Repro. system drugs

Question 1

What is ethinylestradiol?

Answer 1

• It is a synthetic estradiol (E2) that is often combined with progesterone in the COCP

Question 2

Ethinylestradiol MoA

Answer 2

• Induces a negative feedback pathway on the hypothalamus to reduce GnRH secretions
• This reduces LH and FSH levels to:
  
  • Prevent ovulation
  • Thicken cervical mucous
  • Reduce fallopian tube motility
  • Cause an unreactive endometrium

Question 3

Indications for ethinylestradiol

Answer 3

• Pregnancy avoidance
• Acne
• Menstrual disorders
• Endometriosis
• Pre-menstrual syndrome

Question 4

Adverse effects of ethinylestradiol

Answer 4

• Breakthrough bleeding
• Amenorrhoea
• Nausea
• Vomiting
• Breast enlargement/tenderness
• Headaches
• Mood/libido changes
• Increased BP
• Fluid retention
• Acne
• Thrush
• Hirsutism

Question 5

What is levonorgestrel?

Answer 5

• It is a synthetic progesterone that is often combined with ethinylestradiol in the COCP

Question 6

Levonorgestrel MoA

Answer 6

• In progesterone-only contraceptive pills, they elicit effects on the fallopian tubes
• In high doses, they delay/inhibit ovulation

Question 7

Adverse effects of levonorgestrel (mild, emergency, rare)

Answer 7

• Mild:
  
  • Irregular menstrual cycles
  • Amenorrhoea
  • Breast tenderness
  • Depression
  • Acne
• Emergency:
  
  • Nausea/vomiting
  • Dizziness
  • Lethargy
• Rare:
  
  • Cholestatic jaundice
  • Decreased libido
  • Reversible ovarian cysts