Women's Health Flashcards by Nancy Hu

What are the oestradiol formulations for HRT available in NZ? (4 points)

oral tablet
nasal spray [discontinued]
vaginal tablet
transdermal patches

How well did you know this?

Not at all

Perfectly

What are the brands of transdermal oestradiol patches (4 points)

Estroderm
Climara
Femtran
Estrodot

How well did you know this?

Not at all

Perfectly

What are the main components of Estraderm TTS? (4 points)

Estradiol containing reservoir
Release controlling membrane
Adhesive backing
protective liner

How well did you know this?

Not at all

Perfectly

Can a estraderm TTS be halved?

-no as halving it would damage the release controlling membrane.

How well did you know this?

Not at all

Perfectly

What are the main differences between the stengths of Estroderm TTS? (4 points)

Nominal rate of estradiol release
Content of estradiol
Drug releasing area
Imprint

How well did you know this?

Not at all

Perfectly

How does norminal rate of estradiol release differ between the estraderm patches? (3 points)

Estraderm TTS 25 releases 24mcg/day
Estraderm TTS 50 releases 50mcg/day
Estraderm TTS 100 releases 100mcg/day

How well did you know this?

Not at all

Perfectly

How does the content of estradiol differ between the estraderm patches? (3 points)

estraderm TTS 25 contains 2mg
Estraderm TTS 50 contains 4mg
Estraderm TTS 100 contains 8mg

How well did you know this?

Not at all

Perfectly

How does the drug releasing area differ between the estraderm patches? (3 points)

estraderm TTS 25 releases over 5cm^2
estraderm TTS 50 releases over 10cm^2
estraderm TTS 100 releases over 20cm^2

How well did you know this?

Not at all

Perfectly

How long is the release of the active substance maintained for?

-4 days

How well did you know this?

Not at all

Perfectly

How long does it take for the patches to reach steady state concentration? (2 points)

8 hours after administration of any sized patch

- this concentration is maintained for the duration of the treatment

How well did you know this?

Not at all

Perfectly

What are the key points for administration of estroderm TTS? (4 points)

remove protective liner
immediately apply patch to clean, dry and intact area of skin
select an area that will not be exposed to sunlight and which undergoes minimal wrlinking during normal movement
rotate areas of application

How well did you know this?

Not at all

Perfectly

What symptoms are affected by progesterone therapy? (4 points)

hot flushes
endometrial protection
bone mineral density
improved lipid profile

How well did you know this?

Not at all

Perfectly

What are the effects of the oral progesterone formulations? (4 points)

unknown effect on HF
positive effect on endometrial protection
unknown effect on BMD
Positive effect on lipid profile

How well did you know this?

Not at all

Perfectly

What are the effects of vaginal progesterone formulations? (4 points)

unknown effect on HF
positive endometrial protection
unknown effect on BMD
unkonwn effect on lipid profile

How well did you know this?

Not at all

Perfectly

What are the effects of transdermal progesterone formulations? (4 points)

positve effect on HF
Positive effect on endometrial protection
Positive effect on BMD
No effect on lipid profile

How well did you know this?

Not at all

Perfectly

what are the issues related to transdermal progesterone? (5 points)

Lack of data on risks/beneits
transport not fully understood
no standardisation of formulations due to limited comparative data
lack of knowledge on dose response relationships
low bioaailability due to metabolism by 5-alpha-reductase in the skin

What was the formulation which helped to prevent progesterone metabolism in the skin? (1 point)

Dutasteride cream which contained a 5-alpha reductase inhibitor

How is post menopausal OP treated? (3 points)

calcium
vitamin D
bisphosphonates (Alendronate)

What are the physicochemical characteristics of alendronate? (3 points)

water solubility 10mg/mL
various pKa values of phosphate groups
largely ionised in GIT

What are the pharmacokinetics of alendronate? (5 points)

-oral bioavailability

what is the issue with alendronate generics? (3 points)

due to additives in the generic formulation, mucoadhesiveness occurred
this caused esophageal adhesiveness and irritation especially in patients who ingest little water or who recline shortly after taking the dose
fosamax showed little or no bioadhesion

What are the different contraceptive methods? (6 points)

Non pharmacological methods
oral
nasal
IUD
depot injection
implants (norplant, Jadelle, implanon)

What is Mirena? (5 points)

IU system which is long acting reversible contraceptive
contains 52mg Levonorgestrel
Indicated for contraception, menorrhagia, HRT
fitted by medical doctor
PHARMAC funded by SA with conditions around menorrhagia, not funded for contraception alone

How does Mirena work? (3 points)

there is a hormone elastomer core mounted on the vertical stem of a T body
covered with opaque tubing which releases levonorgestrel
Release rate is 20mcg/24 hours which declines to 10mcg/24 hours after 5 years

Why is the dosing in Mirena lower than oral tablet (30mcg)? (1 point)

-the oral tablet has to have enough levonorgestel to account for first pass metabolism, elimination etc.

What are the local effects of mirena?

- thickens normal mucous in cervical canal so sperm cannot enter uterus to fertilise egg - inhibits normal sperm function and movement preventing fertilisation - reduces monthly growth of the lining of uterus making period lighter and preventing pregnancy.

What is depo-provera? (3 points)

- IM depot injection - Medroxyprogesterone acetate oily suspension - administered ever 12-13 weeks

Why is depot provera formulated as a suspension? (4 points)

- in a suspension there is a equilibrium between solid particles and liquid phase - in the liquid phase particles can migrate out of the depot and have effect on the body - Where particles have migrated out, the equilibrium wil allow more solid particles to dissolve - essentially the suspension is the method of controlled release.

What is Norplant? (3 points)

- older implantable contraceptive technology first approved in finland 1983, then USA 1990 - SR levonorgestrel providing contraception for 5 years - release rate slow decreases from 85ug/day in the 1st month to 30ug/day by the 60th month

What is Jadelle? (5 points)

- Subdermal implant containing 2 x 75 mg levonorgestrel - flexible rods 43mm in length and 2.5mm in diameter - funded in NZ - provides contraception for up to 5 years - Removeable with minor procedure

How does the rate of levonorgestrel release differ with its duration for Jadelle? (4 points)

- after 1 month, 100mcg/day - end of 1 year, 40mcg/day - end of 3 years, 30mcg/day - end of 5 years, 25mcg/day

What is the newer implantable contraceptive device? (7 points)

- implanon was first approved in indonesia 1998, followed by USA in 2006 - contains etonogestrel release providing contraception for 3 years - single stiff rod - marketed as easier to insert and remove - registered in NZ but not currently funded - each rod is 4cmx 2mm - rate or release decreases over 3 years, but sufficient to cover for 3 years

What are the current options for male contraception? (3 points)

- condoms - withdrawal - timing of female cycle - vasectomy

What are the potential issues with oral male contraceptives? (2 points)

- women don't trust men to take a pill every day | - men nervous of contraceptive pill having witnessed the evolution of the female oral contraceptive

What are the aims of male contraceptives? (2 points)

- prevent sperm from reaching the egg | - prevent sperm from fertilising the egg

What are the approaches towards male contraception? (4 points)

- hormonal suppression of spermatogenesis - non hormonal suppression of spermatogenesis - blocking sperm functions needed for fertilisation - immunocontraceptive approaches

What are the limitations with male hormonal contraception? (4 points)

- more difficult to achieve azospermia in men than anovulation in women - Sex hormones can be administered to lower sperm count however also reduces testosterone production having its own adverse effects - small pilot studies have been able to achieve azoospermiea however no hormonal contraceptive is ready for clinical use.

What are the considerations for moving towards male contraception? (4 points)

- ideally a pill with low frequency of administration required - minimal side effects - non-hormonal medicines may be preferred - needs to be a shift in contraceptive culture and responsibility and acceptability needs to be shared.