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Flashcards in OCP Deck (77):
1

where is most estrogen produced?

ovaries

2

who makes estrogen in premenopausal women

granulosa cells or fetoplacental unit during pregnancy

3

what is the predominant estrogen type in postmenopausal women

estrone

4

where is estrone made

liver and adipose tissue

5

what is the most potent estrogen

17beta-estradiol

6

rank the potency of estrogens from strongest to weakest

1. 17beta-estradiol
2. estrone
3. estiol

7

all gonadal hormones are synthesized from what

cholesterol

8

what converts androstenedione or testosterone to steroidal estrogens

aromatization of the A ring - catalyzed by aromatase

9

what estrogens does the placenta make and how?

estrone and estriol
DHEA

10

all 3 estrogens are excreted how from body

along with glucuronide and sulfate conjugates

11

estrogen impact on ovaries

- stimulate follicular growth
- too much , atrophy of ovaries

12

estrogen impact on uterus

endometrial growth

13

estrogen impact on vagina

- cornification of epithelial cells
- thickening and stratification of epithelium

14

estrogen impact on cervix

- increase cervical mucous
- lowers viscosity ( favors sperm access)

15

estrogen impact on cholestrol

hypocholesterolemic effect

16

estrogen impact on electrolytes

retention of Na, Cl and water by kidney

17

where is progesterone secreted

corpus luteum
adrenal cortex
testis

18

once fertilization occurs what hormone is secreted

hCG

19

during 2nd and 3rd month of pregnancy what does the placenta secrete

E2 and P

20

name 3 actions of progestrone

1. development of secretory endometrium
2. increase viscosity
3. maintain pregnancy

21

what happens to the women body when progesterone levels decline

menstruation

22

how is GnRh, FSH, and LH secreted. what phase are they secreted in

GnRH: intermittent
FSH and LH: pulsatile

Follicular phase

23

both LH and FSH stimulate what in the follicular phase

Graafian follicle growth

24

FSH by it self stimulates what in the follicular phase

maturation and estrogen production
by granulose cells

25

What are estrogen effects on pituitary during early follicular phase

inhibitory

26

What are estrogen effects on pituitary during midcycle follicular phase

positive

27

what is essential for ovulation

LH surge

28

what follows LH surge

follicle rupture within 24-48 hours

29

progesterone is under influence of what hormone

LH

30

what are 3 therapeutic uses for estrogen and progestins

contraception
postmenopausal hormone therapy

31

when is conjugated estrogens used

post menopausal

32

what is the difference between third generation and second generation contraceptives

third: less acne, nausea, lipid changes

33

how does monophasic contraceptive work

- constant estrogen and progesterone for 21 days
- iron or placebo 7 days

34

how does biphasic contraceptive work

2 different levels of progesterone
constant amount of estrogen

35

how does triphasic contraceptive work? 3 versions

1. 3 levels of progesterone/ constant estrogen

2. 1 dose of progesterone, 3 doses estrogen

3. 21 days of estrogen/progesterone

36

What is the goal for extended COC

attempt to alter the number of pill free interval days

37

what is YAZ FDA approved for

premenstrual dysphoric disorder -PMDD

38

What is the combination of YAZ

EE and drospirenone (DSRP)

39

what is the combination of Yasmin? what is difference of Yaz and Yasmin

EE and drospirenone (DSRP)
Yasmin not FDA approved for PMDD

40

What are symptoms for Mircette

fewer menstrual symptoms such as:
estrogen-withdrawal headaches, bloating, and menstrual pain

41

Drospirenone is a derivative of what drug? side effect

spironolactone
- hyperkalemia

42

what is the combination for Seasonale

levonorgestral - EE

43

how is Seasonale taken

84 days straight
7 days placebo

44

Compare Seasonique and Seasonale

Seasonque: 7 days of EE instead of placebo
- better follicular suppresion
- less unscheduled bleeding

45

how is Lybrel taken

365 days
- no placebo or pill free days

46

what is the combination for Lybrel

EE and Levonorgestrel

47

advantage for transdermal contraceptive

avoids first pass effect through liver
- less adverse effect on liver

48

disadvantages for transderma contraceptive

skin irritation/rash
thrombosis

49

what estrogen is used in monophasic CO

mestranol converts to ethinyl estradiol

50

name 3 types of progestins

pregnanes
estranes
gonanes

51

what is adjusted in pill when side effects occur

progestational and androgenic activity

52

Name progestational and androgenic activity

Levonorgestrel and Norgestrel

53

what progesterone has lowest androgenic activity

Desogestrel
Norgestimate
Gestodene
Drosperinone

54

What progesterone has anti-androgen and anti-mineralocortcoid

Drosperinone

55

what are side effects of Drosperinone

hyperkalemia
less weight gain
reduces acne

56

how do COC work

- inhibit ovulation
- thicken endocervical fluid - reduces sperm penetration
- endometrium unsuitable for eggl implanation

57

how does progesterone work in COC

diminishes frequency and amplitude of GnRH and LH

58

how does estrogen work in COC

suppresses pituitary release of FSH in follicular phase ( negative feedback)

59

when are monophasic COC effective ? triphasic ?

within 21 days
triphasic: 7 days

60

what happens when dosing varies?

- increase failure in the beginning of pack
- increase adverse effects due to greater fluctuations in hormones

61

what are side effects that are most important factor for discontinuation of OC

- nausea, headache, migraines, weight gain
- higher incidence of thrombosis formation
-- increase platelet aggregation
-- higher levels of hepatic coagulation factors
- incidence of hypertension in some patients

62

what is the greatest contraindication for OC

cigarette smoker over age 35

63

what are 5 risks for OC

1. venous thromboembolism
2. myocardial infarction
3. stroke
4. gall bladder disease
5. breast cancer

64

what are non-contraceptive benefits for OC

-increase bone mineral density
- decrease acne
- decreased epithelial ovarian cancer

65

when do you to adjust lower estrogen

- nausea and vomiting
- headaches and migraine
- CYCLIC weight gain
- hypermenorrhea
- leg cramps, edema
- hypertension

66

when do you to adjust higher estrogen

-vasomotor symptoms ( hot flashes)
- early spotting or bleeding between
- hypomenorrhea

67

when do you to adjust less progesterone

depression
reduced breast size

68

when you adjust to less androgenic activity

acne or oily skin
NONCYCLIC weight gain

69

when do you adjust to higher progesterone dose

late bleeding
hypermenorrhea

70

what do you if you miss 1 dose of OC
days 22-28
days 1-21

22-28: take remaining pills on schedule
1-21: take pill as soon as discovered
-- max is 2 pills a day

71

when is greatest potential for failure of pill if you miss it

first 5 days

72

what do you if you miss 2 doses of OC
days 1-14
days 15-21

1-14: take extra pill for 2 days
15-21: stop pack and start new cycle

73

what drug can women with migraines and depression use

Minipill - progesterone only

74

if a mother just delivered and they are not nursing, when can they start OC

4 weeks after delivery
- greater than 2 weeks due to risk of blood clots

75

nursing mothers should use what OC

Minipill - progesterone only

76

why can't smoker take OC

smoking induces P450
-therefore smokers must use higher doses of estrogen and progesterone
- this leads to greater failure if pills missed due to increased clearance

77

OC should not be taken with other drugs

Tetracycline, PENICILLIN V, erythromycin and ampicillin