Reproductive Flashcards
Estradiol esters?
Estradiol valerate, Estradiol cyplonate, Quinestrol
Conjugated estrogens?
Estrone sulfate, Equilin sulfate
Alkyl estrogens?
Ethinyl estradiol, Mestranol
Absorption of synthetic steroidal estrogens?
Skin, mucus membranes, GI
Distribution of synthetic steroidal estrogens?
Body-wide, via SHBG
Indications for synthetic steroidal estrogens?
Contraception, primary hypogonadism, postmenopausal hormone therapy
Common side effects of synthetic steroidal estrogens?
Nausea, breast tension/pain, vaginal bleeding, headache, weight gain, HTN
Less common side effects of synthetic steroidal estrogens?
Breast cancer (controversial), DVT, PE, MI, stroke, gallbladder disease, cervical & endometrial cancer
Contraindications for synthetic steroidal estrogens?
W/ breast or endometrial cancer (or a family history), endometriosis, undiagnosed vaginal bleeding, pregnancy, thromboembolic disease, HTN, hepatic disease
Diethylstilbesterol?
Non-steroidal synthetic estrogen
Risks associated with DES?
Clear cell adenocarcinoma of vagina & cervix
Tamoxifen citrate class?
Non-steroidal anti-estrogen; SERM
Clomiphene citrate class and mxn?
Non-steroidal anti-estrogen; blocks estrogen binding, decreasing negative feedback, inducing GnRH, LH, FSH release, inducing ovulation
Clomiphene citrate side effects?
Hot flashes, upset stomach/pain, vomiting, headache, multiple pregnancy
Cis-isomer of clomiphene?
Zuclomiphene (weak agonist)
Trans-isomer of clomiphene?
Enclomiphene (potent antagonist)
Progesterone indications?
Contraception, hormone replacement therapy
Natural progesterones?
Micronized, Transvaginal progesterone
Natural progesterone side effects?
Minimal (fatigue, drowsiness)
Synthetic progesterone/Progestins?
Medroxyprogesterone, Norethindrone, Norgestrel, Megestrol
Progestin common side effects?
Anxiety/irritability, depression, muscular pain, edema, abdominal bloating, androgenic effects (acne, hirsutism)
Less common side effects of progestins?
Thrombosis, PE
Contraindications of progestins?
Thromboembolic disorders (or Hx of), liver disease, undiagnosed vaginal bleeding, pergnancy, HTN, risk of breast cancer
Combination pills?
Mono-/Bi-/Triphasic Ortho-Novum
Monophasic dosing?
Consistent, 21 days
Biphasic dosing?
Fixed estrogen, Progestin increased days 11-21
Triphasic dosing?
Fixed or variable estrogen, progestin increase in three phases (days 1-7, 3-14, 15-21)
Mini-pill?
Progestin only
Mini-pill benefit?
Suppress endometrial cancer
Mini-pill side effect?
Irregular cycles
Plan B?
Levonorgestrel
Levonorgestrel mxn?
Unknown: interfere with implantation & inhibit/delay ovulation
Levonorgestrel must be taken within?
72 hours of coitus
“Abortion pill?”
Mifepristone (RU-486, Korylym)
Mifepristone mxn?
Anti-progesterone, leading to detachment of the fetus; Glucocorticoid receptor antagonist
Mifepristone must be taken within?
49 days
AKA Viagra?
Sildenafil citrate
AKA Levitra?
Vardenafil HCL
AKA Cialis?
Tadalafil
ED drugs mxn?
Inhibit PDE5, inhibit breakdown of cGP, decreased Ca, increased smooth muscle relaxation, erection
PDE5 inhibitors with 4 hr half life?
Sildenafil citrate, Vardenafil HCL
PDE5 inhibitors with 17.5 hr half life?
Tadalafil
Peak plasma concenctration of PDE5 inhibitors within?
1-2 hours
PDE5 inhibitors contraindicated?
Nitrates, alpha-blockers (unsafe drop in BP)
PDE5 inhibitor side effects?
Change in vision, headaches, dizziness, flushing, upset stomach, stuffy/runny nose, UTI, diarrhea
Unique contraindication of micronized progesterone?
Peanut allergy