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D&T 4 exam 1 > OCP > Flashcards

OCP Flashcards

1
Q

where is most estrogen produced?

A

ovaries

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2
Q

who makes estrogen in premenopausal women

A

granulosa cells or fetoplacental unit during pregnancy

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3
Q

what is the predominant estrogen type in postmenopausal women

A

estrone

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4
Q

where is estrone made

A

liver and adipose tissue

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5
Q

what is the most potent estrogen

A

17beta-estradiol

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6
Q

rank the potency of estrogens from strongest to weakest

A
  1. 17beta-estradiol
  2. estrone
  3. estiol
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7
Q

all gonadal hormones are synthesized from what

A

cholesterol

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8
Q

what converts androstenedione or testosterone to steroidal estrogens

A

aromatization of the A ring - catalyzed by aromatase

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9
Q

what estrogens does the placenta make and how?

A

estrone and estriol

DHEA

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10
Q

all 3 estrogens are excreted how from body

A

along with glucuronide and sulfate conjugates

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11
Q

estrogen impact on ovaries

A
  • stimulate follicular growth

- too much , atrophy of ovaries

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12
Q

estrogen impact on uterus

A

endometrial growth

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13
Q

estrogen impact on vagina

A
  • cornification of epithelial cells

- thickening and stratification of epithelium

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14
Q

estrogen impact on cervix

A
  • increase cervical mucous

- lowers viscosity ( favors sperm access)

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15
Q

estrogen impact on cholestrol

A

hypocholesterolemic effect

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16
Q

estrogen impact on electrolytes

A

retention of Na, Cl and water by kidney

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17
Q

where is progesterone secreted

A

corpus luteum
adrenal cortex
testis

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18
Q

once fertilization occurs what hormone is secreted

A

hCG

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19
Q

during 2nd and 3rd month of pregnancy what does the placenta secrete

A

E2 and P

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20
Q

name 3 actions of progestrone

A
  1. development of secretory endometrium
  2. increase viscosity
  3. maintain pregnancy
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21
Q

what happens to the women body when progesterone levels decline

A

menstruation

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22
Q

how is GnRh, FSH, and LH secreted. what phase are they secreted in

A

GnRH: intermittent
FSH and LH: pulsatile

Follicular phase

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23
Q

both LH and FSH stimulate what in the follicular phase

A

Graafian follicle growth

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24
Q

FSH by it self stimulates what in the follicular phase

A

maturation and estrogen production

by granulose cells

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25
What are estrogen effects on pituitary during early follicular phase
inhibitory
26
What are estrogen effects on pituitary during midcycle follicular phase
positive
27
what is essential for ovulation
LH surge
28
what follows LH surge
follicle rupture within 24-48 hours
29
progesterone is under influence of what hormone
LH
30
what are 3 therapeutic uses for estrogen and progestins
contraception | postmenopausal hormone therapy
31
when is conjugated estrogens used
post menopausal
32
what is the difference between third generation and second generation contraceptives
third: less acne, nausea, lipid changes
33
how does monophasic contraceptive work
- constant estrogen and progesterone for 21 days | - iron or placebo 7 days
34
how does biphasic contraceptive work
2 different levels of progesterone | constant amount of estrogen
35
how does triphasic contraceptive work? 3 versions
1. 3 levels of progesterone/ constant estrogen 2. 1 dose of progesterone, 3 doses estrogen 3. 21 days of estrogen/progesterone
36
What is the goal for extended COC
attempt to alter the number of pill free interval days
37
what is YAZ FDA approved for
premenstrual dysphoric disorder -PMDD
38
What is the combination of YAZ
EE and drospirenone (DSRP)
39
what is the combination of Yasmin? what is difference of Yaz and Yasmin
EE and drospirenone (DSRP) | Yasmin not FDA approved for PMDD
40
What are symptoms for Mircette
fewer menstrual symptoms such as: | estrogen-withdrawal headaches, bloating, and menstrual pain
41
Drospirenone is a derivative of what drug? side effect
spironolactone | - hyperkalemia
42
what is the combination for Seasonale
levonorgestral - EE
43
how is Seasonale taken
84 days straight | 7 days placebo
44
Compare Seasonique and Seasonale
Seasonque: 7 days of EE instead of placebo - better follicular suppresion - less unscheduled bleeding
45
how is Lybrel taken
365 days | - no placebo or pill free days
46
what is the combination for Lybrel
EE and Levonorgestrel
47
advantage for transdermal contraceptive
avoids first pass effect through liver | - less adverse effect on liver
48
disadvantages for transderma contraceptive
skin irritation/rash | thrombosis
49
what estrogen is used in monophasic CO
mestranol converts to ethinyl estradiol
50
name 3 types of progestins
pregnanes estranes gonanes
51
what is adjusted in pill when side effects occur
progestational and androgenic activity
52
Name progestational and androgenic activity
Levonorgestrel and Norgestrel
53
what progesterone has lowest androgenic activity
Desogestrel Norgestimate Gestodene Drosperinone
54
What progesterone has anti-androgen and anti-mineralocortcoid
Drosperinone
55
what are side effects of Drosperinone
hyperkalemia less weight gain reduces acne
56
how do COC work
- inhibit ovulation - thicken endocervical fluid - reduces sperm penetration - endometrium unsuitable for eggl implanation
57
how does progesterone work in COC
diminishes frequency and amplitude of GnRH and LH
58
how does estrogen work in COC
suppresses pituitary release of FSH in follicular phase ( negative feedback)
59
when are monophasic COC effective ? triphasic ?
within 21 days | triphasic: 7 days
60
what happens when dosing varies?
- increase failure in the beginning of pack | - increase adverse effects due to greater fluctuations in hormones
61
what are side effects that are most important factor for discontinuation of OC
- nausea, headache, migraines, weight gain - higher incidence of thrombosis formation - - increase platelet aggregation - - higher levels of hepatic coagulation factors - incidence of hypertension in some patients
62
what is the greatest contraindication for OC
cigarette smoker over age 35
63
what are 5 risks for OC
1. venous thromboembolism 2. myocardial infarction 3. stroke 4. gall bladder disease 5. breast cancer
64
what are non-contraceptive benefits for OC
- increase bone mineral density - decrease acne - decreased epithelial ovarian cancer
65
when do you to adjust lower estrogen
- nausea and vomiting - headaches and migraine - CYCLIC weight gain - hypermenorrhea - leg cramps, edema - hypertension
66
when do you to adjust higher estrogen
- vasomotor symptoms ( hot flashes) - early spotting or bleeding between - hypomenorrhea
67
when do you to adjust less progesterone
depression | reduced breast size
68
when you adjust to less androgenic activity
acne or oily skin | NONCYCLIC weight gain
69
when do you adjust to higher progesterone dose
late bleeding | hypermenorrhea
70
what do you if you miss 1 dose of OC days 22-28 days 1-21
22-28: take remaining pills on schedule 1-21: take pill as soon as discovered -- max is 2 pills a day
71
when is greatest potential for failure of pill if you miss it
first 5 days
72
what do you if you miss 2 doses of OC days 1-14 days 15-21
1-14: take extra pill for 2 days | 15-21: stop pack and start new cycle
73
what drug can women with migraines and depression use
Minipill - progesterone only
74
if a mother just delivered and they are not nursing, when can they start OC
4 weeks after delivery | - greater than 2 weeks due to risk of blood clots
75
nursing mothers should use what OC
Minipill - progesterone only
76
why can't smoker take OC
smoking induces P450 - therefore smokers must use higher doses of estrogen and progesterone - this leads to greater failure if pills missed due to increased clearance
77
OC should not be taken with other drugs
Tetracycline, PENICILLIN V, erythromycin and ampicillin

D&T 4 exam 1 (17 decks)

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