Fe Flashcards
(11 cards)
Explain the mechanism of action adverse effects and regimens of oral contraceptives
Mechanism of action: combined pills containing ethinyl estradiol with a progestin suppress hypothalamic gonadotropin releasing hormone and pituitary LH FSH secretion which prevents the midcycle LH surge and ovulation; progestin thickens cervical mucus making it impermeable to sperm produces an out of phase endometrium and increases tubal motility which interferes with fertilisation and implantation; progesterone only pills rely mainly on cervical mucus thickening and endometrial changes but may inconsistently inhibit ovulation. Regimens: monophasic twenty one active tablets followed by seven pill free or iron tablets; biphasic or triphasic varying progestin or estrogen dose; extended cycle eighty four plus seven placebo; progesterone only minipill taken daily without a break; once a month pill containing high dose estrogen and progestin on day five; emergency or postcoital pills high dose levonorgestrel or combined estrogen progestin within seventy two hours; long acting injectables and implants are depot regimens. Adverse effects: minor nausea vomiting breast tenderness headache weight gain breakthrough bleeding chloasma mood change fluid retention; major hypertension venous or arterial thromboembolism myocardial infarction stroke cholestatic jaundice benign hepatoma glucose intolerance migraine exacerbation increased risk of cervical and possibly breast carcinoma; after cessation fertility returns within one to three months.
Oral contraceptive pills regimens types mechanism of action and adverse drug reactions
Same answer as previous card which should be referred to avoid duplication
Write briefly on therapeutic uses of estrogens and progestins
Estrogens: hormone replacement therapy for menopausal syndrome and osteoporosis prevention primary ovarian failure or castration acne and hirsutism combined oral contraception dysmenorrhoea and dysfunctional uterine bleeding suppression of lactation prostate cancer palliation. Progestins: components of combined oral contraceptives progesterone only contraception treatment of dysfunctional uterine bleeding endometriosis premenstrual syndrome threatened or habitual abortion hormone replacement with estrogen endometrial carcinoma appetite stimulation in AIDS or cancer cachexia.
Write briefly on tamoxifen raloxifene and other selective estrogen receptor modulators
Tamoxifen is a nonsteroidal SERM that acts as an estrogen antagonist in breast tissue but partial agonist in bone liver and uterus; used to treat and prevent estrogen receptor positive breast cancer and for mastalgia; adverse reactions include hot flushes risk of endometrial carcinoma and venous thrombosis. Raloxifene is an antagonist in breast and uterus but agonist on bone and lipid metabolism therefore useful for prevention and treatment of postmenopausal osteoporosis and to reduce risk of breast cancer with little or no risk of endometrial proliferation; adverse effects include vasomotor symptoms and thromboembolism. Other SERMs include bazedoxifene and ospemifene with tissue selective profiles for menopausal symptoms and bone protection.
Write briefly on drugs used for treatment of infertility
Ovulatory failure is treated with clomiphene citrate fifty milligrams daily for five days starting on day two to five of cycle which blocks estrogen feedback and raises gonadotropins; aromatase inhibitor letrozole two point five to five milligrams daily for five days has similar efficacy; human menopausal gonadotropin or recombinant FSH injections followed by hCG trigger are used in anovulatory women who fail to respond; pulsatile GnRH infusion treats hypothalamic amenorrhoea; bromocriptine or cabergoline correct hyperprolactinaemia; progesterone luteal support may be added after ovulation induction.
Write briefly on ovulation inducing agents
Primary agents are clomiphene citrate and letrozole given early follicular phase; injectable gonadotropins hMG or recombinant FSH with hCG trigger are used in assisted reproduction; pulsatile GnRH is effective in hypothalamic amenorrhoea; low dose FSH protocols or sequential clomiphene plus gonadotropin can be employed; dopamine agonists induce ovulation in women with prolactin excess.
Write briefly on sex hormones and their antagonists in malignancy
Estrogen antagonists such as tamoxifen anastrozole letrozole are used in estrogen receptor positive breast cancer; progestins like megestrol acetate are used in endometrial carcinoma and as appetite stimulants in cancer cachexia; GnRH analogues goserelin and leuprolide down regulate gonadotropins and treat hormone sensitive breast and prostate cancer; androgen receptor antagonists flutamide bicalutamide are used in prostate cancer; selective estrogen receptor degrader fulvestrant treats resistant breast cancer.
Write briefly on oral contraceptives
Types include combined monophasic biphasic triphasic pills progesterone only minipill postcoital emergency pills once a month pill depot injectables implants transdermal patch and vaginal ring; efficacy of combined pills approaches one failure per thousand women years when taken correctly; mechanism involves suppression of ovulation thickening of cervical mucus and endometrial changes; adverse drug reactions range from minor gastrointestinal and bleeding disturbances to major thromboembolic cardiovascular and metabolic complications; contraindications include pregnancy unexplained vaginal bleeding carcinoma of breast or endometrium thromboembolic disease severe hypertension hepatic adenoma and heavy smoking over age thirty five; noncontraceptive benefits include regulation of menses reduced dysmenorrhoea protection against ovarian and endometrial cancer and improvement of acne.
Give pharmacological basis for estrogen is frequently used along with progestin in therapeutics
Estrogen alone stimulates continuous endometrial proliferation which predisposes to hyperplasia and carcinoma while addition of progestin converts the endometrium to secretory phase and induces regular withdrawal bleeding thereby preventing neoplasia; progestin also adds contraceptive efficacy by thickening cervical mucus and provides cycle control; estrogen upregulates progesterone receptors permitting lower progestin dose hence combined regimen maximises efficacy and safety.
Write a short note on post coital contraception
Emergency contraception can be achieved by levonorgestrel one point five milligrams single dose within seventy two hours or seven hundred fifty micrograms twice twelve hours apart or by combined Yuzpe method of ethinyl estradiol and levonorgestrel high dose; ulipristal acetate thirty milligrams up to one hundred twenty hours and mifepristone six hundred milligrams single dose are alternatives; copper intrauterine device inserted within five days is most effective; mechanisms include inhibition or delay of ovulation interference with fertilisation or implantation; adverse effects are nausea vomiting headache breast tenderness and altered next menses.
Write a short note on non contraceptive uses and benefits of oral contraceptive pills
Combined pills regularise menstrual cycles decrease dysmenorrhoea menorrhagia and iron deficiency anaemia reduce incidence of pelvic inflammatory disease ectopic pregnancy functional ovarian cyst benign breast disease and endometriosis relieve premenstrual syndrome improve acne and hirsutism prevent osteoporosis and confer long term protection against endometrial ovarian and colorectal cancers; they may also reduce rheumatoid arthritis risk and provide cycle planning convenience.
