Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Quiz 7
Reproductive
| Question | Answer |
|---|---|
| Forms of estrogen in birth control | Ethinyl estradiol most common |
| Mestranol | another form of estrogen that is coverted to ethinyl estradiol (50 mcg mestranol equivalent to 35 mcg of ethinyl estradiol) |
| Estradiol cypionate | for monthly IM injection (Lunelle) |
| True or False, there are not many forms of Progestin | False, there are MANY!!! |
| Estrogen mechanism | Supresses gonadotropin releasing hormone (GnRH)and Luteolysis |
| What does suppression of GnRH do? | decreases FSH and LH, supresses ovulation, and requires relatively constant levels (20-30mcg/d) |
| What does Luteolysis do? | decrease progesterone production and inhibit implantation |
| Progesterone Mechanism | Thickens cervical mucus, capacitation, slowed ovum transport and may inhibit ovulation |
| What does thickened cervical mucus do? | inhibits sperm penetration |
| What does capacitation mean? | Decreases sperm enzymes that facilitate fertilization |
| What does slowed ovum transport contribute to? | increased tubal pregnancies |
| How does progesterone inhibit ovulation | alters LH, FSH preovulatory surge |
| Major complications with estrogen | Venous thromboembolism, MI, Breast Cancer, Stroke, Hypertension, Hypertriglyceridemia, cholestasis, and liver disease. |
| Which BC pill is least likely to cause spotting | Ovral/Norgestrel (0.5) |
| Which BC pill is most likely to cause spotting | Demulen 50/Eth. Diacetate (1) |
| As you lower estrogen, the incidence of breakthrough bleeding increases, true/false | True, lower than 20mcg EE causes significantly increased bleeding. Most common reason women quit taking BC pills. |
| Pills with low bleeding | 30-35 mcg estrogen and neutral progestin (norethindrone, norethindrone acetate, or norgestimate) Examples of these: Ortho Novum 1/35 or 1/50 + generics, Ovcon 35, Ortho-Cyclen, Modicon + generics, and Ortho-Novum 7/7/7, give 3 month supply |
| Who should you give low dose estrogen pills to? | Patients at risk of thromboembolism, women over 40, obese women, <35 and heavy smokers > 1PPD, diabetic |
| patients on older anticonvulsants should receive? | 50 mcg estradiol because these medications will chew up some of the estrogen and make it ineffective. Ex dilantin, tegretol and phenobarbital |
| Side effects that will go away with time? | nausea, breakthrough bleeding, cramping, cyclic weight gain, breast tenderness |
| Excess estrogen problems | Hyper- or dysmenorrhea, bloating, cyclic weight gain, nausea, ad thrombotic events |
| estrogen deficiency problems | minimal or absent withdrawal bleeding, early spotting/bleeding (days 1-9), vasomotor symptoms, irritability |
| Progestin excess problems | increased appetite/non-cyclic weight gain, dereased flow duration, depression, hypertension |
| Progestin deficiency problems | Late spotting/bleeding (days 10-21), hyper or dysmenorrhea, bloating/nausea |
| Androgen excess | acne, hirsutism, cholestatic jaundice, and increased appetite, non/cyclic weight gain |
| Anti-mineralocorticoid ADEs | can cause hyperkalemia and orthostasis |
| Patient instruction for birth control pills | -start on first day of menses or first Sunday following menses -try to take at same time every day -use additional form of birth control for first cycle |
| If you miss three days of BC pill | take make up dose and use alternate birth control for 1 week |
| If miss three days in first week of pills | consider emergency contraception |
| If miss three days of BC pills in third week | just start a new pack |
| Emergency contraception | take within 72 hours, can be combined or progestin only |
| Plan B 0.75 mg Levonorgestrel, how far apart | 2 doses 12 hours apart |
| Combined | 100mcg EE, 0.5 mg levonorgestrel, 2 doses 12 hours apart |
| Missed period | if missed doses get pregnancy test, if none missed, get test on 2nd missed period |
| Seasonale, Seasonique, and Lybrel | Take these for very infrequent periods |
| Hormone replacement therapy HRT estrogen only | increase chance of uterine cancer |
| HRT estrogen plus progestin | decreases chance of uterine cancer |
| HRT androgen therapy | improves bone density, may increase energy and libido due to androgen effects |
| Be weary of prescribing which hormone with a long history of depression? | Progestin |
| Androgen side effect not reversible | deepening of the voice, will also worsen good cholesterol |
| If a woman has a uterus and requests HRT | you must use progesterone combination therapy, do not use estrogen alone. |
| If using estrogen for osteoporosis use | 0.625 mg of premarin |
| Transdermal estrogen good for compliance or: | hypertriglyceridemia |
| How long should you treat with HRT | 2-5 years because that is usually how long hot flashes last, going past this increases adverse side effects |
| Osteoporosis modifiable risk factors | Low calcium diet, high phosphate, caffeine, smoking, sedentary, medications (steroids, older anticonvulsants, levothyroxine, SSRIs, PPIs) |
| Osteoporosis non-modifiable | female, post-menopausal, age, race, family or personal history, small body frame |
| Anyone with a DEXA score less than this is considered osteoporotic | -2.5 |
| Osteopenia is defined by DEXA score of | -1.5 to -2.4 |
| Initiate therapy with FRAX score of higher than or equal to | 20% or greater than 3% risk for hip score |
| Calcium supplement | 1200 mg/d for prevention 1500 mg/d for treatment |
| Calcium sources | Calcium carbonate Calcium citrate |
| Calcium facts | Acidic pH increases absorption Addition of Vit. D (800 IU) increases absorption Maximum of 600 mg/dose absorbed |
| Calcium carbonate | 40% elemental calcium Most common OTC form |
| Calcium carbonate side effects | constipation, nausea Taking with food increases absorption |
| Calcium citrate | 21% elemental calcium more expensive side effects similar to carbonate Can be taken without regard to meals |
| Bisphosphonates | Alendronate (Fosamax) Risedronate (Acotonel) Ibandronate (Boniva) Zoledronic acid (Reclast) |
| Bisphosphonates pharmacology | inhibit bone resorption (osteoclast function) exact mechanism unknown |
| Bisphosphonate efficacy | increases bone mineral density by roughly 4-5% in one year rate of increase slows but continues for at least 10 years decrease vertebral fractures by 40-50% |
| Bisphosphonate side effects | GI discomfort, esophageal erosions, osteonecrosis of the jaw, atypical fractures |
| Bisphosphonate contraindications/warnings | Avoid in patients with esophageal abnormalities, caution with renal impairment, correct hypocalcemia or hypophosphatemia before initiation |
| Zoledronic acid (Reclast) | 5mg IV annually for treatment 5mg IV every other year for prevention |
| Denosumab and renal function | Tolerated slightly better than bisphosphonates with impaired renal function. |
| Denosumab major side effects | Dermatologic reactions infections, especially cellulitis correct hypocalcemia before initiation |
| positive of calcitonin | provides analgesia for bone pain |
| negative of calcitonin | does not help prevent hip fractures |
| Bisphosphonates gold standard because | most researched and most effective |
| Raloxifine good choice with | family history of breast cancer |
Created by:
1096147201
Popular Pharmacology sets