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Pharm Flashcards

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1
Q

Pathway of hypothalamus to signal lactation

A

dopamine from hypothalamus -> suppresses prolactin

Estrogen stimulates pituitary to release prolactin and breast lactates

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2
Q

Pathway of hypothalamus to signal estrogen and progesterone secretion

A

GnRH from hypothalamus -> FSH and LH from anterior pituitary -> ovaries secrete estrogen and progesterone

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3
Q

Negative feedback loop for GnRH and FSH/LH secretion

A

ovarian hormones: progesterone, estrogen, inhibins

opioid/endorphins

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4
Q

Positive feedback effects of estrogen/estradiol

A

Both positive and negative feedback on GnRH

at low/moderate levels… inhibits GnRH, LH, and FSH

at high levels… stimulates LH (“surge”)

also promotes endorphin secretion to increase “opioid tone”

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5
Q

More rapid pulse frequencies of GnRH secretion (1 pulse per hour) preferentially stimulate ____ secretion, whereas slower frequencies (1 pulse per 3 hours) favor ____ secretion.

A

LH

FSH

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6
Q

Conditions that can cause defects in GnRH pulse production

A 
anorexia or malnutrition
severe stress
extreme weight loss
prolonged physical exertion
hyperprolactinema or lactation states
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7
Q

Physiological results of GnRH production defects

A

failure of follicles to develop
no estradiol secretion
secondary amenorrhea

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8
Q

role of FSH

A

recruit and growth of immature follicles; starts follicular phase of ovarian cycle

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9
Q

role of LH

A

triggers ovulation and development of corpus luteum

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10
Q

FSH rise is brought about by ________’s influence on slowing down GnRH pulsatility.

A

progesterone

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11
Q

Risk of estrogen deficiency

A

heart disease (atherosclerosis d/t HDL decrease)
osteoporosis
depression
IBS, bloating (water and Na retention)

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12
Q

Benefits of estrogen

A

development and maintenance of female reproductive organs, secondary sex characteristics, and breasts

promotes pregnancy - stimulates endometrium growth, vaginal lubrication, thickens vaginal wall, increases uterine growth

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13
Q

location of aromatase enzymes

A

liver

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14
Q

most dominant estrogen form lost during menopause or ovarian failure? most dominant in menstruating women?

A

estrone (E1)

estrodial (E2) = estrogen

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15
Q

MOA aromatase inhibitors

A

decreases estrogen

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16
Q

hCG produced by ______ upon implantation.

A

placenta

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17
Q

Progesterone functions

A

make endometrium ideal for implantation - decrease contractility, decrease maternal immune response

inhibits lactation during pregnancy; falls following delivery

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18
Q

What causes increased thickness of endometrial tissue in prep for pregnancy?

A

increase in estrogen (proliferative phase) and progesterone (secretory phase)

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19
Q

4 main groups of estrogen preparations for hormone replacement therapy

A

Human natural estrogens (17 beta-estradiol)
Nonhuman natural estrogens (horse urine)
synthetic estrogen analogs (eg ethinyl estradiol in Nuva ring and transdermal patch)
plant-based estrogens (phytoestrogens)

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20
Q

Estrogen replacement benefits

A

contraception, relief of vasomotor symptoms (eg, hot flashes and night sweats), relief of vulvovaginal atrophy, improvement or prevention of osteoporosis

cardioprotective???

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21
Q

ADRs of estrogen replacement therapy

A

common: nausea, breast tenderness, HA, dizziness

Breast cancer, DVT, PE

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22
Q

Do not give estrogen alone to what patients? Why?

A

patients with uterus

increased risk of endometrial cancer

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23
Q

Activity of 1st generation progestin agents

A

non-selective; affinity for estrogen, androgen, and progesterone receptors

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24
Q

Activity of 2nd generation progestin agents

A

affinity for progesterone and androgen receptors

NO estrogen effect

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25
Progestin agents with only progestational activity
4th generation
26
Can progesterone replacement alone work as contraceptive?
yes like in Minipill but not as well as estrogen
27
ADRs of progestin agents
acne, increased appetite and weight gain, fatigue, HTN, depression
28
Why are estrogens used as contraceptive?
negative feedback loop prevents FSH release; prevents ovulation
29
Why are progestins +/- estrogens used as contraceptive?
inhibits LH surge for ovulation | tricks ovary into thinking it has already released egg
30
Efficacy of combined oral contraceptives with perfect use?
99%
31
Most commonly used form of estrogen in oral contraceptives?
ethinyl estradiol
32
How are biphasic or triphasic formulations of contraceptive different than monophasic?
monophasic: consistent amount of estrogen and progestin in each active tablet bi/triphasic: vary the dose of estrogen, progestin, or both throughout cycle to better mimic the natural menstrual cycle
33
When is contraceptive pack of pills started?
first day of menses
34
How can patients skip their period? How often can this be done?
immediately start a new pack of pills at the beginning of week 4 instead of taking the placebo pills or having the no pill week. Encourage patients to have at least one period every three months.
35
What if patient forgets to take pill 2 days in a row? Longer than 2 days?
take 2 pills for 2 consecutive days +2 days missed, take 1 pill until Sunday and then discard pill pack and start new pack
36
Contraindications of combined oral contraceptives
``` H/O stroke, DVT, PE, MI Smokers > 35 yo CV risk Active liver disease Current or h/o estrogen-dependent tumor Hypertriglyceridemia Migraine w/ aura Undx'd uterine bleed ```
37
ADRs of all combined oral contraceptive
``` DVT, PE, MI, stroke HTN Breakthrough bleeding or spotting Bloating (fluid retention) Skin pigment changes (Chloasma) ```
38
How can dosing be adjusted if breakthrough bleeding?
if during week 1, adjust estrogen | if during week 3, adjust progesterone
39
Black box warning of Ortho Tri-cyclen?
smoking; increases risk of serious CV side effects
40
When is back up protection required for transdermal patch contraception?
if patch off for more than 24 hrs
41
Emergency contraception
``` Progestin-only (Plan B) IUDs Mifepristone Ulipristal Take multiple combo oral contraceptive pills at once ```
42
Levels of estrogen and progesterone during menopause
very random ups and downs of estrogen | virtually no progesterone
43
Levels of estrogen and progesterone during perimenopause
normal estrogen | sudden drop in progesterone
44
Infertility treatment options
Follicular phase: follitrophins Ovulatoin phase: aromatase inibitors, gonadotrophins Luteal phase: GnRH antagonist, progesterones
45
Drugs that treat urge incontinence
antispasmodics (oxybutynin) anticholinergics TCAs Botulinum toxin
46
Drugs that treat stress incontinence
alpha-adrenergic agonists | estrogens
47
HPV vaccine prevents _________.
cervical caner and genital warts
48
Who gets HPV vaccine? When and how many?
all adolescents at age 11-12; 3 dose series (0, 2, and 6 months)
49
Consequences of progesterone deficiency
breakthrough bleeding, amenorrhea, or heavy menstrual flow
50
______ has proliferative effects on endometrium.
estrogen
51
2 types of estrogen found in contraceptives
ethinyl estradiol - most common mestranol - metabolized by liver to ethinyl estradiol
52
MOA of progestin-only contraception
inhibit egg implantation and decrease penetration of sperm/ovum transport
53
Back up birth control if you miss how many "active" pill?
orthotricyclen: back up next 7 days if miss 2 pills Alesse: back up next 7 days if miss 1 pill
54
What oral contraceptive can also be used for menstrual migraines?
Alesse
55
DIs of all contraceptives
tobacco transexamic acid (increases coagulation) antivirals (increases risk of liver damage) antibiotics
56
ethinyl estradiol + levonorgestrel =
Alesse
57
In which patients should Mini-pill be used? (progestin-only)
- lactating (no decrease in milk production) - contraindications to estrogen contraceptives - wish to be pregnant in near future (don't stop ovulation)
58
Why would Mini-pill not be used in unreliable patient?
need stricter adherence to taking pill at same time each day 3 hrs late is considered skipped dose
59
MOA of Ortho Micronor
inhibits sperm penetration by thickening cervical mucous reduces midcycle LH and FSH
60
Copper IUD changed every _____ years, and Mirena changed every _____ years.
10 | 5
61
Most common reasons copper IUD has to be removed within 1st year?
heavy menses | dysmenorrhea
62
Most popular hormone IUD
Mirena
63
Medication in Mirena
releases 20mcg of levonorgestrel daily
64
When is Mirena inserted?
for contraception, within 7 days of menstruation for abortion, immediately after 1st trimester
65
Medication in NuvaRing
ethinyl estradiol/etonogestrel
66
IUDs increase the risks of what?
endometritis, pelvic infections, allergic skin reactions, tubal damage, uterine perforation
67
Higher incidence of __________ with NuvaRing compared to other contraceptives.
vaginitis, vaginal infections
68
When is NuvaRing not recommended?
for patients with cystocele, rectocele, or uterine prolapse
69
NuvaRing placed in vagina by ______ of menstrual cycle and left in for ______. Ring then removed for 1 week and replaced.
5th day | 3 weeks
70
How often is Depo-provera IM injected?
every 3 months
71
What are the major ADRs of Depo shot?
weight gain and reduced libido
72
Home option of Depo shot?
subcutaneous injection called Implanon
73
Who are emergency contraceptives available for?
females 17 yr or older (some states
74
When should emergency contraceptives be used?
within 5 days of unprotected sex
75
Which method of menopause estrogen replacement is associated with lower thromboembolism and stroke risk?
transdermal preps (unlike oral, skips first pass in liver)
76
Benefits of menopause hormone therapy
relief of vasomotor sx's, relief of vaginal dryness, improved sexual function, improved urge incontinence, prevention or improvement of osteoporosis, improved insulin sensitivity
77
Primary pathophysiological purposes of menopause hormone therapy
stabilize endometrial proliferation and promote cyclic shedding, while also relieving menopausal sx's
78
Ethinyl esterdiol patch used for menopause sx's as well as osteoporosis prophylaxis and breast cancer.
Climara
79
What is 1st line treatment for women with ovulatory dysfunction who are trying to get pregnant?
Clomiphene citrate
80
MOA of Clomiphene citrate
inhibits negative feedback response of estrogen on hypothalamus by competing with estrogen receptor binding sites
81
Clomiphene citrate not recommended for women with what?
ovarian cysts, abnormal vaginal bleeding, or abnormal liver function
82
Clomiphene citrate ADRs
abd/pelvic pain or distention, visual sx's, HA, hot flashes, mood change, pregnancy wastage, birth abnormalities, multiple pregnancy (twins/triplets)
83
MOA of oxybutynin
competitively inhibits muscarinic receptor to relax smooth muscle of bladder (esp. detrusor muscle)
84
What is considered an adequate trial for oxybutynin?
4-6 wks at max tolerated dose
85
ADRs of oxybutynin
anticholinergic effects, hypersensitivity, seizures, confusion
86
DIs of oxybutynin
CYP450, potassium, cholinesterase inhibitors, opioids, drugs that lower seizure threshold (e.g. Bupropion)
87
Patients with what condition should definitely not be given oxybutynin?
Dementia patients due to anti-cholinergic effects

Women's Health - GYN (12 decks)

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