Meds for Women's Health

Question 1

Define estradiol

Answer 1

main endogenous estrogen from the inside the body

Question 2

Explain how estradiol and progesterone levels fluctuate during the menstrual cycle

Answer 2

estrogen is higher in the follicular phase and drop at ovulation

progesterone becomes higher in the luteal phase

Question 3

Recite the reproductive roles of estrogen in women

Answer 3

development of secondary sex characteristics (breast, endometrium, etc.)

Question 4

Describe the non-reproductive actions of estrogen in women

Answer 4

• strong bones (blocks bone resorption)
• Decreased vascular constriction (–> low BP, better tissue perfusion)
• lower LDL

Question 5

List the routes of estrogen administration

Answer 5

1. Oral
2. Transdermal
3. Intravaginal

Question 6

Recall where one would apply an estrogen emulsion

Answer 6

Top of thighs & back of calves

Question 7

Recall where one would apply an estrogen spray

Answer 7

Inner forearm

Question 8

Recall where one would apply an estrogen gel

Answer 8

one arm from shoulder to wrist

Question 9

Recall where one should apply an estrogen patch

Answer 9

intact skin (except breasts & waistline)

Question 10

What are common indications for estrogen (estradiol)

Answer 10

sed for symptoms of menopause like vaginal dryness, itching and increased or painful urination, etc.!

Question 11

List some of 3 adverse effects of estrogen therapy

Answer 11

1. nausea
2. increased risk of endometrial carcinoma (if used without progesterone)
3. testicles fail to develop in male fetus

Question 12

What are the risks of estrogen for women >65 years

Answer 12

• dementia
• DVT or stroke

Question 13

Describe why constipation is more common in pregnant women

Answer 13

The answer is progesterone!
Progesterone suppresses uterine contraction & GI smooth muscle contraction

Question 14

Recall the role of progesterone in pregnancy

Answer 14

In the event of conception, progesterone is the fundamental hormone facilitating pregnancy.
It maintains thickness of endometrium, prevent other eggs fertilization, relax uterine muscle, prevent lactation until birth, etc.

Question 15

What are 4 therapeutic indications for progesterone

Answer 15

1. Menopause
2. Heavy uterine bleeding caused by imbalance of endogenous progestin
3. Amenorrhea
4. Support early pregnancy with IVF & if corpus luteum deficient

Question 16

What are some adverse effects of progestin

Answer 16

• breast tenderness, headache, depression, abdominal discomfort, arthralgias
• for older people: risk of dementia, DVT, stroke, etc.

Question 17

List 2 types of oral contraceptives (OCs)

Answer 17

• combination OC (progestin + estrogen)
• mini-pills (progestin only)

Question 18

List contraindications to oral contraceptive use

Answer 18

• Cardiovascular problems (PE, DVT, heart disease)
• Diabetes, heavy smoking
• Seizures
• Postpartum
• Migraine with aura

Question 19

What is the generic name of combination OC?

Answer 19

Ethinyl estradiol/norethindrone

Question 20

Describe the mechanism by which estrogen and progestin prevent pregnancy in those taking combination oral contraceptives (OCs)

Answer 20

Estrogen: suppresses FSH release from AP (follicles do not mature)

Progestin: suppresses hormone LH release (ovulation does not occur)

Question 21

Top 3 adverse effects of combination OC

Answer 21

1. risk of developing clots
2. Abnormal uterine bleeding
3. risk of stroke

Question 22

Recite the patient populations that should not take OCs

Answer 22

1. history of thrombosis
2. breast cancer
3. known or possible pregnancy
4. abnormal liver function
5. Abnormal vaginal bleeding
6. smoker over 35

Question 23

Explain how antibiotics affect birth control (according to current research)?

Answer 23

Only rifampin has been proven to decrease effectiveness of birth control

Question 24

Recall which medications can also lower the effect of birth control

Answer 24

• griseofulvin (anti-fungal)
• carbamazepine, phenytoin, primidone, phenobarbital
• some HIV meds

Question 25

Review how taking oral contraceptives interacts with blood thinners

Answer 25

OCs can reduce the effect (increased levels of clotting factors), so the increased dosage may be required

Question 26

Review how taking oral contraceptives interacts with hypoglycemic drugs

Answer 26

OCs can reduce the effect (increased level of glu), so the increased dosage may be required

Question 27

List drugs that may lead to toxicity when taken with an oral contraceptive

Answer 27

1. theophylline (bronchodilator; asthma, emphysema, chronic bronchitis)
2. TCAs
3. diazepam
4. chlordiazepoxide (long-acting sedative; alcohol detox)