L43- Contraceptives (general + oral) Flashcards Preview

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Flashcards in L43- Contraceptives (general + oral) Deck (23)
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1

(1) = most common goal of contraception

(2) are the other goals

-*prevention of pregnancy

-menstrual cycle regulation
-reduction of premenstrual symptoms
-Acne Tx
-Hirsutism (excess androgens)

2

(1) types of OCPs

(2) and (3) are the major general approaches

1- combined OR progestin-only

2- preventing ovulation
3- impairing implantation

3

describe mechanism of preventing ovulation

1) give estrogen
2) stabilize (prevent fluctuations) of estrogen levels
3) suppress FSH, LH release

4

describe mechanism of impairing implantation

give progestin --> maintains elevate progesterone levels:

-thickens cervical mucus --> prevents sperm penetration
-induces changes in endometrium --> impairs implantation

5

list estrogen oral contraceptives

-ethinyl estradiol

-mestranol (prodrug --> ethinyl estradiol)

6

list progestins

norethindrone
norgestrel
levonorgestrel
desogestrel
norgestimate
drospirenone

7

describe the non-progesterone activity of progestin

variable Androgenic activity:
-levonorgestrel, norgestrel: highest
-norethindrone: 2nd
-desogestrel, norgestimate: 3rd gen.
-drospirenone: antiandrogenic

8

describe oral contraceptive preparations

Monophasic: fixed dose estrogen and progestin in each active pill

Biphasic, Triphasic: variable proportions one or both hormones

9

Biphasic and Triphasic OCP preparations have the following advantages over Monophasic:
-(T/F) more efficacious
-(T/F) less amount and monthly dosing
-(T/F) less AEs
-(T/F) hormone levels more closely related to changes in menstrual cycle

1- F
2- T, reduced progestins
3- T, related to dec amount / dose
4- T

10

name most common combined OCP and discuss most common dosing

35 µg ethinyl estradiol (or less, aka 'low dose') + progestin

One mo: 21 hormonal pills, 7 pill placebo (consecutive- allows withdrawal from bleeding)

11

describe the type of combined OCP dosing regimens

Common: 21 hormonal days, 7 placebos

Extended Cycle: 84 hormonal days, 7 placebo --> only 4 menstrual cycles per year

Continuous: 21 hormonal days, then 4-7 reduced dose days

12

list the many benefits of combined OCPs

-reduced risk endometrial, ovarian cancer
-improve menstruation regulation
-breast disease relief
-ovarian cyst prevention
-reduced risk of symptomatic PID
-acne control

13

OCPs have many AEs, (1) are the main concern limiting long-term use. (2) is an adjustment that have greatly reduced AEs.

1- CVS toxicity
2- reduced dosage

14

________ OCP AEs can improve spontaneously by the third cycle

-nausea
-bloating
-breakthrough bleeding

15

________ most common OCP AE

breakthrough bleeding (vaginal spotting)- more w/ low estrogen doses --> stabilizes endometrium

16

describe HAs as an OCP AE

-usually mild, transient

-migraine maybe associated with CVA
--> indication to stop OCP

17

OCP AEs:
-(1) positive hormone effects
-(2) negative hormone effects
-inc (3) production
-(4), an over effect of hormones administered
-decreases the incidences of (5)
-a few patients with (6) disease may need to stop

1- Androgenic progestins --> acne, oily skin, hirsutism --> switch to less or non-androgenic progestin

2- progestins --> insulin resistance (competes for receptor) --> therefore low progestin content to avoid hyperglycemia

3- estrogen --> melanocyte production--> melasma

4- amenorrhea

5- endometrial and ovarian cancer

6- depression

18

OCP cardiac AEs:
-increases (1) production --> increasing risk of (2) events in general
-(3) name the (2) events
-(4) are the precipitating risk factors

1- Estrogen --> inc factor VII, factor X, fibrinogen

2- thromboembolic events

3- thromboembolism, thrombophlebitis, HTN, MI, cerebral thrombosis

4- obesity, smoking, HTN, DM, >35 y/o

19

OCP AEs: Liver Enzyme (induction/inhibition) is the main concern, explain

drugs that induce CYP450:
**inc estrogen metabolism
-rifampin mainly (+ the others you known)

20

OCP AEs effect on Antibacterials

Ethinyl estradiol --> undergoes bile excretion --> hydrolyzed by intestinal bacteria --> active drug reabsorption

-if given Antibiotic --> dec estrogen levels may occur
-some antibiotics dec OCP efficacy

21

list the ABSOLUTE OCP contraindications

-pregnancy
->35 + smoking (15 cigs)
-surgery or immobilization injury

-thrombophlebitis, thromboembolic disorders
-stroke, CAD

-breast CA, estrogen dependent CA, benign/malignant liver tumor

-vaginal bleeding, uncontrolled HTN, DM + vascular disease
-migrains w/ aura
-active hepatitis

22

list the RELATIVE OCP contraindications

-migraine w/o aura
-lactation

-HTN, DM
-Heart and Kidney disease
-gallbladder disease, cholestasis during pregnancy
-SCD

23

Progestin Only Pills:
-(1) formulation
-(2) efficacy compared to combined OCP
-(3) benefits
-(4) disadvantages

(impairs implantation)
1- norethindrone, norgestrel (not used in US)

2- less --> only blocks 60-80% of cycles

3- NO thromboembolic events + dec dysmenorrhea, des blood in menstruation, dec PMS Sxs

4- bleeding / spotting