Segars: Contraceptive drugs Flashcards
What are the pharmacologic effects of HCs?
- 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
What are the estrogens in combination contraceptives (COC’s)?
- Ethyinyl estradiol (EE)
- Estraediol valerate
- mestranol
What are the progestins in COC’s?
- estranes: ethynodio, Norethindrone
- Gonanes: desogestrel, dienogest, levonorgestrel, norgestrel, norgestimat
- Drospireneone (from a spironolactone-analog)
Which progestin has the best estrogenic effect?
-Ethynodiol
Which progestins have the greatest progestinic and androgenic effect?
- Desogestrel
- levonorgestrel
- norgestrel
What are the monophasic HCs?
-Fixed dose of estrogen and progestin throughout cycle
What are the non-oral progestins?
- Norelgestromin: patch
- Etonogestrel: vaginal ring or progestin-only implantable rods
- Medroxyprogesterone: progestin-only long acting IM or SQ injections
- Levonorgestrel: progestin-only intrauterine system
What is the non-oral non-hormonal contraceptive?
- Copper!
- available in non-hormonal IUD
What are the estradiol and progesterone effects?
-cellular mechanism of Action impacting SE’s
What do estrogens decrease that has nothing to do with contraception?
- cholestero
- osteoclastic activity
- anti-thrombin III
- Bile acid levels
What do estrogens increase that has nothing to do with contraception?
- 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
What are some common adverse effects of HC’s?
- irregular bleeding
- breast tenderness
- fluid retention
- mood changes
- headaches and GI distress
- hyperkalemia
What are some serious adverse effects of HC’s?
- systemic thromboembolism: MI/stroke/ DVT/ PE/Intestinal ischemia
- HTN
- Gallbladder disease
Do HC’s prevent or reduce the risk of STI’s and HIV?
no!
What is a really to do while taking HCs?
smoking!
What are some MEC-4 contraindications for COC?
- smoking
- preggo
- hepatic adenoma or malignant hepatoma
- devere decompensated cirrhosis
- Uncontrolled or severe HTN
- Migraine headaches with aura
What are some MEC-4 contraindications for IUD
- Preggo
- postpartum sepsis
- immediate post-sepsis abortion
- distorted uterine cavity
- unexplained vaginal cavity
- STI
What are some goofy drug interactions that could happen with HC’s?
-Inducers!: antimicrobial agents, antivirals, anti seizure… etc.
How can we be reasonably certain that a woman is not preggo?
- <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
What contraceptive method requires a bimanual examination and cervical inspection before starting the treatment?
- Copper containing IUD
- Levonorgestrel-releasing IUD
What drug do we first need to take their blood pressure with before starting tx?
-Combined hormonal contraceptive
Is a routine follow up visit require after starting contraception?
no
What drug do we have to monitor their blood pressure with?
Combined hormonal contraceptives
What can sometimes happen that we might have to deal with if she is using a copper-containing IUD or levonorgestrel-releasing IUD?
PID
