Other Contraceptives and Related Drugs

Question 1

Norethindrone or norgestrel

Answer 1

“Mini-pills” = Progestin-only
Avoid estrogen effects but less effective
Taken daily
Lack regular menstruation, irregular bleeding
No bleeding for 6-8 weeks ==> prego test
Mech: inhibition of fertilization and implantation
Use: where estrogens are c/i, some prego risk tolerable

Question 2

Medroxyprogesterone acetate

Answer 2

Long-acting progestin prep
IM injection q3m
Concern about possible toxicity
Delayed recovery of fertility

Question 3

Etongestrel

Answer 3

Implantable rod (single-rod)
Skin inside upper arm 
3 years effective 
Risk: irregular bleeding
4% complications, 2% leading to removal 
New version: not detected by airport body scanners

Question 4

Levonorgestrel

Answer 4

2 pills taken within 72 hours (now available in a single dose)
OTC for girls 15 and over

Question 5

Ulipristal

Answer 5

Novel progestin
Mixed agonist/antagonist at progesterone receptors
Structurally related to mifepristone
Take up to 5 days after event
Requires a prescription
Potential mechanisms:
1. “selective progesterone response modifier”
2. P agonist mech (H-P-G axis) (inhibit Gn release)
3. P antagonist mech (uterus) (prevent maintenance)

Question 6

Mifepristone (RU-486)

Answer 6

Progesterone receptor antagonist
Blocks GC receptors
Increases PG levels (stimulates uterine contractility) (inhibits PG dehydrogenase)
3x200mg single dose
Adverse: vaginal bleeding, abd pain (cramps), transient n/v, diarrhea, HA

Question 7

Misoprostol

Answer 7

PG E-1
2-200ug single dose
Stimulate contraction and expulsion
Sometimes used with methotrexate (folic acid antagonist) off label