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Women's Health - GYN > Pharm > Flashcards

Pharm Flashcards

1
Q

Pathway of hypothalamus to signal lactation

A

dopamine from hypothalamus -> suppresses prolactin

Estrogen stimulates pituitary to release prolactin and breast lactates

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2
Q

Pathway of hypothalamus to signal estrogen and progesterone secretion

A

GnRH from hypothalamus -> FSH and LH from anterior pituitary -> ovaries secrete estrogen and progesterone

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3
Q

Negative feedback loop for GnRH and FSH/LH secretion

A

ovarian hormones: progesterone, estrogen, inhibins

opioid/endorphins

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4
Q

Positive feedback effects of estrogen/estradiol

A

Both positive and negative feedback on GnRH

at low/moderate levels… inhibits GnRH, LH, and FSH

at high levels… stimulates LH (“surge”)

also promotes endorphin secretion to increase “opioid tone”

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5
Q

More rapid pulse frequencies of GnRH secretion (1 pulse per hour) preferentially stimulate ____ secretion, whereas slower frequencies (1 pulse per 3 hours) favor ____ secretion.

A

LH

FSH

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6
Q

Conditions that can cause defects in GnRH pulse production

A 
anorexia or malnutrition
severe stress
extreme weight loss
prolonged physical exertion
hyperprolactinema or lactation states
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7
Q

Physiological results of GnRH production defects

A

failure of follicles to develop
no estradiol secretion
secondary amenorrhea

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8
Q

role of FSH

A

recruit and growth of immature follicles; starts follicular phase of ovarian cycle

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9
Q

role of LH

A

triggers ovulation and development of corpus luteum

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10
Q

FSH rise is brought about by ________’s influence on slowing down GnRH pulsatility.

A

progesterone

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11
Q

Risk of estrogen deficiency

A

heart disease (atherosclerosis d/t HDL decrease)
osteoporosis
depression
IBS, bloating (water and Na retention)

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12
Q

Benefits of estrogen

A

development and maintenance of female reproductive organs, secondary sex characteristics, and breasts

promotes pregnancy - stimulates endometrium growth, vaginal lubrication, thickens vaginal wall, increases uterine growth

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13
Q

location of aromatase enzymes

A

liver

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14
Q

most dominant estrogen form lost during menopause or ovarian failure? most dominant in menstruating women?

A

estrone (E1)

estrodial (E2) = estrogen

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15
Q

MOA aromatase inhibitors

A

decreases estrogen

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16
Q

hCG produced by ______ upon implantation.

A

placenta

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17
Q

Progesterone functions

A

make endometrium ideal for implantation - decrease contractility, decrease maternal immune response

inhibits lactation during pregnancy; falls following delivery

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18
Q

What causes increased thickness of endometrial tissue in prep for pregnancy?

A

increase in estrogen (proliferative phase) and progesterone (secretory phase)

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19
Q

4 main groups of estrogen preparations for hormone replacement therapy

A

Human natural estrogens (17 beta-estradiol)
Nonhuman natural estrogens (horse urine)
synthetic estrogen analogs (eg ethinyl estradiol in Nuva ring and transdermal patch)
plant-based estrogens (phytoestrogens)

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20
Q

Estrogen replacement benefits

A

contraception, relief of vasomotor symptoms (eg, hot flashes and night sweats), relief of vulvovaginal atrophy, improvement or prevention of osteoporosis

cardioprotective???

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21
Q

ADRs of estrogen replacement therapy

A

common: nausea, breast tenderness, HA, dizziness

Breast cancer, DVT, PE

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22
Q

Do not give estrogen alone to what patients? Why?

A

patients with uterus

increased risk of endometrial cancer

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23
Q

Activity of 1st generation progestin agents

A

non-selective; affinity for estrogen, androgen, and progesterone receptors

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24
Q

Activity of 2nd generation progestin agents

A

affinity for progesterone and androgen receptors

NO estrogen effect

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25
Q

Progestin agents with only progestational activity

A

4th generation

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26
Q

Can progesterone replacement alone work as contraceptive?

A

yes like in Minipill but not as well as estrogen

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27
Q

ADRs of progestin agents

A

acne, increased appetite and weight gain, fatigue, HTN, depression

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28
Q

Why are estrogens used as contraceptive?

A

negative feedback loop prevents FSH release; prevents ovulation

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29
Q

Why are progestins +/- estrogens used as contraceptive?

A

inhibits LH surge for ovulation

tricks ovary into thinking it has already released egg

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30
Q

Efficacy of combined oral contraceptives with perfect use?

A

99%

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31
Q

Most commonly used form of estrogen in oral contraceptives?

A

ethinyl estradiol

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32
Q

How are biphasic or triphasic formulations of contraceptive different than monophasic?

A

monophasic: consistent amount of estrogen and progestin in each active tablet

bi/triphasic: vary the dose of estrogen, progestin, or both throughout cycle to better mimic the natural menstrual cycle

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33
Q

When is contraceptive pack of pills started?

A

first day of menses

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34
Q

How can patients skip their period? How often can this be done?

A

immediately start a new pack of pills at the beginning of week 4 instead of taking the placebo pills or having the no pill week.

Encourage patients to have at least one period every three months.

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35
Q

What if patient forgets to take pill 2 days in a row? Longer than 2 days?

A

take 2 pills for 2 consecutive days

+2 days missed, take 1 pill until Sunday and then discard pill pack and start new pack

36
Q

Contraindications of combined oral contraceptives

A 
H/O stroke, DVT, PE, MI
Smokers > 35 yo
CV risk
Active liver disease
Current or h/o estrogen-dependent tumor
Hypertriglyceridemia
Migraine w/ aura
Undx'd uterine bleed
37
Q

ADRs of all combined oral contraceptive

A 
DVT, PE, MI, stroke
HTN
Breakthrough bleeding or spotting
Bloating (fluid retention)
Skin pigment changes (Chloasma)
38
Q

How can dosing be adjusted if breakthrough bleeding?

A

if during week 1, adjust estrogen

if during week 3, adjust progesterone

39
Q

Black box warning of Ortho Tri-cyclen?

A

smoking; increases risk of serious CV side effects

40
Q

When is back up protection required for transdermal patch contraception?

A

if patch off for more than 24 hrs

41
Q

Emergency contraception

A 
Progestin-only (Plan B)
IUDs
Mifepristone
Ulipristal
Take multiple combo oral contraceptive pills at once
42
Q

Levels of estrogen and progesterone during menopause

A

very random ups and downs of estrogen

virtually no progesterone

43
Q

Levels of estrogen and progesterone during perimenopause

A

normal estrogen

sudden drop in progesterone

44
Q

Infertility treatment options

A

Follicular phase: follitrophins

Ovulatoin phase: aromatase inibitors, gonadotrophins

Luteal phase: GnRH antagonist, progesterones

45
Q

Drugs that treat urge incontinence

A

antispasmodics (oxybutynin)
anticholinergics
TCAs
Botulinum toxin

46
Q

Drugs that treat stress incontinence

A

alpha-adrenergic agonists

estrogens

47
Q

HPV vaccine prevents _________.

A

cervical caner and genital warts

48
Q

Who gets HPV vaccine? When and how many?

A

all adolescents at age 11-12; 3 dose series (0, 2, and 6 months)

49
Q

Consequences of progesterone deficiency

A

breakthrough bleeding, amenorrhea, or heavy menstrual flow

50
Q

______ has proliferative effects on endometrium.

51
Q

2 types of estrogen found in contraceptives

A

ethinyl estradiol - most common

mestranol - metabolized by liver to ethinyl estradiol

52
Q

MOA of progestin-only contraception

A

inhibit egg implantation and decrease penetration of sperm/ovum transport

53
Q

Back up birth control if you miss how many “active” pill?

A

orthotricyclen: back up next 7 days if miss 2 pills

Alesse: back up next 7 days if miss 1 pill

54
Q

What oral contraceptive can also be used for menstrual migraines?

55
Q

DIs of all contraceptives

A

tobacco
transexamic acid (increases coagulation)
antivirals (increases risk of liver damage)
antibiotics

56
Q

ethinyl estradiol + levonorgestrel =

57
Q

In which patients should Mini-pill be used? (progestin-only)

A
  • lactating (no decrease in milk production)
  • contraindications to estrogen contraceptives
  • wish to be pregnant in near future (don’t stop ovulation)
58
Q

Why would Mini-pill not be used in unreliable patient?

A

need stricter adherence to taking pill at same time each day

3 hrs late is considered skipped dose

59
Q

MOA of Ortho Micronor

A

inhibits sperm penetration by thickening cervical mucous

reduces midcycle LH and FSH

60
Q

Copper IUD changed every _____ years, and Mirena changed every _____ years.

61
Q

Most common reasons copper IUD has to be removed within 1st year?

A

heavy menses

dysmenorrhea

62
Q

Most popular hormone IUD

63
Q

Medication in Mirena

A

releases 20mcg of levonorgestrel daily

64
Q

When is Mirena inserted?

A

for contraception, within 7 days of menstruation

for abortion, immediately after 1st trimester

65
Q

Medication in NuvaRing

A

ethinyl estradiol/etonogestrel

66
Q

IUDs increase the risks of what?

A

endometritis, pelvic infections, allergic skin reactions, tubal damage, uterine perforation

67
Q

Higher incidence of __________ with NuvaRing compared to other contraceptives.

A

vaginitis, vaginal infections

68
Q

When is NuvaRing not recommended?

A

for patients with cystocele, rectocele, or uterine prolapse

69
Q

NuvaRing placed in vagina by ______ of menstrual cycle and left in for ______. Ring then removed for 1 week and replaced.

A

5th day

3 weeks

70
Q

How often is Depo-provera IM injected?

A

every 3 months

71
Q

What are the major ADRs of Depo shot?

A

weight gain and reduced libido

72
Q

Home option of Depo shot?

A

subcutaneous injection called Implanon

73
Q

Who are emergency contraceptives available for?

A

females 17 yr or older (some states

74
Q

When should emergency contraceptives be used?

A

within 5 days of unprotected sex

75
Q

Which method of menopause estrogen replacement is associated with lower thromboembolism and stroke risk?

A

transdermal preps (unlike oral, skips first pass in liver)

76
Q

Benefits of menopause hormone therapy

A

relief of vasomotor sx’s, relief of vaginal dryness, improved sexual function, improved urge incontinence, prevention or improvement of osteoporosis, improved insulin sensitivity

77
Q

Primary pathophysiological purposes of menopause hormone therapy

A

stabilize endometrial proliferation and promote cyclic shedding, while also relieving menopausal sx’s

78
Q

Ethinyl esterdiol patch used for menopause sx’s as well as osteoporosis prophylaxis and breast cancer.

79
Q

What is 1st line treatment for women with ovulatory dysfunction who are trying to get pregnant?

A

Clomiphene citrate

80
Q

MOA of Clomiphene citrate

A

inhibits negative feedback response of estrogen on hypothalamus by competing with estrogen receptor binding sites

81
Q

Clomiphene citrate not recommended for women with what?

A

ovarian cysts, abnormal vaginal bleeding, or abnormal liver function

82
Q

Clomiphene citrate ADRs

A

abd/pelvic pain or distention, visual sx’s, HA, hot flashes, mood change, pregnancy wastage, birth abnormalities, multiple pregnancy (twins/triplets)

83
Q

MOA of oxybutynin

A

competitively inhibits muscarinic receptor to relax smooth muscle of bladder (esp. detrusor muscle)

84
Q

What is considered an adequate trial for oxybutynin?

A

4-6 wks at max tolerated dose

85
Q

ADRs of oxybutynin

A

anticholinergic effects, hypersensitivity, seizures, confusion

86
Q

DIs of oxybutynin

A

CYP450, potassium, cholinesterase inhibitors, opioids, drugs that lower seizure threshold (e.g. Bupropion)

87
Q

Patients with what condition should definitely not be given oxybutynin?

A

Dementia patients due to anti-cholinergic effects

Women's Health - GYN (12 decks)

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