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Repro 2 Midterm > Segars: Contraceptive drugs > Flashcards

Segars: Contraceptive drugs Flashcards

1
Q

What are the pharmacologic effects of HCs?

A
  • suppress function of HPO axis; decrease of GnRH
  • Diminish ovarian hormone production
  • inhibit maturation/release of dominant ovule
  • Modify mid-cycle surges of LH and FSH
  • Increase viscosity of cervical mucus to impede sperm transit
  • Produce endometrial changes, unfavorable for ovum implantation
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2
Q

What are the estrogens in combination contraceptives (COC’s)?

A
  • Ethyinyl estradiol (EE)
  • Estraediol valerate
  • mestranol
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3
Q

What are the progestins in COC’s?

A
  • estranes: ethynodio, Norethindrone
  • Gonanes: desogestrel, dienogest, levonorgestrel, norgestrel, norgestimat
  • Drospireneone (from a spironolactone-analog)
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4
Q

Which progestin has the best estrogenic effect?

A

-Ethynodiol

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5
Q

Which progestins have the greatest progestinic and androgenic effect?

A
  • Desogestrel
  • levonorgestrel
  • norgestrel
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6
Q

What are the monophasic HCs?

A

-Fixed dose of estrogen and progestin throughout cycle

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7
Q

What are the non-oral progestins?

A
  • Norelgestromin: patch
  • Etonogestrel: vaginal ring or progestin-only implantable rods
  • Medroxyprogesterone: progestin-only long acting IM or SQ injections
  • Levonorgestrel: progestin-only intrauterine system
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8
Q

What is the non-oral non-hormonal contraceptive?

A
  • Copper!

- available in non-hormonal IUD

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9
Q

What are the estradiol and progesterone effects?

A

-cellular mechanism of Action impacting SE’s

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10
Q

What do estrogens decrease that has nothing to do with contraception?

A
  • cholestero
  • osteoclastic activity
  • anti-thrombin III
  • Bile acid levels
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11
Q

What do estrogens increase that has nothing to do with contraception?

A
  • TG’s
  • Clotting factors
  • platelet aggregation
  • Renin/Aldosterone secretion/activity (Na+/fluid retention)
  • Thyroid, corticosteroid, and sex hormone binding globulins
  • Iron/ TIBC and prolactin
  • Folate metabolism/excretion
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12
Q

What are some common adverse effects of HC’s?

A
  • irregular bleeding
  • breast tenderness
  • fluid retention
  • mood changes
  • headaches and GI distress
  • hyperkalemia
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13
Q

What are some serious adverse effects of HC’s?

A
  • systemic thromboembolism: MI/stroke/ DVT/ PE/Intestinal ischemia
  • HTN
  • Gallbladder disease
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14
Q

Do HC’s prevent or reduce the risk of STI’s and HIV?

A

no!

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15
Q

What is a really to do while taking HCs?

A

smoking!

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16
Q

What are some MEC-4 contraindications for COC?

A
  • smoking
  • preggo
  • hepatic adenoma or malignant hepatoma
  • devere decompensated cirrhosis
  • Uncontrolled or severe HTN
  • Migraine headaches with aura
17
Q

What are some MEC-4 contraindications for IUD

A
  • Preggo
  • postpartum sepsis
  • immediate post-sepsis abortion
  • distorted uterine cavity
  • unexplained vaginal cavity
  • STI
18
Q

What are some goofy drug interactions that could happen with HC’s?

A

-Inducers!: antimicrobial agents, antivirals, anti seizure… etc.

19
Q

How can we be reasonably certain that a woman is not preggo?

A
  • <7 days after the start of normal menses
  • has not had sexual intercourse since the start of last normal menses
  • has been correctly and consistently using a reliable method of contraception
  • is <7 days after spontaneous or induced abortion
  • is within 4 weeks postpartum
  • is fully or nearly fully breastfeeding, amenorrheic, and <6 months postpartum
20
Q

What contraceptive method requires a bimanual examination and cervical inspection before starting the treatment?

A
  • Copper containing IUD

- Levonorgestrel-releasing IUD

21
Q

What drug do we first need to take their blood pressure with before starting tx?

A

-Combined hormonal contraceptive

22
Q

Is a routine follow up visit require after starting contraception?

A

no

23
Q

What drug do we have to monitor their blood pressure with?

A

Combined hormonal contraceptives

24
Q

What can sometimes happen that we might have to deal with if she is using a copper-containing IUD or levonorgestrel-releasing IUD?

A

PID

25
Q

What do we do for emergency contraception?

A

progestin (levonorgestrel

  • inhibition of ovulation
  • available in 1-dose and 2- dose treatments
  • no effects if implantation has already occurred
26
Q

What is Plan B?

A
  • levonorgestrel
  • take 1st dose ASAP
  • take 2nd dose 12 hrs after first dose
  • there is also just a 1 dose version of this as well
27
Q

Ulipristal (non-progestin) 1-dose emergency contraception

A
  • progesterone receptor modulator

- main action is inhibition of ovulation

28
Q

What do we have to make sure she does after Ulipristal 1-dose Emergency contraception?

A

-Initiate COC’s after EC: due to mechanism, start COC no sooner than 5 days of ulipristal use AND use barrier method until the next menstrual cycle

Repro 2 Midterm (9 decks)

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