Oral Contraceptives

Question 1

Ethinyl Estradiol, Mestrano

Answer 1

Oral Contraceptive
Estrogen
MOA
- inhibit ovulation though negative feedback on the HP axis
-estrogen suppress FSH
-progestin prevents surge of LH that triggers ovulation
-Both hormones also *alter the lining of the endometrium, making implantation less likely
ADE
- nausea, fluid retention, headaches, breast tenderness and hypertension
- Risks of stroke, MI and VTE
- increase in HDL, a decrease in LDL, and an increase in total cholesterol and triglyceride levels
C/I
- >35 yo and smoke
-

Question 2

Combination oral contraceptives

Answer 2

Oral Contraceptive
- synthetic estrogen (EE) + progestin (COCs)
o Monthly-cycle
• Monophasic: equal quantity of hormone in each tablet
• Multiphasic: contain varying amounts of estrogen/progestin in an attempt to mimic natural hormone fluctuations and provide lowest effective dose of hormone.
- (Biphasic, Triphasic, Quadriphasic)
•21-26 days of hormone followed by 2-7 days of inactive tablets to complete 28 day cycle.
-Withdrawal bleeding or “period” occurs during the 2-7 day segment while taking inactive tablets.
o Extended-cycle
• All Monophasic
• Usually 84 days of hormone followed by 7 days of inactive tablets to complete 91 day cycle.
• Withdrawal bleeding or “period” occurs during the 7 day cycle while taking inactive tablets.
o Continuous
• All Monophasic
• Ex. Lybrel
Drug Interactions
- Rifampin
- Ritonavir
- anti-epileptics

Question 3

Levonorgestrel, Drospirenone, Norethindrone

Answer 3

Oral Contraceptive
Progestin -only pills (POPs)
- *must be taken at same time everyday
MOA
- *thickens the cervical mucus
- reduces the activity of the cilia in the fallopian tubes, decreasing tubal transport 
ADE
- oily hair and skin, hirsutism, male-pattern hair loss, increased appetite with weight gain and acne
- decrease in HDL, an increase in LDL levels, decrease in both total cholesterol and triglyceride levels
Drug Interactions
- Rifampin
- Ritonavir

Question 4

Ulipristal, Levonorgestrel

Answer 4

Oral Contraceptive
Emergency oral contraceptive
Ulipristal
- selective progesterone receptor modulator with antagonistic and partial agonistic effects at the progesterone receptor.
- prevents progesterone from occupying its receptor.
- Take as soon as possible within 120 hours (5 days) after unprotected sex
MOA
- inhibition or delay of ovulation, alterations to the endometrium may affect implantation.
**Pregnancy Category X!
- Use of ulipristal is contraindicated during an existing or suspected pregnancy.

Levonorgestrel (progestin)
- Plan B or Next Choice
- Take within a 3 days window
MOA
- preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova).
- inhibit implantation (by altering the endometrium).
ADE
- *will not terminate an existing pregnancy and is not likely to cause harm to a developing fetus.