Pharm for PCOS Flashcards
(31 cards)
Hormonal Contraception Mech of Action?
- High levels of estrogen + progesterone suppress GnRH release from hypothalamus
- Reduced GnRH → reduced FSH + LH release from pituitary
- Inhibition of follicular development + ovulation
- Alteration in cervical mucus inhibiting sperm penetration
Specific job of estrogen + progesterone component of birth control?
Estrogen component:
- suppresses LH → reduction of androgen production + ↑ production of SHBG (liver) which reduces testosterone
Progestin component:
- inhibits the LH surge → reduced ovarian androgen production
progestin have wide range of action + differ in their androgenic ability + progesterogenic acitvity
1st generation progestin?
norethindrone
2nd generation progestin (2)?
Norgestrel
Levonorgestrel
3rd generation progestin?
norgestimate
4th generation progestin (2)?
- drospirenone
- cyproterone acetate
Difference between 1+2nd versus 3rd + 4th progestins?
3rd and 4th have fewer metabolic effects
4th are anti-androgenic
- cyprotenone acetate = most
- drospirenone - 40% of the anti-androgenic activity of cyproterone
Absolute CI on COC (10)?
- breast cancer
- cerebrovascular disease
- any heart disease, MI, IND, vascular disease
- DVT/ PE, coagulation mutations/ deficiencies
- diabetes
- uncontrolled HTN
- < 6 weeks postpartum, current pregnancy
- migraine w. aura
- liver tumour/ cirrhosis
- smoke > 35 yrs of age (15 cig or more)
which COC indicated for PCOS/ acne?
Anti-androgenic - drospirone, cyproterone acetate
Monophasic vs biphasic vs triphasic
- Monophonic pills → most common, provide steady dose of hormones throughout entire pack
- Biphasic pills → contain 2 sets of pills at different strengths. usually estrogen stays the same, and progestin changes
- Triphasic pills →steady estrogen + 3 different progestin dosages
Non-contraceptive benefits of COC (6)?
- ↑ bone mineral density
- ↓ acne
- ↓ ovarian (30-50%), endometrial (30%), colorectal (15-20%) cancers
- ↓ peri-menopausal sx
- ↓ risk of fibroids
- ↓ benign breast disease
Adverse effects of all birth controls?
- breakthrough bleeding/ spotting, amenorrhea, nausea/vomting, bloating, chloasma, breast tenderness, mood changes (depression, headaches)
- Major: thromboembolism (rare), stroke, retinal artery thrombosis, MI, benign liver tumour, cholelithiasis, HTN
- Danger signals → ACHES
- abdominal pain, chest pain, headaches, eye problems, severe leg pain
Adverse effects on drospirenone containing birth controls?
- include hyperkalemia in pts prone to ↑ K+ (renal disease, concomitant use of ACEi, ARB, K sparing diuretics, NSAID)
- may be at higher risk of venous thromboembolism compared to other progestins
- advisable to check K+ levels after 1st cycle
Birth control increases risk of what cancers & is protective against?
increased risk: breast + cervical
Protective: endometrial, ovarian + colorectal cancers
Indications for progesterone only pill?
pts > 35 yrs of age who smoke, cannot tolerate estrogen, have unwanted side effects with COCs, experience migraine headache w/ neurological sx or are breastfeeding
Adverse effects of progestin pill?
higher incidence of ectopic preg (compared to COC)
irregular bleeding
Relative + absolute CI for progestin pill?
relative: viral hepatitis + liver tumours
Absolute: pregnancy + current breast cancers
Emergency postcoital contraception?
levonorgestrel + ulipristal acetate
Which emergency contraceptive is most effective?
both effective within 72 hrs
72-120 hrs ulipristal acetate more effective
- also better for higher BMI
levonorgestrel vs ulipristal & breastfeeding
levonorgestrel = no restriction for breastfeeding
ulipristal = breastfeeding NOT recommended at least 24 hrs (1 week WHO)
Drug options for PCOS?
- COC
- insulin sensitizers
- Meds for hirsutisim
- Ovulation induction meds
Metformin + thiazolidinediones (rosiglitazone + pioglitazone)?
insulin sensitizers
When in metformin indicated in PCOS?
IR
Spironolactone + finasteride?
meds for hirsutism (anti-androgenic)
*spirilactone most often used
