Pharmacological Contraception Flashcards
T/F: Nerethindrone, levonogestrel—androgenic, anbolic
True
Combination oral contraceptive pills almost all now use ________ ________ as estrogen, plus a “19-nor” progestin (_____________ or ______________).
Ethinyl estradiol
Norethindrone, norgestimate
What progestin has the properties not androgenic or estrogenic?
Norgestimate
What progestin has the properties as anti-androgenic and anti-mineralcorticoid activities?
Drospirenone
The contraceptive Yaz has ______________, but lower ethinyl estradiol and 24 active pills instead of 21.
Drosperinone
A new 3 weeks contraceptive vaginal ring has ethinyl estradiol plus ____________, a new progestin.
Etonogestrel
What is the MOA for oral contraceptives. (4)
1) Inhibition of ovulation by disrupting cyclical release of gonadotropins is main effect.
2) Changes in cervical mucus, endometrium, motility and secretions of Fallopian tubes decrease likelihood of fertilization.
3) Endometrial changes decrease likelihood of successful implantation if egg is fertilized.
4) Abrupt withdrawal of progestin support of endometrium at end of cycle promotes prompt and “physiological” bleeding.
What estrogen SE are associated with combination pills?
- Nausea, irritability
- HA, including migraine
- Fluid retention, cyclic weight gain, breast enlargement and tenderness
- Menstrual changes, altered libido
What progestin SE are associated with combination pills?
- Nausea, bloating, menstrual changes, depression, fatigue
- Androgenic progestins cause acne, hirsutism, libido changes, wt. gain
- Some newer pills with non-androgenic progestins are beneficial for treating acne (due to estrogen component)
What other SE are associated with combination pills?
- Cardiovascular risks (high dose). Don’t give to women who smoke >35 y.o.
- New evidence of blood clot risk specifically with preparations containing the progestins drosperinone, etonogestrel
- Cancer: Estrogens alone increase endometrial cancer but adding progestins decrease incidence. Also decrease ovarian CA risk. Conflicting results in breast CA.
- Metabolic: Mild glucose intolerance, altered hepatic lipid metabolism, increased risk of liver, gallbladder disease.
Absolute and relative contraindication with BC pills.
Absolute: Pregnancy, estrogen-responsive tumor
Relative: Thromboembolic disease, HTN, diabetes, liver disease, smoking in older women.
Beneficial effects of BC pills include…
1) Decrease endometrial and ovarian cancer
2) Decrease fibrocyctic breast disease, ovarian cysts, endometriosis, PID, iron deficiency anemia.
3) Improved cycle regularity
4) Increase spinal bone density
List two “mini-pills”
Norethindrone or norgestrel.
T/F: Progestin only preps is taken daily, cyclic, ovulation often occurs so contraception is due to effects on fertilization, implantation.Also less effective but avoid estrogen effects.
False: Not cyclic- thus no regular menstruation. The rest of the statement is true.
What is injected IM every 3 months which is effective, but concern about long term toxicity and delayed recovery of fertility- not best for young who desire pregnancy later.
Medroxyprogesterone
