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Reproductive Pharm > Oral contraceptives > Flashcards

Oral contraceptives Flashcards

1
Q

Estrogen is 70% bound to what in blood?

A

SHBG. If you give estrogen, SHBG will increase to balance out the increased estrogen (keeping free hormone levels normal)

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2
Q

Progesterone is transported via?

A

Transcortin

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3
Q

MOA of estrogen?

A

Acts thru nuclear receptors (ER-alpha & beta). Affects gene transcription by binding HRE

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4
Q

Give me 8 actions of estrogen

A
  1. Breast development
  2. Increase HDL & decrease LDL (favorable)
  3. Inhibit osteoclastic activity (favorable)
  4. Widen pelvis
  5. Increase libido
  6. Increase binding proteins & clotting factors
  7. Build up myometrium
  8. Closes epiphysial plate
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5
Q

Metabolism of estrogen?

A

Hepatic. Synthetic estrogen is metabolized much slower than intrinsic estrogen

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6
Q

AE’s of estrogen therapy?

A
  1. Mastalgia
  2. Breast enlargement
  3. Breakthrough bleeding
  4. CV events (estrogen is prothrombotic)
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7
Q

Progesterone actions? (give me 6)

A
  1. Pregnancy maintenance
  2. Development of breast secretory units
  3. Inhibits uterine contraction
  4. Increases insulin
  5. Bad for cholesterol (increase LDL)
  6. Increases core body temp
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8
Q

5 theraputic uses for estrogen/progesterone therapy?

A
  1. Contraceptive
  2. Hormone replacement- treats effects of menopause like osteoporosis
  3. Dysfunctional uterine bleeding
  4. Luteal phase dysfx (give progesterone)
  5. Ovulation induction- ER blockers (Clomiphene & Fulvestrant) –> increase in LH/FSH –> stimulates ovulation
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9
Q

What are the ER blockers?

A

Clomiphene & Fulvestrant

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10
Q

T/F: Estrogen therapy causes an increased cancer risk?

A

True: can stimulate endometrial, breast, uterus, testis, bone, & kidney cancer. DES can cause clear cell carcinoma

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11
Q

When it comes to CVD, what effects do estrogen & progesterone have?

A

Estrogen decreases risk for CVD. Progesterone increases risk

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12
Q

T/F: Estrogen therapy can lead to increased risk of stroke & DVT

A

True- especially in a patient that SMOKES!

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13
Q

Most effective means of contraception?

A

IUDs, progestin implants, & sterilization

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14
Q

Least effective means of contraception?

A

Barrier & calendar methods

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15
Q

Most popular contraceptive?

A

Hormone pills

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16
Q

Difference between mono/multiphasic OCP?

A

Mono has fixed doses in each pill. Multi has different doses

17
Q

Aside from keeping you kid free, what benefits do OCPs have? (6)

A
  1. Decrease risk for ovarian/endometrial cancer
  2. Decrease dysmenorrhea
  3. Menstrual regularity
  4. Increase Hb
  5. Increase SHBG –> decrease free T –> decreased acne
  6. Used off label for PCOS
18
Q

What can decrease effectiveness for OCPs? (5)

A
  1. Antibiotics
  2. Rifampin
  3. Anti-retrovirals
  4. Anti-convulsants
  5. St. John’s Wort (herb)… Yes, I typed st. john’s wart at first, but then googled it and found out it is in fact not a wart..
19
Q

What is the estrogen component of combined E/P OCP? What is the progestin component?

A

Estrogen: Ethinyl estradiol or Mestranol
Progestin: Norethindrone, Norgestrel, or Levonorgestrel

20
Q

Of the 2 (E and P) which has better things assc with it?

A

Estrogen! Can lead to breast enlargement and increased excitability (nice)
Progestin: can lead to weight gain and acne

21
Q

E/P therapy is contra’d in what? (3)

A
  1. CV things (like thromboembolic state, CVD, MI, CAD)
  2. Hyperlipidemia
  3. Woman cancers (breast, ovarian, endometrial)
22
Q

How does the progestin only pill work?

A

It DOES NOT block ovulation! It impairs sperm transport by thickening cervical mucus & thickens endometrium to impair implantation. Higher risk of failed therapy

23
Q

Why give progestin only pill?

A

When woman is breast feeding, or if she is a smoker..

**“If a woman is on estrogen and she’s smoking, she’s asking for a clot” -Guljan

24
Q

AE’s of a combo P/E transdermal patch?

A
  1. Less effective in obese women
  2. Break through bleeding in first 2 cycles
  3. Skin reaction
25
Q

How does the vaginal ring work?

A

Women put it in their vagina. Its in for 3 weeks then out for 1 week. Delivers E/P. Not effective for the first 7 days

26
Q

How quickly does fertility return when you take out the vaginal ring?

A

Very quickly.. like in a matter of hours

27
Q

What are the 2 types of IUD and how long are they effective?

A
  1. Copper containing (15-20 years)

2. Progestin releasing (5 years max)

28
Q

How long does it take fertility to be restored after removal of IUD?

A

Not long.. wasnt temporally quantified

29
Q

Whats a sponge?

A

Something that contains spermacide that a woman puts “up in there”. Its left in for 6 hours post-coitus

30
Q

What is the morning after pill composed of and how do you take it?

A

2 doses of levonorgestrel separated by 12 hours. Must take first dose w/in 72 hours of intercourse (sooner = better)

31
Q

What are the 2 termination drugs?

A
  1. Mifepristone (7 weeks contragestational

2. Onapristone (antagonizes progestin receptors)

Reproductive Pharm (17 decks)

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