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34 Cards in this Set

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Drugs that may diminish effectiveness
of
OCs
–Carbamazepine
-Phenytoin
(increase hepatic metabolism of OC)

antibiotics
~PCN
~Tetracyclines
Eradicate intestinal flora for enterohepatic cycling of contraceptive steroids = diminish effectiveness
Act primarily by preventing ovulation
Mechanism of action by which oral contraceptives (OC’s) prevent pregnancy

Nm MOA ?
Act primarily by preventing ovulation
Act on feedback inhibition of GNrH secretion
from the
hypothalamus

~Decreased gonadotropin secretion
and
inhibition of ovulation.
Estrogen-Progestin

MOA
Act on feedback inhibition of
GNrH secretion
from
hypothalamus

~Decreased gonadotropin secretion
and
inhibition of ovulation.
Inhibits the mid-cycle

LH surge
Progestin


Inhibits
mid-cycle ....

LH surge
Decreases FSH
Estrogen

MOA
Decreases FSH

(therefore decreases maturation of follicle)
Constant in all

monophasic
biphasic
most triphasic contraceptive.
Estrogen content
-acne vulgaris/ lesions

-manage dysmenorrhea
Other clinical indications for

Estrogen-Progestin combinations besides contraception.

Nm them
2ct
-acne vulgaris/ lesions

-manage dysmenorrhea
~Breast enlargement
~Cyclic Wt Gain
~Dizziness
~Dysmenorrhea
~Edema
~HA
~Irritability
~N/V
Effects of:

~Estrogen Excess

A/E
8ct
~Breast enlargement
~Cyclic Wt Gain
~Dizziness
~Dysmenorrhea
~Edema
~HA
~Irritability
~N/V
~Acne
~Depression
~Fatigue
~Hirsutism
~Libido Changes
~Oily Skin
~Weight Gain
Effects of
Progestin Excess


S/E
6ct
~Acne
~Depression
~Fatigue
~Hirsutism
~Libido Changes
~Oily Skin
~Weight Gain
~DM
~Gallstones
~HTN
~MI
~Stroke
~Thromboembolic Complications
Less frequent
but
more serious adverse effects of
~OC-s

A/E
6ct
~DM
~Gallstones
~HTN
~MI
~Stroke
~Thromboembolic Complications
Greater risk of thromboembolic complications
should use another form of contraceptives

Pt Contraindicators
AGE
Acivity
Smokers over 35 yo

Risk of what A/E?
Greater risk of

thromboembolic complications
Contraindicated for women with:


~Breast CA
~CAD (hx of)
~Hepato Dz
~Gallbladder Dz
~MI (hx of)
~Reproductive Tract CA
~Thromboembolic Dz
Estrogen OC's


Contraindicated for women with:
~Breast CA
~CAD (hx of)
~Hepato Dz
~Gallbladder Dz
~MI (hx of)
~Reproductive Tract CA
~Thromboembolic Dz
Contraindicated for those W:

~Active Breast CA
~Endometrial CA
~Ovarian CA
OCs

Contraindications
3ct
~Active Breast CA
~Endometrial CA
~Ovarian CA
Studies show reduced incidence for

~Ovarian Ca
~Endometrium Ca

but

high dose estrogen preps associated w increased risk of ~Breast CA
OC use

oral contracept
reduced incidence for

~Ovarian Ca
~Endometrium Ca

but

high dose estrogen preps associated w increased ris of ~Breast CA
other clinical indications for
~Estrogen-Progestin Combos
besides contraception:

~Manage Dysmenorrhea
~Good for acne

What Rx?
~Combination OC

~Good for acne

– Desogestrel (least androgenic)


Rx Nm that is Bad for acne:?

– Norgestrel (most androgenic)
Highly Androgenic
Norgestrel


Is Highly what?
Highly Androgenic

1. producing masculine characteristics.
2. pertaining to an androgen.
Drugs(2ct)
increase the hepatic metabolism of OCs

thus

reducing plasma levels
~Carbamazepine

~Phenytoin

A/E is what?
increase the hepatic metabolism of OCs
Antibiotics that eradicate intestinal flora involved in the enterohepatic cycling of OC
Penicillins
tetracyclines
~Norethindrone minipills
~subdermal implants
~IUDs

~Class of Hormone?
~That release (Rx Nm)

long acting IM injections of
~medroxyprogesterone acetate
Progesterone-Only
Contraceptives

~Levonorgestrel


Nm Them?
~Norethindrone minipills
~Subdermal Implants
~IUDs

(They Release)
~levonorgestrel

Long acting IM Injections of
~Medroxyprogesterone Acetate
Mechanisms by which

~Progestin-only contraceptives

prevent pregnancy
Decrease frequency of gnrh pulse generator
to blunt
LH surge

What Rx?
does what?
Mechanisms by which

~Progestin-only contraceptives

~ thickens cervical mucus
&
~slows endometrial growth
~Thinning Endometrium
~Prevent pregnancy
What OC to use?

Smoker
Older woman
Hormone/Rx is contraindicated
Progestin only

Estrogen contraindicated

Nm contraindications
3ct
when to use this Rx
3ct Contras....
Smoker
Older woman
Estrogen is contraindicated
Amenorrhea
Ectopic Preg (Increased Risk)
Frequent Spotting
Irregular Menses

Most common problems –w this Rx
Progestin only


4ct Most common problems –
Amenorrhea
Ectopic Preg (Increased Risk)
Frequent Spotting
Irregular Menses
Used as an emergency postcoital contraceptive

when no other contraceptives have been in use
Levonorgestrel (Plan B)
Time-limitation for

~Levonorgestrel
(Plan B)
Still effective up to 120 hours


What Rx
~Levonorgestrel
(Plan B)
DMPA injection disadvantages

3ct
~Decreased bone density

~Irregular Bleeding

~Irregular Menses...
(...up to 1 year after)

disadvantages of:
DMPA injection
Does not affect bone density like DMPA
but
May cause irregular vaginal bleeding


Depo-Provera
Depot medroxyprogesterone acetate
Implant

Reason to use it 1ct

AE 1ct
Does not affect bone density like DMPA
but
May cause irregular vaginal bleeding
Not for women > 198 lbs.
Patch (combination)
Efficacy
Mechanism of action
Systemic side effects

are similar to those associated with
oral contraceptives.

In addition users may experience an
~Increased incidence of vaginal discharge.
Ring


Efficacy
Mechanism of action
Systemic side effects

Oral Contraceptives.

In addition users may experience an
****
same as OCs


~Increased Vaginal Discharge.
Thought to involve either spermicidal or inhibitory effects on sperm capacitation and transport.
Mechanism of action of

IUDs
If the string is not visible ....
Pt wants to continue pregnancy.....
Pt should be informed of serious risk of sepsis & poss death with such pregnancies

IUDs
Relieve pain of :
endometriosis
adenomyosis

Endometrial protection for women taking
Estrogen Therapy
IUD-Progestin


-Relieve pain of :
-Endometrial protection for women taking
endometriosis
adenomyosis

Estrogen Therapy
Is the ring
estrogen or progesterone based?
Combination
May be optimal method for women with

~Breast CA
~Breast feeding
~DM
~Dysmenorrhea
~Hepatic Dz
~Menorrhagia
~Thromboembolia
IUD
(Progestin Only)

Optimal Indications for:
7ct
May be optimal method for women with
~Breast CA
~Breast feeding
~DM
~Dysmenorrhea
~Hepatic Dz
~Menorrhagia
~Thromboembolia
Indications:

Medical termination of pregnancy thru 49th day (7Wks)
of
Gestation.
Nm Rx?

MOA
causes breakdown of endometrium (decidua)
which causes detachment of blastocyst.

Adverse Effects:

-Anorexia
-Nausea
-Vomiting
-Abd Pain
-Fatigue
-Uterine Bleeding (heavy )
Mifepristone



~Indications: (Rules of Use)
~MOA:
~Adverse Effects (6ct):
-Medical termination of preg thru 49th day (7wks)
of
Gestation.

-Causes breakdown of endometrium (decidua)
which causes detachment of blastocyte

-Anorexia
-Nausea
-Vomiting
-Abd Pain
-Fatigue
-Uterine Bleeding (heavy )