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Pharm- Contracept

contraception drugs

What estrogen is used in all COCs (+what kind of estrogen is it) Ethinyl estradiol, which is a synthetic estrogen
What form of progestin is used in COCs (that includes: 5 divided in 4 categories Synthetic: 1st gen - Estranes: norethinedrone, 2nd gen – Gonanes: levonorgestrel, 3rd gen – Gonanes w/o Andro : Desogestrel & Norgestimate, 4th gen – Spironolactone derivative w/ anti-andro and minero: Drosperin
What is diethylstilbestrol (+kind of compound) A drug not used anymore that “prevents” miscarriage. Stopped cause it also causes cancer and infertility in offspring. Diethylstilbestrol is a non-steroidal estogen
What is medroxyprogesterone (2 uses, kind of compound) Used in both hormonal replacement and depot (IM long-term release) contraception. It is a chemically modified progestin
COC are made of (2, general) 1.Synthetic estrogen (ethinyl estradiol), 2.Synthetic progestin
HRT are made of (2~3) 1.Conjugated Equine Estrogen (equilin sulfate, estrone sulfate), 2.Chemically modified progestin (medroxyprogesterone)
What phase of the menstrual cycle are COC trying to mimic Luteal phase
Why are COC trying to mimic the luteal phase Luteal phase has high E and high P, which prevents the release of GnRH, LH and FSH
By preventing the surge in LH and FSH (especially LH) of the luteal phase, COC prevent: Ovulation
What predominates in COC: E or P (be precise) P which is in mg, E is in µg
Which of E or P has much more complicated interaction in the body (explain 4 things) E only binds ER. P binds PRs but also to a lesser degree AR (androgen), ER, GR (glucocorticoid). Furthermore PR are dependent on some E.
What is one explanation for P to be so promiscuous with other receptors P is a the beginning of the pathways to make E (estradiol), A (testosterone), and G (cortisol)
What are the effects of estrogen on the body (9) 1.secondary sex, 2.ovulatory cycle, 3.pregnancy, 4.increase thrombosis, 5.hypertension (increase Na retention), 6.Increase TGs, HDL, decrease LDL (no net effect), Stimulate cell proliferation: 7.breast cancer, 8.uterine (endometrial) cancer, 9.vasodi
What are the effects of progestin on the body (2) 1.booby development, 2.maintains pregnancy (w/o P: lining softens like at the end of menstrual cycle)
The increase in thrombosis w/ E can lead to (1~2) DVT then PE
Discuss the potency of the different types of E (3) Synthetic > Conjugate Equine > Natural
Discuss the absorption of E Good/rapid
Why aren’t natural E not used in COC or HRT (2) 1st pass effect is huge (has to be IV) + short T1/2
What is the only pharmacokinetic difference btw conjugated equine and synthetic Synthetic have even longer T1/2 (they both have low first pass effect and can be taken orally)
Discuss the metabolism of estrogen (5) Mostly in the liver: 1.-OH by P450, 2.conjugated to glucoronide, 3.E-glucoronide is extred in bile, 4.cleaved by bacteria back to E, 5.reabsorbed - remember this is called enterohepatic circulation
How can antibiotics use prevent the proper functioning of contraceptive Block bacteria cleaving of E-glucoronide, thus E is excreted and you get lower serum levels
What other drug greatly influence E levels Dilantin (in epileptic patients) activates Cyp 3A4, and thus decrease E levels
What has been the trend in the past 50 years in terms of COCs (2) Decrease the amounts, and use mutliphasic COCs
What was the 1st generation of COCs problem Blood clots
What was the 2nd generation’s COCs name + 2 problems Sequential. They did not work well (too little P), and caused endometrial cancer
What was the 3rd gen’s COCs name Lo-dose
What is the current 4st gen COCs Multiphasic (to lower P levels)
What are OCs with only P called (2) POPs or minipills
What is the dosing range of E in COCs 20 to 50 μg
Name the P used in COCs in order of potency (4, don’t include drosperinone) LNG > DSG > NGM > NE
What is the advantage of triphasics 15% less exposure to P
When are monophasics preferred (2) 1.late-cycle bleeding (need more progestin), 2.mood-swings on tri-cyclics
Usually COCs are started with average amounts on E (30μg), when is this not the case Fat women probably need more E
What is the usually cycle of monophasic COCs, in terms of taking the pill 21 days on, 7 days off
What is the point of starting the pill of Sunday No periods during the weekends
What are the 3 ways to start the pill 1.Day 1 start (1st pill on 1st day of period), 2.Sunday Start, 3.Quick start (in doctor’s office)
What is the advantage of Day 1 start You don’t need to use backup contraception for any time (you need 1 week for Sunday Start and Quick Start)
What should do if they missed one pill Take two the next day
What should one do if they missed 2 pills If week one or two: take two pill, then two pill again the next day. Supplement with a week of backup. If week three: start new pack (+ one week backup)
What P is used in POP (2) Norethindrone or norgestrel
What doses are used in POP The lowest needed for efficacy
What is very important with taking POP You need to take it at the same exact time very day.
What is a very common time in a women life, when she would be told to use a POP Lactating mother, the E in COCs can lead to vaginal bleeding in girls and gynecomastia in males
Other than POP (minipills) what are other P only contraceptions (3) (+ duration of each + P used in each) 1. Depot shot (IM, medroxyprogesterone) – 3 months, 2. Implanon (subdermal implant, etonorgestrel) – 3 years, 3. IUD (levonorgestrel) – 5 years
What are the AE of P only OC (5 + 3 specific to one kind) 1.higher failure, 2.irregular bleeding, 3.some women get amenorrhea (think they are pregnant), 4.acne (P activates AR), 5.depression, Depo-provera also has: 1.bone loss, 2.weight gain, 3.return to fertility delayed
How do COC and P-only prevent pregnancy (3) 1.inhibit ovulation by inhibiting LH and FSH level, 2.they thicken the mucosa (physical barrier to sperms), 3.they alter the mucosal lining (sperm can’t stick)
How many COCs can you miss before being at risk More than 2 and you are at risk
How many P-only can you miss before being at risk Only be 3 hours late and you are at risk
Other than preventing pregnancies what are the other benefits of COCs (5~6) 1.decrease ovarian cancer, 2.decrease endometrial cancer (thx to P, E does increase), 3.decrease fibrocystic disease/fibroadenomas, 4.decrease PID (blocks sperm and infections from sticking and passing through), 5.lower blood loss during menses, ~6
What is the greatest AE of COCs (think back about the AE of E & P) (+ thus who should not get COCs) Thrombosis, thus be careful or do not use in women older than 35 and smokers (this is due to Estrogen)
Other than thrombosis the main AE of COCs are: (5 for E, 3 for P – include name of drug for P) Estrogen: 1.breast cancer, 2.hypertension (temporary), 3.gall bladder disease (stones, E increases stasis), 4.CVD/stroke, 5.cervical dysplasia/cancer Progesterone: 1.change HDL/LD
When is the increase in risk for breast cancer the highest when talking COCs If taken before 1st pregnancy (remember: lifetime exposure to E is the reason for breast cancer)
What drug is linked to increase CVD/stroke risk in women taking COCs Levonorgestrel
What two thinks correlate strongly with cervical cancer Smoking, HPV
What are the mild AE of COCs (1 for E, 2 for P) Estrogen: fluid retention (due to Na retention effect), Progesterone: acne/weight gain (androgen effects
Separate the bleeding cause by E deficiency and P deficiency: E deficiency: early bleeding, P deficiency: late bleeding
What are the contraindication for COCs, (10) which ones can be fixed by using P-only (8) 1.Hx of clots, 2.>35+smoke, 3.Hx of stroke/MI/CVD, 4.Hypertension, 5.Migraines, 6.Has to go through surgery (clots), 7.Lactating/had pregnancy, 8.high TGs, 9.has hormone sensitive cancer, 10.predispose for booby cancer
What is newer about Yasmin/Yaz (include 1 AE, and 1 advantage) P is drospirenone, which is antimineralcorticoid thus less fluid retention. However K can become high.
Difference btw Yasmin and Yaz Yaz is 24/4 schedule thus shorter period and thus less PMDD and less Acne
Describe orthe-evra (+ 1 contraindication + 1 AE) It is patch (21/7). Does not work as well in heavy women, increase risk for clots.
Describe nuvaring Ring (21/7)
What is the morning after pill (also called) (what is the timeline) 2 pills containing High dose levo, also called Plan B. you have 72hrs after event (this is not an abortion pill, no ovulation, no implementation)
What is RU-486 (also called) (timeline) Mifepristone, you have 49 days
What are the two extended cycle COCs, what is their 2 uses Seasonale and lybrel: prevent painful periods/excessive bleeding as well as PMDD
Created by: mcafej02