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Pharm II - Week 10
Reproductive Drugs Part 1
| Question | Answer |
|---|---|
| During menopause, __% decrease of estrogen occurs. Some still produced by conversion of ___ | 75%; androgens |
| Estrogen has the following effects: | 1) develop/maintain F reproductive characteristics, 2) improves bone mass, 3) increases HDL/decreases LDL, 4) mixed effect on blood coagulation, 4) growth of uterine myo/breast develop in pg |
| When estrogen is given as a single therapy, risks are: | Increase in breast, uterine, cervical, ovarian cancer. Potential cancers already forming. Increases risk of CV events |
| Estrogen also plays a role in ___ (neuro) | Memory |
| Estrogen's therapeutic uses: | Contraception, menopausal HRT |
| Selective Estrogen Receptor Modulators can do what to estrogen? Prototype known as... | Block or activate estrogen. Tamoxifen prototype to inhibit cell growth in breast |
| Tamoxifen improves ___ and ___ but also increases risk of _____ | Lipids, bone mass. DVTs |
| Progestins ____ endometrial lining and when progestin levels drop, then woman experiences __ | Maintain; menses |
| During pregnancy, progesterone responsible for: | Prevention of uterine contractions, slowing of peristalsis/constipation, suppression of immune response |
| Low progesterone has ____ risk of pregnancy loss | High |
| Progestins are given therapeutically to do the following: (list 4) | 1) Support fertility to get pg and stay pg; 2) birth control; 3) dysfunctional uterine bleeding; 4) adjunct in HRT estrogen replacement |
| Why is progestin given to help pregnancy? | During pregnancy low doses can maintain endometrial lining for viable fetus. High doses are teratogenic however. Also used to prevent premature birth |
| True or false: progestins have many routes | True: PO/topical/SQ/IM/vaginal gel/ring/intrauterine/transdermal patches |
| PMS/PMDD will show sx in __ phase until __ post-menses | luteal; 4 days post-menses |
| PMS/PMDD is a combination of ____ and ____ Sx | Physical, psychological |
| True or false: women with PMS/PMDD have different hormone levels from typical woman | False. Hormone levels similar |
| PMS/PMDD is thought to be an issue of ____ r/t changes in hormones | Sensitivity |
| Recommendation of PMS/PMDD Tx includes a ___ intervention that has the following: | Stepwise intervention: 1) stress relief, 2) diet changes (temp. increase complex carbs), 3) Mg/Ca supplement, 4) exercise |
| What drugs are most effective for PMS/PMDD? | SSRIs for psychological Sx and decrease of physical Sx |
| PMS/PMDD drugs have ______ compliance d/t ______ | Poor; AE |
| PMS/PMDD pts. should avoid what type of Tx? | Hormone Tx. Exception with COC, black cohosh, red clover, evening primrose |
| HRT begins at ___ years when loss of estrogen is greatest | 48-55 yrs. |
| Symptoms of estrogen loss will impact QOL and manifest in: | Hot flashes, sleep, atrophy of genitals, bone loss, worsening of lipid profile |
| Main Tx goal of HRT is to _______ | Improve QOL |
| HRT is protective for bones, lipids, and _____ | Colon cancer |
| HRT can be given with ______ to suppress ______ cancer | Progestin; E-mediated uterine |
| True or false: long-term HRT is recommended | False. Short term OK |
| AE of HRT: | May worsen CVA/MI/PE/DVT.. Does NOT decrease atherosclerosis and increase risk of Alzhemiers |
| True or false: there is still much unknown about HRT | True |
| Bioidentical hormones are ________ and requires _______ | Hormones grind up and put into lotion to use topically. Still requires full medical oversight and Px |
| HRT should be ordered how? | Lowest effective dose for the shortest amount of time |
| Estrogen + progestin causes these AE | Increase CV events, dementia |
| HRT should NOT be used for _____ protection | CV |
| Natural hormone products for HRT carry ___ risks | Same |
| Contraceptive drugs: unwanted pg rate in US (adults and teens) | 50% adults, 82% teens |
| Contraceptive drug types (list 2), drug routes (list 7) | Hormonal/spermicidal. Routes: PO/IM/IU/vag/cervical/transdermal/implant |
| True or false: typical use of contraceptives have higher rate of pg than perfect use | True |
| Safety regarding contraceptives often as ___ data. | Poor, older |
| True or false: contraceptive use has higher morbidity/mortality rates than pg/birth | False! |
| True or false: PO contraceptives more dangerous than other BC drugs | False |
| Criteria for contraceptives in order of priority: | 1) Personal habits/taste, 2) effectiveness, 3) reversibility, 4) AE, 5) frequency of sex |
| ____ is the most commonly chosen form of contraception, followed by these two | Sterilization; OC & condom after it |
| Contraceptive effectiveness is often tied with... | Methods that require LEAST memory/habit: implants, IUDs, IM depot |
| Guidelines for women choosing contraceptives include: | Women who are over 35 who smoke or who have CV disease should avoid combo OC. Progestin-only pill or IUD may be okay |
| Combined oral contraceptives (COC) ___ progestin through cycle. Other OCs may be ______ | Alter; progestin only |
| Typical use for COC is often less for these women: | Overweight/obese |
| COC typical use is usually __% | 92 |
| Contraindications for PO contraceptives: | Not for 35+yo smokers, CV Hx/illness, Hx/problems with clotting, pts. unlikely to adhere |
| Oral contraceptives are category ___ | X |
| PO contraceptive ADE: | Thromboembolic problems, breast cancer risk, HTN, breakthrough bleeding/spotting, reduced lactation if used first 2 mo after birth, increase glucose in diabetics, worsen gallbladder disease |
| PO contraceptive beneficial effects: | Improve menstrual cramps, decrease risk of some cancers (ovarian, uterine), improve PMS/PMDD sx, improve acne |
| The following drugs DECREASE the efficacy of PO contraceptives: | Dilantin, rifampin, Ritonavir, St. John's wort |
| Drugs INHIBITED by PO contraceptives: | Warfarin, insulin, PO hypoglycemics |
| Drugs POTENTIATED by PO contraceptives: | Theophylline, tricyclics, diazepam |
| If missed dose on COC: | Missed 1: take next pill; missed 2: take 2 for 2 days, missed more: wait 1 wk and start new cycle |
| If on a minipill/progestin only and miss dose: | Missed 1: take it right away and use backup x 2 day. Missed 2: restart cycle and use backup x 2d |
| Transdermal patch is used __/wk, with __ days on and __ days off | once a week; 3 days on and 1 day off |
| Transdermal patch has ___ hormones | Combination |
| If patch comes off for >24h, then you should do what? | Restart cycle, backup x 7d |
| True or false: the patch has same contraindications, ADE, DDIs as OC | True (somewhat more cramping) |
| True or false: typical use of patch is lower than pill | True. 82% vs. pill's 92% |
| Vaginal ring is ___ hormone and has ___ contraindications/ADE/DDIs as OC | Combined hormone; same |
| Vaginal ring is inserted __, left in for __, and removed | Inserted once a month, left in for 3 weeks, and removed |
| If vaginal ring is out for more than __ hrs, need backup x 7day | 3 |
| Vaginal ring ADE: | Vaginitis, leukorrhea |
| Typical use for vaginal ring is: | 85% |
| Implants are __-term BC that is also ___ | Long-term; reversible |
| True or false: implants have combination hormonse | False! Only progestin |
| Implants are put in for __ before being removed. | 3 years |
| Implants' effectiveness decreased by ___ | Liver enzyme inducers |
| Implant ADE include | Irregular bleeding (34%), norplant removed from market; amenorrhea in 22% |
| Implants are __ with lactation and have typical use that is ___ | Safe;99.5% |
| IM/SQ Depot is known as... and protects for this long | Depo-Provera; 3 months |
| Depo-Provera is reversible __ after last dose | 9 months |
| ADE of M/SQ depot: | Irregular bleeding, HA, wt gain, decreased libido, decreased bone density (initially) |
| IM/SQ depot effectiveness typical use is: | 90% |
| True or false: IUD can be placed inside for 5-10 years and is highly reversible | True |
| Mechanism of action for IUD | Slight inflammation that is spermicidal and increases cervical mucus density |
| ADE of IUD: | PID r/t STI (9/1000), cramping, change in menses |
| IUD have typical use of __% | 99% |
| Spermacide is __% effective, meaning typical use alone is often __ | 70%; poor |
| Spermacide/nonoxynol 9 may __ HIV transmission d/t irritation causing nonintact skin | Increase |
| Spermacide should be administered when? How should it be administered? | Within an hour before sex foam must be shaken. Wait 15'' to dissolve. Reapplied with each encounter. (Sponge effective for 24h) |
| Spermacide ADE include: | Vaginal irritation and dryness |
| Medical abortion can be induced with the following meds for early, uncomplicated ectopic pregnancy: | Methotrexate (cytotoxic) |
| Within 7 weeks of conception, would use ____ with misoprostol | Mifepristone |
| Mifepristone + misoprostol is NOT intended for: | Ectoptic pregnancy |
| Mifepristone + misprostol's mechanism of action: | Blocks receptors for progesterone |
| ADE of medical abortion drugs: | Cramping, uterine bleeding, N/V |
| Emergency contraception to prevent pregnancy up to __ days | 5 |
| Mechanisms of emergency contraception: | 1) delay/stop ovulation, 2) inhibition of fertilization/implantation |
| True or false: emergency contraception does not determinate a pregnancy but it does hurt an embyro if pregnancy has occurred | False. DOES NOT hurt embyro |
| Emergency contraception is legal in WA for people who are __ or older | 17 |
| Emergency contraception effectiveness is: __% and can be bought by women AND men behind the counter | 98 |
| Plan B is known as _____ | Levonorgestrel - 1 pill as soon after sex as possible |
| Plan B/levonorgestrel has ___ and outcome measure is: | progestin only; menses in 21 days |
| When on HRT, estrogen-only meds can increase risk of | Uterine cancer |
Created by:
choel
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