Week 6 - Reproductive Drugs Flashcards
What are teratogens?
Substances that can cause developmental abnormalities
Teratogens can result in characteristic set of ______. Exerts effects at _____________.
Teratogens can result in characteristic set of malformations. Exerts effects at a particular stage of fetal development.
Cigarette smoking effect on fetus (2)
Intrauterine growth restriction, still birth
Alcohol effect on fetus (2)
Neurocognitive delay, miscarriage
Drugs with significant teratogenic or other adverse effects
ACE inhibitors, amphetamines, acutane, androgens, busulfan, cocaine, diazepam, ethanol, heroin, metronidazole, phenytoin, smoking, thalidomide, tetracycline, warfarin
Tetracycline effect on fetus
Limb reduction
FDA pregnancy categories - A
No risk
FDA pregnancy category A example
Anti-emetics
FDA pregnancy categories - B
No fetal risk in animal studies - no risk assumed in humans
FDA pregnancy categories - C
Fetal risk in animal studies - weigh risk vs benefit
FDA pregnancy categories - D
Proven fetal risk in human studies - weigh risk vs benefit if life-threatening
FDA pregnancy categories - X
Proven fetal risk in humans studies - the risk is greater than benefit, AVOID in pregnancy
Therapeutic Uses of estrogen and progestin (4)
- Menopausal hormone therapy
- Issues with period irregularity and symptom relief
- Anti-estrogen works against hormone responsive breast cancer, and can help with infertility
- Anti-progestin can induce medical abortion (RA46 pill) - only for pregnancies less than 7 weeks
Combined Hormone Contraceptives (CHC) are made up of…
Synthetic version of estrogen (Ethinyl estradiol) and progestin (natural or synthetic progesterone)
Progestins ____ out the badass effects of ______
Progestins balance out the badass effects of estrogen
How are combined hormone contraceptives differentiated?
By the STRENGTH of the estrogen and TYPE of progestin
CHC routes
PO, transdermal, transvaginal
CHC mechanism
Produce drug-induced anovulatory cycles by suppressing pituitary secretion of FSH and LH through negative feedback system
Progestins change the uterine ____ to make it less favorable for ____ of a fertalized ovum
Progestins change the uterine endometrium to make it less favorable for implanatation of a fertalized ovum
Progestins change the _____ and ____ of the cervical mucus, making it thick and hostile to ___ _____
Progestins change the quantity and viscosity of the cervical mucus, making it thick and hostile to sperm penetration
Progestins alter the motility of the fallopian muscles and mucus to “plug” the cervix, preventing _______
Progestins alter the motility of the fallopian muscles and mucus to “plug” the cervix, preventing movement of the ovum and sperm
Estrogen _____ the uterine ______ to inhibit proliferation and secretory changes – this ______ irregular and or heavy bleeding
Estrogen stabilizes the uterine endometrium to inhibit proliferation and secretory changes. This decreases irregular and or heavy bleeding.
What is the most commonly prescribed category of contraceptive? Why? (3)
CHC - easy to use, high degree of effectiveness, relatively safe
Higher the dose of estrogen, ____ risk for (3)
Higher the dose of estrogen, increased risk for VTE, MI, and stroke
Side effects of oral contraceptives (2)
Breakthrough bleeding - occurs during the active pill cycle
Withdrawal bleed - between cycles, not a real menstruation
Dangerous side effects of oral contraceptives - ACHES
A - abdominal pain C - chest pain/SOB H - headache, dizziness, weakness, numbness, speech difficulty E - eye disorder S - severe leg pain/swelling
Oral contraceptives assessment (4)
- Drug and herb use
- Baseline BP and weight
- Pregnancy status
- History of contraindications especially smoking and HTN
Monophasic
Fixed ratio every day
Most common type of oral contraceptive
monophasic
Biphasic
Fixed estrogen, progesterone amount varies
Triphasic
Newest, low doses, few side effects - either the estrogen or progesterone varies throughout the cycle in different ratios during 3 phases
Extended cycle
24 days of active therapy, 4 days of hormone free pills
Continuous
Continuous active therapy
What is drospirenone?
Progestin derived from spironolactone (instead of testosterone)
Drospirenone is used in combination with
Ethinyl Estradiol
Drospirenone can increase ____
Potassium
Drospirenone contraindications (9)
Kidney/liver/adrenal disease, NSAIDs, potassium-sparing diuretics, ACE inhibitors, potassium supplementation, Angiotensin II Receptor Antagonists (ARBs), heparin
What should you always check when giving Drospirenone
Serum potassium levels
Yasmin - classification, type, route
Estrogen Combined with DRSP, monophasic, oral BCP
Yaz - classification, type, route
Estrogen Combined with DRSP, extended cycle (24 days of active hormonal therapy)
Beyaz - classification, type route
Estrogen Combined with DRSP, extended cycle (24 days of active hormonal therapy + 4 days of hormone free pills); during the active pill cycle, contains folic acid to promote healthy folic acid levels
Hormone Therapy improves ____ symptoms and vaginal ___, _____ risk of _____ and ____ ______
Hormone therapy improves vasomotor symptoms and vaginal dryness, decreases risk of osteoporosis and osteoporotic fractures
HT boxed warning: HT should only be used only for the ____ of menopausal symptoms at the ____ dose possible for the ____ duration possible (usually less than ____ years)
HT should only be used for the treatment of menopausal symptoms at the lowest dose possible for the shortest duration possible (usually less than 5 years)
Estrogen-Progestin Therapy (EPT) should be used in women with…
An intact uterus
Estrogen Therapy (ET) should be used in women…
Who have had a hysterectomy (surgical removal of uterus) because estrogen thickens the uterine lining
Contraindications to HT (9)
Pregnancy, history of endometrial or breast cancer, history of thromboembolic disorders, active liver disease/chronic impaired liver function, active gallbladder or pancreatic disease, CAD, undiagnosed vaginal bleeding, endometriosis
Osteoporosis
Progressive, debilitating skeletal disease that affects the elderly
Is HT recommended for treatment of Osteoporosis?
NO
HT can be used as a preventative measure of osteoporosis in who?
Postmenopausal women who are at risk
What kind of medications can be used osteoporosis (2)? Mechanism?
- Biphosphates slow bone resorption
- Selective estrogen receptor modulators (SERMs)
Other methods of preventing osteoporosis
Vitamin D, calcium, weight baring exercise, fall prevention
What category of drugs is used for sexual dysfunction?
Phosphodiesterase
Phosphodiesterase mechanism
cGMP increases vasodilation and relaxation of smooth muscle to increase blood flow and strengthen erection (works mainly on corpus cavernosa)
Sildenafil (Viagra) - classification, onset, contraindications (6)
Phosphodiesterase
- 60 - 120 minutes onset of action
- Contraindicated if on nitrates (potentiates hypotensive effect), CHF, cardiomyopathy, CAD, anatomic deformities, conditions predisposing to priapism
Sildenafil side effects (5)
*H/A, flushing, dyspepsia (GI distress), nasal congestion, diarrhea
Sildenafil rare side effects (4)
Blurred vision, photosensitivity, changes in color perception (blue and green), urinary tract symptoms (frequency, painful urination, cloudy/bloody urine)
What is unique about Cialis?
It is longer acting
What are essentially important to monitor in transgender on HT (3)?
BP, vascular status, lipids
