S2E4: Gonadal hormones Flashcards
Venlafaxine (effexor), fluoxetine (prozac), paroxetine (paxil), sertraline (zoloft)
SSRI tx for vasomotor sx
progesterone route of administration
IM only
medroxyprogesterone (provera)
progesterone
megestrol aceate (megace)
progesterone
norethynodrel
progesterone
levonorgestrel (norplant)
progesterone
norethindrone
progesterone
ethynodiol
progesterone
norgestrel (ovrette)
progesterone
tamoxifen (nolvadex)
Estrogen antagonist (premenopausal pt w estrogen-receptor + breast CA tx)
toremifene (fareston)
Estrogen antagonist (post menopausal pt estrogen-receptor + breast CA tx)
raloxifene (evista)
Estrogen antagonist (osteoporosis prevention)
clomiphene (clomid)
Inhibits estrodiol negative feedback, increasing FSH/LH –> increased estrogen. Use in PCOS.
Mifepristone (RU486 or mifeprex)
Progestin antagonist, luteolytic.
danazol (danocrine)
inhibits FSH/LH, decreases ovarian fnx. Endometriosis tx.
Testosterone, DHT
natural androgens/anabolic steroids
testosterone propionate
injectable synthetic steroid
testosterone cypionate
injectable synthetic steroid
methyltestosterone
PO synthetic steroid
fluoxymesterone
PO synthetic steroid
-fen(e)
estrogen antagonist
finasteride (proscar)
5-alpha reductase inhibitor (antiandrogen). BPH, prostate CA.
dutasteride (avodart)
5-alpha reductase inhibitor (antiandrogen). BPH, prostate CA.
flutamide (eulexin)
5-alpha reductase inhibitor (antiandrogen). Prostate CA
OCP DI
anti-convulsants (phenytoin, phenobarbital, carbamazepine, oxcarbazepine, lamotrigine, primidone, topiramate)
abx (rifampin)
St. John’s wort
implanon
progestin coated, sub q. Effective 3 yrs.
medroxyprogesterone IM (depo provera)
q90d. Progestin only.
* *black box: reduced BMD in Lspine >5 yrs. reversible in 4 yrs.
norgestrel (minipill)
oral progesterone.
norethindrone (minipill)
oral progesterone.
ethinyl estradiol + norethindrone/levonorgestrel/norgestrel/
norethinedrone/ ethynodiol/norgestimate/ desogestrel/drospirenone
combination estrogen + progestin
monophasic combo dose
constant dose of estrogen/progestin q21d, then 7 days placebo (withdrawal bleeding). 28 day pack.
biphasic
amount of estrogen/progestin changes 1/3rd of the way through cycle
triphasic
amount of estrogen/progestin changes qweek (7/7/7)
quadriphasic
four varying amounts throughout monthly pack
same day start
take 1st active pill on first day of menses
sunday start
take 1st active pill first sunday after menses begins.
BUM for 1 week-1 mo
quick start
take 1st active pill when rx filled (regardless of menses).
BUM for 1 week-1 mo
miss 1 pill
no BUM
miss 2 pills, week 1 or 2
take both pills when you remember (2 pills for 2 days). BUM x7d.
miss 2 pills, week 3
start new pack + BUM x7d.
If Sunday start, continue old pack until Sun, then start new pack. BUM x7d.
91 day oral combo
estrogen and progesterone combo for 12 weeks, then 1 week of placebo or estrogen.
combined transdermal patch
topical estrogen/progestin each week for 3 weeks, then remove for 1 week.
**black box: increased estrogen exposure
missed transdermal patch
24 hrs: patch is new “day 1”, BUM x7d.
vaginal ring (nuvaring)
3 weeks estrogen/progestin, removed for 1 week.
Missed nuvaring
3 hrs: reinsert, BUM x7d.
levongesterel IUD (Mirena)
lasts 5 yrs.
As IUD: prevents implantation
Progestin: thickens cervical mucus, thins endometrium, inhibits sperm motility
copper IUD (Copper-T)
lasts 10 yrs.
Cu inhibits sperm motility.
Can be emergency contraception.
High-dose estrogen/progestin
emergency contraception.
Emergency contraception dosing of Ovral
2 pills immediately, 2 pills 12 hrs later
Emergency contraception dosing of low-ogestrel
4 pills immediately, 4 pills 12 hrs later
Emergency contraception dosing of tri- rx (trivor, tri-levelen, triphasil)
4 pills immediately, 4 pills 12 hrs later
Emergency contraception dosing of alesse, levelite, lessina
5 pills immediately, 5 pills 12 hrs later
ovral
High-dose estrogen/progestin
ovrette
progestin only emergency contraception (20 pills immediately, 20 pills 12 hrs later.
Plan B (levonorgestrel 0.75 mg)
emergency contraception. Take 2 pills 12 hrs apart
Plan B one step (levonorgestrel 1.5 mg)
emergency contraception
emergency contraception time frame
High dose estrogen/progestin, or progesterone only: within 120 hrs.
Copper IUD: within 5 days
Copper IUD
Most effective (>99%), but DONT put in pregnant uterus.