Term
| OC can have which two types of etrogen? |
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Definition
| Ethinyl estradiol (active) or mestranol (need to be converted by the liver to the active form) |
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Term
| What are the different progestins used in OCs? |
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Definition
| Norethindrone, norethindrone acetate, norgestrel, levonorgestrel, desogestrel, norgestimate & drospirenone |
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Term
| List the progestins according to most androgenic to least? |
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Definition
Highest – Levonorgestrel & norgestrel
Lower – Norethindrone & norethindrone acetate
Even lower – 3rd generation (desogestrel & norgestimate)
Antiandrogenic – Drospirenone |
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Term
| What are the most common combined OCs used today? |
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Definition
| “Low-dose”, which is <35 ug of ethinyl estradiol. They can be for 21 days, extended (84 days followed by 7 days, thus 4 menstal cycles/ yr) or continuous (where its 21 days plus the rest in very low doses) |
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Term
| List 3 non-contracptive benefits of combined OCs? |
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Definition
| Relief of benign breast Dz, prevention of ovarian cysts, reduction in risk of symptomatic PID (so basically u might get it but u wont know :( ) |
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Term
| What are some of the A/Es of combined OCs? |
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Definition
Nausea, bloating, breakthrough bleeding (?) but usually spontaneously improve by third cycle.
Headaches are transient, but migranes can be made worse. Insulin resistance w/ progestin but at low doses rarely -> hyperglycemia. Androgenic progestins can give u acne, oily skin and hirsutism. Melasma (estrogen stimulating melanocytes). Amenorrhea in some. Low dose OCs have little effect on lipid profile. Depression in 6%. Most serious are the CVS effects: thromboembolism, thrombophlebitis, hypertension, MIs, cerebral & coronary thrombosis |
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Term
| Who are the A/Es in OC use more common with? |
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Definition
| Women who are over 35 and smoke |
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Term
| List the Rxs u know that induce P450? |
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Definition
| Rifampin, carbamazepine, oxcarbazepine, phenytoin, Phenobarbital, primidone, topiramate, vigabatrin & St. John’s wort |
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Term
| What is Ethinyl estradiol and antibacterials relationship? |
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Definition
| Ethinyl estradiol is conjugated in the liver and excreted as bile but in the intestine its hydrolysed by the normal gut flora and reabsorbed as active drug (enterohepatic circulation) |
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Term
| Combined OCs are relatively contraindicated in atleast 4 cases, name them and explain? |
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Definition
Smoking (<15 cigarettes/ day at any age; NB that >15 over 35 yrs of age is absolute contraindication)
Hx of Migraines
Fibroid tumors of the uterus –
Breast-feeding – |
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Term
| Progestin-only pills a.k.a minipills are? |
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Definition
| Norethindrone or norgestrel. NB that there is no risk of thromboembolism, other benefits: decreased dysmenorrhea, menstrual blood loss & premenstrual syndrome Sx’s |
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Term
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Definition
| Only blocks 70% of ovulations but works more along the lines of thickened mucus (decreases sperm penetration) and endometrial alterations (impairs implanting) |
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Term
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Definition
| Ethinyl estradiol & norelgestromin |
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Term
| What does the contraceptive ring have? |
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Definition
| Ethinyl estradiol & etonorgestrel; put in btw day 1-5 of the menstral cycle, removed after 3 wks, new one put in after a wk |
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Term
| Explain Progestin Injections? |
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Definition
| DMPA (Depot Medroxyprogesterone acetate), given every 3 mos; increased incidence of menstral irregularities (including amenorrhea) & weight gain when compared to combined OCs. DMPA has a black box warning abt chance of irreversible bone mineral density (BMD) loss if taken for longer then 2 yrs. NB that DMPA has effects even after withdrawal of the Rx (>>> called???). Depo-SubQ Provera has 30% less MPA |
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Term
| Subdermal progestin implants contain? |
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Definition
| Etonorgestrel, lasts 3 yrs, major A/E is irregular menstral bleeding |
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Term
| What do Intrauterine systems (IUS) use? |
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Definition
| Levonorgestrel in a polyethylene capsule; good for 5 yrs; there is increased menstal bleeding with first few cycles; 20% experience amenorrhea |
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Term
| Explain diaphragms and cervical caps? |
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Definition
| Diaphragms no longer then 24hrs and the smaller cervical caps no longer then 48 hrs else there is a risk of toxic shock syndrome, both are used with a spericide |
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Term
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Definition
| Nonoxynol-9 a surfactant (?) that destroys membrane on sperms |
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Term
| What are 2 emergency postcoital hormonal contraceptives? |
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Definition
| Ethinyl estradiol + levonorgestrel/ norgestrel, 2 tablets within 72 hrs and 2 after 12 hrs (Yuzpe regimen); Plan B, which is the regimen of choice, uses only levonorestrel, 1 tablet within 72 hrs and 1 tablet after 12 hrs, this has decreased side-effects and risk of failure. NB that copper IUDs can also be used within 5 days |
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