Pharm Womens health Part 1

Drug absorption differences in women

longer gastric emptying time

absorption affected by estrogen

lower levels of alcohol dehydrogenase

Drug distribution difference in women

lower body weights and BMIs

higher proportion of fats, lipophilic drugs more absorbed

lower levels of circulating lipophilic drugs

Fiber and estrogen PMS

fiber rich diet with less than 20% calories from fat can lower estrogen and curb side effects

Meds for PMS and PMDD

alprazolam (benzo), danezol (androgen), ibuprofen, SSRIs, herbals (primrose oil, chaste tree berry, calcium and magnesium salts, vitamin E, B

Herbals that can cause AUB

garlic, gingko bilboa, ginseng, soy, st johns wort

dysfunctional uterine bleeding treatment

correct volume status

IV conjugate estrogen therapy or PO for nonsevere cases

ADRS of high dose estrogen

N/v, HA, fluid retention, thrombosis, MI, stroke

caution for estrogen

liver disease, over 35 and smoking or previous thromboembolic event or estrogen dependent tumor

Treatment for heavy bleeding

levonorgestrel IUD called Mirena

Endometrial hyperplasia without atypica tx

cyclic or continuous progestins

OCP and cervical cancer

they DO NOT reduce the risk of cervical cancer

Estrogen and FSH

suppresses release of FSH and LH until ovulation when it is released

when does progesterone rise

after ovulation

OCP dose goal

lowest amount tolerated

Low dose monophasic OCP

allows menses 4x/year, breakthrough bleeding possible

multiphasic pills

used for regular monthly cycles

best used for treating menstrual migraines

more likely to have breakthrough bleeding

progesterone only pills

affected only when taken strictly at same time

do not suppress HPA axis

no withdrawal breaks

COCP

combine estrogen and progestin

suppress HPA axis to prevent ovulation

monthly withdrawal bleeding

low dose COCP

may be used in continuous cycle with 2-3 months on and then one week off for bleeding to occur

estrogen containing OCP contraindications

hx of CVA, migraine with aura, heart or liver disease, estorgen sensitive cancers, clotting disorders, DVT, Factor V, undiagnosed uterine bleeding or high breast cancer risk

estrogen and progesterone components dosing

estrogen in mcg and progesterone in mg

estrogens commonly used in BC

Mestranol, ethinyl estradiol and estropipate

progesterones commonly used in BC

levonorgestrel, norgestimate, norethindrone, desogestrel, and drospirenone, ethynodiol diacetate, medroxyprogesterone and entonogestrel

estrogen effects

suppresses FSH

potentiate progestin to suppress LH to halt follicle growth

stabilize endometrial lining

inhibits ovulation by suppression of FSH and LH

inhibition of implantation in high dose form

Progestins MOA

halts follicle growth

hostile cervical environment to hampers sperm

implantation inhibition

alters mid cycle surge of FSH and LH to prevent ovulation

COC uses

cycle regulation, contraception, acne relief, headaches

Estrogen excess adrs

nausea, edema, cramps, depression

lactation suppression, breast tenderness, CVA

thrombosis, hepatic adenoma, weight gain

estrogen deficiency adrs

hot flashes, spotting, decreased libido, drug vaginal mucosa and depression

progestin excess adrs

fatigue, HTN, decreased libido, acne, weight gain, hair loss

progestin deficiency adrs

breakthrough bleeding, heavy flow, weight loss, dysmenorrhea, delayed menses onset

general adrs of OCP

hypercoag, liver abnormalities, stimulation of estrogen sensitive cells

Black box warning for COC

women over 35 who smoke increases serious CV events

OCP interactions/increase metabolism

interferes with tamoxifen

anticonvulsants

PO antibiotics like penicillins

rifampin

St johns wort

griseofulvin

Transdermal contraceptive

contain estrogen and progesterone like ortho evra

transdermal contraceptive moa

thickening of cervical mucus

regulation of period

increased risk of thromboembolism

NO first pass metabolism, less interactions

lower doses required

transdermal contraception adrs

contact dermatitis, skin hyperpigmentation and irritation

transdermal contraception education

replaced weekly

3 weeks on one week off for bleeding

less reliable in women over 200 pounds

breakthrough bleeding more common with this method over PO

Injectable Contraceptives

progestin only for 2 months or combined effective for 1 month

injectable progestin only MOA

thickens cervical mucus

NOT for IV, only IM

injectable contraceptives adrs

progestin only-no CV events, acne, liver toxicity, decreased libido, elevated BP

Disadvantages of injectables

pain, weight gain and irregular menses, decreased bone density

injectables and wash out period

period of 4 weeks before elective surgery, wait 2 weeks to restart after sx

progestin only protective effects

PID, seizurea, myoma and endometriosis

Depo Provera Shot

progestin only injection taken once every 12 weeks; .3% typical and perfect; higher rate of amenorrhea, spotting, weight gain, mood swings; longer return to fertility

subdermal implantable contraceptives

progesterone agents with no first pass, effective for 3 years

subdermal implant adrs

irregular bleeding, weight gain, acne

intravaginal Rings

NuvaRing 35 days of active use, ethinyl estradiol and etonogestrel, suppresses ovaries locally

spermacide do nots

nonoxynol-9 active agent, do not use in patients with HIV exposure