Pharmacology of Gynecological disorders

  1. Birth control options
    • Barrier methods
    • Hormonal methods
    • Implantable methods
    • Permanent birth control methods
    • Emergency contraception
  2. Natural family planning method/ barrier
    Female and male condoms: 80-84%+ effective
    Cervical sponge/Cervical shields: 68%+ effective :(
    using barrier method or not having sex on most fertile days 5 days prior or 3 days after ovulation
  3. Hormonal method-oral contraceptives
    95%+ effective :)
    • Prevent ovulation through a negative feedback to the pituitary-suppressing LH and FSH, increases cervical mucous and changes linning all to prevent implantation and "Swimmers" :p
    • Monophasic: one level of estrogen/ progesterone continuous dose for 21 days of the cycle
    • Biphasic: two levels of estrogen and progesterone cycles
    • Triphasic: Three levels
    • Adverse: breast tenderness, upset stomach, changes in menstruation, changes in mood, weight gain, HTN, blood clots, stroke, vision problems-Smoking increases the occurrence of adverse effects. 
  4. Hormonal birth control options
    • The pill: not as effective as the biphasic treatments. Risk for ectopic pregnancies, sore breasts, spotting between periods, not associated with breast cancer. 
    • Patch (Orthro-evra): transdermal release of estrogen and progesterone. Great exposure to estrogen than other methods. 
    • Shot/injection (Depo Provera): progesterone every 3 months 99%+ effective
    • Vaginal ring (nuvaring): release estrogen and progesterone in the vagina

    Most adverse effects are similar.
  5. Implantable methods
    • Implanon: the rod under the skin in the arm. releases progesterone for 3-5 years. 99%+ effective.
    • Adverse: acne, weight gain, ovarian cysts, mood changes, depression, hair loss, headache, nausea, dizziness, sore breasts, changes in menstruation, decreased libido 

    • Mirena(IUD): effective for 5 years (releases progestin) or up to 10 years for (copper releasing)
    • Adverse: cramps, bleeding between periods, PID, infertility, tear or hole in the uterus
  6. Extended regimen BCP
    • seasonale, seasonique
    • 84 days.

    Contains: levonorgestrel and ethinyl estradiol
  7. Permanent birth control options
    • Sterilization implant: Essure, Adiana- device inserted into fallopian tubes leading to scar tissue build up.
    • Surgical sterilization: Cauterized, banded, tied and cut-tubes. 99.9% effective
  8. Emergency contraception Plan B
    Levonorgestrel 750 mcg, 2 doses 12 hours apart. Same hormone used in mirena

    must be taken within 72 hours
  9. Abortifacients-Drugs that induce abortion
    • Mifepristone: synthetic steroid that blocks progesterone receptors in the uterus-induces abortion and can be combined with misoprostol
    • methotrexate: followed by misoprostol in 5 days
  10. Post-partum birth control
    Should not be used for for at least 3 weeks after giving birth due to blood clots.

    • estrogen increases clotting factors
    •  Women who: Cesarean birth, Obesity, History of blood clots, Smoking, preeclampsia must wait 6 weeks.
  11. Remember for possible side effects of OC
    • A – abdominal pain
    • C – chest pain
    • H – headache
    • E – eye problems
    • S – swelling
    • Must be reported to health care provider.
  12. 3 different steroid hormones of estrogen?
    Estrogen therapy treats what?
    • Estradiol
    • Estrone
    • Estriol
    • Treatments for: menopause, female hypogonadism, primary ovarian failure, contraception, replacement therapy, chemotherapy.
  13. Conjugated estrogens (Premarin, Enjuvia, Cenestin)
    Hormone therapy.
    • Side effects: headache, infection, cramping, bloating, fluid retention,changes in libido, depression, fatigue....others.
    • High occurrence of endometrial cancers when taken without progesterone.
  14. Progesterone hormone therapy

    Medroxyprogesterone acetate (Provera) can treat?
    • Limits endometrial growth-cancers. 
    • Dysfunctional uterine bleeding
    • Metastatic endometrial carcinoma
    • Secondary amenorrhea
    • Contraception
    • Inoperable metastatic renal carcinoma
  15. Hormone replacement therapy
    • Used to treat hot flashes, night sweats, irregular menstrual cycles, bone loss.
    • Estrogen/progesterone replacement increased risk for MI, Stroke, breast cancer, dementia, embolisms in women over 60.
    • Estrogen alone: increase risk of ovarian cancer, CVA, thromboembolism.
    • Estrogen alone did not increase risk of breast cancer or MI.
  16. Hormone therapy for breast cancers
    • Tamoxifen: estrogen receptor blocker-restrict tumor growth since it needs estrogen to grow.
    • Fluvestrant: causes breakdown of estrogen receptors.
    • Letrozole, anastrozole: prevent conversion to estrogen.
    • Goserlin, Leuprolide: blocks FSH and LH-preventing production of estrogen.
  17. Hormone therapy for endometrial cancer
    Medroxyprogesterone Acetate
  18. estrogen (Premarin)
    • Therapeutic class: Estrogen; endocrine metabolic agent
    • Preg: x
    • MOA: Stimulates luteinizing hormone (LH),  and follicle stimulating hormone (FSH)
    • Indications: Dysfunctional uterine bleeding due to hormonal imbalance, postmenopausal osteoporosis, irregular menstrual cycles.
    • Contraindications: Breast cancer, DVT history, pregnancy, and thromboembolic diseases
  19. medroxyprogesterone (Provera)
    • Therapeutic class: Hormone
    • Preg: X
    • MOA: targets endometrium of the uterus, inhibits effects of estrogen on the uterus to restore normal hormone levels.
    • Indications: Dysfunctional uterine bleeding, secondary amenorrhea, contraception. 
    • Low dose for contraception and high doses for inoperable metastatic uterine or renal carcinoma. 
    • Contraindications: pregnancy, carcinoma of the breast, thromboembolic disease, hepatic impairment, undiagnosed vaginal bleeding.
    • Adverse: breast tenderness, breakthrough bleeding, menstrual irregularities, weight gain, depression, HTN, N/V,  dysmenorrhea.
  20. Estradiol and Norethindrone (ortho-novum, others)
    • Therapeutic class: Combination oral contraceptive
    • Preg: X
    • MOA: Avail, in mono, Bi, and triphasic preparations, nearly 99.9% effective. hormones inhibit the release of FSH and LH
    • Indications: preventing ovulation, off-label, hypermenorrhea, dysfunctional uterine bleeding.
    • Contraindications: Pregnancy, thromboembolic disorders, stroke, coronary artery disease.
    • Alert: smoking increases risk of adverse effects. Can also affect clotting factors. 
    • Adverse: weight gain, breakthrough bleeding, changes in vision gallbladder disease, N/V, dysmenorrhea, breast fullness, fatigue.
  21. sildenafil (Viagra) 
    Phosphodiesterase (PDE)-5 inhibitor
    • Therapeutic class: Errectile dysfunction
    • MOA: relaxing smoth muscles in corpora cavernosa-increasing blood flow to the PENIS
    • Indications: ED
    • Contraindications: patients taking nitrates
    • Adverse: headache, dizziness, flushing, rash, nasal congestion, hypotension.
    • ALERT: Concurrent use of nitrates may cause unsafe drop in bp and possible MI
  22. Testosterone
    Androgen; anabolic steroid; antineoplastic
    • Therapeutic class: Male sex hormone
    • MOA: promotes virilization, including puberty and hypogonadism in males, growth of facial hair, deepening of the voice, increasing libido and ED.
    • Contraindications: suspected breast or prostatic carcinomas. prostate enlargement. 
    • Adverse: increased or decreased libido, salt or water retention, edema
    • Alert: Excess testosterone can be metabolized into estrogen.
  23. ectopic pregnancy treatment
    • Treatment: medical management -methyltrexate (stops fetal growth) & misoprostol (can cause uterine contractions to help expel fetus.) 
    • Surgical management -  salpingostomy, salpingectomy if ruptured.
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Pharmacology of Gynecological disorders