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2022 Adv Pharm Faculty Landing Page > Reproductive/GU > Flashcards

Reproductive/GU Flashcards

1
Q

Main groups of hormonal contraceptives (2 groups)

A

Estrogen-progestin contraceptives

Progestin-only contraceptive

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2
Q

Estrogen-progestin contraceptives Mechanism of Action

A

Estrogens: suppress FSH release, stabilize the endometrial lining, provide cycle control

Progestins: block the LH surge = no ovulation, thicken cervical mucus delay sperm transport, induce endometrial atrophy/inhibit endometrial proliferation

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3
Q

Estrogen-progestin contraceptives - indications

A

Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded, Dysmenorrhea Endometriosis, PCOS Acne, PMS/PMDD

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4
Q

Estrogen-progestin contraceptives - cautions

A

breastfeeding - may decrease milk supply, HLD, DM with complications, prolonged immobility/long leg cast (clot), migraine without aura over the age of 35

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5
Q

Estrogen-progestin contraceptives - contraindications

A

Thromboembolic disease, CAD, Active liver disease, Breast cancer, Smoker over 35 yo, Migraine with aura, Uncontrolled HTN, Undiagnosed vaginal bleeding

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6
Q

Estrogen adverse effects (Excess and deficiency)

A
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8
Q

Progestin adverse effects (excess and deficiency)

A
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9
Q

High doses of estrogen-progestin contraceptives increases the risk of

A

Breast cancer, stroke, MI, DVT

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11
Q

Androgenic adverse effects

A

Acne

Weight gain

Hirsutism

Fatigue

Depression

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12
Q

Progestin only contraceptive options

A

Minipill

Nexplanon implant

DMPA injection - Depo-Provera

IUD - Mirena, Skyla, Lilletta

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13
Q

Continuous dosing of estrogen-progestin ocps is possible with which formulation?

A

monophasic

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14
Q

Transdermal contraceptive patch - adverse effects

A

Greater incidence of venous throboembolism (black box warning_

-60% more estrogen exposure than OC

Not indicated for weight > 198lbs

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15
Q

Depo Provera risks/side effects

A

Bleeding irregularities

Delayed return of fertility (up to 6-18 months)

-don’t use more than 2 yrs

Weight gain

Decrease in bone mineral density

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16
Q

Progestin-only contraceptives Mechanism of Action

A

Inhibition of ovulation- suppression of midcycle peaks of LH & FSH

Thickened, decreased cervical mucous

Thinner, atrophic endometrium

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17
Q

Progestin-only contraceptives - adverse effects

A

Spotting

Amenorrhea

Irregular menstruation

Ectopic pregnancy - increased risks

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18
Q

Paragard IUD Mechanism of Action

A

MOA: copper toxic to sperm, prevents implantation

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19
Q

Paragard benefits/side effects

A

Benefits: nonhormonal, use for up to 10 years

Side effects: increased menstrual flow and dysmenorrhea

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20
Q

Emergency Contraception Options

A

Plan B

Ella

Paragard

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21
Q

Emergency Contraception Mechanism of Action

A

Suppresses Ovulation (if taken prior to LH surge)

Prevent fertilization of an ovulated egg

Copper IUD: may also prevent implantation

No impact if already pregnant

22
Q

Hormone Replacement Therapy (HRT) Indications

A

Menopausal vasomotor symptoms

Vaginal atrphy - vaginal preparations

Added benefits: –increased bone density however decreased bone density is not an indication to start HRT –decreases risk of colon cancer

23
Q

Prescribing HRT

A

Use lowest dose for shortest duration possible

Less risky in younger women

Vaginal preparation less risky than oral/transdermal

In people with an intact uterus both estrogen and progesterone must be used - unopposed estrogen in those with a uterus increases risk for endometrial cancer

24
Q

HRT contraindications

A

Breast cancer, CHD, VTE hx or high risk, liver disease, unexplained vaginal bleeding

25
Q

Estrogen/progestin contraceptive counseling

A

How/when to start

Whether or not a back up method is needed

Common side effects and how to avoid Dangerous side effects

No protection against STIs

Follow-up visit

For pills: strategies to remember to take and what to do if a dose is missed

ACHES

26
Q

Contraindications to IUD placement

A

Current PID/cervicitis or PID within the last 3 months

Nulliparity or remote hx of PID (>3 mos) is not a contraindication

27
Testosterone replacement indications
Primary – disorders of the testes, Low serum testosterone and elevated LH/FSH Congenital: Klinefelter syndrome, cryptorchidism Acquired: mumps, radiation, chemo, medications, trauma, testicular torsion Secondary – disorders of the hypothalamus/pituitary Low serum testosterone and normal or low LH/FSH Congenital syndromes causing GnRH deficiency Acquired: Tumors, eating disorders, post-androgen abuse, DM, Infiltrative diseases, head trauma, Drug use (marijuana, anabolic steroids, opioids)
28
Testosterone Replacement Adverse Effects
Acne, Gynecomastia, Edema, Increased risk of CV disease, Increased risk of prostate cancer, Lower HDL, elevated triglycerides, Increased homocysteine, Male pattern baldness, Mood changes, Increased risk of sleep apnea
29
Men on testosterone replacement should be screened for
prostate cancer
30
Non-estrogen medications used in treatment of menopausal vasomotor symptoms
Antidepressants Black Cohosh Soy
31
Mechanism of action for Mirena
Progestin releasing IUD - Impairs sperm motility and function - Inhibits conception - Thickens cervical mucus - Endometrium atrophy - Impaired tubal motility
32
Progestin IUD benefits and adverse effects
Benefits: Acts locally (systemic effects rare), lighter periods, no weight gain Adverse effects: Irregular cycle 3-6 months
33
Yuzpe Method
Can be used with any combined or progestin only OC Not as effect as other EC methods Can have significant nausea
34
Plan B
Available OTC Effective until LH surge -Best within 3 days, can be used up to 5 days Effectiveness decreases with BMI\>25
35
Ella
Effective until LH peak -Effective up to 5 days after unprotected sex Prescription only Decrease efficacy in BMI\>30
36
Copper IUD as Emergency Contraceptive
Effective at anytime in cycle Not impacted by BMI Insert up to 5 days after unprotected sex
37
Black box warning for testosterone replacement therapy
Risk for MI, CVA, HF, depression, hostility, liver toxicity
38
BPH non-pharm management
Fluid restriction (prior to bedtime especially) Limit caffeine and ETOH Double voiding Seated voiding Avoid diuretics when possible
39
Classes of drugs used to treat BPH
Alpha 1 blockers 5 alpha reductase inhibitors Anticholinergic agents PDE-5 inhibitors
40
Alpha 1 Blockers Mechanism of Action and Examples
Block alpha1 receptors in the vasculature resulting in arterial and venous vasodilation. This causes smooth muscle relaxation and decreases urethral resistance. Doxazosin and Terazosin are older and need more titrating Alfuzosin, Tamsulosin, and Silodosin are newer, and more uroselective – less risk for hypotension and no need to titrate
41
Alpha 1 blockers side effects
Hypotension is major side effect Headache, dizziness, nasal congestion, fluid retention, impotence, palpitations, drowsines Tamsulosin: intraoperative floppy iris syndrome
42
5 Alpha Reductase Inhibitors Mechanism of Action and Examples
Inhibits 5-alpha reductase converstion of testosterone to dihydrotestosterone (DHT) which is responsible for prostate cell proliferation and inhibits apoptosis (cell death) of prostate cells Finasteride (Proscar) Dutasteride (Avodart)
43
5 Alpha Reductase Inhibitor Side Effects
Decreased libido, impotence, decreased semen quantity Decreases PSA by up to 50%, get a baseline prior to intiating if monitoring for change
44
Medications that can exacerbate BPH
45
PDE-5 Inhibitor Mechanism of Action and Examples
PDE-5 converts cGMP to GMP resulting in increased levels of cGMP (necessary for erection to occur). Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Avanafil (Stendra)
46
PDE-5 Inhibitor Contraindication
On nitrate therapy MI/stroke or life threatening arrhythmia in past 6 months Caution with HF, uncontrolled hypo/hypertension, unstable angina, prolonged QT and alpha blocker use
47
PDE-5 Inhibitor Side Effects
Priapism, visual disturbances, hearing loss
48
Anticholinergic indications and side effects
1st line for the treatment of overactive bladder * Urinary retention, dry mouth, constipation, dizziness, blurry vision, tachycardia, drowsiness * Increase dementia risk Use extended release formulations to decrease side effects
49
Anticholinergic contraindications
Contraindicated in narrow angle closure glaucoma and uncontrolled tachycardia

2022 Adv Pharm Faculty Landing Page (22 decks)

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