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101 Cards in this Set
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Female Reproductive Function
Regulatory hormones secreted from (3)? |
Hypothalamus --> GnRH --> pituitary
Pituitary --> FSH & LH --> ovary Ovary --> estrogen & progesterone --> neg feedback to stop GnRH, FSH & LH |
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Female Reproductive Function
What hormones are secreted & where? |
Hypothalamus → gonadotropin-releasing hormone (GnRH), which travels to the pituitary to stimulate the secretion of follicle stimulating hormone (FSH) & luteinizing hormone (LH)
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Female Reproductive Function
What do follicle stimulating hormone (FSH) & luteinizing hormone (LH) do? |
Both of these hormones act on the ovary and cause immature ovarian follicles to begin developing.
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Female Reproductive Function
What creates the two monthly cycles? |
The rising & falling of pituitary hormones create two interrelated cycles that occur on a periodic, monthly basis = ovarian & uterine cycles.
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Female Reproductive Function
What effect does FSH & LH have on ovarian follicles? |
Under the influence of FSH & LH, several ovarian follicles begin the maturation process each month
As ovarian follicles mature, they secrete estrogen & progesterone. |
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Female Reproductive Function
What happens on day 14 of the ovarian cycle? |
On approximately day 14 of the ovarian cycle, a surge of LH causes one follicle to expel its oocyte (ovulation).
Days 12-16 - most likely to conceive (sperm can survive 4-5 days in woman's body) The oocyte begins its journey through the uterine tube & eventually reaches the uterus. |
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Female Reproductive Function
What happens to the ruptured follicle after ovulation? |
The ruptured follicle, minus its oocyte, remains in the ovary & is transformed into the hormone-secreting corpus luteum.
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Female Reproductive Function
What happens if conception does not occur? |
If conception does not occur, the outer lining of the uterus degenerates and is shed to the outside during menstruation.
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Female Reproductive Function
Estrogen is a generic term for what 3 different hormones? |
Estradiol
Estrone Estriole |
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Female Reproductive Function
What does estrogen do? |
Estrogen is responsible for the maturation of the female reproductive organs & for the appearance of secondary sex characteristics.
Helps to maintain low blood cholesterol levels Facilitates Ca+ uptake by the bones. |
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Female Reproductive Function
What happens during the last half of the ovarian cycle? |
In the last half of the ovarian cycle, the corpus luteum secretes a class of hormones called progestins, the most abundant is progesterone.
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Female Reproductive Function
What does progesterone do? |
In combination with estrogen, progesterone promotes breast development & regulates the monthly changes in the uterine cycle.
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Female Reproductive Function
What effect does estrogen & progesterone have on the endometrium? |
Under the influence of estrogen & progesterone, the uterine endometrium becomes vascular & thickens in preparation for receiving the fertilized egg.
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Female Reproductive Function
In the final third of the uterine cycle, what effect does estrogen progesterone levels have on hormone secretion? |
High estrogen & progesterone levels in the final third of the uterine cycle provide negative feedback to shut off GnRh, FSH, & LH secretion.
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Female Reproductive Function
What happens without stimulation from FSH & LH? |
Without stimulation from FSH & LH, estrogen levels & progesterone levels fall, the endometrium is shed & menstrual bleeding begins.
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Oral Contraceptives
What is in most contraceptives? |
Most contraceptives contain a combination of estrogen & progestin. A few contain only progestin.
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Oral Contraceptives
What is the most common estrogen & progestin used for contraception? |
Ethinyl estradiol: the most common estrogen used for contraception
Norethindrone: the most common progestin. |
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Oral Contraceptives
When does drug administration of oral contraceptive begin & when do placebos begin? |
Usually, drug administration of an oral contraceptive begins on day 5 of the ovarian cycle & continues for 21 days.
During the other 7 days, the patient takes a placebo. |
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Oral Contraceptives
What should a patient do if she misses a pill? |
Use another form of birth control AND if she misses
1 = take 2, then finish pack 2 = take 2, then 2, then finish pack 3 = start over the next cycle |
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Oral Contraceptives
How do estrogen-progestin oral contraceptives work? |
Estrogen-progestin oral contraceptives act by providing negative feedback to the pituitary to shut down the secretion of LH & FSH.
Without the influence of these hormones, the ovarian follicle cannot mature & ovulation is prevented. |
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Oral Contraceptives
What are the three types of estrogen-progestin formulations? |
Monophasic
Biphasic Triphasic |
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Oral Contraceptives: Monophasic
Agents? |
Alesse
Desogen Loestrin 1.5/30 Fe Lo/Ovral Ortho-Cyclen Yasmin |
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Oral Contraceptives: Monophasic
MOA? |
Most common; delivers a constant amount of estrogen & progestin in every pill.
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Oral Contraceptives: Biphasic
Agent? |
Ortho-Novum 10/11
Also used for dysfunctional bleeding |
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Oral Contraceptives: Biphasic
MOA? |
Amount of estrogen in each pill remains constant, but the amount of progestin is increased toward the end of the menstrual cycle to better nourish the uterine lining
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Oral Contraceptives: Triphasic
Agents? |
Ortho Tri-Cyclen
Ortho-Novum 7/7/7 Tri-Levlen Triphasil |
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Oral Contraceptives: Triphasic
MOA? |
Amounts of estrogen & progestin vary in three distinct phases during the 28-day cycle
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Oral Contraceptives: Progestin-Only Minipill
Agents? |
Micronor
Nor-Q-D Ovrette |
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Oral Contraceptives: Progestin-Only Minipill
MOA? |
Prevents pregnancy primarily by producing thick, viscous mucus at the entrance to the uterus that discourages penetration by sperm.
Also inhibits implantation of a fertilized egg. |
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Oral Contraceptives: Progestin-Only Minipill
Efficacy? Indications? |
Minipills are less effective than estrogen-progestin combinations. Failure rate: 1-4%
Generally reserved for pts who are at high risk for side effects from estrogen. |
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Oral Contraceptives: Progestin-Only Minipill
Adverse effects? |
Higher incidence of menstrual irregularities such as amenorrhea, prolonged menstrual bleeding or breakthrough spotting.
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What are the adverse effects of oral contraceptives?
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Abnormal menstrual bleeding
Amenorrhea or hypermenorrhea Birth defects Cancer Hypertension Weight gain, increased appetite, fatigue, depression, acne, hirsutism Nausea, edema, breast tenderness Thromboembolic disorders Drug-drug interactions |
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How would you address the OC adverse effect of
Abnormal menstrual bleeding? |
Breakthrough bleeding & spotting are common with the low-dose OCs; may need a higher dose.
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How would you address the OC adverse effect of
Amenorrhea or hypermenorrhea? |
Often caused by low amount of progestin; may need dose increased.
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How would you address the OC adverse effect of
Birth defects? |
Estrogen is pregnancy category X; discontinue OCs if pregnant
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How would you address the OC adverse effect of
Cancer? |
Estrogens promote certain types of breast cancer; patients with + breast CA family history should not take OCs
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How would you address the OC adverse effect of
Hypertension? |
Risk is increased with age, dose & length of therapy.
For a woman taking OCs newly diagnosed with HTN --> consider TLCs & change birth control before starting on HTN meds. |
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How would you address the OC adverse effect of
Weight gain, increased appetite, fatigue, depression, acne, hirsuitism? |
Often caused by high amounts of progestin; may need lower dose.
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How would you address the OC adverse effect of
Nausea, edema, breast tenderness? |
Caused by high amounts of estrogen; may need lower dose.
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How would you address the OC adverse effect of
Thromboembolic disorders? |
Increased risk in some patients; OCs contraindicated in patients with a history of thromboembolic disorders, CVA, CAD or heavy smokers.
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How would you address the OC adverse effect of
Drug-drug interactions? |
Certain antibiotics & anticonvulsants decrease the effectiveness of OCs; when taking antibiotics, use 2 forms of birth control
OCs decrease the effectiveness of warfarin, insulin, & certain oral hypoglycemic. |
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Injection Contraceptives
Agent & MOA? |
Depro-Provera
Deep IM injection of medroxyprogesterone that provides 3 months of contraception. |
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Implant Contraceptives
Agents & MOA? |
Etongestril (Implanon/Nexplanon)
Single rod containing progestin; provides 3 years of protection Levonorgestrel (Mirena/Skyla) Intrauterine system inserted by HCP, provides 3 (Skyla) or 5 (Mirena) years of protection. |
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Patch Contraceptives
Agent & MOA? |
Ortho-Evra
Transdermal patch containing both estrogen & progestin. Patch is changed every 7 days for the first 3 weeks, then no patch is used for week 4. Do not use if > 35, HTN, or smoker |
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Ring Contraceptives
Agent & MOA? |
NuvaRing
2 inch diameter prescriptive vaginal ring of estrogen & progestin. Inserted to provide 3 weeks of protection. Removed during week 4, & a new ring is inserted during the 1st week of the next menstrual cycle. Do not use if > 35, HTN, or smoker |
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Inserted Contraceptives
Agent & MOA |
Mirena
Polyethylene cylinder placed in uterus that releases levonorgestrel. About the size of a quarter & shaped like a T. Mirena acts locally to prevent contraception for 5 years. Very effective, but expensive |
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Extended Regimen Contraceptives
Agent & MOA? |
Seasonale
Combination tablets taken for 84 consecutive days, followed by 7 inert days (w/o hormones). Continuous protection while extending time between menses, only 4 periods/year Seasonique – similar, except low-dose estrogen replaces inert tablets. |
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Emergency Contraception
Agents? |
Ethinyl Estradiol & Levonorgestrel (Preven)
Levonorgestrel (Plan B) |
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Emergency Contraception
Preven? |
One tablet within 72 hours of intercourse, followed by 2 pills 12 hours later.
May need to prescribe antiemetic. Compazine DOC for short-term used, but sedating |
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Emergency Contraception
Plan B? |
One or two tablet preparation taken within 72 hours of intercourse
May need to prescribe antiemetic. |
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Pharmacological Abortion
Agents? |
Carboprost Tromethamine (Hemabate)
Dinoprostone (Cervidil, Prepidil, Prostin E2) Methotrexate with Misoprostol (Cytotec) Mifepristone (Mifeprex) with Misoprostol (Cytotec) |
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Stages of Menopause
S/S of early menopause |
Irritability, mood changes, depression, hot flashes, headaches, insomnia, irregular cycles.
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Stages of Menopause
S/S of mid-menopause |
Dyspareunia, vaginal & skin atrophy, decreased libido, increased vaginal infections
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Stages of Menopause
S/s of post-menopause |
Osteoporosis, CVD, Alzheimer’s like dementia
1 year after last bleeding. |
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Hormone Therapy: WHI 2002
Re: combination therapy? |
Combination therapy caused a small but significant increased risk of CAD, CVA, breast CA, dementia & DVT.
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Hormone Therapy: WHI 2002
Re: taking estrogen alone? |
Taking estrogen alone caused a slight increased risk of CVA, but no increased risk of breast CA or CAD.
In women < 40, slight decrease in CV side effects. |
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Hormone Therapy: WHI 2002
Re: benefits of HRT, symptom relief, CAD & osteoporosis. |
Benefits of HRT may NOT outweigh risks.
HRT does offer relief for many women HRT is NOT recommended to prevent CAD HRT prevents osteoporosis |
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HT: Guidelines
Dosage? When use high dosage? |
Use shortest time & lowest dose possible.
High dose estrogens used for treatment of breast & prostate CA |
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HT: Guidelines
Risk for CA? |
Estrogen only increases risk of uterine CA (only for women w/hysterectomy)
1st degree relative w/ breast or genital CA → use estrogen with extreme caution. |
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HT: Guidelines
Conjugated estrogents contraindications? |
Conjugated estrogens are contraindicated for pts with breast CA & estrogen-dependent CAs, except for those with metastatic disease.
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Hormone Therapy
Estrogen Agents? |
Estradiol (Estraderm, Estrace)
Estradiol Cypionate (Dep-Gynogen, Depogen) Estradiol Valerate (Delestrogen, Duragen-10, Valergen) Estrogen, Conjugated (Premarin) Estropipate (Ogen) Ethinyl Estradiol (Estinyl, Feminone) |
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Hormone Therapy
Progestin Agents? |
Medrosyprogesterone (Provera, Cycrin)
Norethindrone (Micronor, Nor-Q.D.) Norethindrone Acetate (Norlutate) Progesterone Micronized (Prometrium) |
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Hormone Therapy
Estrogen Progestin Combinations? |
Conjugated Estrogens, Equine / Medroxyprogesterone Acetate (Prempro)
Estradiol / Drospirenone (Angeliq) Estradiol / Norgestimate (Ortho-Prefest) Ethinyl Estradiol / Norethindrone Acetate (Femhrt) |
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Uterine Abnormalities
What is dysfunctional uterine bleeding |
Hemorrhage that occurs in a non-cyclic basis or in abnormal amounts. A frequent complaint of all women & a common reason for hysterectomy.
1st test for Hcg, to r/o ectopic pregnancy 2nd vaginal exam then refer to gyn w/ description of bleeding |
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Uterine Abnormalities
What is the DOC for uterine abnormalities & why? |
Progestins are the DOC for treating uterine abnormalities.
Whereas estrogens cause proliferation of the endometrium, progesterone limits & stabilizes endometrial growth. |
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Uterine Abnormalities
What are 6 causes of dysfunctional uterine bleeding? |
Hormonal imbalances between estrogen & progesterone.
Abortion Pelvic CA Thyroid disorders Pregnancy Infections Others |
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Uterine Abnormalities
What is amenorrhea? |
Absence of menses
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Uterine Abnormalities
What is oligomenorrhea? |
Infrequent, irregular menses; frequency > 40 days
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Uterine Abnormalities
What is polymenorrhea? |
Frequent irregular menses; frequency < 18 days.
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Uterine Abnormalities
What is menorrhagia? |
Prolonged or excessive menses with regular frequency
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Uterine Abnormalities
What is metrorrhagia? |
Bleeding between cycles (breakthrough)
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Uterine Abnormalities
What is menometrorrhagia? |
Prolonged, frequent, excessive, irregular bleeding.
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Uterine Abnormalities
What is intermenstrual? |
Variable quantity between cycles
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Uterine Abnormalities
Progestin Treatment? |
Prescribing a progestin 5 days after the onset of menses, continuing for the next 20 days may re-establish a normal monthly cycle; OCs may also be prescribed.
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Uterine Abnormalities
Conjugated estrogens? |
For heavy bleeding, high doses of conjugated estrogens may be administered 3 weeks prior to adding medroxyprogesterone for the last 10 days of therapy.
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Uterine Abnormalities
NSAIDs? |
NSAIDs may also help reduce pain and ease flow.
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Uterine Abnormalities
Refractory patients? |
D&C may ultimately be necessary for refractory patients.
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Uterine Abnormalities
Progestin SE? |
Breakthrough bleeding, nausea, abdominal cramps, dizziness, edema, weight gain, thromboembolic disorders, photosensitivity, pruritus, rash, and alopecia.
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Uterine Stimulants (Oxytocics)
Agents? |
Oxytocin (Pitocin)
Ergonovine Maleate (Ergotrate) Methylergonovine Maleate (Methergine) Carboprost Tromethamine (Hemabate) Dinoprostone (Cervidil, Prepidil, Prostin E2) Misoprostol (Cytotec) |
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Uterine Stimulants (Oxytocics)
Indications? |
Stimulates uterine contractions
Postpartum: may be used to control/decrease bleeding |
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Uterine Relaxants (Tocolytics)
Beta2-adrenergic Agonist? |
Terbutaline Sulfate (Brethine)
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Uterine Relaxants (Tocolytics)
Indications? |
Tocolytics inhibit uterine contractions, premature labor
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Androgens
Agents? |
Danazol (Danocrine)
Fluoxymesterone (Halotestin) Methyltestosterone (Android, Testred) Testolactone (Teslac) Testosterone (Androderm, Testim) Testosterone Cypionate (Depotest, Andro-Cyp, Depo-Testosterone) Testosterone Enanthate (Andro L.A., Delatest, Delatestyrl) |
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Androgens
Indications for androgens & testosterone? |
Androgens &/or testosterone are used for lack of testosterone (hypogonadism)
If c/o decrease in libido, likely low testosterone. Test level before prescribing ED meds |
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Androgens
Androgens & erectile dysfunction? |
Androgens reverse erectile dysfunction & improve libido when low testosterone levels are present
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Androgens
Testosterone & skeletal muscle? |
Testosterone has an anabolic effect on skeletal muscle (anabolic steroids)
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Androgens
Testosterone & erythropoietin? |
Testosterone promotes the synthesis of erythropoietin, thus men have higher Hct values than women.
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Phosphodiesterase (PDE) Inhibitors
Sildenafil (Viagra) / Vardenafil (Levitra) Works? |
30 min / 60 min
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Phosphodiesterase (PDE) Inhibitors
Tadalafil (Cialis) / Avanafil (Stendra) Works? |
15 minutes
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Phosphodiesterase (PDE) Inhibitors
Sildenafil (Viagra) / Vardenafil (Levitra) Lasts? |
4 hours
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Phosphodiesterase (PDE) Inhibitors
Tadalafil (Cialis) / Avanafil (Stendra) Lasts? |
Up to 36 hours
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Phosphodiesterase (PDE) Inhibitors
Sildenafil (Viagra) / Vardenafil (Levitra) Take? |
Without food
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Phosphodiesterase (PDE) Inhibitors
Tadalafil (Cialis) / Avanafil (Stendra) Take? |
With or without food
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Phosphodiesterase (PDE) Inhibitors
Side Effects? |
Nasal congestion
Headache Facial flushing Rash Dizziness Blurred vision Priapism (report erection > 4 hours) Drug-drug interactions |
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Phosphodiesterase (PDE) Inhibitors
Drug-drug interactions? |
Cimetidine (Tagamet), erythromycin & ketoconazole will increase serum levels of sildenafil, requiring lower doses;
Protease inhibitors may increase sildenafil levels → toxicity Hypotension when taken with nitrates (Nitroglycerin / Nitro patch). |
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BPH Drugs: Alpha Adrenergic Blockers
Agents? |
Doxazosin (Cardura)*
Prazosin (Minipress)* Terazosin (Hytrin)* Tamsulosin (Flomax) Alfuzosin (Uroxatral) Silodosin (Rapaflo) |
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BPH Drugs: Alpha Adrenergic Blockers
MOA & Side Effects? |
Relaxes muscles in perineum
May cause orthostatic hypotension, dizziness, and headache; depression May take 2 months to kick in, initially c/o "peeing too much" |
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BPH Drugs: Alpha Adrenergic Blockers
Concerns w/ doxazosin, prazosin & terazosin? |
First dose phenomenon: may cause severe hypotension & syncope, tachycardia
Hypotension less problem with tamsulosin, alfuzosin, silodosin |
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BPH Drugs: 5-Alpha-Reductase Inhibitors
Agents? |
Dutasteride (Avodart)
Finasteride (Proscar) |
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BPH Drugs: 5-Alpha-Reductase Inhibitors
MOA & Side Effects? |
Shrinks prostate
Sexual dysfunction, decreased libido, decreased ejaculate volume |
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BPH Drugs: 5-Alpha-Reductase Inhibitors
Concerns w/dutasteride? |
Warning level for women not to touch medication d/t teratogenic effects: fetal anomalies, feminization of fetus
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