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SMUPASPG19-PHARM 1 > OCP Pharm > Flashcards

OCP Pharm Flashcards

1
Q

41 yo married smoker, G4P3, no desire for future fertility, h/o migranes, 150# 62in2.3.4.1

A

IUD-NON HORMONAL

TUBAL LIGATION

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2
Q

19 yo single student, G1P0, c/o acne, previous preg bc missed pills, 116# 64in

A

STI screen
Ring
Patch
Depo

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3
Q

27 yo newly wed, G0P0, wants children next year, 220#, 69in

A

IUD

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4
Q

13 yo student, 2.5 years since menarch, c/o heavy painful, irregular periods, severe

A

OCP
monophasic
Extended-long cycles

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5
Q

Explain myth that people think “getting pregnant only poss. 1 day b4 menses’

A

Ovulatin ranges from 14-18days prior to period which means preg highly possilble

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6
Q

What are the synthetic Estrogens?

A

Steroidal – ethinyl estradiol, mestranol, quinestrol◦

Non-steroidal: diethylstilbesterol, chlorotrianisene.

Stimulate ovulation via + feed back on pitiuitary-LH

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7
Q

What are common estrogen preparations?

A

Estradiol cypionate (injectable)

Estropipate

Conjugated estrogens◦
Oral◦
Injectable
Vaginal ring◦
Transdermal◦
Vaginal cream/tab◦Lotion/gels◦
implant subdermal

PK-oral, LIVER

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8
Q

What does estrogen promote?

A 
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
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9
Q

Lack of estrongen has risk for what

A

Mood disorders

Bone health

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10
Q

What do you ALWAYS combine with Estrogen?

A

progesterone and estrogen
inc lining- estrogen bricks
progest- mortor, should shed if no preg

NEVER alone- due endometrial carcinoma risk
estrogen inc growth

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11
Q

What are clinical uses of estrogen in postmenopausal women?

A

Primary hypogonadism- develop ovaries
premature menoupuse
castration

Prevent osteoporosis
sleep
atrophic vaginitis

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12
Q

What are ADR of EStrogen

A 
breast cancer high in PM
Endometrial cancer
CV dz
HTN
MOOD
BLEEDING
BREAST TTP
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13
Q

What is differnece btwn natural and syntheitc progesterone

A

Natural- short t1/2

synthetic - PK LIVER

-REL, -GEST, -ETHY
Hydroxyprogesterone
◦Medroxyprogesterone◦
Megestrolacetate◦
Desogestrel◦
Norethynodrel◦
Norethyndrone◦
Levonorgestrel
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14
Q

Which progestin drugs have no androgenic activity

A

Desogestrel (Mircette, Desogen),

Norgestimate (Ortho-Cyclen
TX- Hyperandrogenism/polycystic ovary syndrome-

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15
Q

What are effects of progesterone in body?

A

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

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16
Q

What are clinical use of Progestins

A 
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-
17
Q

Describe Mono, Bi, Triphasic.

A 
Contain combo of progestin and estrogen
mono- 1 dose of meds
bi- two dose (3 colors)
Tri- three doses (4 colors)
Menes- Withdrawal bleedings
18
Q

Which drug offers 4 periods per year?

A 
Extended Cycle (Seasonique, Lybrel) 
◦4-phase extended cycle (Quartette)◦

Low dose – OK for Migraines , young non-smokers

19
Q

What contraceptive do you wear or insert?

A

Transdermal patch
Ortho Evra
Less effective BMI >30

Vaginal Ring- insert 3w, remove 1w

20
Q

What is Progestin Only injection and Not good if trying to conceive ?

A

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

21
Q

What is implanted in arm and ok for obese and smokers?

A

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

22
Q

What is good for 5 yrs, for obese, smokers or if trying to conceive soon?

A

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

23
Q

What may cause ectopic pregnancy and may make menstural worse?

A 
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

24
Q

Which drugs are MORE effective for OBESE women?

A

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

25
Q

***What OCP CAN be given to smokers >35?

A

PROGestin ONLY
1. Injectable Depoprovera,
Medroxyprogesterone

  1. Subdermal implant Nexplanon, Implanon, Jadelle)
  2. NON- HORMONAL- Cooper IUD
  3. Levonogesterel IUD
  4. LAST- seasonige
26
Q

Should women rely on breastfeeding as contraceptive no?

A

NO!!!!

27
Q

Which contraceptive is NOT safe and least effective?

A

Norethindrone
-97% efective, vs 99+% combos

MOA-PROGESTIN ONLY, Suppresses pituitary
change in cervical mucus

ONLY drug that doesnt cross for Lacting women. But AVOID

28
Q

What are SE of contraception? Should you change if SE?

A

YES change!

ADE-dec in CHO tolerance
INC CO, BP
Estogen skin pigmentation
WD not occure-GAD
Acne-higher estrogen

SEVERE- THROMBOEMBOLISM
MI,CEREBRAL-SMOKERS- >35 NO COMBOS
MDD- switch doses
CA? HPV

29
Q

When are postcoital contras effective?

A

***w/in 72 hrs up to 5 days

Postcoital – Plan B
Levonorgestrel -High dose Synthetic progest.

ADE**Nausea- consider giving antiemetic
NOT >165 lbs

30
Q

What pill is also used for termination, Cushings and inoperable adrenal tumor?

A

Mifepristone

MOA- Postcoital – Abortion& Progestin Inhibitor & glucocorticoid receptor antagonist
Expulsion of products of conception thru necrosis, myometrial contractions, and cervical softening

High dose
Administer w/ Misoprostol
Starts contractions
Up to 49 days into pregnancy

off label Cushing’s DZ - blocks glucocorticoid receptor inhibiting activation
Able to reverse many of Sx

Recommend. For inoperable pt’s w/ ectopic ACTH secretion or adrenal tumors

31
Q

What is an ovulation inducing agent?

A

Clomiphene Citrate (Clomid)

MOA-Partial agonist at estrogen receptors
Stimulates ovulation in oligomenorrhea

If not working after 6 cycles then need to change meds , bc should work if ovary this issue

ADE- Psych sx
Vasomotor sx
Breast tenderness
Hypertrophy of ovary
multiple pregnancy
32
Q

What are considerations and reminders for each patient with contraceptives?

A 
Risk ofSTD◦
HTN, CV dz, BMI, cancer 
future pregnancies (return to fertility)◦
Mobility d/t thrombosis risk, 
Adherence◦
Age
BMI >30
LESS EFFECT- Patch,Low dose oral, “seasonale”
MOST EFFECT- ***implant and IUD 
Patient preference
**Migraines- AVOID combo w/ aura or >35 w/ migraines
Smokers- must change @>35 Progestin only
33
Q

What OCP are NOT effected by Rifampin and Rifapentic d/t CYP enyme induced?

A

Medroxyprogesterone and IUD are not afected◦

Antibiotics:◦ ALL abx lower efectiveness of hormonal contraception◦

Studies suggest hormone levels are not lowered by most abx PCN, tetracycline, etc

Caution with vomiting/diarrhea which may lead to poor absorption of OC.

SMUPASPG19-PHARM 1 (17 decks)

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