Contraceptives and Drugs acting on the Uterus

Question 1

the initial rise in _____ is what stimulates the ovarian follicles to developing (ripening of follicles)

Answer 1

FSH

Question 2

the peak in ______ is responsible for the peak in LH/FSH and thus causes ovulation

Answer 2

estrogen

Question 3

peak of ______ occurs slightly before ovulation

Answer 3

estrogen

peak of FSH/LH occurs during ovulation

Question 4

what are two general approaches to prevent pregnancy?

Answer 4

1. prevent ovulation (suppress LH/FSH release by preventing rise of estrogen levels)
2. impair implantation (by maintaining elevated progesterone levels which why you give progestin)

Question 5

the estrogen in combined oral contraceptives is either ethinyl estradiol or ______

Answer 5

mestranol

mestranol is a pro drug that is converted to ethinyl estradiol

Question 6

which of the progestin oral contraceptives has anti androgenic effects

Answer 6

drospirenone

Question 7

______ and ____ of the progestins have the highest androgenic activity

Answer 7

levonorgestrel and norgestrel

-norgestrel

Question 8

most formation of OCP’s have 21 hormonally active pills and 7 placebo’s. what is the use of the placebos?

Answer 8

• facilitates consistent daily pill intake
• allows withdrawal from bleeding. has no benefit but its psychological for women to think that they have not completely wiped out their monthly bleeding

Question 9

thickening of the cervical mucus and prevents sperm penetration is due to _____ (hormone)

Answer 9

progestin

also impairs implantation by induces changes in the endometrium

Question 10

one term use of OCP’s is related to what AE

Answer 10

cardiovascular toxicity

Question 11

when you first prescribe a patient OCP’s how would you advise the about the adverse effects?

Answer 11

they may experience symptoms of bloating nausea and breakthrough bleeding but should spontaneously resolve by the third cycle

Question 12

the most common adverse effect of OCP’s is _______

Answer 12

breakthrough bleeding caused by the low dose estrogen because estrogen is used to stabilize the endometrium

Question 13

women who develop migraine WHILE taking OCP’s should _____

Answer 13

stop taking OCP’s; okay to take them if they had migraines before taking OCP’s

Question 14

why are cardiovascular disorders an AE of OCP’s?

Answer 14

• estrogens ↑ the production f factor VII, X and fibrinogen → ↑ risk of thromboembolic events

Question 15

a patient on OCP’s and taking antibacterial can _____ estrogen levels

Answer 15

↓; ethinyl estradiol is conjugated in ht liver and excreted into the bile, hydrolyzed by intestinal bacterial and reabsorbed as an active drug. if antibiotics reduce the population of intestinal bacterial, that can interrupt the enterohepatic circulation of estrogen

Question 16

________ (antibiotic) has substantial evidence that it substantially lowers steroid levels

Answer 16

rifampin

Question 17

can you give OCP’s to patients who are older than 35 and smokes more than 15 cigarettes per day:

Answer 17

NO;

however you can give them to someone who is over 35 OR if a person smokes more than 15 cigarettes per day

Question 18

you cannot give OCP’s to patients with migraines with aura because there is ↑ risk of ______

Answer 18

cerebrovascular events

Question 19

unscheduled bleeding and spotting are more common in what oral therapy for OCP’s (combined or progestin only)

Answer 19

progestin only therapy however this method had NO RISK of thromboembolic events

Question 20

what is depo-provera? how does it work to prevent pregnancy

Answer 20

it is a progestin only injectable contraceptive and contains DMPA (depot medroxyprogesterone acetate) and is extremely effective because in this case, the progestin levels are high enough to prevent ovulation via negative feedback

Question 21

what are some adverse effects of depo-provera?

Answer 21

• high incidence of menstrual irregularities and weight gain
• SIGNIFICANT loss of bone mineral density with chronic use

Question 22

the major adverse effect of progestin implants is ______

Answer 22

irregular menstrual bleeding

Question 23

the intrauterine systems release ______ (drug)

Answer 23

levonorgestrel (progestin); effective for 5 years

Question 24

Plan B contains tablets of _______

Answer 24

levonorgestrel (progestin)

1st one takin within 72 hours of sex and 2nd is taken 12 hours later

Question 25

in order to reduce the rate of failed induction and for oxytocin to work properly, cervical ripening must occur. Drugs used for cervical ripening include _____ and ______

Answer 25

prostaglandins: dinoprostone and misoprostol

Question 26

what is the use of dinoprostone and misoprostol?

Answer 26

they ripen the cervix and also stimulate uterine contractions (no need for oxytocin)

Question 27

dinoprostone is a ______ analog

Answer 27

PGE2

Question 28

misoprostol is a _____ analog

Answer 28

PGE1

Question 29

which of the prostaglandins can be administered orally or sublingually

Answer 29

misoprostol

Question 30

oxytocin works by ____ protein couple receptors

Answer 30

Gq; activates MLCK and

↑ prostaglandin synthesis (why oxytocin can be used for post partum hemorrhage

Question 31

high concentrations oxytocin can activate ________ receptor and cause _______

Answer 31

vasopressin receptors and cause excessive fluid retention, hyponatremia, HF, seizures and death

Question 32

ergot alkaloids (methylergonovine) can be given for _____. what is its MOA

Answer 32

post partum hemorrhage

partial agonist at α adrenergic receptors and some serotonin receptors

Question 33

tocolytics are given to ________. give examples of some

Answer 33

relax the uterus and delay labor

magnesium sulfate, indomethacin, nifedipine

Question 34

magnesium sulfate is a _______ agent and inhibits cellular action potentials by _______

Answer 34

tocolytic agent that uncles excitation-contraction in myometrial cells through inhibition of action potentials

Question 35

_______ is the main NSAID that is used to speed up/delay labor

Answer 35

Indomethacin; delay labor because prostaglandins stimulate uterine contractions

Question 36

an AE of ______ is that it CAN cross the placenta and lead to respiratory and motor depression of the neonate

Answer 36

magnesium sulfate

Question 37

premature closure or constriction of the ductus arteriosus is an AE of _______________

Answer 37

indomethacin (NSAID given to delay labor)

Question 38

indomethacin should be given during what period of gestation?

Answer 38

given BEFORE 32 weeks gestation because after, there is ↑ chance of premature closure of the ductus arteriosus

Question 39

which tocolytic agent is a calcium channel blocker?

Answer 39

nifedipine; associate with more frequent successful prolongation of pregnancy

Question 40

what are the three abortifacients

Answer 40

• mifepristone (anti progestin)
• misoprostol (prostaglandin analog)
• methotrexate (folic acid antagonist)