Term
| two major preparations of OCs |
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Definition
combination estrogen and progestin
continuous progestin only |
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Term
|
Definition
contraception
help maintain cycle regularity
decrease dysmenorrhea
decrease ectopic pregnancies
decrease risk of ovarian cancer
decrease fibroadenomas/fibrocystic breast |
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Term
| mechanism of action for OCs |
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Definition
override normal ovarian steroid regulation of reproductive function
exert negative feedback on hypothalamus and pituitary
-reduce GnRH secretion
-reduce FSH secretion-->incomplete follicular development
-reduce LH secretion-->no ovulation without pre-ovulatory LH surge |
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Term
| effects of OCs on the ovary |
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Definition
| steroidogenesis (particularly progesterone) is suppressed |
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Term
| effects of OCs on the uterus |
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Definition
| progestagenic component interferes with endometrial structure and consistency of the cervical mucous |
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Term
| Why is progesterone secretion from the ovary suppressed with OCs? |
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Definition
progesterone is primarily produced by the corpus luteum
no ovulation-->no corpus luteum-->diminished progesterone |
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Term
| What is the most commonly used estrogen in OCs? |
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Definition
ethinyl estroadiol
(Ovral, Orthotricyclen) |
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Term
| What type of estrogen is found in some OCs that is converted to ethinyl estradiol? |
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
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Term
| Rank the order of commonly used progestins with regard to their progestagenic potency from highest to lowest. |
|
Definition
desogestrel
norgestrel
norgestimate = norethindrone |
|
|
Term
| Rank the order of commonly used progestins with regard to their androgenicity from highest to lowest. |
|
Definition
norgestrel
norgestimate
norethindrone
desogestrel |
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Term
| Which commonly used progestin is associated with a higher risk of thromboembolism? |
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Definition
|
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Term
|
Definition
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Term
| What is special about drospirenone? |
|
Definition
very low androgenicity
has been reported to have anti-androgenic effects similar in efficacy to spironolactone |
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Term
| ethinyl E2 + levonorgestrel |
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Definition
Seasonale
extended OC (84+7 day regimen) |
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Term
| What are the terms monophasic, biphasic, and triphasic referring to? |
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Definition
| how many doses of progestin |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| daily progestin (norgestrel) pill |
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Term
|
Definition
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|
Term
| medroxyprogesterone acetate |
|
Definition
DepoProvera
injectable progestin |
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Term
| Progestin only is less/more consistent in inhibiting ovulation. |
|
Definition
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|
Term
| When are progestin only OCs used? |
|
Definition
women who are at risk for certain estrogen-dependent cancers
women who do not tolerate the estrogenic component of combos |
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Term
| Progestin only OCs may be a better choice for women who are... |
|
Definition
| breast feeding (only 0.1% of administered progestin ends up in breast milk) |
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|
Term
|
Definition
-phenytoin
-rifampin
-antibiotics/antimicrobials
*lower efficacy of OCs* |
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Term
| OC side effects associated with estrogen |
|
Definition
-thromboembolism
-cardiovascular risk (esp. in smokers)
-hypertension
-nausea
-headache/worsening of migraine
-edema (bloating)
-breast tenderness or "fullness"
-cancer? |
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|
Term
| Why is thromboembolism a side effect of OCs? |
|
Definition
| due to effect of estrogens on clotting factors |
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|
Term
| Why is cardiovascular risk increased with the use of OCs? |
|
Definition
| may be related to the effect of estrogens on clotting as well as effects of grogestagens (particularly norethindrone) on HDL |
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|
Term
| Why can hypertension occur when taking OCs? |
|
Definition
| related to increased levels of renin substrate and sodium retention |
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|
Term
| OC side effects associated with progestin |
|
Definition
-cardiovascular disease
-stroke
-increased appetite
-weight gain (may be more prevalent with angdrogenic progestins)
-fatigue
-depression |
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|
Term
| Why can OCs cause depression? |
|
Definition
| may be related to the ratio of progesterone to estrogen |
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|
Term
| Progestins can increase ______ in certain individuals. |
|
Definition
|
|
Term
| What effect might the more androgenic progestin have on HDL? |
|
Definition
|
|
Term
|
Definition
pregnancy
hx of estrogen-dependent cancer
hx of breast cancer
thromboembolic disorder
liver disease
heavy smokers (esp. >35) |
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Term
|
Definition
levonorgestrel
unlikely to work if fertilized egg has already implanted |
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|
Term
|
Definition
luteolytic effect
usually combined with prostaglandin (such as mioprostol, an analog of PGE1) |
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Term
|
Definition
post-coital contraceptive
may interfere with the "timing" of uterine maturation |
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Term
| female hormone therapy uses |
|
Definition
-menopausal symptoms
-reducing risk of osteoporosis
-primary hypogonadism
-hypopituitarism |
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|
Term
| male hormone therapy uses |
|
Definition
| -andropause ("male menopause") |
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Term
|
Definition
| replace with low dose estrogen and a progestin (esp. in women with intact uterus) |
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Term
|
Definition
| conjugated equine estrogen (CEE) |
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|
Term
|
Definition
medroxyprogesterone
used to treat menopause |
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|
Term
|
Definition
CEE + MPA
used to treat menopause |
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Term
|
Definition
| CEE + phasic replacement of progestin |
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|
Term
|
Definition
| estrogen conjugate given IM once a month |
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|
Term
|
Definition
|
|
Term
| When are progestins given for women undergoing hormone therapy? |
|
Definition
| last 10-14 days of each month to prevent possibility of estrogen-induced endometrial and uterine cancer |
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|
Term
|
Definition
-possibly reduces incidence of MI and stroke in women by 40-50%
-reduces hot flashes
-decreases loss of bone (inhibits osteoclasts) |
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|
Term
| Why is compliance often poor with HT in women? |
|
Definition
cyclical bleeding associated with sequential therapy
fear of cancer |
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|
Term
| adverse effects associated with estrogen therapy |
|
Definition
-post-menopausal uterine bleeding
-nausea
-breast tenderness
-hyperpigmentation
-increased frequency of migraines
-cancer (although some can be reduced with combined progestin/estrogen therapy) |
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|
Term
| hormone therapy contraindications |
|
Definition
-pregnancy
-hx of estrogen-dependent cancer
-hx of breast cancer
-thromboembolic disorder
-liver disease
-heavy smokers (CV risk) |
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|
Term
| Why is the route of administration important? |
|
Definition
oral--large first pass effect
transdermal--less first pass effect
local--fewer side effects, reduced first pass effect |
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|
Term
| advantages of transdermal estradiol vs. oral CEE preparations |
|
Definition
-reduced conversion of estradiol (E2) to estrone (E1)
-no effect on SHBG
-little to no thromboembolic risk |
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|
Term
| What is one advantage that oral CEE preparations may have over transdermal preparations? |
|
Definition
transdermal estradiol may not have the same benefits on serum lipid profiles as oral preparations
(but no negative effects of transdermal E2 on lipid profiles have been reported) |
|
|
Term
|
Definition
-hypogonadal men
-anabolic agent to reverse atrophy following trauma, surgery, or debilitating diseases
-anemia
-osteoporosis (usuall in conjuction with estrogens) |
|
|
Term
| adverse effects of androgen therapy |
|
Definition
-masculinizing effects
-gynecomastia in males
-hirsutism
-acne
-hepatic dysfunction
-azoospermia
-abuse (athletes) |
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|
Term
| androgen therapy contraindications |
|
Definition
-pregnant women
-men with hx of prostate or breast cancer |
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|
Term
| What does the WHI study suggest? |
|
Definition
| women over 65 should not take HT |
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