Contraception

Question 1

What are the three types of estrogen, in order of potency?

Answer 1

Estradiol (ovary)
Estrone (fat?)
Estriole (placenta)

Question 2

What percent of estrogen is protein bound?

Answer 2

70% to SHBG: sex hormone binding globulin

Question 3

What does estrogen administration do to free androgens? How?

Answer 3

Estrogen increases SHBG

More SHBG lowers FREE androgens

Question 4

What transports progesterone? This also carries what?

Answer 4

Transcortin (which also carries cortisol)

Question 5

How does Estrogen work?

Answer 5

nuclear receptors
ERalpha  (female repro tract, elsewhere(
ERbeta   (prostate and ovary)
HRE 
nucleus

Question 6

What is the action of Estrogen overview?

Answer 6

HDL up, LDL down
Breast grows
Osteoclast inhibited
Bones grow
Uterus grow
Increase liver action: clotting and bining globulins
Close episeal plates in both seces 
Tumor growth

Question 7

What is a precursor to adrenal steroids?

Answer 7

Progesterone

Question 8

Where is progesterone made?

Answer 8

Ovary, adrenal, testes, placenta

Question 9

What does progesterone do to breasts?

Answer 9

Increase secretory units development

Question 10

What does progesterone do?

Answer 10

Modulate estrogen actions
Secretory uterus
Thick mucus cervix
Pregnancy maintenance
Increase body temp in luteal phase
Depressant/hypnotic effects possible

Question 11

What are E/P given for?

Answer 11

Fertility control
Hormone replacement
Uterine bleeding
Luteal phase dysfunction
Ovulation induction

Question 12

What is given to increase LH/FSH from the hypothalamus? How?

Answer 12

Clomiphene
Fulvestrant
by blocking ER receptors in hypothalamus

Question 13

What are the AEs of Estrogen?

Answer 13

Cancer: endometrial, breast, uterus, bone, kidney, testes

Stroke: DVT by increased clotting factors

GI, menstrual disorders, mastalgia, HTN, decreased lactation

Question 14

What is the AE of DES?

Answer 14

Women whose mothers took it while pregnant have higher risk of clear cell carcinoma of vagina

Question 15

What are the AEs of Progesterone?

Answer 15

Breast cancer!
LDL up, HDL down
GI
Menstrual disorder

Question 16

What are the most effective birth controls? Least effective?

Answer 16

Most; IUD and sterilization

Least: barrier and calendar

Question 17

What are the benefits of contraception?

Answer 17

No babies
Decrease lifetime risk ovary/endometrial cancer
Decrease free androgens: less acne

Question 18

What causes contraception failure?

Answer 18

Antibiotics! 
Rifampin
Anti-retrovirals
Anticonvulsants
St. John's wort

Question 19

What are estrogen drugs?

Answer 19

Ethinyl estradiol

Mestranol

Question 20

What are progesterone drugs?

Answer 20

Norgestrel

Levonorgestrel

Question 21

Progestin can lead to what skin problem?

Answer 21

acne

Question 22

Estogen does what to breasts?

Answer 22

Enlargement

Question 23

What are contraindications to E/P OCP?

Answer 23

Thromboembolic state
CVD
MI
CAD
Hyperlipidemia
Breast cancer
Endometrial cancer

Question 24

How does progestin only pill work?

Answer 24

Thickens cervical mucus
Alters endometrium
Only blocks 70% of ovulations

Question 25

What is a good birth control pill for breast feeding or smoking women?

Answer 25

Progesterone only! (Norgestrel, levonorgestrel)

Question 26

What is the parch?

Answer 26

Combo P/E

Question 27

How long do you take the patch?

Answer 27

One new one every week, 3 weeks | One week off

Question 28

What is the patch less effective in?

Answer 28

Obesity

Question 29

What is advantageous about the ring?

Answer 29

Rapid return to fertility after removal

Question 30

What is injected? How often and how long does it last?

Answer 30

``` Progesterone only (Medroxyprogesterone) Every 3 months. 2 yrs of injections, then another 6-12 months until return to fertlity ```

Question 31

What is in the implant? how long does it last?

Answer 31

Progesterone only. | 3 years.

Question 32

What are the two types of IUD? How long do they last?

Answer 32

Copper: 15-20 years Progestin: 5 years

Question 33

How long are spermicides effective?

Answer 33

1 hour

Question 34

How long do you leave sponges in vagina?

Answer 34

6 hours

Question 35

What are emergency contraceptives, "plan B pills"? What time window is there to take it?

Answer 35

Progesterone high dose: levonorgestrel 2 doses separated by 12 hours 72 hours: sooner the better

Question 36

What drugs are used for termination after 72 hours?

Answer 36

Mifeprisone Onapristone Within 7 weeks

Question 37

What is the action of mifepristone and onapristone?

Answer 37

Progestin receptor antagonists: Prevent action of progesterone Inhabitable uterus