Women and Men's Health Flashcards
Estrogen
Estrogen is highly present in days 1-14 of menstrual cycle (follicular phase), helping increase levels for egg release
DRUG NAMES: estradiol (one human body uses), ethynyl
Estrogen MOA
MOA: Binds to estrogen receptors (intranuclear) and regulates gene expression
Uses: contraception, uses commonly with progestin
- osteoporosis, acne, menorrhagia
Routs: oral, transdermal, IV, parenteral
Progestin
progesterone
-Highly present in days 14-28 of menstrual cycle (luteal phase) to prepare body for pregnancy
Used for:
contraception (alone or in combo with estrogen)
-combination with estrogen post menopause
Progestin Drugs (5)
medroxyprogesterone [Provera]
norgestrel [Ovrette]
norethindrone [Camilla]
drospirenone [Yaz]
lovonorgestrel [Seasonal]
Oral Contreceptives (OC)
MOA: inhibits ovulation, underlying mechanism unknown
Classifications of OC’s (2)
progestin-only OC’s (minipills)
combination OC’s (COCs)
OC’s AE
N/V
DVT
HTN
headache
weight gain
depression
cancers
OC’s Drug Interactions
antibiotics, HIV drugs, antiepileptic drugs (phenytoin, carbamazepine), smoking, St Johns Wart
Drugs whose effects are increased by OCs: theophylline and imipramine
Drugs whose effects are decreased by OCs: warfarin
Yaz and Yazmin (ethinyl estradiol + drospirenone)*
newer synthetic progestin with anti-mineralocorticoid activity
AE: Same AE of OC, increased risk of blood clots, hyperkalemia
Indicated for:
-Oral contraception
-treatment of moderate acne
-Symptoms of PREMENSTRUAL DYSPHORIC DISORDER
OC’s extended cycle
ethinyl estradiol/levonorgestrel [Seasonique*,seasonale] - 3 mo.
ethinyl estradiol/levonorgestrel [Lybel] - 12 mo.
Combination contraceptives w/novel delivery systems (2)
transdermal contraceptive patch [Ortho-eva] = ethinylestradiol + norelgestromin
vaginal contraceptive ring [Nuvaring] = ethinylestradiol + etonogestrel
Long acting contraceptives
contain progestin only
Drugs: depot medroxyprogesterone acetate (MPA)- IM, subq
IUD device:
-Levonorgesterl releasing intrauterine system [Mirena] *
AE: increased risk of HTN, increased risk of blood clots, birth defects, thromboembolism,
Emergency contraception (EC)
MOA: may prevent ovulation but effectiveness late in cycle suggests other mechanisms
Plan B One Step:
-PROGESTIN ONLY: levonorgesterl 1.5mg as a single dose
-Administer within 72 hours of intercourse
2-dose regimen:
-2 doses of 0.75mg levonorgestrel separated by 12 hours
-First dose within 72hr, 2nd dose 12h after
Drug for Medical Abortion
Mifepristone (RU486) [Mifeprex]
MOA: partial agonist of progesterone receptor -> blocks uterine progesterone receptors -> detachment of the conceptus -> terminate pregnancy
AE: vaginal bleeding, abd. pain, N/V, diarrhea, headache
Drug that promote follicular maturation
Clomiphene citrate [Clomid]
MOA: partial agonist of of estrogen R -> blocks estrogens R -> inhibit feedback effect of estrogen on pituitary gland -> increase secretion of FSH and LH which stimulate ovary -> promote follicular maturation and possibly ovulation
AE: hot flushes, N/V, breast engorgement, 10% multiple births (twins)
Drug that stimulate ovulation
Human chorionic gonadotrophin (hHCG) [Pregnyl, Novarel]
MOA: promote follicular maturation and ovulation
uses: infertility therapy due to anovulation
AE: ovarian hyperstimulation syndrome, multiple births
Alternatives for HT for women w/multiple risk factors
phytotherapy: black cohosh
Paroxetine [Brisdelle]
Drug for Hormone Therapy
conjugated estrogens (peramin)
- can be used in combinations w/medroxyprogesterone MDP [Provera]
estradiol micronised [Estrace], transdermal therapy estradiol [Vivell-Dot]
estrogen/progestin combo (estradiol + norethindrone) [Activella]
HT- Regimen
Continuous: estrogen + progestin administered continuously (no monthly bleeding)
Sequential: estrogen from day 1-28 and progestin added on days 14-28 (for monthly bleeding)
HT and Menopause
Hormonal therapy can be used to decrease symptoms, prevent osteoperosis and fractures, and prevent colorectal cancer
AE of therapy include: CV events (MI, stroke, PE, DVT), breast cancer, ovarian cancer, urinary incontinence
When used in combination with progestin, there is a decreased risk of endometrial cancer than using JUST estrogen alone
DO NOT GIVE IN:
-Undiagnosed vaginal bleeding, anything with blood clots, breast cancer, migraine, etc
Calcium and Vitamin D
Calcium carbonate -> has higher elemental calcium, has acid-dependent absorption (take with OJ), can be taken with or with Vitamin D
Calcium citrate - better absorption but less elemental calcium.
cholecalciferol -> vitamin D3, taken with Ca+
Ca+ needs Vit. D for absorption - D3 (cholecalciferol)
Antiresorptive therapy
drugs that reduce bone resorption
Bisphosphonates -> first line in most patients
MOA: kills osteoclasts (which break down bone) -> increase bone mineral density more than estrogens and raloxifene
Drugs: alendronate [Fosamax], ibandronate [Boniva]
AE: hypocalcemia, back pain, take on empty stomach, N/V, heartburn, ulcers
Antiresorptive therapy II
Estrogen [Premarin] (no longer used)
raloxifene [Evista]
denosumab [Prolia] - monoclonal antibody that binds to RANKL and prevents osteoclast formation -> decreased bone resorption -> increase in bone mass
Bone forming therapy
Drugs that promote bone formation
Teriparatide [Forteo] - recombinant human PTH, for patients at high risk of fracture
MOA: increase activity of osteoblast and decrease osteoclast
AE: ortho hypotension
BBW: osteosarcoma
Androgens
Testosterone - management of androgen deficiency in males
Oxandrolone - treatment of muscle mass loss in AIDS patients
Erectile Dysfunction
phosphodiesterase 5 inhibitor I (PDE5):
MOA: increase cGMP -> increase erectile response to sexual stimuli
sildenafil [viagra] or [Revatio]
PDE5 inhibitors II:
MOA: similar to viagra
tadalafil [Cialis] (longer half life)
Indications: ED, BPH, pulmonary hypertension **** (QUESTION APPARENTLY)
Erectile Dysfunction Drug AE
AE: hypotension, priapism (condition where penis wont return to flaccid state), ototoxiciy, dont take with nitrates or with BB
Selective estrogen receptor modulators or SERMs, partial ER agonists
Tamoxifen [Nolvadex]
Toremifene [Fareston]
Pure estrogen receptor antagonist
Fulvestrant [Faslodex]
Aromatose Inhibitors
Anastrozole [Arimidex]
Exemestane [Aromasin]
Trastuzumab [Herceptin]
monoclonal antibody for IV therapy of metastatic breast cancer -> anti-HER2 -> blocks HER2 receptors
Drug for prostate cancer
Leuprolide [Lupron] - GnRH agonist
Flutamide [Eulexin] - androgen receptor blockers
Bicalutamide [Casodex] - androgen receptor blockers
