Reproductive Health Flashcards
generic name and class
premarin
generic: conjugated estrogens
class:estrogens
indication
premarin
Abnormal uterine bleeding (acute); breast cancer (metastatic, palliative); postmenopausal osteoporosis prevention, prostate cancer (palliative); secondary amenorrhea due to hypoestrogenism, vasomotor symptoms associated with menopause with or without vulvar/vaginal atrophy associated with menopause
MOA
premarin
he mixture of estrogens in this product replace the estrogens produced by the body responsible for the development and maintenance of the fame reproductive system and secondary sex characteristics. Responsible for modulation of gonadotropins (luteinizing hormone and follicle stimulating hormone) through negative feedback
major contraindications
premarin
Angioedema or anaphylactic reaction to estrogens or any component of the formulation; undiagnosed
abnormal genital bleeding; DVT or PE (current or history of); active or history of arterial thromboembolic disease (eg, stroke, MI); breast cancer (except in appropriately selected patients
being treated for metastatic disease); estrogen-dependent tumor (known or suspected); hepatic impairment or disease; known protein C, protein S, antithrombin deficiency or other known
thrombophilic disorders; pregnancy
BBW
premarin
Endometrial cancer, breast cancer, cardiovascular disease, dementia, risk v. benefit
common ADRs
premarin
> more than 10%: Weight change, headache, migraine, depression, disorder of menstruation, breast pain
1-10%: Edema, vasodilation, abdominal pain, hirsutism, diarrhea, nausea, stomach cramps, vomiting, backache
rare but serious ADRs
premarin
Heart disease, HTN, MI, breast cancer, diabetes mellitus, hypercalcemia, venous thromboembolism,
anaphylaxis, cerebrovascular accident, cervical cancer, malignant neoplasm of endometrium of corpus uteri, ovarian cancer, PE
key counseling points
premarin
Discuss potential long-term adverse effects of hormone therapy including MI, stroke, DVT, PE, and breast cancer. Take at bedtime to minimize side effects. Take with or without meals
generic name and class
estrace
generic: estradiol
class: estrogens (oral)
indication
estrace
Abnormal uterine bleeding (acute); breast cancer (metastatic, palliative); postmenopausal osteoporosis prevention, prostate cancer (palliative); secondary amenorrhea due to hypoestrogenism, vasomotor symptoms associated with menopause with or without vulvar/vaginal atrophy associated with menopause
MOA
estrace
Estradiol (a form of estrogen) in this product replaces the estrogens produced by the body responsible for the development and maintenance of the fame reproductive system and secondary sex characteristics. Responsible for modulation of gonadotropins (luteinizing hormone and follicle stimulating hormone) through negative feedback
major contraindications
estrace
Angioedema or anaphylactic reaction to estrogens or any component of the formulation; undiagnosed abnormal genital bleeding; DVT or PE (current or history of); active or history of arterial
thromboembolic disease (eg, stroke, MI); breast cancer (except in appropriately selected patients being treated for metastatic disease); estrogen-dependent tumor (known or suspected); hepatic impairment or disease; known protein C, protein S, antithrombin deficiency or other known
thrombophilic disorders; pregnancy
BBW
estrace
Endometrial cancer, breast cancer, cardiovascular disease, dementia, risk v. benefit
common ADRs
estrace
1-10%: Weight change, nausea, vomiting, disturbance in mood, swelling of breast, depression
rare but serious ADRs
estrace
Heart disease, MI, DM, venous thromboembolism, anaphylaxis, cerebrovascular accident, PE, breast,
endometrial or ovarian cancer
key counseling points
estrace
Report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder. Do not smoke during therapy, as this increases the risk of thromboembolic events.
generic name and class
alora, climara, minivelle, menostar, vivelle-DOT, estraderm
generic: estradiol transdermal patch
class: estrogens
generic name and class
prometrium
generic: progesterone
class: progestins
oral, vaginal gel or insert
indication
prometrium
Prevention of estrogen-induced endometrial hyperplasia (oral) )while conjugated estrogens are administered; secondary physiologic amenorrhea (oral or gel); assisted reproduction for infertile women (gel or insert)
MOA
prometrium
Progesterone transforms proliferative endometrium into secretory endometrium. Systemically administered progesterone inhibits gonadotropin production, which in turn prevents follicular maturation and ovulation
major contraindications
prometrium
Abnormal vaginal bleeding, history of estrogen- or progesterone-dependent neoplasia, active or history of DVT or PE, known or suspected pregnancy
BBW
prometrium
Should not be used for the prevention of cardiovascular disorders, dementia or breast cancer
common ADRs
prometrium
> 10%: weight changes, headache, amenorrhea, breast tenderness, abdominal pain
1-10%: nausea, asthenia, feeling nervous, break through bleeding
rare but serious ADRs
prometrium
Thromboembolism (DVT, PE), thrombophlebitis, osteoporosis
key counseling points
prometrium
If using for amenorrhea, menstrual bleeding should occur 3-7 d after last oral dose. Report if menstruation does not occur within 7 d after last dose. For vaginal formulation, avoid using other
vaginal drugs within 6 h before or 6 h after using progesterone
generic name and class
provera - oral, depo-provera - injection
generic: medroxyprogesterone
class: progestins
indication
medroxyprogesterone
Abnormal uterine bleeding unrelated to menstrual cycle (oral); prevention of estrogen-induced endometrial hyperplasia (oral); secondary physiologic amenorrhea (oral); prevention of pregnancy (injection); endometriosis (injection)
MOA
medroxyprogesterone
Medroxyprogesterone transforms proliferative into secretory endometrium. Androgenic and
anabolic effects have been noted, but the drug is devoid of significant estrogenic activity.
major contraindications
medroxyprogesterone
Hypersensitivity to medroxyprogesterone, abnormal genital bleeding, history of estrogen- or
progesterone-dependent neoplasia, active or history of DVT or PE, severe liver dysfunction, known or suspected pregnancy
BBW
medroxyprogesterone
Increased risk of cardiovascular disorders, breast cancer and dementia; loss of BMD; not for long-term use
common ADRs
medroxyprogesterone
> 10%: Weight gain, headache, amenorrhea, breast tenderness, nervousness
1-10%: Abdominal pain, asthenia, breakthrough bleeding
rare but serious ADRs
medroxyprogesterone
DVT, thrombophlebitis, osteoporosis, PE
key counseling points
medroxyprogesterone
Menstrual bleeding should occur 3-7 d after last dose. Contact HCP if menstruation does not occur within 7 d after last dose. Do not use if you become pregnant.
class of oral contraceptives
estrogen/progestin combo
indication
oral contraceptives
contraception and some for acne
MOA
oral contraceptives
As contraceptives, estrogens suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to inhibit ovulation, cause edematous endometrial changes that are hostile to
implantation of the fertilized ovum, accelerate ovum transport, and produce degeneration of the corpus luteum (luteolysis). Progestins inhibit ovulation by suppression of LH, inhibit
sperm capacitation, slow ovum transport, produce a thinning endometrium that hampers
implantation, and cause cervical mucus changes that are hostile to sperm migration
major contraindications
oral contraceptives
Hypersensitivity to ethinyl estradiol or progestin component, history or risk of thromboembolic disorders, breast or endometrial cancer, uncontrolled HTN, hepatic disease, known or suspected pregnancy, thrombogenic cardiac value or rhythm disease, headaches with focal neurologic symptoms; women >35 y of age who smoke
BBW
oral contraceptives
Women >35 y of age who smoke
common ADRs
oral contraceptives
more than 10%: weight change, breast tenderness, breast swelling
1-10%: Bloating, nausea, stomach cramps, vomiting, depression
rare but serious ADRs
oral contraceptives
Arterial thromboembolism, AMI, thrombophlebitis, cerebral hemorrhage, cerebral thrombosis,
PE, HTN
key counseling points
oral contraceptives
Hormonal contraceptives do not protect against HIV infection or other sexually transmitted diseases. Take this drug at approximately the same time each day. If spotting occurs and no
doses have been missed, continue to take tablets even if spotting continues. Report immediately if new severe or persistent headache; blurred or loss of vision; shortness of breath; severe leg, chest, or abdominal pain; or any abnormal vaginal bleeding occur. If you
miss 1 dose, take it as soon as you remember it and take the next tablet at the correct time even if you take 2 tablets on the same d or at the same time. If you miss 2 doses in wk 1 or
2, take 2 tablets on the day you remember and 2 tablets the next day. If you miss 2 doses in wk 3 or miss 3 or more active tablets, (if you start on day 1) start a new pack the same day
or (if you start on Sunday) take 1 tablet daily until Sunday and then start a new pack that day. Use an alternative form of contraception for the next 7 d after you miss 2 or more doses in weeks 1, 2, or 3.
generic name and class
nuvaring
generic: ethinyl estradiol/etonogestrel ring
class: estrogen/progestin combo
indication
nuvaring
contraception
MOA
nuvaring
same as COC
major contraindications
nuvaring
Hypersensitivity to ethinyl estradiol or progestin component; history of thromboembolic disorders, endometrial cancer, uncontrolled HTN, pregnancy; smoking ≥15 cigarettes per d and >35 y of age
BBW
nuvaring
smoking risk
common ADRs
nuvaring
more than 10%: headache, intermenstrual bleeding, vaginitis
1-10%: Mood changes, acne, weight gain, amenorrhea, nausea, vomiting, abdominal pain, vaginal
discharge
rare but serious ADRs
nuvaring
AMI, anaphylaxis, angioedema, thromboembolism, galactorrhea not associated with childbirth,
hypersensitivity reaction, toxic shock syndrome, urticaria, thromboembolism
key counseling points
nuvaring
Same as COC. If the vaginal ring is inadvertently expelled or removed, it may be rinsed in cool to lukewarm water and reinserted as soon as possible, at the latest within 3 h. If the ring-free interval has been extended beyond 7 d or if the vaginal ring has been left in place for >4 wk, an additional form of contraception must be used until the vaginal ring has been used continuously for 7 d.
generic name and class
androgel, androderm
generic: testosterone
class: testosterone
indication
testosterone
hypogonadism (men)
MOA
testosterone
estosterone is an endogenous androgen. Androgens are responsible for normal growth and development of male sex organs. Testosterone is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution; laryngeal enlargement; vocal cord thickening; alterations in body musculature; and fat distribution
major contraindications
testosterone
hypersensitivity to testosterone; men with breast or prostate cancer; women (in cross contamination) who are pregnant, who may become pregnant, or who are breast-feeding
BBW
testosterone
Secondary exposure (topical), BP increases (oral); pulmonary oil microembolism (injectable)
common ADRs
testosterone
more than 10%: Benign prostatic hyperplasia, testicular atrophy, PSA increase
1-10%: Acne, headache, gynecomastia, alopecia, impotence, aggressive behavior, HTN
rare but serious ADRs
testosterone
Cardiac arrest, cerebrovascular accident, hepatotoxicity, hallucinations, hostility, and aggression
key counseling points
testosterone
Gel to be applied to clean, dry, intact skin of the shoulders and upper arms and/or abdomen but should not be applied to genitals. Gel should be allowed to dry well; swimming and showering should be avoided for 5-6 h after application. Patients should keep application site covered, as direct skin contact can transfer drug to others. Virilization has been reported in children who were secondarily exposed to testosterone gel. Male patients should report too frequent or persistent erections. Female sexual partners of patients using drug should report male-like changes. Do not use higher doses than you have been prescribed, or combine with other anabolic steroids, serious adverse effects can occur. Seek medical attention if chest pain, shortness of breath, signs of stroke, or behavioral changes.
generic name and class
folacin-800
generic: folic acid
class: supplements for reproductive health
indication
folic acid
Megaloblastic and macrocytic anemia due folic acid deficiency
MOA
folic acid
Folic acid is required for the conversion of deoxyuridylate to thymidylate, which is a rate-limiting step in DNA synthesis. Folic acid deficiency presents clinically as macrocytic anemia when red blood cells are unable to extrude their nucleus
major contraindications
folic acid
hypersensitivity
common ADRs
folic acid
more than 10%: loss of appetite
1-10%: confusion, irritation
rare but serious ADRs
folic acid
anaphylaxis
key counseling points
folic acid
May require several weeks for maximum effect. Avoid alcohol as it inhibits the absorption of folic acid.
generic name and class
precare, prenexa
generic: prenantal vitamin
class: supplements for reproductive health
indication
prenatal
diet supplementation during pregnancy
MOA
prenatal
Provide vitamin and mineral supplementation throughout pregnancy and during the postnatal
period for both the lactating and the non-lactating mother. It is also useful for improving nutritional status prior to conception
major contraindications
prenatal
hypersensitivity
BBW
prenatal
iron toxicity (some formulations)
common ADRs
prenatal
more than 10%: Nausea
1-10%: vomiting, constipation
key counseling points
prenatal
May contain iron, so important to keep out of the reach of children. Take in the evening if morning sickness present. May take with food to avoid GI upset, but administration with milk will decrease extent of iron absorption. May darken stool due to iron content.
