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PHARM > Week 6 Drugs Affecting the Reproductive System ALREADY STARTED > Flashcards

Week 6 Drugs Affecting the Reproductive System ALREADY STARTED Flashcards

1
Q

Endocrine system is a system of __ and __ __ (aka ___ ) throughout the body

A

glands
circulating substances
messengers

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2
Q

These circulating substances and messengers (which is part of the endocrine system) interact with the __ __. This interaction is termed __.

A

nervous system

feedback

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3
Q

Feedback responses by the nervous system helps maintain __.

A

homeostasis

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4
Q

We are so honored to be in the presence of such trust and faith in our abilities to care……

A

without judgments directed toward the patient

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5
Q

Many patients and families ___ ____ that you will judge them or look down upon them in some way when it comes to content in this area and to aspects of our most private lives. We must be on our guard to not let this happen.

A

simply expect

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6
Q

What are the different types of reproductive agents?

A
  1. oral contraceptives
  2. hormone replacement therapy (HRT)
  3. male reproductive agents
  4. Hormone therapy in transgender care
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7
Q

What are the 3 types of male reproductive agents?

A
  1. testosterone
  2. anabolic steroids
  3. drugs for erectile dysfunction (ED)
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8
Q

What are the MOST effective contraceptive option?

A
  1. Male/Female Sterilization

2. IUD/ IUS Implants

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9
Q

The MOST effective contraceptive options prevent pregnancy __ of the time

A

> 99%

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10
Q

What are VERY effective contraceptive options?

A

Pills
Injectables
Patch
Ring

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11
Q

The VERY effective contraceptive options prevent pregnancy ~ __ - ___of the time

A

~91-99%

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12
Q

What are MODERATELY effective contraceptive options?

A

Male/Female Condom
Sponge
Diaphragm

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13
Q

The MODERATELY effective contraceptive options prevent pregnancy ~ __ - ___of the time

A

~81-90%

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14
Q

EFFECTIVE contraceptive options include?

A
  1. fertility awareness
  2. cervical cap
  3. spermicide
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15
Q

Effectiveness rates for most of the contraceptive method are expressed as __ __ , or the percentage of women who can be expected to become pregnant within the __ __ they use that method.

A

failure rates

first year

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16
Q

Effectiveness rates are given with both __ use and __ use.

A

perfect

typical

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17
Q

What does perfect use mean when it comes to effectiveness rates?

A

correct and consistent use of the method with every act of intercourse

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18
Q

What does typical use mean when it comes to effectiveness rates?

A

actual use, including occasional, inconsistent, or incorrect use

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19
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use NO METHOD?

A

850

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20
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use WITHDRAWAL ?

A

270

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21
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use a MALE CONDOM?

A

150

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22
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use PILL?

A

80

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23
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use an INJECTABLE?

A

30

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24
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use an IMPLANT?

A

0.5

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25
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use IUD (LNG-IUS, Copper T)?

A

2-8

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26
Q

What are the number of unintended pregnancies among 1,000 women in their 1st year of (typical) use when they use STERILIZATION (M/F)?

A

1.5 -5

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27
Q

According to data from Trussell and WHO Global FP handbook, studies show withdrawal’s failure rate at __ %

A

18%

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28
Q

Implants are __ times more effective than injectables.

A

60

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29
Q

IUDs are __-__ times more effective than pills.

A

10-40

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30
Q

Vasectomy is __ times more effective than condoms.

A

100

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31
Q

LAPMs are __-__ times more effective and this translates into much lower greatly reduction the deleterious health, economic, and social effects of unintended pregnancies

A

30-50

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32
Q

In pregnancy and postpartum the use of __ and __ __ are a concern

A

prescription

nonprescription

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33
Q

Many maternal physiologic changes of pregnancy and postpartum affect __ __ and __

A

drug action and use

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34
Q

There are a __ number of drugs conclusively safe for embryo

A

limited

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35
Q

What are substances that cause developmental abnormalities?

A

teratogens

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36
Q

Teratogenic fetus results in characteristic set of __

A

malformations

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37
Q

Teratogens exert effects at a __ stage of fetal development

A

particular

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38
Q

What are two teratogens and their detrimental effects to the fetus?

A
  1. Cigarette smoking (intrauterine growth restriction, stillbirth)
  2. Alcohol (neurocognitive delay, miscarriage)
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39
Q

What are the 5 FDA pregnancy categories?

A

A. Studies show no fetal risk.
B. No fetal risk in animal studies; no risk assumed in
humans.
C. Fetal risk in animal studies; weigh risk vs. benefit.
D. Proven fetal risk; weigh risk vs. benefit if life-
threatening
X. Proven fetal risk; risk > benefit; avoid in pregnancy

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40
Q

Which drugs have a significant teratogenic effects/adverse effects?

A 
ACE Inhibitors
Amphetamines
Androgens
Busulfan
Cocaine
Diazepam
Ethanol
Heroin
Metronidazole
Phenytoin
Smoking
Thalidomide
Tetracycline
Warfarin
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41
Q

For the maternal pt, medications may have different effects on __ __ due to __ __

A

reproductive tissues

hormonal changes

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42
Q

Physiologic changes during pregnancy may lead to need for __

A

medications

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43
Q

What are two examples of meds that pregnant pts need because of physiologic changes?

A

Cardiac Glycoside and Diuretics for heart failure due to increased cardiac workload during pregnancy

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44
Q

In the menstrual cycle, the menarche average age is

A

11.6 years

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45
Q

At the start of the menstrual cycle, ovaries being a __ to __ year period of cyclic function

A

30-40

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46
Q

In menopause, there is a failure to respond to __ secreted by the __ __ __

A

gonadotropoins

anterior pituitary gland

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47
Q

Gonadotropins are produeced by

A

anterior pituitary

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48
Q

What role does follicle-stimulating hormone (FSH) play in women and men?

A

Women: follicle development
Men: spermatogenesis

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49
Q

What role does Luteinizing hormone (LH) play in women and men?

A

Women: estrogen and progesterone production, mid-cycle surge leads to ovulation

Men: testosterone production

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50
Q

Interaction of __ and __ are necessary for ovulation and sperm maturation

A

FSH ; LH

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51
Q

What are the therapeutic uses for estrogen and progestin?

A
  1. contraception

2. menopausal hormone therapy

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52
Q

What are the two estrogen- and progesterone-receptor antagonists?

A
  1. Anti-estrogen

2. Anti-progestin

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53
Q

What is anti-estrogen used for?

A

hormone responsive to breast cancer and infertility

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54
Q

What is anti-progestin used for?

A

medical abortion

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55
Q

What are the most commonly prescribed contraceptives?

A

Estrogen-Progestin Combination Products

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56
Q

Estrogen-Progestin Combination Products are __ to use, have a __ degree of effectiveness, and are relatively __.

A

easy
high
safe

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57
Q

Estrogen-Progestin Combination Products are differentiated based on the __ of the __ component and type of __ used

A

strength

estrogen

progestin

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58
Q

The goal of Estrogen-Progestin Combination Products is to have the __ __ and fewest undated __ __

A

best protection; side effects

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59
Q

Estrogen-Progestin Combination Products can be administered:

A

oral
transdermal
transvaginal

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60
Q

What is the physiologic mechanism of oral contraceptives?

A
  1. suppresses pituiatry secretion of FSH and LH
  2. Creates changes in the endometrium to make it less favorable for implantation of fertilized ovum
  3. Change quantity and viscosity of the cervical mucus to make it hostile to sperm
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61
Q

What are factors influencing a woman’s use of contraceptives?

A
  1. cultural/personal attitudes
  2. personal situation
  3. contraceptive use/ knowledge
  4. sexual education
  5. media
  6. health care system barriers
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62
Q

How does the media influence a woman’s use of contraceptives?

A

the media overemphasizes sex while virtually ignoring contraception

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63
Q

How does sexual education influence a woman’s use of contraceptives?

A

Lack of comprehensive sexual education and emphasis on abstinence-only sex ed

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64
Q

How do cultural/personal attitudes influence a woman’s use of contraceptives?

A

Cultural and personal attitudes and barriers that prevent patients from adequately assessing pregnancy risk and using contraceptives when they don’t want to become pregnant

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65
Q

How does partner situation influence a woman’s use of contraceptives?

A

Partner situation (eg, partner’s feeling about contraception, situations involving intimate partner violence)

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66
Q

What health care barriers are there that influence a woman’s use of contraceptives?

A
  1. delayed initiation of contraception, common myths and misperceptions about obtaining and using contraceptives
  2. insurance barriers (eg, lack of insurance or aspects of insurance that interfere with effective use of contraceptives)
  3. and clinician limitations (including lack of experience and training in providing certain contraceptive methods and/or counseling)
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67
Q

What are the three types of estrogen-progestin combination BCPs (Birth Control Pills)?

A
  1. Monophasics
  2. Biphasics
  3. Triphasics
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68
Q

Monophasic BCPs are __ __ . They have a fixed ratio of __ and __ throughout the cycle

A

most common

estrogen; progestin

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69
Q

Biphasic BCPs have fixed __ but their __ varies

A

estrogen

progesterone

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70
Q

Triphasic BCPs are the __ combination pill. In low doses, they have __ __ __ (e.g. __)
Either __ or __ varies during 3 phases

A

newest
few side effects; bleeding
estrogen; progesterone

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71
Q

Is withdrawal bleeding a true menstrual period?

A

no

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72
Q

In withdrawal bleeding, bleeding can…

A

vary in amount and duration

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73
Q

Researchers have established that a monthly episode of withdrawal bleeding is…

A

NOT necessary to maintaining a healthy uterus

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74
Q

What is an EXTENDED CYCLE BCP?

A

Loestrin 24 Fe (Norethindrone acetate/ethinyl estradiol and ethinyl estradiol and ferrous fumarate)

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75
Q

Loestrin 23 Fe is a…

It has also has __ days of __ __ pill

A

24 day active hormonal therapy

4 ; iron supplement

76
Q

What are 2 Continuous Dosing BCPs?

A
  1. Seasonale (Jolessa)& Seasonique
    4 periods per year, may have break thru bleeding
  2. Lybrel- Continuous dose 28 day packets
    Taken continuously without interruption for withdrawal menses
77
Q

Estrogen Combination BCPs with Drospirenone (drsp) is a progestin derived from __ and not __

A

spirinolactone

testosterone

78
Q

What are 3 examples of Estrogen Combination BCPs with Drospirenone (drsp)?

A
  1. Yasmin (Drospirenone and Ethinyl Estradiol) - monophasic
  2. Yaz (Drospirenone/Ethinyl Estradiol) – 24 day active
  3. Beyaz (Ethinyl Estradiol, Drospirenone, and Levomefolate) – promotes healthy folic acid levels
79
Q

Estrogen Combination BCPs with Drospirenone (drsp) are used in combination with __ __

A

ethinyl estradiol

80
Q

Estrogen Combination BCPs with Drospirenone (drsp) may increases __

A

potassium

81
Q

Estrogen Combination BCPs with Drospirenone (drsp) should NOT be taken if you have __, __, or __ disease

A

kidney, liver, adrenal

82
Q

If you are taking other drugs long term that increase potassium levels other than Estrogen Combination BCPs with Drospirenone (drsp), you should get routine __ __ to check potassium.

A

blood test

83
Q

Which drugs when taken with Estrogen Combination BCPs with Drospirenone (drsp) should you make sure to check Potassium levels?

A 
1.NSAIDs 
Ibuprofen, naproxyn
2.K + sparing diuretics
Spironolactone
3.ACE inhibitors
Capoten, Vasotec, Zestril
4.Angiotensin-II receptor antagonists
Cozaar, Diovan, Avapro
5.Heparin
84
Q

Progestin only BCPs are known as the “__-__”

A

mini-pill

85
Q

Progestin Only BCPs alter __ __ and alter __ to inhibit implantation

A

cervical mucus

endometrium

86
Q

Progestin Only BCPs are designed to decrease

A

circulatory side effects

87
Q

Progestin Only BCPs have an increased risk of __ and break thru __ .

A

pregnancy

break thru

88
Q

If a progestin only BCP pill is taken more than __ __ late, back up contraception for __ hours

A

3 hours

48

89
Q

Progestin Only BCPs: all __ pills are active

A

28

90
Q

Ortho-Eva Transdermal Patch is a patch that is placed :

A

once a week for 3 weeks in a row

91
Q

Ortho-Eva Transdermal Patch:

FOURTH week is __-__ to allow for withdrawal bleeding

A

patch-free

92
Q

Ortho-Eva Transdermal Patch works in a similar manner to:

A

Combined Oral Contraceptive pills

93
Q

Depo-Provera is a highly __, __-acting injectable __ in the form of __ __

A

effective; long
progestin

depot-medroxyprogesterone acetate (DMPA or MPA)

94
Q

What is characteristic of using Depo-Provera? (2)

A
  1. Anovulation

2. Amenorrhea

95
Q

The NuvaRing Transvaginal Contraception is __ __ in diameter and is a __ __ __ inserted into the vagina

A

2 inches

flexible indwelling ring

96
Q

The NuvaRing Transvaginal Contraception is:

__-___, __, __ (or almost __)

A

non-biodegradable
transparent
colorless
colorless

97
Q

What is an example of an implantable progestin?

A

Nexplanon

98
Q

Nexplanon is a __-__ device that contains __ __

A

single-rod

progestin etonogestrel

99
Q

Nexplanon lasts for __ __

A

3 years

100
Q

Most monophasics are __ and __ tablets

A

21 ; 28

101
Q

The 28 tablets in monophasics include __ __ __

A

7 placebo “counters”

102
Q

For Monophasics, you start the 1st __ after menstruation. Back up method at least __ days.

On the first menstrual cycle day, this is no need for __ __ method.

For monophasics, you start __.

A

Sunday

7

back up

quickly

103
Q

Consult __, __, or __ for complete information about start dates and back-up methods for missed doses of monophasics

A

lexicomp
micromedex
uptodate

104
Q

What are BCP Contraindications?

A 
Pregnancy
Breast feeding  35y/o
Hx DVT, PE, or stroke
Endometrial CA
Multi CV risk factors
Age, smoking, DM, HTN
Ischemic/valve HD
Major surgery & prolonged immobilization
Breast cancer
105
Q

If you have diabetic __, __, __, it is a BCP contraindication. Diabetes of greater than __ __ duration is also a contraindication b/c BCPs can increase __ __.
IF you have have __ __ __ or __ it is also a contraindication.

A

nephropathy, retinopathy, neuropathy

20 years

blood glucose

active viral hepatitis

cirrhosis

106
Q

What should you be cautious about for a person who is going to take BCPs?
IF the person has:

A
  1. Undiagnosed genital bleeding
  2. Postpartum 15 cig/day
  3. Gallbladder disease
  4. Past history of breast cancer > 5 years
  5. Drugs that affect liver enzymes
  6. Mild hypertension without other risk factors for cardiovascular disease
  7. Hyperlipidemia
  8. insulin dependent diabetes
  9. Known hyperlipidemia
107
Q

What should you assess for a person on oral contraceptives?

A
  1. Drug and herb use
  2. Baseline BP and weight
  3. Pregnancy status
  4. Hx contraindications, esp. smoking and HTN
108
Q

What are nursing diagnoses for person on oral contraceptives?

A
  1. Deficient knowledge
  2. Noncompliance
  3. Risk for impaired liver function
  4. Nausea
109
Q

What should be included in the planning for person on oral contraceptives?

A
  1. Client will use method suitable to lifestyle & risk factors
  2. Client will take BCPs as prescribed & report side effects
110
Q

What are nursing interventions for person on oral contraceptives?

A
  1. Separate personal views from those of client
  2. Concurrent use of some drugs & herbs may ↓ effectiveness
    therefore, Use alternate contraceptive methods
111
Q

What should you educate the patient about on oral contraceptives?

A

Oral contraceptives:

  1. ↓ risk Fe deficiency anemia
  2. May ↓ risk uterine, ovarian, & endometrial cancers
  3. Thromboembolism risk assoc with ↑ dose estrogen
  4. Doesn’t protect against STDs
112
Q

What are rare side effects of oral contraceptives?

A

Thromboembolism, PE, MI, CVA, retinal thrombosis

113
Q

What is the pneumonic for dangerous side effects of oral contraceptives?

A

ACHES

114
Q

What does ACHES stand for?

A

A - abdominal pain (severe)
C - chest pain or SOB
H - headaches (severe); dizziness, weakness, numbness, speech difficulties
E = eye disorders
S - severe leg pain or calf/thigh swelling

115
Q

What are 3 types of emergency contraceptions?

A
  1. combined hormone contraception pills
  2. Plan B (Progestin levonorgestrel )
  3. copper intrauterine devices
116
Q

How do combined hormone contraception pills work as an emergency contraceptive?

A
  1. Raises estrogen and progestin levels to delay or prevent ovulation
  2. Interfere with tubal transport of the embryo, egg, or sperm
  3. Changes uterine lining
117
Q

How does Plan B (Progestin levonorgestrel ) work as an emergency contraceptive?

A
  1. Progestin levonorgestrel (0.75mg each)

2. Most effective if first dose is taken within 72 hours of intercourse

118
Q

Menopause is termed the “__ __ __” event
It is a continuum from __ __ to __ __. IT is a permanent end of menstruation caused by decreased __ __ function .
Average age is around __.

A

“change of life”

no difficulty ; severe difficulty

ovarian function

50

119
Q

Symptoms of menopause:

A 
Irregular menstruation vasodilation
 hot flashes
sweating
 “heat” to upper chest, neck and head; flushing
 chills
loss of sleep
tachycardia
 Vaginal alterations: dryness and thinning. Decreased bone mass:  Osteoporosis
120
Q

__ is a stage when the body adapts to a new hormonal environment

A

Postmenopause

121
Q

During post menopause, production of __ and __ from the ovaries decrease

A

estrogen; progesterone

122
Q

Hormonal Therapy (HT) improves __ __ and __ __ . It also decreases the risk of __ and __ __.

A

vasomotor symptoms
vaginal dryness
osteoporosis
osteoporotic fractures

123
Q

What is the BOXED WARNING for Hormone Therapy (HT)?

A

HT should be used only for the treatment of menopausal symptoms, at the lowest dose possible, for the shortest duration possible, usually less than 5 years.

124
Q

HT includes __ and __

A

EPT ; ET

125
Q

What is EPT?

A

Estrogen-progestin therapy for use with women have an intact uterus

126
Q

What is ET?

A

Estrogen therapy (ET) for use with women who have had a hysterectomy

127
Q

What is a hysterectomy?

A

surgical removal of the uterus

128
Q

What are the contraindication to Hormone Therapy?

A 
Pregnancy
History of endometrial cancer
Personal history of breast cancer
History of thromboembolic disorders
Acute liver disease or chronic impaired liver function
Active gallbladder or pancreatic disease
Coronary artery disease (CAD)
Undiagnosed vaginal bleeding
Endometriosis
129
Q

Osteoporosis is a __ debilitating skeletal disease that affects __ men and women

A

progressive

older

130
Q

HT is no longer recommended for the treatment of __ but should be considered as a __ measure in postmenopausal women who are at risk

A

osteoporosis

preventive

131
Q

What slows bone reposition?

A

Biphosphonates

132
Q

What is used to treat osteoporosis in postmenopausal women?

A

Selective estrogen receptor modulators (SERMs) - such as raloxifene

133
Q

How do you prevent osteoporosis?

A
  1. Calcium
  2. Vitamin D
  3. Weight-bearing exercises
  4. Fall prevention
134
Q

What medications are used for treating osteoporosis?

A

(Bisphosphonates)

  1. Alendronate (Fosamax)
  2. Ibandronate sodium (Boniva)
  3. Risedronate (Actonel)
135
Q

Name 4 types of male reproductive agents

A
  1. Androgens: Testosterone being primary
  2. Anabolic Steroids
  3. Drugs for Sexual Dysfunction
  4. Masculinization: FTM (transmale)
136
Q

What is the main androgen?

A

testosterone

137
Q

Where is testosterone synthesized?

A

primarily in the testes and lesser extent in adrenal cortex

138
Q

What are the physiologic effects of androgens?

A
  1. Male sex hormones
  2. Sexual processes
  3. Accessory sexual organs
  4. Cellular metabolism (↑ RBC production)
  5. Bone and muscle growth (protein anabolism)
139
Q

What are the uses for testosterone?

A
  1. Hypogonadism
  2. Constitutional growth delay
  3. Treatment of refractory anemia
  4. Masculinization: FTM Transgender (transmale)
140
Q

What are the side effects of testosterone?

A
  1. Abdominal pain
  2. Nausea
  3. Constipation
  4. ↑ or ↓ libido
  5. Insomnia
  6. Headache
  7. Aggressive behavior
  8. Weakness
  9. Dizziness
  10. Pruritus
  11. Mouth soreness
141
Q

What are adverse reactions of testosterone?

A 
Acne
Hirsutism
Masculinization
Irregular menses
Urinary urgency
Gynecomastia 
Priapism 
Jaundice
Allergic reaction
Na+ & water retention
Depression
Habituation
Oily skin/hair
Testicular atrophy
Emotional lability (when used by women)
142
Q

What are 4 life-threatening reactions of testosterone?

A
  1. Hepatic necrosis
  2. Hepatitis
  3. Hepatic tumors (risk for liver cancer)
  4. Respiratory distress (and coughing)
143
Q

__ __ are testosterone derivatives that maximize __ and __ effects

A

Anabolic steroids

anabolic; androgenic

144
Q

There is an abuse potential of Anabolic steroids among

A

athletes and trainers

gay and bisexual adolescent boys

145
Q

Where can anabolic steroids be purchased? (5)

A
  1. grocery stores
  2. health food markets
  3. sports stores
  4. underground
  5. through internet
146
Q

What are the three types of erectile dysfunctions?

A
  1. organic
  2. psychogenic
  3. mixed
147
Q

What are the 4 types of ejaculation/orgasm disorders

A
  1. anejaculation
  2. dysorgasmia (painful orgasm)
  3. anorgasmia/retarded orgasm
  4. premature
148
Q

What are the two types of sexual incontinence

A
  1. arousal incontinence

2. climacturia

149
Q

What is climacturia?

A

when a man leaks urine as he ejaculates

150
Q

What is hirsutism?

A

unwanted, male-pattern hair growth in women like facial hair and chest hair

151
Q

What is gynecomastia?

A

enlarged breasts in men

152
Q

What is priapism?

A

when erect penis does not return to its flaccid state

153
Q

What is habituation?

A

the diminishing of a physiological or emotional response to a frequently repeated stimulus

154
Q

What is emotional lability?

A

a tendency to laugh or cry unexpectedly at what might seem the wrong moment

155
Q

What is the type of drug for sexual dysfunction? (erectile dysfunction)

A

Phosphodiesterase reuptake inhibitors

156
Q

What is one component of phosphodiesterase reuptake inhibitors?

A

cGMP

157
Q

What are 3 examples of phosphodiesterase reuptake inhibitors?

A
  1. Sildenafil (Viagra)
  2. Tadalafil (Cialis)
  3. Vardenavil (Levitra)
158
Q

What does cGMP do?

A

helps to relax smooth muscle which increases vasodilation and increases blood flow

159
Q

What does cGMP stand for?

A

cyclic guanosine monophosphate

160
Q

Sildenafil (Viagra) is a potent and selective reuptake inhibitor of __ in __ __

A

cGMP

corpus cavernosa

161
Q

Sildenafil (Viagra) restores __ __ . Onset of action is __ - __ min.

A

erectile response

60-120

162
Q

Sildenafil (Viagra) - potentiates __ __ of nitrates

A

hypotensive effects

163
Q

Sildenfail (Viagra) should be contraindicated if using any __

A

nitrates

164
Q

Contraindications of Sildenafil (Viagra) :

A
  1. CHF, cardiomyopathy, coronary artery disease
  2. Anatomic deformities
  3. Conditions predisposing to priapism
165
Q

What are the side effects of Sildenafil (Viagra)

A
  1. Headache (most common)
  2. Flushing
  3. Dyspepsia – GI distress
  4. Nasal congestion
  5. Diarrhea

*Report these promptly to HCP

166
Q

What are rare side effects of Sildenafil (Viagra)?

A
  1. Blurred vision
  2. Photosensitivity
  3. Changes in color perception
    Esp. blue & green
  4. Urinary tract symproms
    Frequency
    Painful urination
    Cloudy or bloody urine
167
Q

To achieve congruence with gender identity, hormones may be used to “____-___”. There are therapies called __ __ __ therapies ( __, __)

A

trans-gender

cross sex hormone

FTM, MTF

168
Q

Feminizing/masculinizing interventions have a __ spectrum of possibilities

A

wide

169
Q

MTF (transfemale) who take feminizing hormones may be at increased risk of __ __ compared to __ __ but significantly decreased risk compared to __ __

A

breast cancer

natal males

natal females

170
Q

It is important to monitor __ , ___ __, and ___ for people on cross sex hormone therapies

A

BP
vascular status
lipids

171
Q

What are the effects of hormone therapy for female to male: testosterone?

A
  1. Deepening of the voice
  2. Genital changes
  3. Irregular menses cessation of menses
  4. Clitoral enlargement
  5. Atrophic vaginitis (thinning/shrinking of the tissues, decreased lubrication)
  6. Increased libido
  7. Redistribution of fat from hips to waist
  8. Increased upper body strength (with exercise)
  9. Integument
    Male-pattern facial and body hair growth
    Male-pattern hair loss
  10. Psychological sense of well-being
172
Q

What are side effects of hormone therapy - FTM: testosterone?

A
  1. Acne
  2. headaches
  3. weight gain
  4. fluid retention
173
Q

What are risks of FTM hormone therapy (testosterone) ?

A
  1. Polycythemia (overproduction of red blood cells)
  2. hepatotoxicity (chemically driven liver damage)
  3. worsening of lipid profile (risks of coronary heart disease) and increased homocysteine (amino acid in blood related to heart disease) level
  4. emotional changes
  5. infertility
  6. insulin resistance
  7. osteoporosis
174
Q

What are the effects of male to female (MTF) hormone therapy? (estrogens & anti-androgens)

A
  1. Breast development
    Magnitude of enlargement is highly variable;
    size beyond B cup is uncommon
    Maximum effect after two years
  2. Integument
    Body hair diminishment
    Slowing, stopping, or reversal of androgenic hair loss
    Softening of the skin
  3. Fat redistribution (smaller waist, wider hips)
  4. Reduction in upper body muscle mass and strength
    May result in loose skin for a short time
  5. Psychological sense of well-being
  6. No effect on beard hair
    Electrolysis
175
Q

What are the genital changes of MTF hormone therapy (estrogen & anti-androgens)?

A
  1. Testicular atrophy
  2. Reduction in penis size
  3. Decrease in frequency and strength of erections
  4. Decrease in volume and content of semen
  5. Reduction in prostate size
176
Q

Is there an effect on the prominence of the larynx (adam’s apple) for a person on MTF hormone therapy?

A

NO

177
Q

Is there an effect on pitch and resonance of voice for a person on MTF hormone therapy?

A

NO

178
Q

What are the risks of MTF hormone therapy?

A
  1. thromboembolism (DVT)
  2. increased risk of breast cancer
  3. high levels of prolactin/tumors in pituitary gland
  4. liver damage
  5. cardiovascular risk
  6. infertility
  7. anxiety/depression
  8. gallstones
  9. hypertension
  10. osteoporosis
179
Q

What are the two types of drugs used for benign prostatic hypertrophy (BPH)?

A
  1. Alpha 1 blockers

2. 5-alpha-reductase inhibitors

180
Q

What is the mechanism of action for alpha 1 blockers?

A

relaxes the muscles around the prostate = less pressure on the urethra improving urinary flow.

Dilates arterioles and veins and relaxation of sympathetic effects on the bladder and urinary tract.

181
Q

What are the side effects of alpha 1 blockers?

A
  1. GI distress
  2. stuffy nose
  3. headache
  4. dizziness
  5. fatigue
  6. orthostatic hypotension
182
Q

What are 4 examples of alpha 1 blockers?

A
  1. Cardura/doxazosin
  2. Flomax/tamsulosin
  3. Uroxatral/alfuzosin
  4. Hytrin/terazosin
183
Q

What is the mechanism of action for 5-alpha-reductase inhibitors?

A

inhibits enzymes that converts testosterone to a potent androgen dihydrotestosterone (DHT), which the prostate glad need for its development.

“Shrinks” the prostate.

184
Q

What are the side effects of 5-alpha-reductase inhibitors?

A

↓ libido, impotence (due to ↓ DHT)

185
Q

What are two examples of 5-alpha-reductase inhibitors?

A
  1. Avodart/dutasteride

2. Proscar/finasteride)

186
Q

What is important to note for a person who is taking 5-alpha-reductase inhibitors?

A

Restrict blood donation for 6 months after last dose to prevent exposure of recipients

PHARM (3 decks)

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