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47 Cards in this Set
- Front
- Back
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Estrogen decrease in menopausal women:
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75%
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Positive effects of estrogen act on:
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Brain
Bone Breast Heart & Liver |
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Estrogen needed for:
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Development and maintenance of female reproductive tract and secondary sex characteristics
Improves bone mass Increases HDL and decreases LDL Mixed effect on blood coagulation Pregnancy |
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Estrogen and Progesterone therapeutic uses:
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PMS, PMDD
Menopausal HRT Contraception Used in combination with one another because one alone increases risk of cancer |
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Progestins;
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prevent uterine contractions
slows peristalsis, constipation May suppress the woman's immune response Low progesterone=high risk of pregnancy loss |
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Progestins given therapeutically:
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support fertility, birth control, treat dysfunctional uterine bleeding, adjunct in HRT estrogen replacement as a protection against cancer
Given in many different routes as to patient preference and weighing the different options |
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PMS and Premenstrual dysphoric disorder
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Nothing to laugh about, decreases the quality of life of the woman
Combination of psychological and physical sx Hormone levels are NOT different in women with PMS Every woman has different sensitivity to changes in hormones often not taken seriously |
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Treatment of PMS and PMDD
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Stress relief/diet changes (increase complex carbs)/Mg and Ca supplementation/Exercise
SSRIs for psychological sx, but many a/e and compliance is poor Avoid hormone treatment, black cohosh, red clover, evening primrose |
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Hormone Replacement Therapy
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Symptoms very profound, affecting quality of life, hormone levels become dramatically unbalanced
hormones given to improve QOL, protection for bone, lipids, colon cancer. Given with progestin to suppress E-mediated uterine cancer |
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Long-term HRT:
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NOT recommended, short term may be okay. There is still a lot we dont know.
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Bioidentical hormones
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Still require medical oversight and prescription even though they are almost identical to natural
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Black box warning with HRT:
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do not use for CV protection
E used alone increases uterine cancer "Natural" hormone products still cary risks Order at lowest effective dose for shortest amount of time |
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Contraceptive drugs:
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To prevent unplanned pregnancy
Many types Effectiveness of the contraceptive varies with perfect use vs. typical use Do not protect against STIs, including HIV |
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Criteria for choosing a birth control:
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Personal habits and tastes are the most important
The most effective habits are those that require the least amount of memory or habit, as long as you remember to get the next dose/set of doses, etc |
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Women over 35 who smoke or have CV disease should ______ take combination OC
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NOT. NO NO NO
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Oral contraceptives ("The Pill")
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Inhibit ovulation, increase density of cervical mucous
Typical use may be less effective for overweight women Effectiveness: Perfect use: 99.7% Typical use: 92% |
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Contraindications with oral contraceptives:
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Women 35+ who smoke
CV history/illness Current/history of clotting problems Not for women who are unlikely to adhere DC 4 weeks prior to surgery First degree relative with breast cancer (or +gene) History of reproductive cancers Pregnancy (category X) Full history is required prior to starting |
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A/E of oral contraceptives
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Most are rare:
Thromboembolic problems (clots) Cancer risk increases (primarily breast), but mixed data HTN Breakthrough bleeding Reduce lactation risk of CVA in women who have migraines Increase glucose in diabetic women Worsen gallbladder disease in women who already have it |
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Other effects of OC:
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Improve cramps
May decrease risk of come cancers (ovarian and uterine?) Improve PMS/PMDD sx Improve acne |
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Drugs that decrease the effect of OC:
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Dilantin
Rifampin Ritonavir St. John's Wort |
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Drugs that OC's inhibit:
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Warfarin
Insulin Oral Hypoglycemics |
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Drugs that OC's potentiate:
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Theophylline
Tricyclics Diazepam |
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What to do if missed a OC pill:
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Missed 1: take with the next pill
Missed 2: take two for 2 days Missed more: wait 7 days and start new cycle |
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What to do if missed progestin ("Minipill"):
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Missed 1: take it right away and use backup X2D
Missed 2: restart cycle and use backup X2D |
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Transdermal Contraceptive Patch
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3 weeks on/1 week off, need memory
Combined hormones Chance of it coming off: 4% (reapply it, or if it has been off for 24+ hours restart cycle and use backup for 7 days) Effectiveness: Perfect use: 99.7% Typical use: 82% |
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Contraindications/a/e for the patch:
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same as the pill
Somewhat more cramping than the pill Clotting: mixed reviews |
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Vaginal Ring:
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Combined hormone
Contraindications+s/e same as OC 3 weeks in/1 week out, new one in If it comes out, rinse it with COLD water, and reinsert. Can be out for 3 hours, if more use backup for 7 days Additional ADE: vaginitis leukorrhea Effectiveness: perfect use: 99.7% Typical use: 15% |
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IM/SQ Depo-provera
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Protects for 3 months, just need memory to remember next appointment
More a/e: irregular bleeding, HA, weight gain, mood alteration, decreased libido, deceased bone density initially Effectiveness: Perfect use: 99.7% Typical use: 90% |
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Implants for contraception:
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Long term reversible birth control
Lasts for 3 years, then you remove it Highly reversible, hormone no longer detected after 7 days of removal ADE: irregular bleeding, amenorrhea Safe with lactation Effectiveness: Perfect use: 99.5% Typical use: 99.5% |
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IUD
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Highly reversible
ParaGard=non-hormonal, good for 10 years Mirena=hormonal, good for 5 years Risk: pelvis inflammatory disease 9/1000 Effectiveness: Perfect use: 99.2% Typical use: 99% |
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Spermacide:
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Destroys sperm cell membrane
May increase transmission of HIV Administer within an hour BEFORE sex ADE: vaginal irritation and dryness Effectiveness: Perfect use: 80% Typical use: 68% |
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Sponge for contraception is effective for:
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24 hours
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Women with health issues:
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may need to have special considerations when choosing a birth control
i.e. women on anti-seizure meds, women with HTN |
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Medical Abortion:
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Methotrexate (kills all fast growing cells) for an early, uncomplicated ectopic pregnancy
Mifepristone: blocks receptors for progesterone, NOT for use in ectopic pregnancy--within 7 weeks of conception Misoprostol: prostoglandin ADE: cramping, uterine bleeding, n/v |
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Emergency Contraception
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Take WITHIN 5 days of having sex, chances decrease with each day that passes
Does NOT terminate or hurt a pregnancy if it has already occurred Can buy in the US once 17+ years of age, under that you need a prescription 98% effective Plan B Levonorgestrel |
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Androgens:
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Primary is testosterone
plays a role in male sex characteristics and spermatogenesis increases skeletal muscle synthesis of RBCs in bone marrow |
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Androgen (T) as a supplement:
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Given for treatment of hypogonadism
Congenital Aging male: increases libido, volume of ejaculate, looks, helps erectile dysfunction Helps with muscle wasting (AIDS) Helps a females poor libido Serious need for thorough diagnosis, make sure there arent other causes like diabetes, depression, thyroid |
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Androderm (patch) and Androgel (gel)
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Administration is topical, can be IM every 2-4 weeks
Gel cannot fall off, and more consistent levels will be absorbed if constantly applied Do not apply to scrotum Wait 5-6 hours before showering Can transfer to others even after dried, need to share with partner because CATEGORY X |
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Adverse effects of Androgen
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Virilization, premature epiphyseal closure, hepatotoxicity, worsen lipid profile, category X, worsen or potentiate prostate cancer: need to stop immediately, edema, gynecomastia, abuse potential: hypogonadism, rage
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Erectile Dysfunction:
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May be associated with Type II diabetes, HTN, Depression
50% of men ages 40-70 may experience Requires good arterial flow in the first place |
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Treatment of ED:
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Psychotherapy
Surgery Drugs (vadodilators that enhance the response of erection, do not necessarily fix something that is not possible) Viagra Sildenafil, Cialis |
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Adverse effects of PDE5Is (ED drugs)
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Hypotension
Priapism (erection >4 hours)--need to aspirate blood, give epinephrine for vasoconstriction Nitrates CONTRAINDICATED 36 hour duration with cialis |
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BPH Benign prostatic Hyperplasia
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Prostate surrounds male urethra, produces fluids that add to ejaculate
BPH=excessive growth of cells. 50% by age 60, 90% by age 85 Sx not related to size of prostate Causes difficulty urinating, dysuria, notcuria, can lead to UTIs |
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Treatment of PBH
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Surgery
Drugs: (moderate BPH) 5 Alpha reductase inhibitor Alpha1 antagonist Flomax, sometimes given concurrently |
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5 alpha reductase inhibitors
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Finasteride (Proscar) for BPH
PO Daily, for life PSA level should be checked prior to taking drugs and again in 6 months, PSA level should go down, if not immediately stop drug and check for cancer |
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ADE of Finasteride Proscar
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Decreased libido in 10%, so it may affect testosterone in some
Gynecomastia Takes 6-12 months to work Now can grown hair, takes 3 months to work, if stop will lose the hair you grew |
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Alpha 1 antagonist- Tamsulisin Flomax
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Blocks receptors selectively in the bladder & prostate and relaxes smooth muscle to decrease obstruction to the urethra
Must take PO, daily, for life Selective: does not affect BP Does not affect PSA levels |
