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Oral Contraceptives Flashcards

(49 cards)

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1
Q

Synthetic progestogens are used in OCP because

A

progesterone (naturally occurring) are not orally active

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2
Q

Synthetic oestrogens are used in OCP becuase

A

oestradiol (natural oestrogen) is absorbed but rapidly broken down; synthetics enter the enterohepatic circulation and tf last longer

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3
Q

What is the mechanism of OCPs?

A

negative feedback on anterior pituitary and hypothalamus to inhibit release of FSH and LH thereby stopping ovulation

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4
Q

In the menstrual cycle, oestrogen is responsible for

A

proliferative phase and proliferation of the endometrium

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5
Q

Oestradiol (natural estrogen) will always inhibit

A

FSH

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6
Q

Oestradiol will sometimes inhibit

A

LH depending on concentration; surge in oestrogen causes LH surge and rupture of the follicle for ovulation

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7
Q

Progesterone only comes from

A

the corpus luteum following ovulation

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8
Q

Prolific cervical secretion of mucous occurs

A

When oestrogen peaks just prior or at ovulation

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9
Q

Progesterone drives which phase of the menstrual cycle?

A

Secretory/luteal

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10
Q

Progesterone in the secretory phase is dependent upon

A

oestrogen previously priming the endometrium

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11
Q

What happens to the endometrium during the secretory/luteal phase?

A

synthesizes proteins necessary for implantation, increases blood supply to increase nutrients

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12
Q

If fertilization occurs, the corpus luteum serves to

A

release progesterone and oestrogen to negatively feed back on the anterior pituitary and hypothalamus to prevent ovulation until the placenta takes over to support the pregnancy (10-12 weeks)

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13
Q

Testosterone is released from

A

testes and small amounts from ovaries and adrenal cortex

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14
Q

Progesterone is released from

A

the ovary, placenta, adrenal cortex, and testes as an intermediary to testosterone

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15
Q

Oestrogens are released from

A

ovary and placenta, small amounts from adrenal cortex and testes

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16
Q

Ethinyloesrtradiol is a

A

synthetic estrogen

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17
Q

Levonorgestrel is a

A

synthetic progestogen

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18
Q

Cyproterone is a

A

synthetic progestogen

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19
Q

Drospirenone is a

A

synthetic progestogen

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20
Q

Combined preps of OCP contain

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A

mixture of oestrogen and progesterone in a fixed ratio of doses

21
Q

Sequential OCP preps contain

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A

ratio of O and P doses corresponding approximately to endogenous changes of these hormones

22
Q

Progestogen-only oral prep OCP (mini pill) contains

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A

Only progestogen, for when oestrogen is contraindicated eg during lactation - these are the LEAST effective OCPs

23
Q

The most frequently used synthetic oestrogen in OCP is

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A

ethinyloestradiol

24
Q

Levonorgestrel is used in

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A

in older OCPs along with norethisterone; tx of menstrual irregularities, HRT, and the morning after pill

25
What was the downside to older progestrogens levonorgestrel and norethisterone?
many side effects: androgenic (hirsutism)
26
Newer progestrogens include
cyproterone and drospirenone
27
Which OCPs can be used to tx symptoms of PCOS?
newer OCPs with fewer androgenic SEs eg cyptoretone and drospirenone which have anti-androgenic effects
28
How do OCPs help in tx of PCOS?
overcome the symptoms of hyperandrogenism: acne, hursutism, weight gain; combat insulin resistance, CVD risk factors, and endometrial cancer risk
29
Drugs used in the management of PCOS include
OCP (cyproterone and drospirenone), sprionolactone (aldosterone receptor antagonist), metformin
30
Cyproterone is said to have the highest risk of
venous thromboembolic disorder and clotting - removed from market in france (Diane)
31
Cyproterone is a derivative of
progesterone
32
Drospirenone is a derivative of
spironalactone
33
Activity of drospirenone includes
progestogenic, anti-mineralocorticoid (mild diuretic), anti-androgenic
34
Drospirenone is marketed as
Yasmin, Yaz
35
Which progestogens are most commonly used in the mini-pill?
Levonorgestrel, norethisterone (older progestogens)
36
Why is oestrogen-containing OCP contraindicated in breastfeeding women?
Oestrogen will negatively feed back on the anterior pituitary to prevent prolactin release and hence stop lactation
37
The mechanism of the oestrogen component of OCPs is to
inhibit FSH (sometimes LH depending on the dose)
38
The mechanism of the progesetogenic component of the OCP is to
negatively feed back on LH in some cycles (not much of an effect on FSH) - higher doses are needed to do it EVERY cycle but are associated with side effects
39
T/F women on the mini-pill do not ovulate
False; if they are having regular periods they are likely ovulating because progestogen is not high enough to inhibit LH
40
How do progestrogens act as OCPs if they do not fully inhibit LH?
continuous, exogenous progestogens make the endometrium unfavourable to implantantion and the cervical mucous inhospitable to sperm preventing fertilization; interference with contractions of uterus, cervix, and FTs that facilitate fertilization and implantation
41
What are the adverse effects of COCs?
Hypertension (reverisble); increased risk of venous thromboembolism; increased risk of cancer (breast, cervical, and uterine)
42
Which OCPs are least likely to give rise to increased risk of VTE?
earlier OCPs with oestrogen and the older progestogens (levonorgestrel and norethisterone)
43
Which component of the OCP is attributed to for the increased risk of VTE?
Oestrogen - increasing dose increases risk; type of progestogen (older = safer)Why
44
Why is it recommended that women on OCP (and HRT) have regular cervical cancer screening?
increased risk of cervical cancer; increases with duration of use but declines to normal after 10 years cessation of OCP
45
Increased risk of uterine cancer while taking OCP is abolished if
oestrogen is prescribed with a progestogen (and the woman has an intact uterus)
46
What are the benefits of COCs?
decreased risk of endometrial cancer; decreased incidence of ovarian cancer and ovarian cyst formation; reduction in risk of colorectal cancer (HRT too); protective effect on benign breast tumours; reduction in risk of bone fractures; reduction in dysmenorrhoea and menorrhagia (and tf protection against iron deficiency anaemia)
47
The morning after pill contains
1500ug of levonorgestrel
48
MAP must be taken within
72 hrs
49
Effectiveness of MAP is
~85%

Reproduction (11 decks)

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