Reproductive Flashcards by Joshua Eaton

Androgens/what they are used for

Testosterone: fluixymesterone, methyl testosterone
Tx: hypogonadism, cancer, HIV

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Androgens contraindicated in:

Male breast or prostate cancer
Pregnancy category X / lactation
Transdermal drug not used in women

*anabolic steroids are scheduled drugs

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Androgens ADRs

LIVER issues
Men: gynecomastia, reduced sperm levels, decreased libido, depression

Women: menstrual irregularities, virilization

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Androgen monitoring:

Serum testosterone levels
Liver function
CBC/lipids

Also monitor PSA and digital prostate exams in men

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__________ can decrease testosterone levels

Statins. Can drop levels statistically but clinically insignificant level

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Anti-androgens / what are they used for

Aka 5a-reductase inhibitors.
Finasteride/ flutamide/ spironolactone

Used for: prostate cancer, BPH, hair loss men, hypersexual behavior, precocious puberty boys

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Estrogens / what are they used for:

Estrogen/premarin/ estradiol

Contraception,
peri- post menopausal symptoms
Vaginal atrophy/dryness
Osteoporosis (but not primary treatment)

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Estrogen only products can only be used in women with:

AN INTACT UTERUS.
Must have uterus
Uterus uterus

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Estrogen contraindicated in:

Pregnancy
Breast cancer current or history
Active DVT/PE
History of stroke/MI
Liver dysfunction
Smokers

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Anti-estrogens / uses

Clomid, Danocrine, Tamoxifen

Treat breast cancer/ fibrotic breast disease

initiate ovulation
Treat endometriosis

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Progesterone / uses

Progesterone/ provera / megace
*androgen derived progestins

Used for:
Contraception
Post menopausal hormone therapy (combine with estrogen if intact uterus)

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Progesterone precautions/contraindications

Clotting disease
Breast cancer
Liver dysfunction
Depression
Fluid retention

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Progesterones ADR

Irregular bleeding
Amenorrhea
Acne

Injectable/implanted progesterone:
-weight gain
-osteoporosis risk

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Anti-progesterone (progesterone antagonists) / uses

Mifepristone

when combined with misoprostol works as an abortifacient

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Fertility drugs / uses

Gonadotropin- releasing hormone :
Human menopausal gonadotropon:

Also used to treat endometriosis and uterine fibroids and to suppress prostate cancer

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Lactation suppression drugs

Bromocriptine

Used to suppress lactation, also used in Parkinson’s Tx.

Begins to work in 2 hours. Many drug interactions.

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Erectile Dysfunction drugs

Phosphodiesterase type 5 inhibitors:
Sildenafil, tadalafil, vardenafil

DO NOT USE WITH NITRATES

Erectile Dysfunction drugs

Phosphodiesterase type 5 inhibitors:
Sildenafil, tadalafil, vardenafil

DO NOT USE WITH NITRATES

Addyi

“Pink viagra”
For women with diagnosed severe sexual dysfunction
Takes about 3 months to work.

BLACK BOX WARNING: severe hypotension if combined with alcohol

Normal menstrual cycle:

GnRH—> FSH/LH ——> regulated secretion of estrogen and progesterone from ovary

Phases of the menstrual cycle

Follicular
Ovulation
Luteal
Menstrual

Estrogen has a ________ effect in bone mass

Positive

Contraception significantly reduces the risk of which cancers

Endometrial and ovarian

Contraception dosing:

Traditional: 21 days + 7 days inactive tablets

Extended cycle: 84 days active drug then 7 days off

Monophasic: same dose of estrogen and progestin for full cycle

Starting methods:

First-day start: pills start on the first day of menstrual cycle. No backup method needed. Sunday start: pills taken on the Sunday following menses, backup method needed for 7 days. Same day start: pill taken on day of office visit. Needs back up method for 7 days.

Vaginal ring

Left in place for 3 weeks then out for 1 week Lower systemic exposure to estrogen

Progestin only pills

Only used when estrogen is contraindicated Works by thickening of the cervical mucus to prevent sperm penetration MUST TAKE AT EXACT SAME TIME EVERYDAY

Emergency contraception:

Should be taken asap after unprotected intercourse (less than 72 hours) but can go up to 120 hours. Plan B / next choice

Monitoring for contraception prescribing

Check BP and ADR at 3 months then annually

Highest rates of gonorrhea/chlamydia seen in:

Females 15- 24 years old

Sexually active men who are gay or bisexual should be tested:

For syphilis, chlamydis, ginorrhea are least once/ year. HIV testing at least once/year Hepatitis C once/year if living with HIV

Sexually active women younger than 25:

Get tested for gonorrhea and chlamydia every year

HPV testing

Start at age 25 and every 5 years through age 65. Or regular Pap test every 3 years

Syphilis treatment

Penicillin G

Gonorrhea tx

Ceftriaxine IM one time

Chlamydia tx:

Azithromycin 1g one time Or doxycycline for 7 days

Bacterial vaginosis treatment

Metronidazole for 7 days or Clindamycin cream for 7 days

HSV treatment

Acyclovir or valcyclovir

HPV treatment

Patient applied: podofilox solution Provider applied: cryotherapy with liquid nitrogen

PIV TX

Can he from delay in STI treatment of BV Tx: may need IV abx Ceftriaxine IM + doxy + metronidazole

Vaginitis

Cytolytic vaginosis: overgrowth of lactobacillus. Antifungals Atrophic vaginitis: perform cultures