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
1.11
Hormonal Contraceptives
| Term | Definition |
|---|---|
| benefits of hormonal contraceptives (8) | 1. decrease bone resorption (loss = osteopenia) 2. decrease non-cancerous changes 3. few ovarian cysts and benign breast changes 4. decreased cancer 5. ovarian and endometrial 6. prevention of ectopic pregnancy 7. decrease acne 8. decrease PMS |
| principles of hormonal contraceptives: constant non-physiological levels of estrogens and progestins suppress _____&_____ secretion | FSH and LH |
| Suppressing FSH and LH secretion prevents maturation of ________ | the dominant follicle (FSH) and ovulation (LH surge) |
| estrogen provides cycle control by stablilizing: | endometrium |
| estrogen and progestin effects prevent: | ovulation |
| progestins thicken: | cervical mucus |
| progestins prevent proliferative effects of estrogen on the _______________ reducing likelihood of ____________________ | endometrium, implantation |
| removal of progestin leads to the loss of the: | functional zone |
| Break through bleeding is reduced with: | estrogen |
| first generation of combined oral contraceptives | higher concentration of estrogens (>50ug day) and progestins (>1mg) estrogen led to increased risk of thromboembolism |
| second generation combined oral contraceptives | because of the side effects associated with higher doses of estrogen and progestin, the "modern pill" has less estrogens (20-35 ug/day) and progestins (levonorgestrel) |
| third generation combined oral contraceptives | similar to the 2nd generation except the type of progestin used has minimal androgenic side effects (but slightly higher risk of thromboembolic disease) |
| The combined pill contains: a synthetic estrogen | ethinyl estradiol or mestranol( prodrug of ethinyl estradiol) |
| The combined pill contains: variety of progestins | -gonanes: norgestrel, levonorgestrel, desogestrel, norgestimate -estranes: ethynodiol diacetate, norethindrone acetate -spironolactone derivative: drospirenone |
| The combined pill: monophasic | doses of estrogen and progestin stay approximately in the same throughout 21 days of pill |
| the combined pill: multiphasic | -doses of estrogen and progestin change during the menstrual cycle -types: biphasic, triphasic, 4-phasic |
| Triphasic combined pill | reduce the total exposure to both hormones and physiologic effects related to progestin component of oral contraceptives |
| why cant you just lower the progestin dose? | not an option since contraceptive effect may also be reduced |
| OCs common side effects | weight gain, nausea, acne, increased pigmentation (age spots), oily skin |
| estrogen excess | nausea, age spots, hypertension, migraine, breast tenderness, edema |
| estrogen deficiency | early breakthrough bleeding |
| progestin excess | increased appetite, weight gain, acne, oily scalp, hair loss, hirsutism, breast regression |
| progestin deficiency | mid-late cycle breakthrough bleeding |
| alternative formulations of the combined pill: 2 drugs | 1. transdermal patches (ORTHOEVRA, XULANE, XAFEMY) 2. Vaginal ring (NUVARING) |
| serious adverse effects of oral contraception | A.C.H.E.S. A-abdominal pain C-chest pain, shortness of breath, coughing blood H-headaches E- eye problems S- severe leg pain |
| symptom: abdominal pain | condition: gallstones, blood clot, pancreatitis |
| symptom: chest pain, shortness of breath, coughing blood | condition: blood clot in lung, myocardial infarction |
| symptom: headaches | condition: stroke, hypertension, migraine |
| symptom: eye problems | condition: stroke, hypertension, vascular occlusion |
| symptom: severe leg pain | condition: blood clot |
| risk of thromboembolism is small but increases with: | heavy smokers >35 yo obese women hypertensive women |
| transdermal preparations: risk of DVT | risk of deep vein thrombosis has been reported with some patch preparations |
| oral contraceptives in heavy smokers | -heavy smokers over 35 should not use oral contraceptives containing estrogen (estrogen increased production of pro-thrombotic factors) |
| oral contraceptives in light smokers | -light smokers, 20 ug dose estrogen formulations is acceptable since it doesn't appear to impact coagulation/clotting factors |
| oral contraceptives in smokers | progestin-only pills may be used when estrogen is contraindicated |
| oral contraceptives in hypertensive women | oral contraceptives are NOT acceptable (especially with end-organ damage) |
| oral contraceptives in hypertensive women drug | drospirenone-containg oral contraceptives (YASMIN) |
| drospirenone-containg oral contraceptives (YASMIN) | increases serum K+ levels in women using anti-hypertensives bc. of anti-aldosterone properties |
| patients with high levels of LDL | use pills with more estrogen then progesterone |
| Contraindications to COCs use | 1. history/presence of cardiovas. diseases (venous thromboembolism, MI, stroke, congenital hyperlipdidemia) 2.known/suspected carcinoma of breast/reproductive tract 3. known/suspected pregnancy 4. liver tumors/impaired liver function |
| progestin only pills: mini pill- is similar to but not as effective as: | the combined pill (suppresses FSH and LH to prevent follicle maturation and ovulation) |
| progestin only pills: mini pill- promotes: | thick cervical mucus that impedes sperm's progress |
| progestin only pills: mini pill-prevents: | proliferative effects of of estrogen on endometrium reducing likelihood of implantation |
| progestin only pills: mini pill- removal of progestin leads to: | the loss of the functional zone |
| progestin only pills: mini pill- break through bleeding is __________with estrogen | REDUCED |
| the mini-pill: advantages- is able to avoid: | estrogen-mediated side effects (headaches, hyper pigmentation, hypertension and changes in clotting factors) |
| the mini-pill: advantages- useful for which group of people: | smokers with history of cardiovascular disease |
| the mini-pill: advantages- non-contraceptive benefits: | decreased dysmenorrhea decreased bleeding protection against pelvic inflammatory disease endometrial cancer |
| the mini-pill: advantages- used in women who are: | breast feeding |
| the mini-pill: disadvantages: | strict compliance- NO MISSED DOSES to avoid failure of contraception (chance of ovulation cycles, need back up contraception) |
| long-acting Progestin-only contraceptive DRUG: | Depot medroxyprogesterone acetate (DMPA) |
| DMPA (long-acting progestin) common side effects: | menstrual irregularities, cessation of menses, weight gain |
| DMPA (long-acting progestin) cavoite of drug after you stop taking it: | infertility persists from months after stopping the drug |
| Pharmacokinetics and drug interactions of hormonal contraceptive pills- metabolized by: | hepatic cytochrome p450 enzymes |
| Pharmacokinetics and drug interactions of hormonal contraceptive pills- minimum effective doses of estrogen and progesterone are used for contraception, if increases: | CYP450 levels will increase clearance |
| Pharmacokinetics and drug interactions of hormonal contraceptive pills- what causes contraceptive failure: | enzyme-inducing drugs (rifampin, antiepileptic drugs: carbamazepine, phenytoin) |
| Pharmacokinetics and drug interactions of hormonal contraceptive pills- caused by antibiotic use: | altering enterohepatic recirculation (reabsorbed in intestine rather than being removed from body) |
| Emergency contraceptive DRUG | Plan B (levonorgestrel) |
| Emergency contraceptive DRUG (progesterone ANTAGONIST) | Mifepristone, Ulipristal |
| Termination of pregnancy: Mifepristone MOA | ANTAGONIST of progesterone receptors a prostaglandin (misoprostol) is administered after |
| Termination of pregnancy: Methotrexate with Misoprostol | methotrexate is toxic to trophoblastic tissue |
Created by:
megangodfrey97
Popular Pharmacology sets