Female reproduction- pharm
Card Set Information
Female reproduction- pharm
Pharm; Female reproduction
oral contraceptives work by:
- suppressing ovulation- main mechanism
-thickening the cervical mucus, preventing sperm from getting through
- changing the lining of the uterus, making implantation of a fertilized egg less likely
-reducing sperm access to the fallopian tubes, where eggs are fertilized
How are progestins primarily responsible for the contraceptive activity?
- Prevent the LH surge needed for release of the ovum·
Prior to ovulation, there is a big LH surge. Progestins prevent that from happening
-Thicken cervical mucus, hindering sperm entry into the uterus
- Decrease tubal motility, impeding sperm transit through fallopian tubes
-Thin the endometrium, reducing implantation probability
How are estrogens primarily responsible for the cycle control?
-Stabilize the endometrium, minimizing irregular bleeding
- Inhibit the release of FSH, preventing the development of the dominant follicle
-Potentiate progestin’s inhibition of the LH surge
Block LH and FSH to inhibit ovulation
produced by gonadotroph cells in the anterior pituitary gland. Acute rise of LH triggersovulation & dev of the corpus luteum
temporary endocrine structure in XX mammals that is involved in the production of relatively high levels of progesterone & moderate levels of estradiol and inhibin A
regulates dev, growth, pubertal maturation, & reproductive processes of the body. Acts synergistically in reproduction c/ LH.
indication of hormone contraception:
to prevent preg
what are other benefits from hormone contraception?
-less menstrual flow and cramping
-less iron deficiency anemia that results from heavy menses
-fewer premenstrual symptoms, as well as related headaches and depression
-May help peri-menopausal women to smooth the transition
Most COCs contain estrogen in the form of:
maximum dose of ethinyl estradiol that most women should receive:
what are some circumstances when higher doses of estrogen are appropriate?
if women had spotting and needed more cycle control, if enzyme induced
least potent progestin
most potent progestin:
Desogestrel, levonorgestrel, & norgestrel
least androgenic progestins:
Desogestrel & norgestimate
least likely to cause acne & hirtusim
most androgenic profile:
intermediate in terms of androgenic activity:
Norethindrone & ethynodiol
Has anti-androgenic properties:
and similar to spironolactone
What is imp to monitor in a pt on Drospirenone?
Potassium, for hyperkalemia
Components that make up COC:
-20–50 mcg ethinyl estradiol
—newer formulations rarely contain >35 mcg
-0.1–1.5 mg progestin
How are oral contraceptives available?
- As progestin only
-As a combination of estrogen and progestin (Most preparations are a combination of an estrogen plus a progestin)
-And in many options: a vaginal ring, a patch, IM, an IUD, a subdermal rod, and a large variety of oral choices
Dose that you would start an ethinyl estradiol + an older progestin (levonorgestrel, norethindrone, etc) have good balance of safety & efficacy
Start c/ 10 mcg if you are worried about SE
what do you do if pt has breakthrough bleeding (spotting)?
common during 1st few cycles
Tweak the dose
Increase the estrogen if the XX is taking less than 30 mcg, or change progestin if she on 30 mcg or higher
What are cautions for COC?
migraines c/ aura (consider progestin only)
SE of too much estrogen:
Nausea, breast tenderness, increased blood pressure, melisma (darkening of the skin), headache
SE of too little estrogen
Early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea
SE of too much progestin:
Breast tenderness, headache, fatigue, changes in mood
SE of too little progestin:
Late breakthrough bleeding
SE of too much androgen:
Increased appetite, weight gain, acne, oily skin, hirsutism, increased LDL cholesterol, decreased HDL cholesterol
hormone levels remain constant
Its a change of one hormone level of either estrogen or progestin
one will change and one stays the same
3 diff doses of hormones changing q 5-10 days in 1st 3 weeks
4 diff doses of hormones changing thru out 28 day cycle
the first OC to contain estradiol instead of ethinyl estradiol
Drug reps will promote Natazia for:
heavy menstrual bleeding
Instead of the usual 7-day hormone free interval, Natazia has:
4 estrogen-only tabs plus 2 inert tabs.
Idea behind it was decreased breakthrough bleeding.
But they don’t really know what causes this
Many women start with an NSAID to reduce cramps and bleeding. Why?
Prostaglandin levels are higher in women who have heavy bleeding.
NSAIDs block the prostaglandins
Go to a contraceptive if an NSAID isn't enough for bleeding.
what other OC’s can also be used for heavy bleeding?
Natazia and other combo OCs reduce blood loss by about____ in women with heavy menstrual bleeding.