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during the menstrual cycle, which hormone predominates the 7-10 days before ovulation (the days after each menses):
estrogen
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which hormone predominates the 2 weeks after ovulation (the 2nd half of the cycle)
progesterone
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what does the decrease of estrogen secretion stimulate:
the anterior pituitary to release LH and FSH
the LH and FSH spike causes ovulation
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what is the MOA for BCP:
prevents the normal drop in estrogen that stimulated LH and FSH production
without LH and FSH the ovarian follicle doesnt mature and ovulation doesnt occur
BCP may also make the uterine lining less accepting of a fertilized egg so it may be aorifiactant
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what do you tell a pt. to do if one pill is missed:
2 pills are taken the next day
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what do you tell a pt. to do if 2 consecutive pills are missed:
back up birth control should be used until a new cycle is started
2 tablets should be taken on the day the missed dose was remembered, and again the following day, then start regular schedule should be resumed, with back up birth control
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list the 3 categories of estrogen-progestin OCs:
- monophasic
- biphasic
- triphasic
-
a constant dose of estrogen and progestin throughout the 21 day tx cycle is called:
monophasic
-
the amount of estrogen in each pill remains constant, but the amount of progestin is increased toward the end of the tx cycel is called:
biphasic
-
the amount of both estrogen and progestin vary in 3 distinct phases during the tx cycle, called:
triphasic
-
what are is the failure rate for progestin only (minipills):
failure of progestin only: 1-4%
failure rate for traditional estrogen -progestin pills are less than progestin only!
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what is the pregnancy category for BCP:
category X
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what are the contraindications for OCP/BCPs:
- pregnancy
- current breast cancer
- severe hepatic cirrhosis
- major surgery with prolonged immobilization
- migraines
- imparied cardiac fxn
- complicated valvular heart disease
- HTN
- smoking
- hx of stroke
- systemic lupus erythematosus
- thromboembolic disorders
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what are the adverse effects of OCP/BCPs:
- HTN, or increased BP
- increased glucose levels
- weight gain
- fatigue
- depression
- acne
- hirsutism
- nausea
- edema
- brest tenderness
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what are the contraindications for HRT:
- personal or family hx of breast or liver cancer
- any estrogen-dependednt cancer
- fx of abnormal mammograms
- hx of gall bladder disease
- DM
- liver or kidney disease
- HTN
- Clots
- CAD
- smoking
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estrogens...
estrace
estradiol
-
estrogens...
premarin
estrogen, conjugated
-
progestins...
provera
medroxyprogesterone
-
estrogen-progestin combinations..
prempro
conjugated estrogens/medroxyprogesterone acetate
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the major storage form of fat in the body and the only type of lipid that serves as an important energy source is:
triglycerides
-
what is the structure of triglycerides:
3 fatty acid molecules attached to a glycerol molecule
-
what is the structure of phospholipids:
- 1 phosphorus molecule
- 2 fatty acid molecules
- ..attached to a glycerol molecule
-
lipids with a common chemical feature of sterol nucleus, or ring structure is are called:
steroids
-
an essential steroid part of the plasma membrane of cells and a building block for a # of biochemical is:
list 5 biochemical
cholesterol
- biochemicalsvitamin D
- bile acid
- cortisol
- estrogen
- testosterone
-
because lipid molecules are not soluble in plasma, they must be specially packaged for transport through the blood, called:
lipoproteins
-
the lipoprotein that contains the most protein, up to 50% by weight are called:
high density lipoproteins (HDL)
-
the lipoprotein that has a high amount of cholesterol (fat) and little protein is called:
low density lipoprotein (LDL)
-
which lipoprotein transports cholesterol from the liver to the tissues and organs, where it is used to build plasma membranes or to synthesize other steroids:
LDLs
-
which lipoprotein is called the "bad" cholesterol due to is contribution to plaque deposits and coronary artery disease:
LDLs
-
the primary carrier of triglycerides in the blood is:
very low density lipoprotein (VLDL)
-
which lipoprotein is manufactured in the liver and small intestine and assists in transport of cholesterol away from the body tissues back to the liver:
HDLs
-
what is the MOA for statins:
inhibit HMG-CoA reductase, which results in less cholesterol biosynthesis
as the liver makes less cholesterol, it responds by making more LDL receptors on the liver cells
more LDL receptors increases the removal of LDL from the blood
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what are the adverse effects of stains:
- headache
- fatigue
- muscle or joint pain
- heartburn
- GERD
- rhabdomyolysis
- myopathy
-
when are statins with a short half life to be given:
why:
statins with short half lives such as lovastatin should be administered in the evening
why: cholesterol synthesis in the liver is higher at NOC
-
a breakdown of muscle fibers usually due to muscle trauma, the contents of the muscle cells spill into the systemic circulation, causing potentially fatal acute renal failure is called:
rhabdomyolysis
-
which drugs should be avoided because they can interfere with statin metabolism and increase the risk of rhabdomyolysis:
- macrolide antibiotics such as....
- erythromycin
- azole antifungals
- fibric acid agents
- certain immunosuppressants
-
what are the s/sx of rhabdomyolysis:
- painful, swollen, tender or bruised areas of the body
- muscle weakness; having trouble moving arms/legs
- nausea/vomiting
- confusing
- dehydration
- fever
- lack of consciousness
- dark urine
- no urine output
-
what foods/fluids should a pt. avoid when on a statin:
grapefruit juice
-
statins also decrease the synthesis of:
coenzyme Q10
pts. may benefit from taking a CoQ10 supplement
- CoQ10 deficiency includes..
- High BP
- CHF
- low energy
-
what are the contraindications for statins:
- pregnancy
- breast feeding
- increased LFT
- liver disease
- excess alcohol intake
-
what is the pregnancy category for statins:
category x
-
what is the MOA for bile acid sequestrants:
bind to bile acids, which have a high concentration of cholesterol, and are eliminated in the feces
the liver responds to the loss of cholesterol by making more LDL receptors , which remove more cholesterol from the blood
-
which type of lowering agent is best at lowering the LDL levels:
bile acid sequestrants
-
bile acid -binding agents:
questran
cholestyramine
-
bile acid binding agents..
welchol
colesevelam
-
statins..
lipitor
atorvastatin
-
statin
crestor
rosuvastatin
-
-
what type of drug is simvastatin:
statin
zocor
-
what type of drug is atorvastatin?
statin
lipitor
-
what are the adverse effect of bile acid sequestrants:
they are large molecules, not absorbed so can cause GI side effects...
- bloating
- constipation
- flatus
- abdominal pain
- n/v/d
- steatorrhea (excess fat in the feces)
- obstruction
-
which agent is preferred for primarily elevated triglycerides:
niacin
-
what can be done to decrease the flushing/hot flashes that occurs with prescription-strength niacin:
taking aspirin 30 minutes before niacin
avoid taking it with hot fluids
-
fibric acid agents...
tricor
fenofibrate
-
fibric acid agents...
lopid
gemfibrozil
-
-
-
Combines with bile acids and cholesterol the GI tract thus decreasing cholesterol absorption. This causes the liver to pull more LDL cholesterol out of the blood, lowering the serum cholesterol level:
bile acid resins
-
Decreases triglycerides, thus indirectly decreases the cholesterol level
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