Sex Hormones Flashcards
Norethindrone, Medroxyprogesterone acetate, and Etonogesterel are:
A. Emergency contraceptives
B. Progesterone only agonists
C. IU Devices
B. Progesterone only agonists
Levonorgestrel and Ulipristal are:
A. Emergency contraceptives
B. Progesterone only agonists
C. IU Devices
A. Emergency contraceptives
True or False: Medroxyprogesterone has been shown to cause weight gain
True
Copper ParaGuard and Levonotgestrel Mirena, Skyla, etc are:
A. Emergency contraceptives
B. Progesterone only agonists
C. IU Devices
C. IU Devices
Most effective contraceptive class? Least?
Most = Intrauterine
Least = Emergency
Combination Oral Contraceptives contain synthetic __ and ___
estrogen (ethinyl estradiol) and progestin
COC’s are usually given for __ days, followed by __ days with no pills
21; 7 days
Monophasic vs. Multiphasic COC therapy?
Monophasic: fixed estrogen + progestin dose
Multiphasic: mimic normal hormonal events of menstrual cycle
- first half = low prog:E2 (endo proliferation)
- second hald = high prog:E2 (secretory endo)
- allows for overall decreased hormone exposure
In biphasic COC, __ dose remains constant while ___ dose changes twice during the cycle
estrogen = constant
progesin = changes twice (increases)
___: dose of one or both steroidal agents are changes three times during cycle
A. Monophasic
B. Triphasic
C. Biphasic
B. Triphasic
____ is four-phasic drug that uses estradiol VALERATE
Natazia
When are two good ‘start dates’ for COC?
1) First Sunday after menses - more rapid
2) First day of menses (use backup contraception for 7 days)
True or False: The predominant and most potent estrogen made by ovary is E2 (17-beta-estradiol)
True
____ is the primary synthetic estrogen used in COC’s. How does it prevent first pass metabolism?
Ethinyl estradiol
- Ethinyl group at C17 prevents first pass metabolism
Where does sulfate and glucuronide conjugation occur for enterohepatic recirculation?
Liver
Where does biliary secretion of conjugates occur in enterohepatic recirculation?
Intestine
___ enzymes cleave conjugates, allowing for reabsorption of estrogen in enterohepatic recirculation
Bacterial
- Oral Antibiotics could affect this
True or False: Synthetic progestins vary in the androgenic activity, estrogenic activity, and anti-estrogenic activity
True
True or False: Gonane progestines (e.g norgestimate and desogestrel) are reported to be less androgenic (less acne causing) than estranes
True
___ is a derivative of spironolactine and is anti-androgen. It is indicated for treatment of moderate acne vulgaris.
Drospirenone
Estrogen and Progesterone inhibit the release of ___ and ___. Therefore, no ___
LH and FSH; ovulation
True or False: One will ovulate while taking COC’s
False
True or False: Women taking COC’s have an LH spike
False
Most common AE associated with COC’s?
Nausea*
What are the three dermatological AE’s associated with COC’s?
1) chloasma (brown pigmentation of skin)
2) acne (due to increased sebum)
3) hirsuitism
True or False: HTN is an AE of COC’s
True
- can start 1-3 s/p therapy
- increased risk with duration and age
- estrogens increase RAAS
What is a life-threatening AE associated with COC’s?
Thromboembolitic disorders
- cause: estrogen (increased clotting factors, decreased anti-thrombin 3)
Newer progestins, such as ___, ___, and ___may be associated w increased risk of blood clot formation
desogestrel; gestodene; drospirenone
What are two metabolic effects of COC’s?
1) Decreased glucose tolerance
2) Increased LDL’s and TG
True or False: Breakthrough bleeding is associated with use of COC’s
True
- most common in first three months
- estrogen deficiency is associated with BTB in early part of cycle while prog def is associated with BTB in later part of cycle
COC’s may increase risk of ____ cancer in general population of women and increased risk of cervical cancer in women who are ___+
breast; HPV+
True or False: Infertility can occur after COC use, last longer in 30-34 year old women
True
Whey should COC’s be avoided until at least 3-4 weeks postpartum?
Estrogen in COC’s can decrease quality of quantity of milk
What are three beneficial side effect of COC’s?
- Reduced risk of endometrial cancer
(progestin prevents endo prolif) - Reduced risk of ovarian cancer
(decreased stimulation of ovaries by FSH and LH) - Reduced acne
(estrogen decreases seb. gland activity and increase SHBG (decrease free testosterone))
____ kill normal microbial flora that produces enzymes that cleave sulfate and glucoronide conjugates of ethinyl estradiol - no enterohepatic circulation
Abx
Which antibiotics induce CYP3A4, thereby increasing metabolism of COC, leading to greater failure rate?
Rifbutin
Rifampin
True or False: Anti-convulsants can decrease effectiveness of COC’s
True
Patient with smoking history, h/o thromboembolism should take which type of BC?
Progestin only preparations
True or False: Estrogen only preparations can be used when women are lactating and want contraception
False - Progestin only preparations used!
True or False: Progestin only preparations consistently inhibit ovulation
False - they do not consistently inhibit ovulation
Which progesterone only preparation is given via IM and can cause osteoporosis because it decreases estrogen
Medroxyprogesterone
True or False: Nexplanon (etonogestrel) is a progestin only preparation
True
Levonorgestrel is seen in ____ contraception
emergency
How does emergency contraception affect ovulation?
Delays or inhibits ovulation
Which emergency contraceptive is a progesterone antagonist and partial agonist?
A. Levonorgestrel
B. Medroxyprogesteron
C. Ulipristal acetate
C. Ulipristal acetate
True or False: Ethinyl estradiol + Levonorgestrel is more effective and has less side effects than Levonorgestrel alone
True
How do intrauterine devices produce a spermicide?
Cause low grade inflammation -> increases prostaglandins
Which IUD prevents fertilization, implantation, and interferes w sperm transport and viability?
A. Paraguard
B. Mirena
A. Paraguard
Which IUD causes thick, cervical mucus, decreases sperm transport activity, and prevents ovulation by making endometrium inhospitable?
A. Paraguard
B. Mirena
B. Mirena
AE associated with IUD?
Insertion may introduce bacteria into pelvis, leading to PID
