Pharm- Gonadotropins

Gonadotropins

• Definition: Ovarian stimulants used to induce ovulation in patients with ovulatory dysfunction.

• Example: Clomiphene (Clomid).

  • Mechanism of Action: A selective estrogen receptor modulator (SERM) that binds to estrogen receptors in the hypothalamus. This blocks the negative feedback of endogenous estrogen, triggering an increase in the release of $GnRH$, $FSH$ (Follicle-Stimulating Hormone), and $LH$ (Luteinizing Hormone).

• Patient Information & Safety:

  • Multiple Births: Patients must be counseled that the risk of multiple gestations (most commonly twins) increases by approximately $5-10\%$.

  • Ovarian Hyperstimulation Syndrome (OHSS): A serious complication where ovaries become painfully enlarged; patients should report sudden weight gain or abdominal pain immediately.

  • Timing: Typically administered for $5$ days, starting on the $3^{rd}$ or $5^{th}$ day of the menstrual cycle.

STD Treatments

Gonorrhea

• Common Names: "The Clap" or "The Drip".

• Causative Agent: Neisseria gonorrhoeae, a Gram-negative diplococcus bacterium that thrives in mucous membranes (mouth, throat, anus) and the reproductive tract.

• Signs & Symptoms:

  • Discharge: Profuse greenish-yellow or whitish discharge from the urethra or vagina.

  • Systemic Signs: Lower abdominal pain, burning sensation during urination (dysuria), and potentially conjunctivitis if the eyes are contaminated.

  • Complications: If untreated, it can lead to Pelvic Inflammatory Disease (PID) in females and epididymitis in males.

• Treatment: Ceftriaxone (Rocephin) $500$ mg via a single Intramuscular (IM) injection.

  • Note: Due to high rates of co-infection, patients are often empirically treated for Chlamydia as well.

Trichomoniasis

• Causative Agent: Trichomonas vaginalis, a flagellated protozoan parasite.

• Epidemiology: One of the most common curable STDs globally, affecting millions of sexually active individuals annually.

• Signs & Symptoms:

  • Vaginal Presentation: Frothy, greenish-yellow vaginal discharge with a distinct "fishy" odor.

  • Clinical Sign: "Strawberry cervix" (punctate hemorrhages on the cervix) may be visible during a pelvic exam.

  • Sensation: Intense vaginal itching, irritation, and dyspareunia (painful intercourse).

• Treatment: Metronidazole (Flagyl) or Tinidazole.

  • Important Education: Patients must avoid alcohol during therapy and for at least $24-72$ hours after the last dose to prevent a disulfiram-like reaction (severe vomiting, tachycardia, and flushing). Dual treatment of sexual partners is mandatory to prevent re-infection.

Chlamydia trachomatis

• Classification: Obligate intracellular Gram-negative bacteria.

• Epidemiology: The most frequently reported bacterial STD in the United States; particularly prevalent in adolescents ($15-24$ years old).

• Clinical Implications: Known as the "silent" infection because up to $75\%$ of women and $50\%$ of men exhibit no symptoms, yet it remains a leading cause of preventable infertility.

• Signs & Symptoms:

  • General: Abnormal discharge and localized burning during urination.

  • Complications: Can progress to Pelvic Inflammatory Disease (PID), which may cause irreversible scarring of the fallopian tubes, increasing the risk of ectopic pregnancy.

• Treatment: Doxycycline ($100$ mg orally twice daily for $7$ days).

  • Pregnancy Note: In pregnant patients, Azithromycin ($1$ g single oral dose) is typically used instead of tetracyclines like Doxycycline.

HPV Vaccine (Gardasil 9)

• Causative Agent and Implications: Human Papillomavirus (HPV) is linked to nearly all cases of cervical cancer, as well as vulvar, vaginal, penile, anal, and oropharyngeal cancers.

• Vaccine Scope: Gardasil 9 protects against $9$ strains ($6, 11, 16, 18, 31, 33, 45, 52, 58$).

  • Types $16$ and $18$ are responsible for the majority of HPV-related cancers.

  • Types $6$ and $11$ cause approximately $90\%$ of genital warts.

• Recommended Administration:

  • Age Group: Recommended for males and females aged $9-26$ (can be given up to age $45$ in certain clinical scenarios).

  • Dosing Schedule:

    • Before age 15: Two doses administered $6-12$ months apart.

    • Age 15 and older: Three doses administered at $0, 1-2,$ and $6$ months.

• Clinical Goal: The vaccine is most effective when administered prior to initial sexual exposure, as it is a preventive measure and does not treat existing HPV infections.