Pharm - Women's Health

Ovaries produce estrogen, what enzyme converts it into the main form, estradiol?

aromatase

What is the main mechanism of combined oral contraceptives?

Estrogen suppresses FSH release and stabilizes endometrium – Progestin suppresses LH surge prevents ovulation – Thickens cervical mucus – Atrophies endometrium

What are benefits of combined oral contraceptives?

Cycle regulation – Less dysmenorrhea – Less acne – Decreased ovarian and endometrial cancer risk

What are adverse effects of combined oral contraceptives?

Nausea – Breast tenderness – Breakthrough bleeding – Increased risk of VTE – Stroke – MI – Especially in smokers over 35

What are contraindications for combined oral contraceptives?

History of VTE – Stroke – CAD – ER positive breast cancer – Migraines with aura – Smokers over 35 – Severe HTN – Active liver disease

What non oral hormonal contraceptive options exist?

Transdermal patch – Vaginal ring – Injectables medroxyprogesterone – Implants etonogestrel – IUDs levonorgestrel or copper

What are unique issues with the patch and ring contraceptives?

Patch has higher estrogen exposure risk of clot – Ring local side effects vaginal discharge and infection

What are characteristics of progestin only mini pill?

Taken daily at same time – Less effective than combined – Used when estrogen contraindicated

What are characteristics of LARC methods?

IUDs and implants – Highly effective – Long duration – First line recommendation

What are side effects of LARC?

Bleeding changes – Cramping – Expulsion risk – Rare perforation

What are features of spermicides for contraception?

Nonoxynol 9 – Damages sperm cell membrane – Must be applied before each act – Not very effective – May increase risk of HIV

What is Phexxi and its mechanism?

Vaginal gel – Lactic acid citric acid potassium bitartrate – Maintains acidic pH – Inactivates sperm

What EC pill delays ovulation and is effective up to 72h?

Levonorgestrel Plan B – Best ASAP – Less effective in obesity – OTC available

What EC pill delays ovulation and is effective up to 5 days?

Ulipristal Ella – More effective closer to ovulation – Requires prescription – Less effective in obesity

What is the most effective form of emergency contraception?

Copper IUD – Within 5 days – Not affected by obesity

What is the mechanism of mifepristone in medical abortion?

Progesterone receptor antagonist – Breaks down endometrium – Sensitizes uterus to misoprostol

What is the mechanism of misoprostol in medical abortion?

Prostaglandin E1 analog – Induces uterine contractions – Expels pregnancy

What is the standard regimen for medical abortion up to 10 weeks?

Mifepristone 200 mg orally – then misoprostol 800 mcg buccal 24–48h later

What is the mechanism of tranexamic acid in heavy menstrual bleeding?

Antifibrinolytic – Blocks plasminogen activation – Reduces menstrual blood loss

What is the mechanism of clomiphene in infertility?

SERM – Blocks estrogen receptors in hypothalamus – Increases GnRH → increases FSH and LH → stimulates ovulation

What is the mechanism of letrozole in infertility?

Aromatase inhibitor – Lowers estrogen – Releases hypothalamic pituitary inhibition – Increases FSH and LH

What are uses of gonadotropins in infertility?

FSH and LH injections – Directly stimulate ovaries – Used in assisted reproduction

What are 1st line meds for nausea and vomiting in pregnancy?

Vitamin B6 pyridoxine – Doxylamine – Antihistamines

What are 2nd line meds for nausea and vomiting in pregnancy?

Ondansetron – Metoclopramide – Promethazine

What drug prevents seizures in pre eclampsia and eclampsia?

Magnesium sulfate – CNS depressant – Requires monitoring for toxicity loss of reflexes respiratory depression

What physiologic changes affect drug use in pregnancy?

Increased plasma volume – Increased renal clearance – Altered hepatic metabolism – Decreased albumin – Delayed gastric emptying

What drugs are classic teratogens?

ACE inhibitors – ARBs – Warfarin – Isotretinoin – Valproate – Thalidomide – Methotrexate

What replaced the old pregnancy letter categories?

FDA PLLR rule – Narrative summary of risks – Clinical considerations – Data

What drugs are contraindicated in breastfeeding?

Chemotherapy – Radioactive isotopes – Lithium – Amiodarone – Drugs of abuse

What drugs are generally considered safe in breastfeeding?

Acetaminophen – Ibuprofen – Penicillins – Cephalosporins – Most antidepressants

What drugs are used for induction of labor?

Oxytocin – Prostaglandins misoprostol dinoprostone

What drugs are used for postpartum hemorrhage?

Oxytocin – Misoprostol – Methylergonovine – Carboprost

What anesthetics and analgesics are used in labor?

Epidural local anesthetics plus opioid – IV opioids – Nitrous oxide