OCSH1 Flashcards
Levels
LH
FSH
Progesterone
Estradiol
Body Temp
LH -Really low after menstruation. Approximately day 14 LH will surge
FSH - a wave
Progesterone - after menstruation progesterone levels are low, after she ovulates, progesterone levels rises and right before menstruation it comes down
Estradiol - slowly increases, and just like LH surges then comes back down
Body temp: increases when ovulating. Also her saliva crystalizes when ovulating
Female cycle
Approximately day 14- ovulation, egg is released, progesterone increases day after ovulation, body temp rises along with elevated progesterone.
-progesterone and body temp remain high throughout rest of the cycle; however, if patient doesn’t get pregnant, both will gradually decrease and ultimately menstruation will day place on cycle day 28
Ovulation tests
Pregnancy tests test for
Checking for LH surge
Preg: beta-HCG level
components of COCs
Estrogens we use:
• ethinyl estradiol ( EE ): 10-50 mcg of estrogen
• Estradiol Valerate ( Tazia )
Estrogen Pharmacology :
- inhibits ovulation by suppressing hypothalamus release of FSH and LH
- inhibits fertilized ovum implantation
- accelerates ovum transport, decreasing fertilization time.
- cycle control
Progesterones
Progestins we use:
• DLNG ( norgestrel )- Ovral, • DSG ( desogestrel ) - Apri , Mircette, Ortho Cept, • ED ( ethynodiol diacetate ) - zovia, demulen
• LNG ( levonorgestrel ) - allese, levlen, triphasil, • NE ( Norethindrone ) - ortho-novum, •NEAC ( norethindrone acetate ) Loestrin, • NGM ( norgestimate ) - ortho tri cyclin
1st gen, 2nd gen, 3rd gen,
Progestin pharmacology :
- cycle control
- thickens cervical mucus that slows sperm transport and ability to penetrate ovum
-causes endometrial transformation
-Drospirenone: is a type of progestin equivalent to 25 mg spironolactone ( aldactone )
Regimens
Monophasic : every active pill are the same
Biphasic: pill change in dose of hormone over cycle. eg) constant estrogen; progestin increase in the late cycle.
Triphasic : 3 different hormones over cycle eg ) progestin /estrogen vary in 3 phase cycle ( q 7 days ) - have Tri in the name. Changing the phase 3 different times.
Qaudriphasic : 4 different phases
Extended cycle: seasonique ( having menstruation once a season. 91 day regimen, not 28 day. Having menstruation 4 times a year instead of 12 times a year.
Noncyclic regimen: librel; no cycle at all.
Progestin only : mini pill…
Monophasic
Eg ) lots of different kinds
Femcon Fe* and minastrin 24 Fe* are both chewable
Fe= iron ( can cause constipation )
Loestrin 1/20 EE= 20 mcg 1 is progesterone ( norethindrone 1 mg )
Ogestrel - EE= 50 mcg
Lybrel
Monophasic but really noncyclic bc no placebo days
20 mcg EE + levonorgestrel 90 mcg
Patient will complain about spotting in the beginning. Worst spotting in 1st 3 months but it will get better
YAZ/ Yasmin
Progestin = Drospirenone = sprinolactone 25 mg ( less water retention but risk of hyperkalemia )
- Drospirenone and desogestrel ; those 2 progestins have increased risk of clot formations vs other choice of progestins
Sprinolactone has antiandrogenic effects. Great choice for patients who have acne, excessive hair growth.
Yasmin - 30 mcg EE = 0.03 mg EE + 3 mg Drospirenone
-21 tabs 3mg Drospirenone & 30 mcg EE , -7 inert white tabs ( placebo days )
YAZ - 20 mcg EE ( 0.02 mg EE ) + 3 mg Drospirenone
- 24 tabs active tabs, - 4 white inert tabs
DDI: Drospirenone is 25 mg of spironolactoen so worry about ddi with ace, arb, Direct renin inhbitor ( tekturna ) so additive
Beyaz is like YAZ ( Drospirenone /EE but difference levomefolate calcium ( increases folic acid ) )
Biphasic
Mircette
Days 1-21 - 0.02 mg EE + 0.15 mg desogestrel
Days 22 -23 2 inactive tabs
Days 24-28 0.01 EE ( low amount ) so biphasic
Lo Loestrin fe
Really low amount of EE.
Reason biphasic day 25,26 no progesterone but EE 10 mcg continuing
Triphasic
7/7/7 = Triphasic
It either affects estrogen or progesterone.
7/7/7 - this has progesterone increase slowly over 3 phases
Tri- progesterone is changing
Enpresse, Levonest, - progesterone is changing but also estrogen is changing
Estrostep Fe - in the name. Affecting estrogen over 3 phases.
20 to 30 to 35 mcg
4 phases
Natazia ( estradiol valerate and dienogest )
All other contraceptives ( say they start on first day of menstruation ) ( or first Sunday after menstruation ) - have to use backup for 7 days,
For natazia - patient needs to use back for 9 days
extended cycle regimen
Seasonique
LoSeasonique
Quartette
Seasonique / LoSeasonique
Difference is amount EE
LoSeasonique has lower EE
91 tabs total, start on first day of menstruation or after fist Sunday after menstruation
84 tabs are active tabs
In placebo tabs on last 7 days you still get low dose of estrogen in them - ( sudden drop in estrogen can cause bleeding, migraines due to menstruation )
Quartette
91 tabs
84 active
7 inactive
Not true placebo days bc you get 10 mcg of EE in inactive pills
Progesterone stays the same except in placebo - 84 days
And estrogen changes in 4 phases - 91 days