Hormone Contraception Flashcards

(36 cards)

1
Q

Menotropins

A

human menopausal gonadotropin, or hMG

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2
Q

Follicle stimulating hormone (3)

A

Follitropin alfa (rFSH alfa), Follitropin beta (rFSH beta), Urofollitropin (uFSH)

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3
Q

Leuteinizing hormone

A

Lutropin alfa

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4
Q

Human choriogonadotropin hormone

A

Choriogonadotropin alfa (rhCG)

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5
Q

Gonadotropin-releasing hormone analogs (6)

A
  • Leuprolide
    * You have to grow up to ride loop-rollercoasters
  • Goserelin, Histrelin, Nafarelin, Triptorelin, Gonadorelin (synthetic human GnRH)
    * Ellen was always very little
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6
Q

Gonadotropin-releasing hormone antagonists (3)

A

Cetrorelix, Degarelix, Ganirelix

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7
Q

Estrogens (4)

A

Conjugated estrogens (Premarin), Estradiol valerate, Ethinyl estradiol, Mestranol

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8
Q

Progestins (6)

A

Desogestrel/Etonogestrel, Drospinenone, Medroxyprogesterone, Norethindrone, Norgestimate, Norgestrel

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9
Q

Estrogen and Progesterone inhibitors and antagonists (4 classes)

A
  • Mifepristone
  • Selective estrogen receptor modulators (Raloxifene, Tamoxifen Toremifene)
  • Aromatase inhibitors (Anastrazole, Exemestane, Letrozole)
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10
Q

Which estrogen is commonly found in oral and implantable contraceptives?

A

Ethinyl estradiol

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11
Q

Which has more variation in oral and implantable contraceptives, estrogen or progesterone?

A

Progesterone

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12
Q

Why is Ethinyl estradiol so common?

A

Very potent; resistant to hepatic metabolism –> can give very low dose

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13
Q

Estrogen adverse effects

A

Nausea, breast tenderness, hyperpigmentation, increased migraines, cholestasis, gallbladder disease, HTN, Breast/Endometrial cancer(?)

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14
Q

Estrogen contraindications

A

Estrogen-dependent neoplasm, genital bleeding, liver disease, blood disorder, heavy smoker, CV disease, migraine with aura

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15
Q

Progesterone adverse effects

A

Breakthrough bleeding, Breast cancer, androgenic effects (weight gain, acne, hirsutism, low HDL)

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16
Q

When to give progestin-only contraceptive

A

Migraines, 35yo+ and smoker or obese, blood disorder, CV disease, HTN, SLE, high cholesterol

17
Q

Which progesterone is not androgenic?

A

Desogestrel, Norgestimate
Dropsirenone

Dees No Drops (your voice)

18
Q

Acne treatment

A

Desogestrel, Norgestimate, Dropsirenone

19
Q

Combination oral contraceptives MOA

A

Prevent ovulation (feedback inhibition)

  • suppressed GnRH/LH/FSH
  • absent LH surge
  • low endogenous steroids
20
Q

Progestin-only pills

A

Highly effective - thick cervical mucus, impaired implantation; only blocks 60% ovulations

21
Q

Benefits of Combination oral contraceptives

A

Estrogen - osteoporosis prevention, reduced cholesterol
Combination - reduce ovarian & colon cancer, ectopic pregnancy, breast disease, dysfunctional uterine bleeding/dysmenorrhea; improve PMS, hirsutism, acne

22
Q

Benefit of LARC

A

e. g. Mirena (Levonorgestrel)

- Rapid return to fertility after removal

23
Q

Implantable contraceptive

A

Etonogestrel (progestin)

24
Q

Depo-provera

A

Medroxyprogesterone acetate

  • IM or SQ every 3 mos
  • can take 6-12 mos for fertility to return
25
Transdermal preparatoin
Ethinyl estradiol & Norelgestromin
26
Vaginal contraceptive ring
Ethinyl estradiol & Etonogestrel (NuvaRing) - rapid return to fertility after removal
27
Failure rate with typical and perfect use - COC - Progestin-only - Transdermal - Vaginal
Typical use: 9% | Perfect use: 0.3%
28
Failure rate with typical and perfect use - IUD - Implant - Sterilization (female)
Typical use - IUD: 0.15-0.4% - Implant: 0.05% - Sterilization: 0.5% Perfect use - IUD: 0.2-0.4% - Implant: 0.05% - Sterilization: 0.5%
29
DDIs
Cytochrome P450 inducers - Phenytoin - Rifampin Antibiotics (interfere with GI flora's ability to increase bioavailability of estrogens)
30
Pregnancy termination
Mifepristone *"But I want my life to be pristine... wahh." - progesterone receptor antagonist - used with Misoprostol (prostaglandin E1) - 95% effective within 7 weeks ADR: prolonged bleeding
31
Morning after
Levonorgestrel - progesterone receptor antagonist - DOES NOT reverse pregnancy - No rx Ulipristal acetate - progesterone receptor antagonist - may interfere with pregnancy - Rx required
32
Time frame for most postcoital contraceptives
72 hours (for 99% effectiveness)
33
Absolute contraindications of estrogen therapy
- Thromboembolic disease - Undiagnosed abnormal genital bleeding - Potential for estrogen-dependent neoplasia - Impaired liver function - Possible pregnancy
34
Selective Estrogen Receptor Modulators (SERMs)
Tamoxifen, Toremifene - competitive partial agonist inhibitors of estradiol * antagonist on breast; agonist at other tissues - Tx of ER+ breast cancer Raloxifene * antagonist on endometrium and breast; agonist on lipids and bone - Prevent osteoporosis and breast cancer
35
Aromatase inhibitors
Anastrazole, Letrozole, Exemestane - inhibit aromatase function (can't produce estrone or estradiole) - Tx of breast cancer in postmenopausal women - DO NOT GIVE TO FERTILE WOMEN
36
What do you NOT give to a fertile woman who has breast cancer?
Aromatase inhibitors (Anastrazole, Letrozole, Exemestane)