what positive effects does estrogen have?
positive effect on bone mass and cholesterol levels
- increase skin vascularity
estrogen increases the risk of what?
thromboses
when is estrogen used?
- birth control
- menopause - hormone replacement
- reproductive deficiency
what is the action of conjugated estrogen (Premarin)?
stimulates estrogen production
what form does conjugated estrogen (Premarin) come in?
PO, transdermal patch, IM, topical gel
what is hormone replacement therapy? what types are there?
the replacement of estrogen when ovaries no longer producing it
- can be estrogen only
- can be estrogen + progestin
what are the benefits of hormone replacement therapy?
- relief of vasomotor symptoms
- management of urogenital atrophy
- prevention of osteoporosis and fractures
- prevention of colon cancer
what are the risks of hormone replacement therapy?
- nausea and fluid retention
- thromboembolic events
- endometrial cancer
- breast cancer
- ovarian cancer
- dementia
- gallbladder disease
when should hormone replacement therapy be used?
- when benefits outway risks
- should be shorter (less than 4 years)
- use specifically for symptoms and adverse effects of menopause
what is the action of oral contraceptives?
- inhibit ovulation
- thicken cervical mucous
what are the different types of oral contraceptives?
- combination of estrogen and progestin
- progestin only
what are the different types of combination oral contraceptives?
- monophasic
- biphasic
- triphasic
what is unique about monophasic combination oral contraceptives?
- estrogen and progestin levels are constant
- more side effects
what is unique about biphasic combination oral contraceptives?
- progestin dose increases second-half
what is unique about triphasic combination oral contraceptives?
- progestin dose changes for each phase of the cycle
- most tolerated
what are the uses for oral contraceptives?
- pregnancy prevention
- decrease menstrual cramps (endometriosis)
- acne
- reduce symptoms of PMS
- ovarian cysts
what are dosing regimens like for oral contraceptives?
- 28 day cycle (21 days on, 7 days off)
- extended cycle (84 days of active pills, 7 days of low dose estrogen - better for endometriosis)
what are the adverse effects of oral contraceptives?
- thromboembolism
- hypertension
- abnormal uterine bleeding
- nausea
what are drugs that decrease the effectiveness of oral contraceptives?
- barbiturates
- benzodiazepines
- rifampin
- st. john’s wort
- some seizure medications (carbamazepine. phenytoin)
what symptoms increase as progestin increases?
- fatigue
- weight gain
- depression
estrogen decreases the effectiveness of what drugs?
- tamoxifen - breast cancer
- sulfonylureas - diabetes
- anticoagulants
what are other forms of birth control?
- transdermal patch (ethinyl estradiol + progestin)
- NuvaRing (ethinyl estradiol + progestin)
- subdermal implants
- depot IM injections (progesterone)
what drugs are used for BPH?
- 5-alpha-reductase inhibitors (-teride)
- alpha 1 blockers
what is the action of 5-alpha-reductase inhibitors (-teride)?
inhibits metabolism of testosterone, which decreases proliferation of prostate cells
what does finasteride (proscar) do?
decreases the size of the prostate by blocking the active form of testosterone in prostate
- 5-alpha-reductase inhibitors (-teride)
how long does it take for 5-alpha-reductase inhibitors (finasteride) to produce results?
6-12 months
how long does it take for 5-alpha-reductase inhibitors (finasteride) to produce results?
6-12 months
what is the normal dose for 5-alpha-reductase inhibitors (finasteride)?
5mg PO daily
what are the adverse effects of 5-alpha-reductase inhibitors (finasteride)?
- decreased libido
- gynecomastia
true or false: 5-alpha-reductase inhibitors (finasteride) are only helpful if the prostate is very enlarged
true
what is the action of alpha 1 blockers?
relax the smooth muscle of the prostate through alpha 1 blockage
what are examples of alpha 1 blockers used for BPH?
doxazosin (cardura) and tamsulosin (flomax)
- osin
what are the adverse effects of alpha 1 blockers (-osin)?
- hypotension - second line treatment for HTN
- dizziness
- nasal congestion
- blurred vision
- abnormal ejaculation
what 2 medications don’t mix for men?
viagra and nitroglycerin
what type of drugs can treat erectile dysfunction?
phosphodiesterase type 5 inhibitors (-afil)
- sildenafil (Viagra)
- tadalafil (Cialis)
what is the action of phosphodiesterase type 5 inhibitors (-afil)?
enhances effects of nitric oxide to enhance blood flow to the corpus cavernosum
what are adverse effects of phosphodiesterase type 5 inhibitors (-afil) ?
- headache
- MI, sudden death
- dyspepsia (indegestion)
- flushing
what are female causes of infertility?
- anovulation
- follicular immaturity
- abnormal cervical mucus
- increased prolactin levels
- endometriosis
- PCOS
what are male causes of infertility?
- decreased sperm motility
- erectile dysfunction
what is the action of clomiphene citrate (Clomid)?
used for infertility
- promotes follicular maturation and ovulation by blocking estrogen receptors
- produces more follicles
what should be monitored with the use of clomiphene citrate (Clomid)?
the risk of multiples
what are the risks of clomiphene citrate (Clomid)?
- nausea, bloating, breast enlargement
- visual disturbances
- multiple births (8-10%)
- ovarian hyperstimulation syndrome
what is the action of menotropins and follitropins?
used for infertility - IM
- promote follicular development directly in ovaries
- can be used with IVF
what are the adverse effects of menotropins and follitropins?
- ovarian hyperstimulation syndrome
- multiple births (15-20%)
what is the difference between menotropins and follitropins?
menotropins - equal amounts of LH and HSG
follitropins - FSH
what is the action of leuprolide (Lupron)?
prevents premature ovulation to improve the number of quality eggs
what are the other uses of leuprolide (Lupron) besides infertility?
- precocious puberty
- endometriosis
- advanced prostate cancer
what are the adverse effects of leuprolide (Lupron)?
like menopause
- hot flashes
- mood swings
- insomnia
- vaginal dryness/painful intercourse
