OB-GYN and Genitourinary Drugs Flashcards Preview

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Flashcards in OB-GYN and Genitourinary Drugs Deck (58)
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1

Short acting, non-permanent methods of birth control; 2 different types; take daily to suppress release LH and FSH by the pituitary glands so ovulation does not occur
First approved in the 60s and later became popular
Formulations have now changed to lower doses
Available in a variety of formulations
Most are given as 21 tablets of either a fixed dose or varying dose followed by a week of placebo or iron tablets (this "gap" is when the withdrawal bleed occurs)

Oral Contraceptives (OCs)

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most popular type of OC; use both synthetic estrogen and a synthetic progestin in combination

COCPs--combined oral contraceptives

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Synthetic progestin only; prevents ovulation if taken for more than one cycle;
Provides pregnancy protection by:
thickening cervical mucous and preventing the uterine lining from maturing enough to accept fertilized ovum
*less effective for pregnancy prevention but is better to use for women with risk of cancer and CV

the "mini-pill"

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LH

Luteinizing hormone

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FSH

Follicle stimulating hormone

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They also:
*thicken cervical mucous, impeding sperm passage
*thin uterine lining--interferes with implantation of fertilized egg
*prevent shedding of endometrium, potentially preventing menstruation
*All OCs can act as abortifacients

Other effects of oral contraceptives

*some indication that OCs slightly increase risk of breast cancer
*increase risk of thromboembolic events (DVTs, PE and stroke)

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contains a fixed dose of an estrogen and a progestin

Monophasic OC pill

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have a fixed amount of estrogen with 2 different amounts of progestin

Biphasic OC pill

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the amount of the progestin (usually) varies 3 times during the cycle

Triphasic OC pill

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drugs are the same as OCs but are administered other ways: injection, vaginal rings, patches, subcutaneous implants and intrauterine devices

Non-Oral Contraceptives

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A q3 week vaginal insert that slowly leaks a combo of estrogen and progestin

Vaginal Ring (NuvaRing)

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Progestin-only drugs like Depo-Provera (medroxyprogesterone); sometimes used:
because of safety (history of DVT or pulmonary embolism)
because of convenience and flexibility of 4/year dosing
as a fail-safe method for irresponsible patients

Injection

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The only one currently available marketed in the U.S.; shown to be effective as a COCP with perfect use

Ortho Evra Transdermal Patch

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Consist of 1-2 small silicone rods implanted under the skin about ever 3 years; rods slowly leach a progesterone-only drug;
These devices have been very popular worldwide because of their ease of use, reliability and low rate of adverse effects
*newer ones last 4-5 years

Implantable contraceptives

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the old standbys: condoms, diaphragms and cervical caps

Barrier methods of contraception

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Temporary devices that disrupt implantation by virtue of their presence in the uterine cavity; most also store a progestin drug slowly released to prevent ovulation

IUD-Intrauterine Device

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FDA approved COCP marketed to eliminate periods or reduce frequency
(90mcg levonorgestrel / 20mcg ethinyl estradiol

Lybrel

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using the abortifacient properties of COCPs as a "morning after pill"; can reduce risk of pregnancy by as much as 89%
(i.e. the progestogen-only (levonorgestrel) pill "Plan B", which makes the uterus inhospitable to implantation; better sooner than later because it won't stop pregnancy once an ovum is implanted)

Emergency Contraception

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Technically all COCPs are included but this really refers to a group of meds that terminate an established pregnancy (usually 1st tri); called 'medical abortion'

*mifepristone (Mifeprex) or RU-486--an anti-progesterone drug that causes vigorous contractions of the uterus to terminate pregnancy

Abortifacients

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The first OC approved for treating premenstrual dysphoric disorder (PMDD); Yasmin was its predecessor; became the most popular OC by 2008
Is formulated with a manmade hormone drospirenone, which mimics female progesterone

*approved for contraception and treatment of moderate acne and PMDD but has potentially serious side effects (shouldn't be take by all)

Yaz

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The most severe form of PMS (affects 5% of women); some believe they are separate disorders;
-symptoms are noticeable depressed mood with anger, irritability, anxiety, muscle and headaches
*SSRI antidepressants like Prozac are treatment

PMDD--Premenstrual dysphoric disorder

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the practice of replacing declining levels of natural estrogens with conjugated estrogens from equine sources (Premarin)
*used to be the preferred drug therapy until the early 2000s to treat hot flashes, irritability, weight gain, insomnia, bone loss (preserves bone mass)
*Doubts about safety because of the 20-year Women's Health Initiative

MHT--Menopausal hormone therapy

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Large, 20-year study done on over 160k women from 21 countries (52k WITH breast cancer and 100k WITHOUT) because of suspicions about using MHT; study began in 1991;
1st data announce in 2002 led to big changes in medical practice--data showed that:
-women using HRT for 5+ years had 35% increased risk of breast cancer
-sales of Premarin for HRT dropped drastically
*risk remained during HRT use but went away 5 years after cessation

Women's Health Initiative--WHT

*As a result: 3 other drug strategies developed to preserve bone mass and prevent osteoporosis complications:
Calcium supplements
Bisphosphonate drugs--qweekly drug alendronate (Fosamax)
SERMs--Estrogen receptor agonists (Evista)

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inhibit the osteoclastic process to preserve bone mass by suppressing specialized white blood cells that "eat" bone
*side effects of stomach upset, G.I. inflammation and esophageal erosion

Bisphosphonates

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uses drugs that aren't estrogens but are selective estrogen receptor modulators with similar benefits:
improve lipid profile, reduce hot flashes and stabilize bone mass without increasing risk of breast cancer

SERMs--selective estrogen receptor modulators, Estrogen receptor agonists:
'Evist' (raloxifene)

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all part of normal vaginal flora

bacteria, fungi, and some protozoan organisms

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perturbations like changes in pH, female hormone fluctuations and sexual activity can upset the normal balance and cause overgrowth of certain organisms--vaginal yeast
*sometimes the overgrowth is an STI but usually just a normal nuisance and easy to treat

Vaginitis, vaginal yeast infections, vaginal trichomoniasis, or bacterial vaginosis

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Monistat (miconazole)
Gyne-Lotrimin (clotrimazole)
nystatin or terbinafine

non-systemic antifungals for vaginitis/treat C. albicans (same yeast for oral thrush)

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One of the most common causes of vaginitis; best thought of as a mild imbalance of the normal vaginal bacterial flora
*more common in sexually active women but you can't catch if from another person

Bacterial Vaginosis--BV (vaginitis)

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-having more than one sexual partner or a new partner
-smoking
-douching

risk factors for BV