Reproductive Health & Hormones Flashcards

Indication: Used to treat Benign Prostatic Hyperplasia (BPH).

MOA: Selectively antagonizes alpha‑1 adrenoceptors, leading to relaxation of smooth muscle in the lower urinary tract.

Side effects: dizziness; lightheadedness; fainting; headache; fatigue; nasal congestion

Contraindications: Hepatic impairment; use with potent CYP3A4 inhibitors

Considerations:

• Advise patients to rise slowly to reduce the risk of orthostatic hypotension.
• Use caution in elderly patients or those with mild hepatic impairment.

Indication: Used for Hormone Receptor-Positive Breast Cancer and Metastatic Breast Cancer.

MOA: Selectively inhibits the aromatase enzyme, reducing estrogen receptor stimulation.

Side effects: hot flashes; sweating; joint pain; stiffness; arthralgia; osteoporosis; nausea; vomiting; constipation; fatigue; headache; occasionally increased cholesterol levels

Contraindications: Hypersensitivity to the drug or any of its components.

Considerations:

• Monitor lipid profiles periodically, as estrogen reduction may impact cholesterol levels.

Indication: Used as an anti-inflammatory or immunosuppressant agent; cerebral edema; severe allergic reactions; certain malignancies

MOA: Decreases capillary permeability and vasodilation; inhibits phospholipase A2, reducing arachidonic acid derivative formation; more potent and longer-acting than prednisone with minimal mineralocorticoid activity

Side effects: anxiety; Cushing’s syndrome; electrolyte imbalance; headache; hirsutism; hypertension; nausea; osteoporosis; peptic ulceration; sleep disorders; weight gain; oligomenorrhea

Contraindications: Severe active infection; systemic fungal infections

Considerations:

• Avoid in severe hepatic and renal impairment
• Abrupt cessation of therapy can precipitate adrenal insufficiency; always taper dose
• Crosses the placenta; use with caution in pregnancy
• Acceptable in breastfeeding with caution

Indication: Used for contraception; Premenstrual Dysphoric Disorder (PMDD); moderate to severe acne vulgaris

MOA: Inhibits the hypothalamic-pituitary-ovarian axis, preventing LH surge and suppressing ovulation; thickens cervical mucus

Side effects: headaches; hot flashes; nausea; vomiting; breast tenderness; mood swings; depression; breakthrough bleeding; slight weight gain; increased risk of venous thromboembolism (VTE)

Contraindications: Thromboembolic disorders; stroke; myocardial infarction; significant cardiovascular disease; known or suspected breast cancer; active liver disease; migraine with aura; pregnancy; lactation

Considerations:

• Yaz is typically taken once daily at the same time each day
• Adherence is crucial for effective contraception

Indication: Used to treat Benign Prostatic Hyperplasia (BPH).

MOA: Inhibits type I and II 5-alpha-reductase enzymes, reducing testosterone conversion to DHT.

Side effects: reduced libido; erectile dysfunction; ejaculation issues; gynecomastia; mild dizziness; headache; gastrointestinal disturbances

Contraindications: Pregnancy; pediatrics

Considerations:

• PSA levels may be lowered; adjust screening thresholds for prostate cancer
• Often combined with alpha-blockers
• Educate on delayed onset of symptomatic improvement
• Women, especially pregnant or potentially pregnant, should avoid contact with dutasteride tablets

Indication: Used for contraception; HRT for women; hormone therapy for transgender women; osteoporosis; advanced prostate cancer

MOA: Enters target cells and associates with receptors, controlling gene transcription and decreasing FSH and LH through negative feedback.

Side effects: breast enlargement and pain/tenderness; melasma; nausea; edema; headaches

Contraindications: Severe hepatic impairment; abnormal genital bleeding; DVT or PE; arterial thromboembolic disease; breast cancer; estrogen-dependent tumor; pregnancy

Considerations:

• Can be administered orally or IM
• Educate about risk factors of smoking, increased age, and VTE risk
• Available in patch form

Indication: Used for contraception.

MOA: Releases ethinyl estradiol and etonogestrel, inhibiting gonadotropins and suppressing ovulation; thickens cervical mucus.

Side effects: vaginal irritation; discharge; discomfort; irregular bleeding or spotting; headaches; nausea; breast tenderness; mood changes; increased risk of blood clots; weight gain; changes in libido

Contraindications: History of thromboembolic events; estrogen-dependent tumors; undiagnosed genital bleeding; severe liver disease; migraine with aura; pregnancy; breastfeeding; certain hepatitis C drug combinations; uncontrolled hypertension; age >35 who smoke

Considerations:

• Inserted into the vagina for three weeks, followed by a one-week ring-free interval
• Important to assess cardiovascular, liver, or thromboembolism risk before initiating therapy

Indication: Used for contraception and acne vulgaris.

MOA: Suppresses LH and FSH, prevents endometrial changes, and increases cervical mucus thickness.

Side effects: fluid retention; headache; weight gain; acne; uterine bleeding; nausea; alopecia; rare VTE

Contraindications: History of hormone-sensitive cancers; hepatic tumors; hepatic disease; cholestatic jaundice; certain hepatitis C drug combinations

Considerations:

• Avoid in breastfeeding
• Educate about smoking, age, and VTE risk

Indication: Used for BPH and Androgenetic Alopecia (Male Pattern Baldness).

MOA: Inhibits type II 5-alpha reductase, decreasing androgen stimulation.

Side effects: decreased libido; erectile dysfunction; reduced ejaculate volume; gynecomastia

Contraindications: Pregnancy

Considerations:

• It may take several months for full therapeutic effect.

Indication: Used for abnormal uterine bleeding and contraception.

MOA: Releases levonorgestrel, thickening cervical mucus and thinning the endometrial lining.

Side effects: irregular bleeding; cramping; device expulsion or uterine perforation; ovarian cysts

Contraindications: PID; STIs; structural anomalies; pregnancy; severe cervical dysplasia; recent endometritis; untreated cervicitis or vaginitis; unremoved IUD; hepatic disease

Considerations:

• Must be inserted by a trained provider
• Follow-up visit recommended to check placement

Indication: Used for contraception, abnormal uterine bleeding, endometrial hyperplasia, amenorrhea, HRT, endometriosis.

MOA: Binds to progesterone receptors, inducing secretory changes and inhibiting ovulation.

Side effects: regular bleeding; spotting; amenorrhea; weight gain; depression; mood swings; injection site reactions; headache; dizziness; bone mineral density loss

Contraindications: Undiagnosed abnormal uterine bleeding; active liver disease; pregnancy; breast cancer; estrogen-or-progesterone-dependent tumor; arterial thromboembolic disease

Considerations:

• Administered as an intramuscular injection every 12–13 weeks.
• Ensure adequate calcium and vitamin D intake for bone health.

Indication: Used for prevention of NSAID-induced ulcers and pregnancy termination.

MOA: Synthetic prostaglandin E1 analog with cytoprotective effects on the GI mucosa; stimulates uterine contractions.

Side effects: diarrhea; abdominal pain; uterine contractions; premature labor

Contraindications: Pregnancy

Considerations:

• Educate on expected effects and instruct to report severe pain or signs of infection.

Indication: Used for contraception, abnormal uterine bleeding, endometriosis, amenorrhea, HRT.

MOA: Mimics progesterone, inducing endometrial changes and increasing cervical mucus viscosity.

Side effects: breakthrough bleeding; spotting; amenorrhea; weight gain; gastrointestinal issues; nausea; abdominal discomfort; bloating; headache; mood changes; breast tenderness; mild swelling; occasional acne

Contraindications: Active liver disease; estrogen-dependent neoplasms; undiagnosed bleeding; pregnancy; DVT/PE; arterial thromboembolic disease

Considerations:

• Suitable for women who cannot use estrogen-containing contraceptives
• Emphasize regular pill-taking for efficacy

Indication: Used for rheumatoid arthritis, lupus, severe allergies, asthma exacerbations, eczema, psoriasis, IBD flares, leukemias, and lymphomas.

MOA: Binds to glucocorticoid receptors, modulating gene transcription and reducing inflammation.

Side effects: weight gain; increased appetite; hyperglycemia; dyslipidemia; osteoporosis; muscle weakness; edema; hypertension; potassium loss; peptic ulceration; adrenal suppression; mood swings; skin issues

Contraindications: Systemic fungal infections; live virus vaccines

Considerations:

• Use the lowest effective dose for the shortest duration
• Taper gradually for long-term use
• Consider calcium and vitamin D supplementation

Indication: Asthma; suppression of allergic/inflammatory disease; croup; ITP; IBD; myasthenia gravis; polymyalgia rheumatica; GCA and temporal arteritis; cluster headache prophylaxis (short-term)

MOA: Converted in the liver to prednisolone, which inhibits phospholipase A2 to decrease prostaglandin and thromboxane production, thereby decreasing inflammation

Side effects: Cushing’s syndrome; oligomenorrhea; osteoporosis; nausea; peptic ulceration; weight gain; increased risk of infection; fatigue; hypertension; hirsutism; impaired healing

Contraindications: Systemic fungal infections; live or attenuated virus vaccines

Considerations:

• Avoid long-term use of corticosteroids; taper if used long-term to avoid adrenal crisis
• Secondary infections, osteoporosis, and fat redistribution are common with long-term use
• Caution in elderly due to psychiatric effects
• Monitor height in children on long-term therapy
• Avoid drugs that increase hypokalemia risk, e.g., citalopram, chlorpromazine
• Avoid digoxin due to increased toxicity risk
• Avoid vaccinations due to immunosuppressive effects