Female Reproductive Drugs

Question 1

most effective contraceptives

Answer 1

orals then condoms cyclebeads/sdm

then diaphrams

Question 2

Oral contraceptives

Answer 2

hormones used to prevent pregnancy or regulate menses
most combination of estrogens & progestins
block ovulation

Question 3

what reduces the effectiveness of OCPs

Answer 3

anticonvulsants
ABX
warfarin
insulin 
some oral DM meds

Question 4

Missed pills

Answer 4

if 1 take 2 pills next day same time
if 2 take 2 pills for the next 2 days
if 3 use alt form of contraceptive til next month
combination & progestin-only

Question 5

combination contraceptives

Answer 5

act by providing negative feedback to pituitary (stop LH & FSH to prevent ovulation)
monophasic
biphasic
triphasic

Question 6

combo contraceptives cons

Answer 6

mimic some symptoms of pregnanc (breast tenderness, nausea, bloating, appetite changes
monitor for s/s of thromboembolism
may increase risk of breast cancer

Question 7

combination oral contraceptive examples

Answer 7

estrogen: ethinyl estradiol
progestin: desogestrel, norethindrone, norgestimate, progesterone

Question 8

Contraceptive BBWs

Answer 8

if 35 y/o or older and heavy smoking (>15 cigs/day) increases risk of CV adverse effects [DON’T PRESCRIBE]
preg cat X
don’t give with st. john’s wort (bleeding)

Question 9

serious complications of birth control pills (ACHES)

Answer 9

abdominal pain
chest pain - shortness of breath
headaches (sudden/persistent = CVA or ^ BP)
eye problems = ^ BP
severe leg pain (thromboembolic)

Question 10

monphasic OCP

Answer 10

estrogen & progestin remain same thru month

Question 11

biphasic OCP

Answer 11

E/P same first 21 days then E only for last 5 days

Question 12

triphasic

Answer 12

E same 3 weeks but P changes each week

Question 13

progestin-only contraceptives

Answer 13

no estrogen
take continuously
no week off
thick viscous mucous at cervix to discourage sperm penetration
less effective than combo
need to take at same time every day
doesn’t increase DVT or Breast cancer but increased menstrual irregularities

Question 14

norethindrone

Answer 14

progestin only contraceptive
used for women who can’t take estrogen (usually during lactation)
SE: ectopic pregnancy, ovarian cysts, breast carcinoma, HA, irregular vaginal bleeding
contra: breast cancer, undiagnosed irregular bleeding, liver tumors

Question 15

ortho-evra

Answer 15

transdermal patches )1 patch/week for 3 weeks 1 wk off)
combination mechanism
concern for reduced absorption in high BMI

Question 16

nuvaring

Answer 16

vaginal ring

insert for 3 weeks 1 wk off

Question 17

medroxyprogresterone (depoprovera)

Answer 17

injection Q3 months
inhibits effect of estrogen on uterus
SE: breakthrough bleeding, breast tenderness, weight gain, depression, HTN, n/v, dysmenorrhea
BBW: risk for thromboembolic disease, stroke, breast cancer, 65+ risk of dementia, risk of bone mineral loss

Question 18

etonogesterel (nexplanon)

Answer 18

subdermal implant Q3 years
suppresses ovulation
increases viscosity of cervical mucus
SE: HA, vaginitis, weight increase, acne, ab pain, depression, menstrual irregularities, gallbladder disease

Question 19

skyla, liletta

Answer 19

3 year intrauterine

Question 20

mirena kyleena

Answer 20

5 yr intrauterine

Question 21

paragard

Answer 21

10 yr intrauterine

Question 22

conjugated estrogens

Answer 22

replacement for female sex hormones
mixture of different natural estrogens
TX: abnormal uterine bleeding due to hormonal imbalance, post-menopausal symptoms, hypogonadism, atrophy, increase bone density, reduce LDL
SE: nausea, fluid retention, edema, breast tenderness, ab cramps, bloating, acute pancreatitis, appetite changes, acne, depression, decreased libido, headache, fatigue, nervousness, weight gain
BBW: alone = higher risk of endometrial cancer and embolus
should not be used to prevent cardiovascular disease, or treat dementia
adding progestin can be protective
X

Question 23

oxytocin

Answer 23

uterine stimulant
induces labor by increasing frequency & force of uterine contractions
given before partum by IV to increase frequency/force of contractions
given post partum to reduce hemorrhage
SE: fetus: dysrhthmias, intracranial hemorrhage, respiratory depression
maternal: uterine rupture (increased risk if more children)
BBW: don’t give for initiation of labor
interx: vasoconstrictors may cause severe HTN
X

Question 24

magnesium sulfate

Answer 24

tocolytic
delays labor by 24-72 hrs
SE: comblete heart block, circulatory collapse, respiratory paralysis

Question 25

hydroxyprogesterone

Answer 25

tocolytic

SE: thromboembolic disorders, clincal depression

Question 26

nifedipine

Answer 26

tocolytic

SE: complete heart block

Question 27

terbutaline

Answer 27

tocolytic
SE: bronchoconstriction
dysrhythmias
tachycardia for mom/fetus

Question 28

dinoprostone

Answer 28

prostaglandin
cervical rippening
inserted into vagina at or near term pregnancy
SE: uterine hyperstimulation, fetal distress
BBW: uterine rupture, postpartum DIC (bleeding from everywhere)
contra: fetal distress, unexplained vaginal bleeding, previous cesarean, hx of ruptures

Question 29

carboprost

Answer 29

labor inducer prostaglandin
causes intense smooth muscle contractions
indicated for postpartum hemorrhage
SE: hot flashes, wheezing, dypsnea, hypertension, palpitations, d
VVW: history of asthma, uterine rupture
C, only indicated after delivery

Question 30

ergot alkaloid: methylergovovine

Answer 30

labor inducer
increases tone/rate/amplitude of contraction ions on smooth muscle of uterus
SE: shock, severe HTN, dysrhythmias
BBW: can cause uterine rupture
contra: HA, migraine, stroke, eclampsia, heart disease, renal disease, pulmonary disease
over 50 drug interx and grapefruit
only indicated after delivery