Estrogens and Progestins
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| Selective Estrogen Receptor Modulators (SERMs) | active in some tissue and block estrogen receptors selectively in others, provide benefits of estrogens w/o side effects
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| Tamoxifen | blocks some ERs adn activates others, used for breast CA, inhibits cell growth in the breast, protect against osteoporosis
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| Tamoxifen side effects | hot flashes, increase risk for endometrial CA and thromboembolism
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| Raloxifene | similar to tamoxifen but does not activate estrogen, protects against breast CA and osteroporosis and promotes thromboembolism and hot flashes
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| Duavee (conjugated estrogens/bazedoxifene) | bazedoxifene component reduces risk of excessive growth of uterine lining, decreased risk for endometrial CA
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| Progestin Adverse Effects | teratogenic effects, gynecologic effects, breast CA, depression, breast tenderness, bloating
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| Progestin uses | postmenopausal HRT, dysfunctional uterine bleeding, amenorrhea, infertility, prematurity prevention, endometiral CA and hyperplasia
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| Menopausal Hormone Therapy (MHT) benefits | provides relief of vasomotr symptosm, mgmnt of urogential atrophy, prevent osteopoorsis, cardioprotection, prevent colorectal CA, positive effect on wound healing, tooth rentention, glycemic control
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| Menopausal Hormone Therapy (MHT) risks | MI, stroke, PE, DVT, endometrial CA, breast CA, Ovarian CA, gallbladder disease, dementia, urinary incontinence
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| Estrogen & Progestin therapy | inhibits ovulation by suppressing release of FSH and LH, thickens cervical mucous and alter endometrium making conditions unfavorable for implantation
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| Monophasic OC | dose of hormones remain constant
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| Multiphasic OC | dose of hormones vary
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| Adverse effects of OC | thromboembolic disorders, HTN, CA, stroke, teratogenic effects, abnl uterine bleeding, benign hepatic adenoma, glucose intolerance
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| Antibiotics that interact with OC | rifampin, ampicillin/amoxicillin, tetracycline, erythromycin
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| Antifungals that interact with OC | griseofulvin
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| Antiepileptics that interact with OC | phenytoin, carbamazipine, phenobarbitol
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| Other drugs that interact with OC | theophylline, st. John's wort
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| Progestin-only OCs | Camila, Errin, Heather, Jolivette, Ortho Micronor, Nor-QD, and Nora-BE
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| Effects of Progestin-only OCs | do not cause thromboemoblic disorders, HA, nausea, safer than combo therapy, less-effective, may cause irregular bleeding
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| Estrogen preparations | Ethinyl estradiol, mestranol and estradiol valerate
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| Drospireone | progestin that antiandrogen action
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| Levonorgestrel & Norgestrel | progestins that have greater androgenic effects
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| Leveonorgestrel | progestin only emergency contraceptive, taken w/in 72hrs, act before fertilization and implantation to delay or stop ovulation
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| Ullipristal Acetate (Ella) | emergency contraceptive works by preventing conception by suppressing ovulation, remains effective up to 5 days
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| Mifepristone (Ru 486) w/misoprostol | used for medical abortion, blocks uterine progesterone receptors, utltimately results in expulsion of conceptus
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| Mifepristone (Ru 486) w/misoprostol adverse effects | bleeding, cramping, nausea, vomiting, diarrhea, HA
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| Mifepristone (Ru 486) w/misoprostol Contraindications | ectopic pregnancy, hemorrhagic disorder, use of anticoagulant drugs, and adrenal insufficiency
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| Prostaglandins | act like local hormones and cause uterine stimulation and cervical softening
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| Uses for prostaglandins | induction of abortion, cervical ripening before induction of labor, and control of postpartum hemorrhage
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| Prostaglandin agents | misoprostol (cytotec), Carboprost (Hemabate), Dinoprostoine (Cervidil)
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| Clomiphene (Clomid) | used to promote follicular maturation and ovulation, blocks receptors for estrogen
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| Menotropins (Repronex, Meopur) | used in conjunction with hCG to promote follicular maturation and ovulation in anovulatory patients, causes ovarian hyperstimulation syndrome and multiple births
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| Gosrelin (Zoladex) | used to thin the endometrium
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| Bromocriptine (Parlodel) & Cabergoline (Dostinex) | used to correct amenorrhea and infertility, activates dopamine receptors, inhibits prolactin release, normalization of menstrual cycle
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| Follitropins | used in infertility tx, promote follicular maturation, stimulate ovulation
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| Adverse effects of Clomiphene (clomid) | hot flashes, nausea, bloating, abd pain, breast engorgement, blurred vision, multiple births
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| Adverse effects of Follitropins | HA, abd pain, nausea, breast pain, ovarian enlargement, ovarian hyperstimulation syndrome
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| Human chorionic gonadotropin (hCG) | polypetide hormone produced by the placenta, used to promote follicular maturation and ovulation, promotes spermatogenesis
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| Adverse effects of Human chorionic gonadotropin (hCG) | ovarian hyperstimulation syndrome, edema, injection site pain, HA, irritability, restlessness, fatigue
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| Danazol (Danocrine) | reduce symptoms of endometriosis
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| Magnesium Sulfate | used as a uterine relaxant, to prevent PTL
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| Terbutaline (Brethine) | beta adrenergic agonist, used to prevent PTL, can cause edema, hypotension, and tachycardia- in mom and fetus
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| Nifedipine (Procardia, Adalat) | uterine relaxant can cause transient tachycardia in mom
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| Indomethacin (Indocin) | uterine relaxant used for very early labor, risk to the neonate
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| Hydroxyprogesterone caproate | used to prevent PTL in women with a single pregnancy and hx of at least one preterm birth
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| Oxytocin (Pitocin) | peptide hormone, increased the frequency, force, and duration of contx, caution: uterine rupture may occur, caution with active genital herpes
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| Ergot alkaloids: Ergonovine and methylergonovine | used for postpartum bleeding and augmentation of labor
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| Oxytocin, misoprostol (cytotec), carboprost (hemabate) | all used in tx of postpartum hemorrhage
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| Biophosphonates | used to tx osteoporosis, decrease bone turnover, prevent bone resorption, inhibit osteoclasts, orally can cause esophogitis (sore throat)
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| Oral Biophosphonates | Aldendronate (Fosamax), Tiludronate, Risendronate (Actonel), Ibandronate (Boniva),
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| Zolendronate (Zometa) | IV biophosphonate, infusion given 1x/yr, can cause bone osteronecrosis
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