone)

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25
Q

What is the most common SE of CHC ?

A

Breakthrough bleeding

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26
Q

What are the SE due to estrogen ?

A

nausea
§ breast tenderness
§ fluid retention/edema
§ headaches/migraines
§ chloasma
§ poor contact lens fit

27
Q

What are the SE due to progesterone

A

mood: depression, PMS, fatigue
§ breast tenderness
§ bloating
§ fluid retention
§ increased appetite
§ headache/migraines

28
Q

What proportion of unintended pregnancies are among contraceptive users?

A

50%

29
Q

Your professor in a seminar asks you to pick a 19-nortestosterone derivative progestin found in combined hormonal contraceptives which maintains progesterone selectivity but has less androgenic activity compared to a 2nd generation progestin. You would tell her the following progestin has these features:

A

3rd gen CHC : Desogestrel

30
Q

Which type of congestion would be beneficial for patient that has acne?

A

Antiandrogenic , cyproterone
4th gen, drospirenone

30
Q

What are the non-contraceptive of the benefits of CHC?

A

Cycle control: less painful menstrual cycle, less menstrual loss
Acne control
Inhibited ovulation: lower risk of the topic, pregnancies or overian cysts
Lower risk of ovarian and endometrial cancer
Positive effects on bone density
Symptom control in perimenopause

31
Q

Why is there medical risk of VTE with CHC?

A

It contains estrogen, which is a dose dependent proCOAGULANT effect, and fubronolytic balance

32
Q

What is the most potent synthetic estrogen in reproductive years ?

A

Estradiol E2

33
Q

When is the risk of VTE highest for patient on CHC ?

A

In the first year of use
Pregnancy
Peripartum period

34
Q

Why does the third generation progestin have an increased rate of VTE compared to second gen progestin ?

A

Because second generation have more androgenic properties that adds to counteract the coagulant effect of estrogen

35
Q

What are the risk factors for patients are taking CHC for MI or stroke?

A

Does related more than 50 µg of estrogen synthetic hormone
Smoking and over the age of 35 and hypertension

36
Q

What are the contradictions of a patient whose fourth generation CHC drospirenone?

A

Since it is an anti-mineral cortical steroid

Renal and liver failure, adrenal disease, drugs that increase potassium levels like ace inhibitors, and spironolactone .

37
Q

What are the signs for deficiencies in estrogen?

A

Break through bleeding mood changes, menopausal symptoms like vaginal dryness
Hypomenorrhea

38
Q

What can you expect in a patient who has low progesterone levels ?

A

Late breakthrough bleeding/spotting
Heavy period
Delayed menses

39
Q

Which of the sex hormones goes through enterohepatic recirculation ?

A

EE - synthetic estrogen

40
Q

What is the CYP for the metabolism of estrogen & progestins ?

A

CYP 3A4

41
Q

Which drug interactions should you pay attention to when a patient is on CHC

A

Anticonvulsant
Antimicrobial : rifampin
Lamotrigine

42
Q

What is the drug interaction between Lamotrigine and CHC?

A

CHC induces a metabolism of lamotrigine and clearance and results in a loss of seizure control
Lamotrigine may need to be adjusted after starting and after discontinuation

43
Q

Why does antibiotics affect CHC?

A

And the fact of micro biome, which and then interferes with her hepatic recirculation of EE

44
Q

What level of synthetic estrogen should you to sit there? My patient starting on CHC ?

A

All we start with a low dose of EE less than 35 µg
Patient is over 35 years old considered EE lesson 20 µg

45
Q

What are the type of altered hormone free interval regimen?

A

Shorten hfi
Extended cycle (continue, extended cycle)

46
Q

What is the rationale for shortening hfi ?

A

There are list of pregnancy since fsh levels may have not been suppressed during the 70 days hfi

47
Q

What is your recommendation for patient and continuous cHc having more spotting and break through bleeding?

A

Use monophasic products

48
Q

What is something to keep in mind when recommending contraceptive patches?

A

Potentially increase of VTE compared to oral contraceptive, the patient weight is over 90 kg. because they have 3rd gen

49
Q

How long can a patient wear vaginal contraceptive range?

A

Technically, four weeks equal 28 days
Or three weeks and remove for one week free interval

50
Q

It’s a patient from the vaginal ring more than three hours. What do they do?

A

No longer viable and 7 days of back up

51
Q

What is the MOE of estetrol/dropirenone CHC ?

A

Estetrol E4 —> selective and binds to ER in the nucleus and membrane

52
Q

What are the advantages of estetrol/ drospironone ?

A

Less risk of VTE, weak estrogen effects on the mammary glands , not metabolize by CYP

53
Q

When does the CHC start to work ?

A

7 days

54
Q

When would you need back up contraceptive ?

A

First trial : Sunday/Quick start / missed dose

55
Q

How long does a side effect last for CHC after initiation?

A

Within 3 months

56
Q

What are the warning times after contraceptive oral use?

A

ACHES - abdominal pain, chest pain, headaches, eye problems, severe leg pains

57
Q

What should the patient do if they missed more than 1 pill in week 2 or 3 ?

A

Take 1 pill and finish cycle
No HFI

58
Q

What should a pt do is they missed > =3 pills in week 2-3 ?

A

Take one pill
No HFI
7 days back up or EC if unprotective sex in last 5 days

59
Q

When should we follow up on a patient after the initiation of CHC ?

A

1-3 months

60
Q

What is the cause and the recommendation where a pt has BTB from a monophasic CHC ?

A

if early : Due to the deficiency in estrogen
Take a break and INCREASE the dose of EE

Late : due to progestin , take biphasic next time

61
Q

What should you do is the pt mentions water retention after CHC ?

A

Estrogen ADR —> lower EE
Progestin ADR —> change progestin to drospirenone

62
Q

If the pt experiments BTB after 3 months of CHC ? Solutions ?

A

Find the cause ( both estrogen and progestin deficiency)
Early in the cycle = Increase the dose of EE
Late in the cycle = change progestin

Stop the pill for 3-4 days to see if it is resolved

PHARM 443 : Sex Ed/MSK (10 decks)

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