Pharm Womens Health Part 2

Types of emergency contraceptives

Copper IUD, ulipristal, progestin only and combined pills

copper IUD and ulipristal instruction for effective use

must be inserted/taken within 5 days of first act of unprotected sex

copper IUD MOA

Prevents sperm from reaching the egg for fertilization. Makes environment inhospitable

copper IUD ADRS

heavy bleeding, ectopic pregnancy, perforation, migration, back pain and anemia

copper IUD contraindications

-endometriosis, PID, malignancy, known pregnancy

Ulipristal acetate MOA

selective progesterone receptor modulator, prevents progestin from binding to progesterone

Ulipristal ADRs

altered menses, acne, abdominal pain, dysmenorrhrea, HA, dizziness

Ulipristal and progestin only EC contraindications

pregnancy because it will not be effective

Ulipristal considerations

-requires RX

-most effective PO EC

What do progestin only pills contain

levonorgestrel

can be 1 or 2 pill packet for total dose of 1.5 mg

time frame for taking levonorgestrel as EC

within 3 days of unprotected sex

progestin only EC MOA

-thickens cervical mucus to inhibit sperm passage

-alters endometrium

-inhibits ovulation

progestin only EC ADRs

hypermenorrhea, acne, alopecia, abdominal pain, HA

Progestin only EC considerations

-available OTC

-Plan B one step not age restricted

-Plan B two step age limit 17 and up

Describe the Yuzpe method

the use of everyday BC as EC by combining pills in a specific order to prevent unplanned pregnancy

Combined progestin-estrogen EC doseage target

100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel, repeat after 12 hours

-must be taken within 5 days

combined progestin-estrogen EC ADR

increased clot risk, altered menses, nausea, breast tenderness, uterine cramps, irritability

combined pills contraindications

cigarette smoking over 35, liver, heart diseases, breast cancer,

treatment of nausea with extreme estrogen dose

OTC dramamine 20 min prior to each estrogen dose

what is the least effective form of oral EC

combined progestin-estrogen EC

Most often reported complaints of menopause

hot flashes, sweats, vaginal dryness

most effective treatment for vasomotor symptoms of menopause

estrogen replacement therapy

health concerns for menopause

CV, breast, bone health.

Who is estrogen only replacement therapy used for

patients without a uterus

Estrogen only replacement therapy increase the risk for

uterine cancer

alternatives to estrogen for treating menopausal symptoms

-alpha adrenergic blocking agents like clonidine

-gabapentin

-lifestyle mod

-phytoestrogens like black cohosh and soy

-SSRIs

-VItamin E

types of hormone replacement therapy

estrogen replacement therapy

conjugated estrogen

progestins

combined estrogen/progestin

synthetic female hormones can be used to

-prevent pregnancy

-reduce menopausal symptoms

-prevent bone loss

-treat certain cancers

what decline causes the signs and symptoms of menopause

declining 17-beta estradiol production

oral options for estrogen replacement therapy

conjugated equine estrogens (natural)

17 beta estradiol (natural)

ethinyl estradiol (synthetic)

what must be administered with estrogen in women who have intact uterus

progestin

what is premarin/conjugated estrogen made from

pregnant mare urine

use of conjugated estrogen

reduce hot flashes, vaginal dryness, osteoporosis

conjugated estrogen MOA

mixture of subtypes of estrogen, module secreting of LH and FSH reducing elevated levels in postmenopausal women

conjugated estrogen adrs

thromboembolism, MI, stroke, breast tenderness, hypercalcemia, increased pigmentation

interactions with conjugated estrogen

grapefruit juice can increase levels

Most common oral and IM progesitn

medroxyprogesterone (depoprovera)

Medroxyprogesterone (oral) MOA

inhibits gonadotropin release to prevent follicular maturation and turns proliferative endometrium into secretory AND is antineoplastic

medroxyprogesterone uses

-decrease endometrial hyperplasia

-treatment of secondary amenorrhea and AUB

-EC

medroxyprogesterone adrs

alopecia, acne, oily scalp, breakthrough bleeding, decreased libido

interactions of medroxyprogesterone in use as EC

phenobarbital, phenytoin, rifampin

timing of giving medroxyprogesterone

given 1 hour before or 4 hours after bile acids like cholestyramine

patient education for oral health on medroxyprogesterone

good oral hygiene due to gingival bleeding side effect

Most common causes of iron deficiency anemia

menstrual blood loss and pregnancy

signs and symptoms of iron deficiency anemia

heavy blood loss, fatigue, hypochromic microcytic RBCs, low serum ferritin and iron

treatment of iron deficiency anemia

increase iron in diet

ferrous sulfate supplement taken between meals

common side effects of iron products

constipation and nausea

meds that impair response to oral iron supplementation

PPI and H2 blockers

first line for lessening of hyperandrogenic features in PCOS

COC

antiandrogen meds

spironolactone, finasteride, dutasteride

spironolactone class

andorgen receptor antagonist

finasteride and dutasteride class

5-alpha reductase inhibitor for BPH and alopecia.

finasteride, dunasteride and Pregnancy

pregnancy category X, patient must be on birth control when using

PCOS medication for metabolic abnormalities

metformin to reduce hepatic glucose output and increase insulin hypersensitivity

statins

meds for ovulation induction in PCOS

letrozole and clomiphene

Letrozole MOA

aromatase inhibitor from converting androgens into estrogen

Clomiphene MOA

triggers pituitary gland to increase FSH and LH

Meds with known teratogenic effects

alcohol

andorgens

ACE/ARB

anticonvulsants

chemo

statins

isotretinoin

lithium

tetracyclines

DES

warfarin

Meds contraindicated in lactating women

ACE/ARB

benzos

carbamazepine

diclofenac

estrogen

flurazepam

statins

misoprostol

methotrexate

phenobarbital

valproate