Reproductive Flashcards
Androgens/what they are used for
Testosterone: fluixymesterone, methyl testosterone
Tx: hypogonadism, cancer, HIV
Androgens contraindicated in:
Male breast or prostate cancer
Pregnancy category X / lactation
Transdermal drug not used in women
*anabolic steroids are scheduled drugs
Androgens ADRs
LIVER issues
Men: gynecomastia, reduced sperm levels, decreased libido, depression
Women: menstrual irregularities, virilization
Androgen monitoring:
Serum testosterone levels
Liver function
CBC/lipids
Also monitor PSA and digital prostate exams in men
__________ can decrease testosterone levels
Statins. Can drop levels statistically but clinically insignificant level
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
Estrogens / what are they used for:
Estrogen/premarin/ estradiol
Contraception,
peri- post menopausal symptoms
Vaginal atrophy/dryness
Osteoporosis (but not primary treatment)
Estrogen only products can only be used in women with:
AN INTACT UTERUS.
Must have uterus
Uterus uterus
Estrogen contraindicated in:
Pregnancy
Breast cancer current or history
Active DVT/PE
History of stroke/MI
Liver dysfunction
Smokers
Anti-estrogens / uses
Clomid, Danocrine, Tamoxifen
Treat breast cancer/ fibrotic breast disease
initiate ovulation
Treat endometriosis
Progesterone / uses
Progesterone/ provera / megace
*androgen derived progestins
Used for:
Contraception
Post menopausal hormone therapy (combine with estrogen if intact uterus)
Progesterone precautions/contraindications
Clotting disease
Breast cancer
Liver dysfunction
Depression
Fluid retention
Progesterones ADR
Irregular bleeding
Amenorrhea
Acne
Injectable/implanted progesterone:
-weight gain
-osteoporosis risk
Anti-progesterone (progesterone antagonists) / uses
Mifepristone
- when combined with misoprostol works as an abortifacient
Fertility drugs / uses
Gonadotropin- releasing hormone :
Human menopausal gonadotropon:
Also used to treat endometriosis and uterine fibroids and to suppress prostate cancer
Lactation suppression drugs
Bromocriptine
Used to suppress lactation, also used in Parkinson’s Tx.
Begins to work in 2 hours. Many drug interactions.
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
