Module 14 - Reproduction Flashcards
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
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
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)
AE recommended formulation: Acne
higher Estrogen dose, lower androgen potency
AE recommended formulation: breakthrough bleeding
higher Estrogen and progestin potency
lower androgen potency
AE recommended formulation: absent/ light menstrual flow
higher estrogen, lower progestin dose
AE recommended formulation: Depression
lower progestin potency
AE recommended formulation: Moodiness or irritability
lower Progestin potency
AE recommended formulation: HA (not menstrual migraines)
lower estrogen and progestin potency
AE recommended formulation: breast soreness
lower estrogen and progestin potency
AE recommended formulation: weight gain
lower estrogen and progestin potency
AE recommended formulation: severe menstrual cramps
higher progestin potency
AE recommended formulation: endometriosis or endometriosis prevention
lower estrogen, higher progestin and androgen potency
AE recommended formulation: endometriosis or endometriosis prevention
lower estrogen, higher progestin and androgen potency
5a reductase inhibitor
competitive inhibitor
More specific for type II receptors in scalp
Inhibits conversion of testosterone to DHT
Finasteride
Med used to treat BPH and alopecia
Finasteride
5a reductase inhibitor
competitive inhibitor
Inhibits conversion of testosterone to DHT
Dutasteride
Aromatase inhibitor
competitive inhibitor
Inhibits conversion of androgen to estrogen
Anastrazole, Letrozole
Aromatase Inhibitor
Noncompetitive Inhibitor*
Inhibits conversion of androgen to estrogen
Exemestane, Formestane
SERM, Can stimulate endometrial cancer- pro-estrogenic effect on endometrium, antagonistic estrogenic effects on breast tissue
Tamoxifen
SERM, Inhibits growth of estrogen dependent (ER+) breast tumors, agonist activity in bones can delay or prevent osteoporosis, does not stimulate endometrium
Raloxifene (Evista)
SERM, ER antagonist in hypothalamus gland anterior pituitary gland = increased GnRH , Induces ovulation via partial agonism in ovaries
Clomiphene (clomid)
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
- High
2. Low
A SERM that can stimulate endometrial growth?
Tamoxifen
What happens when SERMS activate receptors on osteoblasts ?
leads to bone anabolism