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Quiz 7


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



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