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Repro 2 > Hormonal Contraceptives - Segars > Flashcards

Hormonal Contraceptives - Segars Flashcards

1
Q

**5 MoAs of HCs

A
  • Modify mid-cycle surges of LH and FSH
  • Inhibit ovulation by suppressing HPO axis
  • Diminish ovarian hormone production
  • Produce unfavorable endometrial changes
  • Thicken cervical mucus to impede sperm transit
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2
Q

3 types of oral tablets

A
  • Combo
  • Progestin only
  • Extended cycle
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3
Q

5 types of non-daily methods

A
  • Injectable
  • Implantable
  • Patch
  • Vaginal ring
  • IUD
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4
Q

3 estrogens in oral HCs

A
  • Ethinyl estradiol
  • Estradiol valerate
  • Mestranol
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5
Q

How is ethinyl estradiol different from normal estradiol?

A

Ethinyl group slows hepatic/enzymatic degradation (much longer half life)

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6
Q

What is estradiol valerate?

A

Synthetic pro-drug of 17-beta estradiol, metabolized to estradiol

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7
Q

What is Mestranol?

A

Metabolized to ethinyl estradiol

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8
Q

Progestin groups in HCs

Which group has more masculinizing effects?

A
  • 19-Nortestosterone-analogs
  • Spironolactone-analog

19-NT

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9
Q

Groups of 19-Nortestosterone-analogs

Which group has more estrogenic effects and issues?

A

Estranes
Gonanes

Estranes

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10
Q

A patient is having an estrogen-related side effect of her HC. Which progestin drug group is a better substitute: Estranes or Gonanes?

A

Gonanes

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11
Q

3 Estrane drugs

A

Norethindrone
Norethindrone acetate
Ethynodiol diacetate

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12
Q

5 Gonane drugs

A 
Desogestrel
Dienogest
Levonorgestrel
Norgestrel
Norgestimate
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13
Q

Spironolactone-analog drug

A

Drospirenone

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14
Q

Progestin drugs with the most Progestin effect

What class are those? Are ALL gonanes like them?

A

Desogestrel (++++), Levonorgestrel (++++), Norgestrel (+++)

Gonanes (19-NT); NO, only these 3

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15
Q

Progestin drugs with any Estrogen effect

What drug class are they?

A

Ethynodiol diacetate (+++), Norethindrone (++), Norethindrone acetate (++)

Estranes (19-NT)

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16
Q

Progestin drugs with the most Androgenic effect

Only progestin drugs with NO androgen effect

A

Levonorgestel (++++), Desogestrel (+++), Norgestrel (+++)

Drospirenone (Spironolactone-analog), Dienogest

17
Q

Non-Oral Progestins (w/ administration type)

A 
Norelgestromin (patch WITH ESTROGEN)
Etonogestrel (vaginal ring WITH ESTROGEN)
Etonogestrel (implantable rod)
Medroxyprogesterone (injection)
Levonorgestrel (IUD)
18
Q

Non-contraceptive benefits of combination HCs include reduction in what cancers?

A

Ovary, Endometrium, Colon/Rectum

19
Q

Non-contraceptive benefits of combination HCs include improvements in what other symptoms?

A

Irregular cycles, dysmenorrhea, menorrhagia, function ovarian cysts, acne, anemia, PMDD

20
Q

Non-contraceptive benefits of combination HCs include the prevention of what things?

A

Bone loss, fibrocystic/benign breast disease, PID, ectopic pregnancy

21
Q

Non-contraceptive benefits of combination HCs include the treatment of what other symptoms?

A

Acne, hirsutism, peri-menopausal symptoms

22
Q

***Estrogens have been shown to DECREASE what lab values/physiologic activities?

A

Cholesterol (TC, LDL)
Anti-thrombin 3
Osteoclastic activity (bone turnover)
Bile acid levels

23
Q

***Estrogens have been shown to INCREASE what lab values/physiologic activities?

A 
TGs and HDL
Clotting factors
Platelet aggregation
RAAS activity (Na/fluid retention)
Hormone-binding globulins
Iron/TIBC
Prolactin
24
Q

Adverse effects of HCs

A

Irregular bleeding, breast tenderness, fluid retention (weight gain), mood changes, headaches and GI distress, hyperkalemia (Drospirenone), acne/hirsutism/wt gain (androgenic effects)

25
Q

SERIOUS adverse effects of HCs

A

MI/Stroke/DVT/PE/intestinal ischemia
HTN
Gallbladder disease

26
Q

**CONTRAINDICATIONS to using HCs

A 
Hx of vascular-related disease
Pregnancy
Breast/endometrial/hepatic neoplasms
Undiagnosed vaginal bleeding
Uncontrolled HTN
SMOKER (>35 y/o)
27
Q

Emergency contraception - drug

MoA

A

Levonorgestrel

Inhibition of ovulation

28
Q

Emergency contraception must be administered before what?

A

Implantation

29
Q

What is Ella?

MoA

A

Ulipristal acetate – emergency contraception

Progesterone-receptor modulator – inhibits ovulation

Repro 2 (28 decks)

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