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Pharmacy 408 pharmaceutical lectures > Women's Health > Flashcards

Women's Health Flashcards

1
Q

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

A
  • oral tablet
  • nasal spray [discontinued]
  • vaginal tablet
  • transdermal patches
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2
Q

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

A
  • Estroderm
  • Climara
  • Femtran
  • Estrodot
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3
Q

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

A
  • Estradiol containing reservoir
  • Release controlling membrane
  • Adhesive backing
  • protective liner
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4
Q

Can a estraderm TTS be halved?

A

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

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5
Q

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

A
  • Nominal rate of estradiol release
  • Content of estradiol
  • Drug releasing area
  • Imprint
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6
Q

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

A
  • Estraderm TTS 25 releases 24mcg/day
  • Estraderm TTS 50 releases 50mcg/day
  • Estraderm TTS 100 releases 100mcg/day
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7
Q

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

A
  • estraderm TTS 25 contains 2mg
  • Estraderm TTS 50 contains 4mg
  • Estraderm TTS 100 contains 8mg
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8
Q

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

A
  • estraderm TTS 25 releases over 5cm^2
  • estraderm TTS 50 releases over 10cm^2
  • estraderm TTS 100 releases over 20cm^2
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9
Q

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

A

-4 days

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10
Q

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

A
  • 8 hours after administration of any sized patch

- this concentration is maintained for the duration of the treatment

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11
Q

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

A
  • 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
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12
Q

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

A
  • hot flushes
  • endometrial protection
  • bone mineral density
  • improved lipid profile
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13
Q

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

A
  • unknown effect on HF
  • positive effect on endometrial protection
  • unknown effect on BMD
  • Positive effect on lipid profile
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14
Q

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

A
  • unknown effect on HF
  • positive endometrial protection
  • unknown effect on BMD
  • unkonwn effect on lipid profile
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15
Q

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

A
  • positve effect on HF
  • Positive effect on endometrial protection
  • Positive effect on BMD
  • No effect on lipid profile
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16
Q

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

A
  • 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
17
Q

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

A

Dutasteride cream which contained a 5-alpha reductase inhibitor

18
Q

How is post menopausal OP treated? (3 points)

A
  • calcium
  • vitamin D
  • bisphosphonates (Alendronate)
19
Q

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

A
  • water solubility 10mg/mL
  • various pKa values of phosphate groups
  • largely ionised in GIT
20
Q

What are the pharmacokinetics of alendronate? (5 points)

A

-oral bioavailability

21
Q

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

A
  • 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
22
Q

What are the different contraceptive methods? (6 points)

A
  • Non pharmacological methods
  • oral
  • nasal
  • IUD
  • depot injection
  • implants (norplant, Jadelle, implanon)
23
Q

What is Mirena? (5 points)

A
  • 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
24
Q

How does Mirena work? (3 points)

A
  • 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
25
Q

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

A

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

26
Q

What are the local effects of mirena?

A
  • 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.
27
Q

What is depo-provera? (3 points)

A
  • IM depot injection
  • Medroxyprogesterone acetate oily suspension
  • administered ever 12-13 weeks
28
Q

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

A
  • 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.
29
Q

What is Norplant? (3 points)

A
  • 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
30
Q

What is Jadelle? (5 points)

A
  • 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
31
Q

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

A
  • after 1 month, 100mcg/day
  • end of 1 year, 40mcg/day
  • end of 3 years, 30mcg/day
  • end of 5 years, 25mcg/day
32
Q

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

A
  • 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
33
Q

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

A
  • condoms
  • withdrawal
  • timing of female cycle
  • vasectomy
34
Q

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

A
  • 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

35
Q

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

A
  • prevent sperm from reaching the egg

- prevent sperm from fertilising the egg

36
Q

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

A
  • hormonal suppression of spermatogenesis
  • non hormonal suppression of spermatogenesis
  • blocking sperm functions needed for fertilisation
  • immunocontraceptive approaches
37
Q

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

A
  • 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.
38
Q

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

A
  • 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.

Pharmacy 408 pharmaceutical lectures (5 decks)

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