Week 9 cards

Your female patient is requesting "Viagra for women" to help with her depressed libido. What can you share with her?

1.This drug does not have the same rapid onset as a phosphodiesterase type 5 (PDE5) for men.2.The "pink Viagra" is focused on a proposed neurotransmitter dysfunction.3.It takes about three months for full effect and many patients do not see a major clinical effect.4.All of the above.

estrogen therapy, symtoms improve in

2 weeks, max effect in 8 weeks

nuva ring

3 weeks in one week out

ortho evra patch

3 weeks on 1 week off

birth control monitoring

BP and ADRs at 3 months then annually

Evista (raloxifene)

Estrogen receptor modulator, Post-menopausal Osteoporosis

Addyi: "Pink Viagra"

For women with diagnosed with severe sexual dysfunction (serotonin and dopamine agonist) •Black Box warning for severe hypotension when used with alcohol NOT a same day effect as with PDE5 inhibitors for men; takes about 3 months for full effect, and many do not benefit at all

best route testosterone

IM

"Fertility drugs" linked with female infertility treatments can also be used for:

Male spermatogenesis issues

The U.S. Food and Drug Administration warns that androgens may cause:

Peliosis hepatis

Shana received her first medroxyprogesterone (Depo-Provera) injection six weeks ago and calls the clinic, concerned that she has been having a light period off and on since receiving her Depo shot. What should the provider do?

Reassure her that some spotting is normal the first few months of Depo and it should improve

A 19-year-old female is a nasal Staph aureus carrier and is placed on five days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications

She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness.

Androgens are indicated for:

Symptomatic treatment for male deficiency

Male patients require ______________________ before and during androgen therapy.

a prostate exam

§Mifepristone (Mifeprex)

abortion pill

Tamoxifen

adjuvant therapy for breast cancer in patients with estrogen receptors tumors

Clomid/clomiphene

antiestrogen, used to initiate ovulation

HRT monitoring

anual pelvic exam, mamogram, liver function tests at baseline, lipid proficle ae at baseline, older than 45 should be screend for DMII, uterine biopsy with bleeding

Estrogen-only products

are contraindicated in women with an intact uterus.

testosterone therapy for menopause

can help with hot flashes if combined with estrogen

statin therapy and testosterone

can statistically decrease testosterone but not clinically

Mirena IUD

can stay in for 5 years

HRT shouldnt be used in

cardiac disease, breast cancer,

Obese women may have increased risk of failure with which contraceptive method?

combined topical patch

The medroxyprogesterone (Depo-Provera) injection has a black box warning due to:

decreased bone density

Testosterone gel negatives

expensive, can touch clothes

Estrogen

has positive effects on bone mass, increases serum triglycerides, and improves ratio of high-density lipoprotein to low-density lipoprotein. stimulates coagulation and fibrinolytic pathways.

transdermal testosterone

more common than gel, oral doesnt work well

menopause

no menses for 12 months

depot provera

one dose every 12 weeks

testosterone

primary male androgen

Luteal phase:

progesterone prevents new follicle development as well as differentiation of the endometrium

symptoms that are helped with menopause and HRT

reduce vasomotor symptoms, reduce vaginal atrophy, reduce osteoporosis,

Gonadotropin-releasing hormone (GnRH) pulses

regulate follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn, regulate the secretion of estrogen and progesterone from the ovary.

Monophasic Oral Contraceptives

same dose of estrogen and progestin for full cycle

implanon

up to threee years, rod

androgens

used to treat disorders in both male and females, ex hypogonadism, cancer, HIV

Danazol

used to treat endometriosis

triphasic contraceptive

vary the dose of estrogen, progestin, or both

emergency contraception

within 72 hours up to 120 hours

HRT monitoring

yearly, use lowest dose for up to 5 years

§Progesterone

§ increases body temperature and insulin levels. may depress the central nervous system.

extened BC cycle

§84 days of active drug, then 7 days off •Withdrawal bleed once every 3 months

antiandrogens

§Androgen hormone inhibitors •Also known as 5a-reductase inhibitors •Finasteride (Propecia, Proscar) §Leuprolide acetate (Lupron) •AKA luteinizing hormone-releasing hormone antagonist

Estrogen clinical usage

§Contraception •Combination of estrogen and progestin §Relief of peri- and postmenopausal symptoms •Start on lowest dose. •Do not give unopposed estrogen to women with a uterus. •See Hormone Therapy chapter for full information. §Vaginal atrophy and dryness •Vaginal cream, tablets, or ring §Osteoporosis (not for primary treatment use)

noncontraceptive benefits of contraception meds

§Decreased dysmenorrhea, menstrual irregularities, and menstrual blood loss §Lessening of acne and hirsutism §Fewer ovarian cysts §Significantly reduced endometrial and ovarian cancer risk §Lower incidence of benign breast conditions, such as fibrocystic changes and fibroadenoma §Reduced risk of hospitalization for gonorrheal pelvic inflammatory disease §Suppression of endometriosis in women who do not currently desire pregnancy

progresterones ADRS

§Irregular bleeding §Amenorrhea §Acne §Injectable and implanted progesterone •Weight gain •Irregular menstrual bleeding •Osteoporosis risk with 2+ year use

progesterone clinical uses

§Postmenopausal hormone replacement •Combined with estrogen when uterus is intact §Progestin-only contraception •Progestin-only pills (norethindrone) •Medroxyprogesterone acetate (Depo-Provera) §Progestin implanted intrauterine device (Mirena)

Ovulatory phase:

§estradiol levels peak and exert positive feedback to induce an LH surge, which facilitates release of the mature ovum.

Two formulations of estrogen are available in contraceptive preparations

§ethinyl estradiol and mestranol.

mentstrual phases

§follicular, ovulatory, luteal, and menstrual.

The menstrual cycle is regulated by

§positive and negative feedback in the hypothalamic-pituitary-ovarian axis.

Biphasic Oral Contraceptives

§vary the dose of progestin

drug interactions contraceptives

‒Tuberculosis drugs, antiepileptic drugs, St. John's Wort

ADRs of contraceptives

‒Venous thromboembolism risk increases three to five times with OC use ‒Also: cholestatic jaundice, benign hepatic neoplasms, myocardial infarction, stroke, and neurological migraines

Gonadotropin-releasing hormone

•A stimulant in pulsatile doses if the patient has a functional pituitary gland and an ovary to produce the luteinizing hormone surge initiating ovulation •Also used to treat endometriosis and uterine fibroids and to suppress prostate cancer

§Spironolactone (Aldactone)

•An aldosterone antagonist and inhibitor of 5a-reductase

progesterone monitoring

•Depression •Increased risk of seizures •In diabetes, monitoring of blood glucose

§Third-generation progesterones

•Desogestrel and norgestimate

Exogenous estrogens

•Estradiol •Equine estrogen •Esterified and micronized estrogen

Bromocriptine (Parlodel)

•Has an inhibitory effect on pituitary gland, which produces prolactin ‒Also works for hyperprolactinemia ‒Also used in Parkinson's disease •Begins to work within 2 hours •Many drug interactions

adverse drug reactions of androgens (testosterone)

•Hepatitis, hepatic neoplasm, cholestatic hepatitis, jaundice, and hepatocellular carcinoma •Men: gynecomastia, reduced sperm levels, decreased libido at high levels, depression •Women: menstrual irregularities, virilization

Effects of estrogen

•Increases bone density •Results in normal skin and blood vessel structure •Affects lipid levels •Reduces bowel motility •Enhances coagulability of blood •Causes edema because of its action on the renin-angiotension system •Maintains stability of the thermoregulatory center

Direct antiandrogens

•Inhibit androgen uptake or nuclear binding of androgen at target tissues •Flutamide (Eulexin), bicalutamide (Casodex), and nilutamide (Nilandron)

estrogen for vulvovaginal atrophy or dryness

•Low-dose estrogen (0.3 to 0.625 mg daily) alleviates symptoms. •Vaginal application of estrogen (ring or cream form) can improve symptoms in as little as 2 weeks. •Topical application is preferred because of lower overall estrogen dose and no systemic effect.

Effects of estrogen

•Maintains bone density •Maintains normal skin and blood vessel structure •Alters lipids •Reduces bowel motility •Enhances coagulability of blood •Causes edema because of its action on the renin-angiotension system •Maintains stability of the thermoregulatory center

testosterone contraindications

•Male breast cancer or prostate cancer •Pregnancy (category X) and lactation •Transdermal drugs not used in women

Exogenous progestins

•Medroxyprogesterone •Norethindrome •Micronized progesterone

Human menopausal gonadotropin: follitropin (Fertinex), menotropins (Pergonal, Humegon)

•Men: stimulate spermatogenesis •Women: stimulate maturation of follicules and ovulation

§First-generation progesterones

•Norethindrone, norethindrone acetate, and ethynodiol diacetate

Androgen-derived progestins

•Norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, desogestrel, levonorgestrel, and norgestimate •Drospirenone: a progestin developed as a derivative of spironolactone

§Second-generation progesterones

•Norgestrel and levonorgestrel

Estrogen contraindications

•Pregnancy (unless specialist directed low hormone level) •Breast cancer •Estrogen-dependent neoplasia •Active deep vein thrombosis or pulmonary embolism •History in past year of stroke or myocardial infarction •Liver dysfunction •Smokers

use of androgens

•Primary hypogonadal males •Hypogonadotropic hypogonadism •Male climacteric

Progesterones

•Progesterone (Promethrium, Progesterone in Oil, Crinone, Prochieve) •Medroxyprogesterone acetate (Provera, Depo-Provera) •Norethindrone (Aygestin) •Megestrol acetate (Megace)

Monitoring of androgens

•Serum testosterone levels, lipids, liver function, complete blood count •Men need prostate-specific antigen and digital prostate examinations

In females, androgen production during puberty contributes to:

•Skeletal growth spurt •Pubic and axillary hair •Sebaceous gland activity •Libido

Fourth-generation progesterones

•Spironolactone derivative: drospirenone •19-nortestosterone derivative: dienogest

injectable birth control

•Spotting, followed by amenorrhea •Weight gain •Depression •Black Box warning: decreased bone density with longer-term use

Effects of progestin are:

•Thickening of endometrium in preparation for pregnancy •Thickening of cervical mucus •Thinning of vaginal mucosa •Relaxation of smooth muscles of uterus and fallopian tubes

progesterone precautions

•Thromboembolic disease •Breast cancer •Impaired liver function •Depression •Disorders that worsen with fluid retention •Progesterone: Old pregnancy category D. Norethindrone acetate: Old pregnancy category X

PDE5 inhibitors

•Used in neonatal intensive care unit for persistent pulmonary hypertension