Contraceptives Flashcards Preview

Pharmacology > Contraceptives > Flashcards

Flashcards in Contraceptives Deck (27):
1

Oral hormonal contraceptives

Monophasics, Biphasic, Triphasic -> combined oral contraceptives (estrogen and progesterone)
Norethindrone and norgestrel -> progestin only pills

2

Non oral hormonal

The patch
The ring
Progestin injection
Progestin Implant
Intrauterine systems

3

Emergency post coital contraception hormonal

One or two tablets of levonorgestrel*** taken before 72 hrs and followed 12 hours later -> nausea and vomiting; no prescription needed if over 17yrs
Ulipristal acetate is a selective progesterone receptor modulator-> inhibits or delays ovulation
Other *high dose norgestrel or levonorgestrel* formulations can be used

4

Emergency post coital contraception non hormonal

Copper IUD inserted within five days of intercourse

5

Estrogens

ethinyl estradiol or mestranol (a prodrug of ethinyul estriol)

6

Non hormonal contraceptive methods

Barriers (least effective) -> condoms, diaphragm, cervical caps, spermicides
IUD
Sterilization

7

Progestins

Most have some *androgenic activity*
Levonorgestrel and norgestrel -> highest
Norethindrone (2nd gen) -> low
Desogestrel and norgestimate (3rd gen) -> lowest
Drospirenone-> anti androgenic

8

Contraceptive use

Prevention of pregnancy
Menstrual cycle regulation
Reduction of premenstrual symptoms and treatment of acne
Inconsistent use may increase failure rate

9

Monophasic combined oral contraceptive description

Fixed dose in each active pill

10

Monophasic combined oral Mechanism

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

11

Biphasic oral mechanism

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

12

Triphasic oral mechanism

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

13

Biphasic and Triphasic oral description

Variable proportions of one or both hormones in each pill to mimic the menstraul cycle

Reduces the monthly progestin dose

14

Monophasic, Biphasic, Triphasic oral PK

21 active + 7 placebo (most common)

Extended cycle: 84 active + 7 placebo -> 4 periods a year

Continuous regimens: 21 active + 4-7 very low dose -> NO periods

15

Monophasic, Biphasic, Triphasic oral Adverse

Nausea, bloating, breakthrough bleeding (improve by third cycle)

HA
Migraine and CVA
Depression
Insulin resistance

Hirsutism, oily skin, acne (from progestin)
Melasma (dark skin discoloration)
Amenorrhea
Dyslipidemia

CVD -> increase prouction of PF VII, X and fibrinogen

16

Monophasic, biphasic, triphasic oral contraindications

Thromoboembolic disease
Stroke, CAD
Breast CA, estrogen dependent neoplasm
Hepatic tumors or liver disease
Abnormal uterine bleeding
Heavy smoking over age 35 yrs

Minor: history of migraine disorder, HTN, diabetes, uterine fibroids, breast feeding, smoking at any age

Rifampin and other CYP450 inducers increase metabolism of estrogen

Broad spectrum antibiotics (especially Rifampin) reduce intestinal flora and interrupt enterohepatic circulation of estrogen and decreasing efficacy of OCP's

17

Norethindrone and Norgestrel class

Progestin only pills

18

Norethindrone and Norgestrel description

Less effective than combined OCP
NO thromboembolism
Decreased dysmenorrhea, menstrual blood loss and PMS symptoms

19

Norethindrone and Norgestrel mechanism

Blocks ovulation in 60-80% of cycles, but highly efficacious -> thickening of cervical mucus and endometrial alterations that impair implantation

20

Norethindrone and Norgestrel Adverse

Not widely used in US
Unscheduled bleeding
Spotting

21

The patch description

Ethinyl estradiol and progestin

22

The ring description

Transvaginal delivery of ethinyl estradiol and progestin

23

Progestin injection description

Depo-Provera
Contains depo medroxyprogesterone acetate (DMPA)
Extremely effective

24

Progestin injection PK

IM injections every three months

25

Progestin adverse

Menstrual irregularities
Weight gain
Significant loss of bone mineral density (black box)

26

Progestin implant description

Contains a progestin
Placed under skin in upper arm
Effective for 3 years
Adverse->irregular menstrual bleeding

27

Intrauterine Systems

Polyethylene body
Levonorgestrel releasing
Effective for five years