Estrogen/Progestin

Question 1

Therapeutic class

Answer 1

combination oral contraceptive

Question 2

Examples

Answer 2

Estrogen: ethinyl estradiol
Progestin: desogestrel, northindrone, norgestimate, drospirenone, levonorgestrel, medroxyprogesterone, progesterone

Question 3

Mechanism of Action

Answer 3

Inhibit release of FSH and LH leads to prevent ovulation

Question 4

Actions and Uses

Answer 4

-As contraceptive, prevents pregnancy
-improve menstrual cycle regularity, decreases incidence of dysmenorrhea
Off label, some indicated for acne, endometriosis

Question 5

Adverse Effects

Answer 5

Edema, nausea, abdominal cramps, dysmenorrhea, breast tenderness, fatigue, rash, acne, headache, weight gain, breakthrough bleeding
Breast milk reduction  progestin only at 6wk PP
Cancer  HPV (no prophylactic); Breast Cancer
Glucose Elevation  DM should monitor serum glucose closely
Hypertension  increases with age, dosage & length of therapy
Increased appetite, weight gain, fatigue, depression, acne & hirsutism  caused by high progestin
Lupus exacerbation  may be come worse with combination OCP; progestin only may be an option
Menstrual irregularities  low amount of progestin
Migraines  concern due to migraines risk factor for stroke
Nausea, edema, breast tenderness  high amount of estrogen
Teratogenic  discontinue if pregnancy confirmed
Thromboembolism  estrogen promote blood clotting

Question 6

Blank Box Warning

Answer 6

cirgaretter smoking incrreases risk of CV adverse effecs, risk increases greater than 35 y/o and heavy smoking greater cigarettes/day

Question 7

contraindications

Answer 7

thromboemolitic disorders, stroke, coronary artery, disease, hepatic tumors; carcinoma of breast, uterus, or ER or PR dependent tumors, pregnancy

Question 8

Interactions

Answer 8

decreased efficacy: rifampin, antibiotics, barbiturates, anticonvulsants, protase inhibitors, anti fungals
-breakthrough bleeding: st. john’s wort

Question 9

Preg Cat

Answer 9

X