Contraception Flashcards Preview

Pharmacology Drugs > Contraception > Flashcards

Flashcards in Contraception Deck (27)
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1
Q

What are the routes of administration for contraceptives?

A
  • Oral
  • Transdermal patch
  • Implants
  • Nasal
  • Vaginal
2
Q

How is sex stored hormone transport influenced?

A
  • Transport bound to Sex Hormone Binding Globulin or SHBG (except progesterone) and albumin. 1-2% is free
  • SHBG upregulated by oestrogens to protect them against hepatic metabolism
3
Q

How does storage affect sex steroid hormones?

A
  • Increases the half life
  • Sex steroid are easily sotred in fatty tissue because they are lipophilic. They complex into plasma membrane just like cholesterol
4
Q

How are sex steroid hormones excreted?

A

-Metabolites are excreted through faeces and urine

5
Q

How do sex steroid hormone work?

A
  • ER-alpha and ER-beta for oestrogen
  • PR-A and PR-B for progesterone
  • AR-1 and AR-2 for testosterone
6
Q

How does liver metabolism affect progesterone?

A

-Progesterone is almost totally metabolised in one pass through the liver

7
Q

What are the types of oral contraceptive pills?

A
  • COCP (Oestrogen and Progestin)

- POP (progestin only pill)

8
Q

What are some examples of COCP?

A

1st Gen- Norethynodrel
2nd Gen -Levonorgestrel, Norethisterone
3rd Gen - Desogestrel, Gestodene, Norgestimate
4th Gen - Drospirenone (anti-mineralocorticoid, anti-androgen)

9
Q

What are the effects of COCP?

A
  • Suppression of Ovulation: inhibits FSH, LH
  • Hold the hypothalamus and gonadotrophin in the ready to go state
  • Holds ovary in non-dominant follicular state
  • Makes cervical mucus which makes it more viscous
  • Prevents secretory phase on the endometrium so endometrium remains atrophic
10
Q

How does COCP work?

A
  • Tricks the body into thinking that ovulation has already occurred
  • Alters the lining of the womb
  • Thickens the naturally occurring fluids in the cervix and prevents sperm from traveling into the womb
11
Q

What are some side effects of COCP?

A
  • Venous thromboembolism
  • Myocardial infarction
  • Hypertension
  • Decrease glucose tolerance
  • Increase risk of stroke in women with focal migraine
  • Headaches
  • Mood swings
  • Cholestatic jaundice
  • Increase incidence of gallstones
  • Precipitate porphyria
12
Q

How can drugs reduce the efficacy of COCP?

A

-Metabolised by CP450. COCP efficacy reduced by enzyme inducing drugs such as they increase production of P450 in liver

13
Q

Which drugs reduce efficacy of COCP?

A
  • Antiepileptics such as carbamazepine or phenytoin
  • Antibiotics such as rifampicine and rifabutine
  • Natural products such as St John’s Worts
14
Q

How does Soya protein affect COCP?

A
  • Soya protein products enhance oestrogen absorption and reduces its storage in adipose and muscle
  • This cause half life to be reduced from 15 to 7 hours
15
Q

What are some examples of progestin only pills?

A
  • Levonorgestrel
  • Norethisterone
  • Ethynodiol Diacetate
  • Desogestrel
16
Q

How does POP work?

A
  • Effecting the cervical mucous and the endometrium
  • Needs receptor to work and receptor requitres oestrogen to form
  • Works best when started in the follicular phase of menstrual cycle
17
Q

What are some side effects of POP?

A
  • Breast discomfort
  • Changes in libido
  • Depression
  • Disturbance of appetite
  • Dizziness
  • Headache
  • Menstrual irregularities
  • Nausea
  • Skin disorders
  • Vomiting
18
Q

What are the methods of emergency contraception and their period of use?

A

Up to 72 hours post coitus
-Levonorgestrel

Up to 120 hours

  • Ullipristal acetate
  • Cu2+ IUD
19
Q

How does copper IUD work?

A

Prevents blastocyst attachment to endometrium

20
Q

How does ullipristal acetate work?

A

Selective progesterone receptor modulator

21
Q

How is Progestin Depot administered?

A

-Given every 12 weeks

Medroxy Progesterone Acetate

22
Q

How does a progestin depot work?

A

Works by releasing progestin slowly into the body, suppressing oestrogen and other hormone levels

23
Q

How does the progestin depot affect the reproductive system?

A
  • Thickening of mucus from the neck of the womb
  • Makes the lining of the womb thinner
  • Prevents the ovaries releasing an egg
24
Q

What is the advice given for missing one pill?

A
  • Take the last (missed) pill immediately, even if this means taking two pills in one day.
  • Continue taking the rest of the pack as normal.
  • Take seven-day pill-free break as normal or, take (inactive) pills
25
Q

What is the advice given for missing two pills anywhere in the pack or starting a pack 2 days late?

A
  • Take the last pill immediately, even if this means taking two pills in one day.
  • Continue taking the rest of the pack as normal.
  • Use extra contraception for the following seven days
26
Q

What is the advice given if there are seven or more pills left in the pack after the last missed pill?

A

-Finish the pack and take seven-day pill-free break as normal or, take (inactive) pills

27
Q

What is the advice given if there are less than seven pills left in the pack after the last missed pill?

A

Finish the pack and start a new pack the next day; this means missing out the pill-free break or not taking your inactive pills