OCP Pharm Flashcards
41 yo married smoker, G4P3, no desire for future fertility, h/o migranes, 150# 62in2.3.4.1
IUD-NON HORMONAL
TUBAL LIGATION
19 yo single student, G1P0, c/o acne, previous preg bc missed pills, 116# 64in
STI screen
Ring
Patch
Depo
27 yo newly wed, G0P0, wants children next year, 220#, 69in
IUD
13 yo student, 2.5 years since menarch, c/o heavy painful, irregular periods, severe
OCP
monophasic
Extended-long cycles
Explain myth that people think “getting pregnant only poss. 1 day b4 menses’
Ovulatin ranges from 14-18days prior to period which means preg highly possilble
What are the synthetic Estrogens?
Steroidal – ethinyl estradiol, mestranol, quinestrol◦
Non-steroidal: diethylstilbesterol, chlorotrianisene.
Stimulate ovulation via + feed back on pitiuitary-LH
What are common estrogen preparations?
Estradiol cypionate (injectable)
Estropipate
Conjugated estrogens◦ Oral◦ Injectable Vaginal ring◦ Transdermal◦ Vaginal cream/tab◦Lotion/gels◦ implant subdermal
PK-oral, LIVER
What does estrogen promote?
Female maturation Closing of bone plates developed organ alter body fat distribution INc endometrial lining coordinate w/ progesterone DEC Ca resorption//release of bone INC HDL DEC LDL, TC Libido INC Well being Na/H20 retention- wt gain during cycle
Lack of estrongen has risk for what
Mood disorders
Bone health
What do you ALWAYS combine with Estrogen?
progesterone and estrogen
inc lining- estrogen bricks
progest- mortor, should shed if no preg
NEVER alone- due endometrial carcinoma risk
estrogen inc growth
What are clinical uses of estrogen in postmenopausal women?
Primary hypogonadism- develop ovaries
premature menoupuse
castration
Prevent osteoporosis
sleep
atrophic vaginitis
What are ADR of EStrogen
breast cancer high in PM Endometrial cancer CV dz HTN MOOD BLEEDING BREAST TTP
What is differnece btwn natural and syntheitc progesterone
Natural- short t1/2
synthetic - PK LIVER
-REL, -GEST, -ETHY Hydroxyprogesterone ◦Medroxyprogesterone◦ Megestrolacetate◦ Desogestrel◦ Norethynodrel◦ Norethyndrone◦ Levonorgestrel
Which progestin drugs have no androgenic activity
Desogestrel (Mircette, Desogen),
Norgestimate (Ortho-Cyclen
TX- Hyperandrogenism/polycystic ovary syndrome-
What are effects of progesterone in body?
INC basal insulin- DM risk
Competes with aldosterone decreased Na reabsorption
breast,
Synthetic
reduce aldosterone-
gonadotropin inhibitors androgenic activity
ADR-PMS
Thrombosis, CVA, TIA
Hepatic dysfunction
What are clinical use of Progestins
Hormone replacement Contraception Prevention of menstruation Secondary physiologic amenorrhea Delay of premature labor Endometrial hyperplasia prophylaxis Diagnostic use – test of estrogen secretion Adjunct female infertility Hyperandrogenism/polycystic ovary syndrome-
Describe Mono, Bi, Triphasic.
Contain combo of progestin and estrogen mono- 1 dose of meds bi- two dose (3 colors) Tri- three doses (4 colors) Menes- Withdrawal bleedings
Which drug offers 4 periods per year?
Extended Cycle (Seasonique, Lybrel) ◦4-phase extended cycle (Quartette)◦
Low dose – OK for Migraines , young non-smokers
What contraceptive do you wear or insert?
Transdermal patch
Ortho Evra
Less effective BMI >30
Vaginal Ring- insert 3w, remove 1w
What is Progestin Only injection and Not good if trying to conceive ?
Depoprovera
Medroxyprogesterone
150mg IM q 3 mo
ovulation inhibited x 14 wks after shot
dec risk of endometrial cancer
**Ok for migraines, smokers
prolong ovulation after cessation if BMI >30
***1+ yr of dec fertility
What is implanted in arm and ok for obese and smokers?
Nexplanon
Implanon
Jadelle
Upper arm insertion Good for 3 yrs Use: contraception only ***Ok for migraines, smokers ***Good BMI >30
Contra ind: AVOID W/ current breast cancer OR BMI > 30,
Good if trying to conceive soon
Fertility in 1-4 wks
1+ yr of dec fertility- Not good if trying to conceive later
What is good for 5 yrs, for obese, smokers or if trying to conceive soon?
IUD - hormonal
Levonorgestrel
24% have Amenorrhea
AVOID-breast/ cervical cancer, PID, uterine cavity distortion, abnormal pap d/t possibility of tx
Good for BMI >30
Good if trying to conceive soon
Immediate return to fertility
Have to take out if get STI – not good if at high risk
What may cause ectopic pregnancy and may make menstural worse?
Copper IUD non hormonal Placed anytime during cycle conceive soon return to fertility Good for BMI >30
5 days after sex for post coital effect ***
SE-menstrual sx worse***
Ectopic pregnancy can still occur
take out if get STI – not good if at high risk
Which drugs are MORE effective for OBESE women?
Ulipristal (Ella) Oral is a progesterone agonist/antagonist marketed for emergency contraception.
Others not effective, INC dose doesn’t help
Other- Levonorgesterel IUD
Copper IUD
LAST SEASONAle oral
