Reproductive deck 2 Flashcards
Progestin antagonists example and use
Mifepristone (Mifeprex)
Mifepristone inhibits the activity of both endogenous and exogenous progesterone; without progesterone to maintain the pregnancy, termination results.
Will act as an ABORTIFACIENT when used in conjunction with misoprostol during the first 7 weeks of pregnancy.
Gonadotropin-releasing hormone what is is ant use
A stimulant in pulsatile doses if the patient has a functional pituitary gland and an ovary to produce the luteinizing hormone surge initiating ovulation - Used to initiate ovulation
Also used to treat endometriosis and uterine fibroids and to suppress prostate cancer
Human menopausal gonadotropin: follitropin (Fertinex), menotropins (Pergonal, Humegon)
Men:
stimulate spermatogenesis
Human menopausal gonadotropin: follitropin (Fertinex), menotropins (Pergonal, Humegon)
women:
stimulate maturation of follicules and ovulation
Lacation supression drugs MOI and also works for
Has an inhibitory effect on pituitary gland, which produces prolactin
Also works for hyperprolactinemia
Also used in Parkinson’s disease
Bromocriptine begins to work and has
Begins to work within 2 hours
Many drug interactions
Erectile dysfunction drugs PDE5 examples
Sildenafil citrate (Viagra), tadalafil (Cialis), vardenafil (Levitra)
PDE5 contrindications
In patients using nitrates because of a risk of severe, even fatal hypotension
Alpha blockers have additive hypotension effect
PDE5 inhibitors Small studies in women
Small studies in women are inconclusive
Used in neonatal intensive care unit for persistent pulmonary hypertension
Addyi is also known as
pink viagra
Addyi is used in and what is the black box warning
For women with diagnosed with severe sexual dysfunction (serotonin and dopamine agonist)
Black Box warning for severe hypotension when used with alcohol
Addyi does not have a
a same day effect as with PDE5 inhibitors for men; takes about 3 months for full effect, and many do not benefit at all.
Estrogen has positive effects on
bone mass, increases serum triglycerides, and improves ratio of high-density lipoprotein to low-density lipoprotein.
Estrogen stimulates
coagulation and fibrinolyticpathways.
Progesterone increases
body temperature and insulin levels.
Progesterone may depress
the central nervous system.
Two formulations of estrogen are available in contraceptive preparations
ethinyl estradiol and mestranol.
First-generation progesterones
Norethindrone, norethindrone acetate, and ethynodiol diacetate
Second-generation progesterones
Norgestrel and levonorgestrel
Third-generation progesterones
Desogestrel and norgestimate
Fourth-generation progesterones
Spironolactone derivative: drospirenone
19-nortestosterone derivative: dienogest
Progestins are primarily responsible for
the contraceptive effect
Progestins exhibit a negative
effect in the hypothalamic-pituitary-ovarian axis.
Progestins cause atrophy
of the endometrium, preventing implantation.
The estrogen component improves
efficacy by suppressing FSH release
Estrogen provides
cycle control
Contraceptives goal of treatment
Use the safest, best-tolerated, and most effective method that the patient desires.
Safety
Tolerance
Effectiveness
Rational Drug Selection Contraceptives three steps
Start with absolute contraindications.
Delivery method should be of patient’s choice.
Fine tune based on:
Menstrual pattern
Side-effect profile
Consider:
Patient’s desire for discretion
Timing of subsequent pregnancy
All types of oral contraception (OC) have similar
effectiveness
Contraceptive cost
Retail cost of OC is $30 to $100 per cycle.
Generic OC is available on $4 retail lists.
Intrauterine device (IUD) or implant: upfront cost is expensive, but may have lower overall cost.
Noncontraceptive Benefits
Decreased dysmenorrhea, menstrual irregularities, and menstrual blood loss
Lessening of acne and hirsutism
Fewer ovarian cysts
Significantly reduced endometrial and ovarian cancer risk
Lower incidence of benign breast conditions, such as fibrocystic changes and fibroadenoma
Reduced risk of hospitalization for gonorrheal pelvic inflammatory disease
Suppression of endometriosis in women who do not currently desire pregnancy
Contracepive drug interactions
Tuberculosis drugs, antiepileptic drugs, St. John’s Wort
lipid levels affected by
OC
Adverse drug reactions for OC
Venous thromboembolism risk increases three to five times with OC use
Also: cholestatic jaundice, benign hepatic neoplasms, myocardial infarction, stroke, and neurological migraines
OC traditional dosing
21 days active drug + 7 days inactive tablets with withdrawal bleed during inactive tablets
Extended cycle OC
84 days of active drug, then 7 days off
Withdrawal bleed once every 3 months
Monophasic OC
same dose of estrogen and progestin for full cycle
Biphasic and Triphasic dosing for OC
Biphasic: vary the dose of progestin
Triphasic: vary the dose of estrogen, progestin, or both
Starting method first day
Pills started on first day of menstrual cycle
No back up method needed
Starting method sunday start
First pill taken on the Sunday following the start of menses
Back up method for first 7 days
Menses only occur during the week
OC quick start “same day”
Quick or “same-day” start
First pill taken on the day of the office visit
Back up method for first 7 days (like condom) because not as effective for the first 7 days
What to do if doses are missed of OC
follow what is said to them on the handout for the medication
50% of women discontinue OC because of
side effects
