Module 14 - Reproduction Flashcards by katie gazda

Proposed uses of uterotonics

To empty Uterus- labor/ terminate pregnancy

Stop Bleeding- Immediately Postpartum/ late postpartum hemorrhage

Subinvolution- reduction of uterus to its normal size after childbirth

How well did you know this?

Not at all

Perfectly

Potential benefits of Oral contraceptives

Avoid unwanted pregnancy 
Decrease menorrhagia
Decrease dysmenorrhea
Decrease ectopic pregnancy 
Decreased iron deficiency anemia 
Decreased PID
Decrease risk of ovarian and endometrial cancer

How well did you know this?

Not at all

Perfectly

Potential Harm of Oral Contraceptives

Increase risk of MI/stroke/ VTE
Relative CI if woman > 35 yrs and smokes due to increased risk of VTE and cardiovascular events*
slight increased risk of breast cancer (if at all)

How well did you know this?

Not at all

Perfectly

AE recommended formulation: Acne

higher Estrogen dose, lower androgen potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: breakthrough bleeding

higher Estrogen and progestin potency

lower androgen potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: absent/ light menstrual flow

higher estrogen, lower progestin dose

How well did you know this?

Not at all

Perfectly

AE recommended formulation: Depression

lower progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: Moodiness or irritability

lower Progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: HA (not menstrual migraines)

lower estrogen and progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: breast soreness

lower estrogen and progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: weight gain

lower estrogen and progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: severe menstrual cramps

higher progestin potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: endometriosis or endometriosis prevention

lower estrogen, higher progestin and androgen potency

How well did you know this?

Not at all

Perfectly

AE recommended formulation: endometriosis or endometriosis prevention

lower estrogen, higher progestin and androgen potency

How well did you know this?

Not at all

Perfectly

5a reductase inhibitor
competitive inhibitor
More specific for type II receptors in scalp
Inhibits conversion of testosterone to DHT

Finasteride

How well did you know this?

Not at all

Perfectly

Med used to treat BPH and alopecia

Finasteride

How well did you know this?

Not at all

Perfectly

5a reductase inhibitor
competitive inhibitor
Inhibits conversion of testosterone to DHT

Dutasteride

How well did you know this?

Not at all

Perfectly

Aromatase inhibitor
competitive inhibitor
Inhibits conversion of androgen to estrogen

Anastrazole, Letrozole

How well did you know this?

Not at all

Perfectly

Aromatase Inhibitor
Noncompetitive Inhibitor*
Inhibits conversion of androgen to estrogen

Exemestane, Formestane

How well did you know this?

Not at all

Perfectly

SERM, Can stimulate endometrial cancer- pro-estrogenic effect on endometrium, antagonistic estrogenic effects on breast tissue

Tamoxifen

How well did you know this?

Not at all

Perfectly

SERM, Inhibits growth of estrogen dependent (ER+) breast tumors, agonist activity in bones can delay or prevent osteoporosis, does not stimulate endometrium

Raloxifene (Evista)

How well did you know this?

Not at all

Perfectly

SERM, ER antagonist in hypothalamus gland anterior pituitary gland = increased GnRH , Induces ovulation via partial agonism in ovaries

Clomiphene (clomid)

How well did you know this?

Not at all

Perfectly

Pure ER receptor antagonist, competitively inhibits estrogen receptors in hormonally responsive breast cancer cells, inhibits growth of estrogen dependent (ER+) breast tumors

Fulvestrant

competitively inhibits binding of endogenous androgen to androgen receptors

Flutamide, Bicalutaminde

Who derives the biggest benefit of hormone replacement therapy? *

Pts with most severe symptoms | In mild-moderate symptoms the benefit might not outweigh the risks

What med class stimulates receptors on osteoblasts - can lead to bone breakdown

SERMS- Tamoxifen, Raloxifene (Evista) , and Clomiphene (clomid)

Synthetic form of PGE1, Pregnancy category X, Cervical ripening agent, vaginal administration*

Misoprostol (cytotec)

Induces labor by promoting contractions, administered IV*, use w/ caution in cardiac/ renal disease, PIH

Oxytocin (pitocin)

Cervical ripening agent, naturally occurring PGE2, vaginal administration*

Dinoprostone (Cervidil)

MOA of OCPs (oral contraceptive pills)

Suppression of mid-cycle gonadotropin (FSH, LH) secretion = inhibiting ovulation*

why is estrogen always administered with progesterone?

unopposed estrogen promotes endometrial growth = increased risk of endometrial cancer

Progestin AEs

breast tenderness, weight gain, depression, moodiness, irritability, headaches

what component is largely responsible for the androgenic effect of a combination pill? for pt w/ acne

Progestin (precursor to androgen and estrogen synthesis)

What formulation might work better for a pt with acne that has no androgenic activity? Possible AEs?

Drospirenone (Yaz) monitor for hyperkalemia* may decrease h20 retention, breast tenderness, and acne

what would be some good options for a 35 yr old pt, mom of 3, who does not want more kids, and IUD, or OCP

Ortho Evra (transdermal patch) - find out her weight? - less effective in pts weighing 90kg (198 lbs) Nuva Ring

In what forms of BC are hormone drug levels less variable? Why?

Transdermal patch and vaginal ring because of relatively continuous absorption

what is best form of BC for pt with hx of DVT?

Transdermal patch

What do you need to consider when prescribing corticosteroids to pt on OCP?

OCPs potentiate corticosteroids, may be related to steroid metabolism or the ability of the steroid to bind to serum protein may need lower steroid dose

What happens when drugs induce metabolism of contraceptives? Examples? * what to do?

Dilantin/ Rifampin/ Griseofulvin/ Tegretol = decrease effectiveness of the contraceptive ... use back up method

What kind of hormonal contraceptives would be useful for breastfeeding mother? Route of admin, AE, CI Who else could benefit?

Progestin Only- Oral/ IM/ Intrauterine must take at same time everyday, more breakthrough bleeding, less effective than combo pills anyone who would benefit from avoiding estrogen- lupus sickle cell, cardiovascular disease, VTW, migraines

AEs of Plan B | How to get this med?

Nausea and vomiting | OTC w/out prescription regardless of age

What are some other med options for terminating early pregnancy?

Mifepristone | Misoprostol (cytotec)- off label use

Ideal candidate for HRT and general recommendations

only in women with severe menopausal symptoms for the shortest time possible

What to say to pt about natural estrogen supplements?

make sure there are no interactions with other meds they are on

TX of vasomotor sxs of menopause, SIgnificant 1st pass metabolism-> increased binding of globulins, TGs, HDL, clotting factors

Oral Estrogen

TX of vasomotor sxs of menopause, as effective as oral estrogen for menopause and bone density but less AEs

Transdermal Estrogen

TX of vasomotor sxs of menopause, caution w/ transfer to children/ pets

Topical Estrogen

TX of vasomotor sxs of menopause, Tx vaginal atrophy, GU sxs of menopause

Vaginal Estrogen

What to counsel pts taking topical testosterone gel/ patch?

caution w/ transfer to children or pets - kids can develop premature pubic hair, increased libido, aggressive behavior

Tx of hypogonadism, perimenopause transgender, can be fluctuations in hormone levels

IM Testosterone

What are PDE 5 inhibitors contraindicated to take with?

Nitrates (will have too much smooth muscle relaxation)

Examples of PGE 5 inhibitors

Sildenafil, Vardenafil

What should you do in a pt develops breakthrough bleeding on OC?

estrogen dose should be increased

A pt with acne would benefit from OC with _____ estrogen content and ______ androgenic progesterone

1. High | 2. Low

A SERM that can stimulate endometrial growth?

Tamoxifen

What happens when SERMS activate receptors on osteoblasts ?

leads to bone anabolism