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50 Cards in this Set
- Front
- Back
|
What are the benefits of hormonal contraceptives?
|
Contraception
Dysmenorrhea PMS Hirsutism Ovarian and endometrial ca Benign breast cysts Acne Endometriosis Menorrhagia |
|
|
What are the two names of estrogen available?
|
Ethinyl Estradiol (EE)
Mestranol (gets metabolized to EE by liver, less potent) |
|
|
What is the MOA of ethinyl estradiol and mestranol?
|
INHIBITS OVULATION by decreasing FSH/LH production
Inhibits ovum implantation and breaks down corpus luteum |
|
|
What are the names of the different types of progestin available?
|
Norgestel/levonorgestel, Ethynodiol diacetate, Norethindrone, Norethynodrel, Norgestimate, Desogestrel
|
|
|
What is the MOA of Norgestel/levonorgestel, Ethynodiol diacetate, Norethindrone, Norethynodrel, Norgestimate, Desogestrel?
|
Promote THICK cervical mucus to decrease sperm transport and penetration
INHIBIT ovulation by decreasing FSH/LH surge Produce UNFAVORABLE endometrial changes for ovum implantation |
|
|
Which progestin has high angrogenic effects? Progestational effects? Estrogenic effects? Anti-estrogenic effects?
|
Norgestel/levonorgestel > Desogestrel (androgenic and progestational)
Norethynodrel (estrogenic) Norethindrone (anti-estrogenic) |
|
|
How do progestins exhibits progestational, estrogenic (anti-estrogenic), and androgenic activities?
|
Act on progestin receptors -> prevent ovulation
Progestin is anti-estrogenic, can be metabolized to estrogenic substances Struct similar to testosterone |
|
|
What are the kinetics of estrogen and progestin?
|
Highly protein bound (sex hormone-binding globulin)
Hepatic, 1st pass metabolism: gut flora breaks down further to active metabolites (ABX can LOWER effectiveness by altering gut flora, use backup) |
|
|
What are the estrogen-related AE?
|
Nausea, breast neoplasia (cancer), weight gain from fluid retention, breast tenderness, inc bile cholesterol, thromboembolic complications, cerebrovascular accidents, HTN
|
|
|
What are the progestin-related AE?
|
Inc appetite and weight gain, depression, fatigue, dec libido, acne, oily skin, diabetogenic effect, hirsutism, inc LDL/dec HDL, HA
|
|
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What is the name of the new progestin and what is it?
|
Drospirenone (Yasmin), analogue of spironolactone (blocks aldosterone)
|
|
|
What is the MOA of drospirenone?
|
Potent progestogenic activity, anti-androgenic activity, ANTI-MINERALOCORTICOID activity: inc Na/water excretion, good for modest weight loss
|
|
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When is drospirenone CI?
|
LIVER, KIDNEY, ADRENAL problems bc anti-mineralocorticoid activity leads to potassium retention!
|
|
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What is a monophasic formulation and what problems do these patients encounter?
|
Fixed ratio of estrogen/progestin
Problem: may have progestin deficiency (late cycle bleeding) |
|
|
What is a biphasic formulation and what problems do these patients encounter?
|
Inc ratio of progestin in 2nd half of cycle: overall dec total progestin dose
Benefit: minimize progestin AE Problem: midcycle spotting and late cycle breakthrough bleeding |
|
|
What is a triphasic formulation and what problems do these patients encounter?
|
3 variable progestin concentrations, overall less than biphasic products
Benefits: mimics normal cycle, dec total progestin intake, dec midcycle BTB Problems: estrogen-related (fluid retention, breast tenderness) during phases with lower progestin (note: menstrual bleeding may seem excessive bc greater endometrial development with estrogen) |
|
|
What are the progestin only products offered? When are they recommended?
|
Minipill, Injection (Depo-provera), Subdermal (Implanon), IUDs
Preferred for nursing mothers, smokers over 35, migraines, DM (less impact on milk production and NO estrogen exposure to breast-fed infants) |
|
|
When should you be cautious with progestin-only products?
|
Hx of lactation failure, low milk supply, hx of breast sx, multiple births, preterm birth
|
|
|
What is the mini pill and its problesm?
|
Active progestin-only pill for 28 days
Problem: irregular menses (no endometrium build-up bc no estrogen) |
|
|
What the Depo-provera injection and what are its problems/advantages?
|
Progestin-only injection every 12 weeks
Problem: more progestin AE - menstrual irregularity, weight gain, delayed return to fertility, dec bone mineral density Adv: good for ENDOMETRIOSIS (no E to build up endometrium) |
|
|
What is the name of the new progestin and what is it?
|
Drospirenone (Yasmin), analogue of spironolactone (blocks aldosterone)
|
|
|
What is the MOA of drospirenone?
|
Potent progestogenic activity, anti-androgenic activity, ANTI-MINERALOCORTICOID activity: inc Na/water excretion, good for modest weight loss
|
|
|
When is drospirenone CI?
|
LIVER, KIDNEY, ADRENAL problems bc anti-mineralocorticoid activity leads to potassium retention!
|
|
|
What is a monophasic formulation and what problems do these patients encounter?
|
Fixed ratio of estrogen/progestin
Problem: may have progestin deficiency (late cycle bleeding) |
|
|
What is a biphasic formulation and what problems do these patients encounter?
|
Inc ratio of progestin in 2nd half of cycle: overall dec total progestin dose
Benefit: minimize progestin AE Problem: midcycle spotting and late cycle breakthrough bleeding |
|
|
What is a triphasic formulation and what problems do these patients encounter?
|
3 variable progestin concentrations, overall less than biphasic products
Benefits: mimics normal cycle, dec total progestin intake, dec midcycle BTB Problems: estrogen-related (fluid retention, breast tenderness) during phases with lower progestin (note: menstrual bleeding may seem excessive bc greater endometrial development with estrogen) |
|
|
What are the progestin only products offered? When are they recommended?
|
Minipill, Injection (Depo-provera), Subdermal (Implanon), IUDs
Preferred for nursing mothers, smokers over 35, migraines, DM (less impact on milk production and NO estrogen exposure to breast-fed infants) |
|
|
When should you be cautious with progestin-only products?
|
Hx of lactation failure, low milk supply, hx of breast sx, multiple births, preterm birth
|
|
|
What is the mini pill and its problesm?
|
Active progestin-only pill for 28 days
Problem: irregular menses (no endometrium build-up bc no estrogen) |
|
|
What the Depo-provera injection and what are its problems/advantages?
|
Progestin-only injection every 12 weeks
Problem: more progestin AE - menstrual irregularity, weight gain, delayed return to fertility, dec bone mineral density Adv: good for ENDOMETRIOSIS (no E to build up endometrium) |
|
|
What is the name of the new progestin and what is it?
|
Drospirenone (Yasmin), analogue of spironolactone (blocks aldosterone)
|
|
|
What is the MOA of drospirenone?
|
Potent progestogenic activity, anti-androgenic activity, ANTI-MINERALOCORTICOID activity: inc Na/water excretion, good for modest weight loss
|
|
|
When is drospirenone CI?
|
LIVER, KIDNEY, ADRENAL problems bc anti-mineralocorticoid activity leads to potassium retention!
|
|
|
What is a monophasic formulation and what problems do these patients encounter?
|
Fixed ratio of estrogen/progestin
Problem: may have progestin deficiency (late cycle bleeding) |
|
|
What is a biphasic formulation and what problems do these patients encounter?
|
Inc ratio of progestin in 2nd half of cycle: overall dec total progestin dose
Benefit: minimize progestin AE Problem: midcycle spotting and late cycle breakthrough bleeding |
|
|
What is a triphasic formulation and what problems do these patients encounter?
|
3 variable progestin concentrations, overall less than biphasic products
Benefits: mimics normal cycle, dec total progestin intake, dec midcycle BTB Problems: estrogen-related (fluid retention, breast tenderness) during phases with lower progestin (note: menstrual bleeding may seem excessive bc greater endometrial development with estrogen) |
|
|
What are the progestin only products offered? When are they recommended?
|
Minipill, Injection (Depo-provera), Subdermal (Implanon), IUDs
Preferred for nursing mothers, smokers over 35, migraines, DM (less impact on milk production and NO estrogen exposure to breast-fed infants) |
|
|
When should you be cautious with progestin-only products?
|
Hx of lactation failure, low milk supply, hx of breast sx, multiple births, preterm birth
|
|
|
What is the mini pill and its problesm?
|
Active progestin-only pill for 28 days
Problem: irregular menses (no endometrium build-up bc no estrogen) |
|
|
What the Depo-provera injection and what are its problems/advantages?
|
Progestin-only injection every 12 weeks
Problem: more progestin AE - menstrual irregularity, weight gain, delayed return to fertility, dec bone mineral density Adv: good for ENDOMETRIOSIS (no E to build up endometrium) |
|
|
What are the benefits of hormonal contraceptives?
|
Contraception
Dysmenorrhea PMS Hirsutism Ovarian and endometrial ca Benign breast cysts Acne Endometriosis Menorrhagia |
|
|
What are the two names of estrogen available?
|
Ethinyl Estradiol (EE)
Mestranol (gets metabolized to EE by liver, less potent) |
|
|
What is the MOA of ethinyl estradiol and mestranol?
|
INHIBITS OVULATION by decreasing FSH/LH production
Inhibits ovum implantation and breaks down corpus luteum |
|
|
What are the names of the different types of progestin available?
|
Norgestel/levonorgestel, Ethynodiol diacetate, Norethindrone, Norethynodrel, Norgestimate, Desogestrel
|
|
|
What is the MOA of Norgestel/levonorgestel, Ethynodiol diacetate, Norethindrone, Norethynodrel, Norgestimate, Desogestrel?
|
Promote THICK cervical mucus to decrease sperm transport and penetration
INHIBIT ovulation by decreasing FSH/LH surge Produce UNFAVORABLE endometrial changes for ovum implantation |
|
|
Which progestin has high angrogenic effects? Progestational effects? Estrogenic effects? Anti-estrogenic effects?
|
Norgestel/levonorgestel > Desogestrel (androgenic and progestational)
Norethynodrel (estrogenic) Norethindrone (anti-estrogenic) |
|
|
How do progestins exhibits progestational, estrogenic (anti-estrogenic), and androgenic activities?
|
Act on progestin receptors -> prevent ovulation
Progestin is anti-estrogenic, can be metabolized to estrogenic substances Struct similar to testosterone |
|
|
What are the kinetics of estrogen and progestin?
|
Highly protein bound (sex hormone-binding globulin)
Hepatic, 1st pass metabolism: gut flora breaks down further to active metabolites (ABX can LOWER effectiveness by altering gut flora, use backup) |
|
|
What are the estrogen-related AE?
|
Nausea, breast neoplasia (cancer), weight gain from fluid retention, breast tenderness, inc bile cholesterol, thromboembolic complications, cerebrovascular accidents, HTN
|
|
|
What are the progestin-related AE?
|
Inc appetite and weight gain, depression, fatigue, dec libido, acne, oily skin, diabetogenic effect, hirsutism, inc LDL/dec HDL, HA
|
