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CorticosteroidsCorticosteroids
Adrenal glands produce Adrenal glands produce glucocorticoids and glucocorticoids and mineralocorticoidsmineralocorticoids
Glucocorticoids:Glucocorticoids:– Involved in cholesterol, fat, and Involved in cholesterol, fat, and
protein metabolismprotein metabolism
CorticosteroidsCorticosteroids
Adrenal glands produce Adrenal glands produce glucocorticoids and glucocorticoids and mineralocorticoidsmineralocorticoids
Glucocorticoids:Glucocorticoids:– Involved in cholesterol, fat, and protein Involved in cholesterol, fat, and protein
metabolismmetabolism Mineralocorticoids:Mineralocorticoids:
– Involved in regulating electrolyte and Involved in regulating electrolyte and water balancewater balance
CortisolCortisol
Principal adrenal steroid hormonePrincipal adrenal steroid hormone Responsible for:Responsible for:
– GluconeogenesisGluconeogenesis– Protein catabolismProtein catabolism– Anti-inflammatory reactionsAnti-inflammatory reactions– Stimulation of fat depositionStimulation of fat deposition– Sodium and water retentionSodium and water retention
CorticosteroidsCorticosteroids
Adrenal hormones excluding sex Adrenal hormones excluding sex hormoneshormones
Steroid production follows a Steroid production follows a circadian rhythmcircadian rhythm
Properties of Properties of glucocorticosteroides used glucocorticosteroides used in clinicsin clinics
Anti-inflammatoryAnti-inflammatory Immune-depressiveImmune-depressive
Anti-allergicAnti-allergic Anti-shockAnti-shock Anti-toxicAnti-toxic
Anti-inflammatory action Anti-inflammatory action of GCSof GCS
Nonspecific Nonspecific inflammationinflammation
Auto-immune componentAuto-immune component Hyperergic characterHyperergic character
Therapy of despairTherapy of despair
Mechanism of anti-inflammatory action of Mechanism of anti-inflammatory action of GCSGCS
GCS
activation of lipomoduline
decreasing of activity of phospholipase А2
slowing down of arachidonic acid metabolites production
(prostaglandins, leucotriens, thromboxan А2)
stabilization of cellular and
lyzosomalmembranes
decreasing of leucocytes’
migration processes, depression of
phagocytes activity
decreasing of capillaries’ wall permeability
depression of histamine, serotonin, bradykinine releasing
Indications for administration Indications for administration of GCSof GCS
Insufficiency of adrenal cortexInsufficiency of adrenal cortex Rheumatoid illnesses Rheumatoid illnesses ((rheumatoid arthritis, rheumatoid arthritis,
rheumatism, system red lupus etc.rheumatism, system red lupus etc.)) Chronic active hepatitisChronic active hepatitis Bronchial asthmaBronchial asthma Ulcerative colitisUlcerative colitis Nephritic syndromeNephritic syndrome Auto-immune hemolytic anemiaAuto-immune hemolytic anemia Shock and collapse of any etiologyShock and collapse of any etiology Brain, lungs, larynx edemaBrain, lungs, larynx edema Acute allergic reactionsAcute allergic reactions Transfusion reactionsTransfusion reactions Heavy infectionsHeavy infections ( (hiding behind the etiotropic drugshiding behind the etiotropic drugs!)!) Liver disesaesLiver disesaes
Doses and terms of GCS therapyDoses and terms of GCS therapy
Situation Situation Daily doseDaily dose Terms of Terms of treatmenttreatment
Acute casesAcute cases ( (shock, shock, collapse, brain, lungs collapse, brain, lungs edema, septic shock, edema, septic shock, asthmatic condition etc.asthmatic condition etc.))
200-500-200-500-800-1000 800-1000 mg mg i.v.i.v.
1-3 1-3 daysdays
Subacute and acute Subacute and acute attacks of chronic attacks of chronic processesprocesses ( (rheumatoid rheumatoid diseases, ulcerative colitis, diseases, ulcerative colitis, bronchial asthma etc.bronchial asthma etc.))
20-50 20-50 mgmg((rarely tillrarely till 200 200 mgmg))
4-6 4-6 weeksweeks--several several monthsmonths
Primary and secondary Primary and secondary insufficiency of adrenal insufficiency of adrenal cortexcortex
2,5-10 2,5-10 mgmg life-longlife-long
CorticosteroidsCorticosteroids
Act as anti-inflammatory and Act as anti-inflammatory and immunosuppressive agents in immunosuppressive agents in treating diseases of different treating diseases of different origins:origins:– HematologicHematologic– AllergicAllergic– InflammatoryInflammatory– NeoplasticNeoplastic– Autoimmune Autoimmune
Administration of GCSAdministration of GCS Insufficiency of adrenal cortexInsufficiency of adrenal cortex Rheumatoid illnesses Rheumatoid illnesses ((rheumatoid arthritis, rheumatoid arthritis,
rheumatism, system red lupus etc.rheumatism, system red lupus etc.)) Chronic active hepatitisChronic active hepatitis Bronchial asthmaBronchial asthma Ulcerative colitisUlcerative colitis Nephritic syndromeNephritic syndrome Auto-immune hemolytic anemiaAuto-immune hemolytic anemia Shock and collapse of any etiologyShock and collapse of any etiology Brain, lungs, larynx edemaBrain, lungs, larynx edema Acute allergic reactionsAcute allergic reactions Transfusion reactionsTransfusion reactions Heavy infectionsHeavy infections ( (hiding behind the hiding behind the
etiotropic drugsetiotropic drugs!)!) Liver diseasesLiver diseases
Doses and terms of GCS therapyDoses and terms of GCS therapy
Situation Situation Daily doseDaily dose Terms of Terms of treatmenttreatment
Acute casesAcute cases ( (shock, shock, collapse, brain, lungs collapse, brain, lungs edema, septic shock, edema, septic shock, asthmatic condition asthmatic condition etc.etc.))
200-500-200-500-800-1000 800-1000 mg i.v.mg i.v.
1-3 1-3 daysdays
Subacute and acute Subacute and acute attacks of chronic attacks of chronic processesprocesses ( (rheumatoid rheumatoid diseases, ulcerative diseases, ulcerative colitis, bronchial colitis, bronchial asthma etc.asthma etc.))
20-50 20-50 mgmg((rarely tillrarely till 200 200 mgmg))
4-6 4-6 weeksweeks--several several monthsmonths
Primary and Primary and secondary secondary insufficiency of insufficiency of adrenal cortexadrenal cortex
2,5-10 2,5-10 mgmg life-longlife-long
FluocinarFluocinar – – SinaflanSinaflan – – SinalarSinalar((Fluocinole acetonideFluocinole acetonide))
Addison’s DiseaseAddison’s Disease
Life-threatening deficiency of Life-threatening deficiency of glucocorticoids and glucocorticoids and mineralocorticoidsmineralocorticoids
Treated with daily corticosteroidsTreated with daily corticosteroids
Symptoms of Symptoms of Addison’s DiseaseAddison’s Disease Debilitating weaknessDebilitating weakness HyperkalemiaHyperkalemia Hyperpigmentation of skinHyperpigmentation of skin Low levels of serum sodium and Low levels of serum sodium and
glucoseglucose Reduced blood pressureReduced blood pressure Weight lossWeight loss
Cushing’s DiseaseCushing’s Disease
Caused by an overproduction of Caused by an overproduction of steroids or excessive steroids or excessive administration of corticosteroidsadministration of corticosteroids
Symptoms:Symptoms:– Protruding abdomen; round, puffy Protruding abdomen; round, puffy
face; fat over the shoulder bladesface; fat over the shoulder blades
Reasons for Using Reasons for Using CorticosteroidsCorticosteroids Inhibit inflammationInhibit inflammation Useful in treating asthma, rashes, Useful in treating asthma, rashes,
and skin disordersand skin disorders Available in many different Available in many different
dosage formsdosage forms
Problems with Problems with CorticosteroidsCorticosteroids Lessen the ability of leukocytes to Lessen the ability of leukocytes to
destroy infection which decreases destroy infection which decreases fever, redness, and swellingfever, redness, and swelling
Also may cause infection to Also may cause infection to spreadspread
Corticosteroid Corticosteroid Dispensing IssuesDispensing Issues
Take caution in patients with Take caution in patients with diabetes, uncontrolled diabetes, uncontrolled hypertension, CHF, severe infection hypertension, CHF, severe infection or altered immunity, or peptic ulcer or altered immunity, or peptic ulcer disease with active GI bleedingdisease with active GI bleeding
Warning!
CorticosteroidsCorticosteroids
Usage must be tapered off, not Usage must be tapered off, not abruptly stoppedabruptly stopped
May cause withdrawal symptomsMay cause withdrawal symptoms– Anorexia, nausea, vomiting, myalgia, Anorexia, nausea, vomiting, myalgia,
arthralgia, lethargy, headache, arthralgia, lethargy, headache, sluggishness, weight loss, postural sluggishness, weight loss, postural hypotension, fever and depressionhypotension, fever and depression
Doses should be given in the Doses should be given in the morningmorning
Adverse Effects of Adverse Effects of GlucocorticoidsGlucocorticoids Cardiovascular effectsCardiovascular effects Dermatologic effectsDermatologic effects Gastrointestinal effectsGastrointestinal effects Immune system effectsImmune system effects Metabolic effectsMetabolic effects Musculoskeletal effectsMusculoskeletal effects Neuropsychiatric effectsNeuropsychiatric effects Ophthalmic effectsOphthalmic effects
Adrenal Sex HormonesAdrenal Sex Hormones
Androgens are produced by:Androgens are produced by:– The testesThe testes– The ovariesThe ovaries– AdrenalsAdrenals– Peripheral fat tissuePeripheral fat tissue
Most important male hormone is Most important male hormone is testosterone which is produced testosterone which is produced by the testesby the testes
Responsibilities of Responsibilities of TestosteroneTestosterone Initiating sperm productionInitiating sperm production Behavioral characteristicsBehavioral characteristics LibidoLibido Sexual potencySexual potency Muscle mass and strengthMuscle mass and strength Fat distributionFat distribution Bone massBone mass ErythropoiesisErythropoiesis Prevention of baldnessPrevention of baldness
HypogonadismHypogonadism
Deficient hormone production and Deficient hormone production and secretionsecretion
Androgens must be replaced by Androgens must be replaced by medicationsmedications– May cause virilization, muscle May cause virilization, muscle
building, and hematologic stimulation building, and hematologic stimulation of erythropoiesisof erythropoiesis
– Can be used to treat anemia, breast Can be used to treat anemia, breast cancer, or endometriosiscancer, or endometriosis
Androgen’s Side Androgen’s Side EffectsEffects VirilizationVirilization HirsutismHirsutism AcneAcne HepatoxicityHepatoxicity High levels of erythrocytesHigh levels of erythrocytes Oily skinOily skin GynecomastiaGynecomastia PriapismPriapism
Male ImpotenceMale Impotence
Failure to initiate or maintain an Failure to initiate or maintain an erection until ejaculationerection until ejaculation
Causes:Causes:– Testosterone deficiencyTestosterone deficiency– AlcoholismAlcoholism– Cigarette smokingCigarette smoking– Psychological factorsPsychological factors– Medications Medications
Drugs That May Cause Drugs That May Cause ImpotenceImpotence
Alcohol (most Alcohol (most significant)significant)
AmphetaminesAmphetamines AntihypertensiveAntihypertensive
ss CorticosteroidsCorticosteroids EstrogensEstrogens
HH22 blockers blockers haloperidolhaloperidol lithiumlithium OpiatesOpiates Some Some
antidepressantsantidepressants
Agents for Male Agents for Male ImpotenceImpotence
alprostadil (Caverject, Edex, Muse)alprostadil (Caverject, Edex, Muse) danazol (Danocrine)danazol (Danocrine) methyltestosterone (Android, Testred)methyltestosterone (Android, Testred) oxymetholone (Anadrol)oxymetholone (Anadrol) papaverine papaverine testosterone (Androderm, AndroGel, testosterone (Androderm, AndroGel,
Striant, Testoderm)Striant, Testoderm)
Drug List
Agents for Male Agents for Male Impotence – Impotence – Phosphodiesterase Phosphodiesterase InhibitorsInhibitors
sildenafil (Viagra)sildenafil (Viagra) tadalafil (Cialis)tadalafil (Cialis) vardenafil (Levitra)vardenafil (Levitra)
Drug List
sildenafil (Viagra)sildenafil (Viagra)
11stst oral therapy for impotence oral therapy for impotence Allows an erection to occur Allows an erection to occur
naturallynaturally Take at least 1 hour before Take at least 1 hour before
activityactivity
sildenafil Dispensing sildenafil Dispensing IssuesIssues
Potentially lethal interaction Potentially lethal interaction with nitrateswith nitrates
Warning!
tadalafil (Cialis)tadalafil (Cialis)
Duration of action is 36 hoursDuration of action is 36 hours Faster onset and longer duration Faster onset and longer duration
than others in this classthan others in this class
tadalafil Dispensing tadalafil Dispensing IssuesIssues
Potentially lethal interaction Potentially lethal interaction with nitrateswith nitrates
Warning!
Drugs of female sex Drugs of female sex hormoneshormones
Estrogens Estrogens
estron(oil solution of folliculin)estradiolethynilestradiol(microfollin)synestrol
Gestagens Gestagens
progesteroneoxyprogesterone caproatealilestrenol (turinal)
Estrogens Estrogens UsesUses
– Hormone replacement therapy (HRT)Hormone replacement therapy (HRT)– Palliative and preventive therapy Palliative and preventive therapy
during menopauseduring menopause Actions Actions
– Protecting the heart from Protecting the heart from atherosclerosisatherosclerosis
– Retaining calcium in the bonesRetaining calcium in the bones– Maintaining the secondary female Maintaining the secondary female
sex characteristicssex characteristics
Administration of drugs of female sex hormones
estrogensestrogens
1) Genital hypoplasia, primary and secondary amenorrhea2) Sexual underdevelopment of women3) After ovary-ectomia4) Climacteric disorders 5) Lactation depression6) Weak labor activity(estrogen background)7) Prostate cancer of men, breast cancer of women after the age of 608) A part of contraceptive agents
Effects of Progesterone on the BodyEffects of Progesterone on the Body
Decreased uterine motilityDecreased uterine motility Development of secretory Development of secretory
endometriumendometrium Thickened cervical mucusThickened cervical mucus Breast growthBreast growth Increased body temperatureIncreased body temperature Increased appetiteIncreased appetite Depressed T-cell functionDepressed T-cell function Anti-insulin effectAnti-insulin effect
Administration of gestagens
1) miscarriage, habitual abortion
2) dysfunctional uterus bleedings, algomenorrhea
3) as component of contraceptives
4) Climacteric disorders5) As part of fertility programs
6) Treat specific cancers with specific receptor site sensitivity
Hormonal contraceptivesHormonal contraceptives
1)1) combined estrogen-gestagencombined estrogen-gestagen aa)) monophased monophased ((bisecurin, non-ovlon, rigevidonbisecurin, non-ovlon, rigevidon, ,
marvelon, demulenmarvelon, demulen)) bb) ) double-phaseddouble-phased ( (anteovin, neo-eunominanteovin, neo-eunomin))
cc) ) triple-phasedtriple-phased ( (tri-regol, trisistontri-regol, trisiston))2)2) monohormonal gestagenmonohormonal gestagen ( (mini-pillimini-pilli))
exluton, ovret, continuinexluton, ovret, continuin3)3) postcoital hestagenpostcoital hestagen ( (postinorpostinor))
4)4) depot-contraceptivesdepot-contraceptives - - of prolonged actionof prolonged action norplantnorplant ( (levonorgestrellevonorgestrel))
depot-proveradepot-provera ( (medroxyprogesterone acetatemedroxyprogesterone acetate))
hypertension hypertension hypercoagulationhypercoagulationdyspeptic disordersdyspeptic disorders ( (nausea, vomitingnausea, vomiting))migraine migraine depressiondepressionobesityobesitycholestatic jaundicecholestatic jaundicebreast cancer, cancer of uterus cervixbreast cancer, cancer of uterus cervixischemic heart diseaseischemic heart diseasemyocardium infarctionmyocardium infarctionstrokestrokeembryotoxic and teratogenic actionembryotoxic and teratogenic action
thrombo-emboliathrombo-embolia
Complications in case of administration ofhormonal contraceptives
Focus on the Fertility Drug Focus on the Fertility Drug Prototype: ClomiphenePrototype: Clomiphene
Indications:Indications: Treat ovarian failure in patients with Treat ovarian failure in patients with normal liver function and normal endogenous normal liver function and normal endogenous estrogens; unlabeled use: treat male sterility estrogens; unlabeled use: treat male sterility
Actions:Actions: Binds to estrogen receptors, decreasing Binds to estrogen receptors, decreasing the number of available estrogen receptors, which the number of available estrogen receptors, which gives the hypothalamus the false signal to increase gives the hypothalamus the false signal to increase FSH and LH secretion, leading to ovarian stimulationFSH and LH secretion, leading to ovarian stimulation
PO route:PO route: Onset 5–8 days; duration 6 weeks Onset 5–8 days; duration 6 weeks TT½½:: 5 days, with hepatic metabolism and5 days, with hepatic metabolism and excretion excretion
in the fecesin the feces
AbortifacientsAbortifacients
UseUse– Evacuate the uterus by Evacuate the uterus by
stimulating intense uterine stimulating intense uterine contractions contractions
TypesTypes– Carboprost (Carboprost (HemabateHemabate))– Dinoprostone (Dinoprostone (Cervidil, Prepidil Cervidil, Prepidil
Gel, Prostin E2Gel, Prostin E2))– Mifepristone (RU-486, Mifepristone (RU-486, MifeprexMifeprex))
Androgens and Their Androgens and Their IndicationsIndications
Testosterone Testosterone ((Duratest, Testoderm,Duratest, Testoderm, others) others) – Hypogonadism;Hypogonadism; breast cancerbreast cancer
DanazolDanazol ( (DanocrineDanocrine))– Block the release of FSH and LH in womenBlock the release of FSH and LH in women
FluoxymesteroneFluoxymesterone ( (HalotestinHalotestin))– Hypogonadism; breast cancerHypogonadism; breast cancer
TestolactoneTestolactone ( (TeslacTeslac))– Breast cancersBreast cancers
ANABOLIC STEROIDSANABOLIC STEROIDSPhenobolinum, Retabolil, Phenobolinum, Retabolil, MethandrostenolonumMethandrostenolonum
PHARMACOLOGICAL EFFECTSPHARMACOLOGICAL EFFECTS- Stimulation of protein synthesisStimulation of protein synthesis- Depression of phosphor and CaDepression of phosphor and Ca++ ++ excretionexcretion- Increase of bones, muscles and Increase of bones, muscles and
parenchymatous organs massparenchymatous organs mass- Stimulation of regenerationStimulation of regeneration
ADMINISTRATIONADMINISTRATION- Aplastic anemia (bone marrow suppression)Aplastic anemia (bone marrow suppression)- Osteoporosis, bone fracturesOsteoporosis, bone fractures- Exhausted diseasesExhausted diseases- Prolonged treatment with GCS Prolonged treatment with GCS
COMPLICATIONSCOMPLICATIONS Hepatitis, sexual disorders (impotence), Hepatitis, sexual disorders (impotence),
edemas, masculinization, nausea, vomitingedemas, masculinization, nausea, vomiting
Female HormonesFemale Hormones
Can prevent conception, ease Can prevent conception, ease symptoms of menopause, and symptoms of menopause, and help prevent osteoporosishelp prevent osteoporosis
2 main female hormones:2 main female hormones:– Estrogen Estrogen – ProgesteroneProgesterone
EstrogenEstrogen
Formed in the ovaries when FSH is Formed in the ovaries when FSH is releasedreleased
Responsible for:Responsible for:– Endometrial growthEndometrial growth– Increased cervical mucusIncreased cervical mucus– Cornification of vaginal mucosaCornification of vaginal mucosa– Growth of breast tissueGrowth of breast tissue– Increased epiphyseal closureIncreased epiphyseal closure– Sodium retentionSodium retention– Carbohydrate metabolism Carbohydrate metabolism – Calcium utilizationCalcium utilization
Estrogen Deficiency Estrogen Deficiency SymptomsSymptoms Irregular bleeding and cyclesIrregular bleeding and cycles ““hot flashes” that start in the face hot flashes” that start in the face
and move down through the bodyand move down through the body Atrophic vulvovaginitis, excessive Atrophic vulvovaginitis, excessive
drynessdryness DyspareuniaDyspareunia Frequent infectionsFrequent infections
MenopauseMenopause
As women reach menopause As women reach menopause estrogen production decreasesestrogen production decreases
HRT can be used to supplement HRT can be used to supplement estrogen levelsestrogen levels
estrogens Dispensing estrogens Dispensing IssuesIssues
Patients should not smoke Patients should not smoke during therapy, whether birth during therapy, whether birth control or HRTcontrol or HRT
Warning!
Estrogen’s Side EffectsEstrogen’s Side Effects
NauseaNausea VomitingVomiting BloatingBloating Weight gainWeight gain Breast tendernessBreast tenderness Breakthrough bleedingBreakthrough bleeding Glucose intoleranceGlucose intolerance
HRTHRT
Reduces symptoms of menopauseReduces symptoms of menopause Decreases bone lossDecreases bone loss Lowers risk of cardiovascular Lowers risk of cardiovascular
diseasedisease Small risk of breast cancerSmall risk of breast cancer
EstrogensEstrogens
conjugated estrogen (Enjuvia,Premarin)conjugated estrogen (Enjuvia,Premarin) conjugated estrogen-conjugated estrogen-
medroxyprogesterone (Premphase, medroxyprogesterone (Premphase, Prempro)Prempro)
estradiol (Alora, Climara, Esclim, estradiol (Alora, Climara, Esclim, Estrace, Estraderm, Estrasorb, Estring, Estrace, Estraderm, Estrasorb, Estring, Femring, Menostar, Vivelle, Vivelle Dot)Femring, Menostar, Vivelle, Vivelle Dot)
Drug List
EstrogensEstrogens
estradiol-levonorgestrel (Climara estradiol-levonorgestrel (Climara Pro)Pro)
estradiol-norethindrone (Activella, estradiol-norethindrone (Activella, CombiPatch)CombiPatch)
estradiol-norgestimate (Ortho-estradiol-norgestimate (Ortho-Prefest)Prefest)
Drug List
EstrogensEstrogens
estropipate (Ogen)estropipate (Ogen) ethinyl estradiol (Estinyl)ethinyl estradiol (Estinyl) ethinyl estradiol-norethindrone ethinyl estradiol-norethindrone
(Femhrt)(Femhrt)
Drug List
estrogen-estrogen-medroxyprogesterone medroxyprogesterone (Premphase, Prempro)(Premphase, Prempro)
Provides estrogen and Provides estrogen and progesterone replacementprogesterone replacement
Prevents uterine cancerPrevents uterine cancer
ProgestinsProgestins
Used primarily in birth control and Used primarily in birth control and to prevent uterine cancerto prevent uterine cancer
Also used for menstrual Also used for menstrual dysfunctiondysfunction
Progestin’s Side Progestin’s Side EffectsEffects
Similar to pregnancySimilar to pregnancy:: Weight gainWeight gain DepressionDepression FatigueFatigue AcneAcne Hirsutism Hirsutism
ProgestinsProgestins
levonorgestrel (Norplant II)levonorgestrel (Norplant II) medroxyprogesterone (Depo-medroxyprogesterone (Depo-
Provera, Provera)Provera, Provera) norethindrone (Micronor)norethindrone (Micronor)
Drug List
ContraceptivesContraceptives
Most OCs are combinations of Most OCs are combinations of estrogen and progestinestrogen and progestin
Interfere with hormones Interfere with hormones responsible for regulation of the responsible for regulation of the menstrual cyclemenstrual cycle
Change the consistency of cervical Change the consistency of cervical mucus mucus
Alter the endometrial liningAlter the endometrial lining
Benefits of OCsBenefits of OCs
Prevention of pregnancyPrevention of pregnancy Regulates menstrual cycleRegulates menstrual cycle Reduces menstrual flowReduces menstrual flow Lessens severe menstrual cramps Lessens severe menstrual cramps
and painand pain Protects against ovarian and Protects against ovarian and
endometrial cancer, benign breast endometrial cancer, benign breast disease, ectopic pregnancy, disease, ectopic pregnancy, fibroadenomas, and ovarian cystsfibroadenomas, and ovarian cysts
Oral ContraceptivesOral Contraceptives
There are different combinations There are different combinations of estrogen and progestin as well of estrogen and progestin as well as differing strengthsas differing strengths
Tricycling – taking meds for 3 - 21 Tricycling – taking meds for 3 - 21 day cycles without a pill-free day cycles without a pill-free intervalinterval
Contraceptive Contraceptive AgentsAgents
estradiol cypionate-estradiol cypionate-medroxyprogesterone (Lunelle)medroxyprogesterone (Lunelle)
ethinyl estradiol-desogestrel ethinyl estradiol-desogestrel (Cyclessa, Desogen, Kariva, Mircette, (Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept)Ortho-Cept)
ethinyl estradiol-drospirenone ethinyl estradiol-drospirenone (Yasmin)(Yasmin)
Drug List
Contraceptive Contraceptive AgentsAgents
estradiol cypionate-estradiol cypionate-medroxyprogesterone (Lunelle)medroxyprogesterone (Lunelle)
ethinyl estradiol-desogestrel ethinyl estradiol-desogestrel (Cyclessa, Desogen, Kariva, Mircette, (Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept)Ortho-Cept)
ethinyl estradiol-drospirenone ethinyl estradiol-drospirenone (Yasmin)(Yasmin)
Drug List
Contraceptive Contraceptive AgentsAgents
ethinyl estradiol-ethynodiol diacetate ethinyl estradiol-ethynodiol diacetate (Demulen)(Demulen)
ethinyl estradiol-etonogestrel ethinyl estradiol-etonogestrel (NuvaRing)(NuvaRing)
ethinyl estradiol-levonorgestrel ethinyl estradiol-levonorgestrel (Levlen, Nordette, Seasonale, Tri-(Levlen, Nordette, Seasonale, Tri-Levlen, Triphasil, Trivora-28)Levlen, Triphasil, Trivora-28)
Drug List
Contraceptive Contraceptive AgentsAgents
ethinyl estradiol-norelgestromin (Ortho ethinyl estradiol-norelgestromin (Ortho Evra)Evra)
ethinyl estradiol-norethindrone ethinyl estradiol-norethindrone (Estrostep Fe, Femhrt, Loestrin Fe, (Estrostep Fe, Femhrt, Loestrin Fe, Ovcon)Ovcon)
ethinyl estradiol-norgestimate (Ortho ethinyl estradiol-norgestimate (Ortho Tri-Cyclen, Ortho Tri-Cylcen Lo)Tri-Cyclen, Ortho Tri-Cylcen Lo)
Drug List
Contraceptive Contraceptive AgentsAgents
ethinyl estradiol-norgestrel ethinyl estradiol-norgestrel (Lo/Ovral, Low-Ogestrel, Ovral)(Lo/Ovral, Low-Ogestrel, Ovral)
Drug List
ethinyl estradiol-ethinyl estradiol-desogestrel (Cyclessa, desogestrel (Cyclessa, Desogen, Kariva, Desogen, Kariva, Mircette, Ortho-Cept)Mircette, Ortho-Cept) Inhibits ovulationInhibits ovulation Includes 2 days of placebo Includes 2 days of placebo
followed by 5 days of low-dose followed by 5 days of low-dose estrogenestrogen
May be safer for smokersMay be safer for smokers
ethinyl estradiol-ethinyl estradiol-levonorgestrel levonorgestrel (Seasonale)(Seasonale) Taken for 3 months at a timeTaken for 3 months at a time Patient only has 4 menses per Patient only has 4 menses per
yearyear Prevents egg release from the Prevents egg release from the
ovaries, increases mucus ovaries, increases mucus thickness, and thickness of the thickness, and thickness of the endometrial liningendometrial lining
ethinyl estradiol-ethinyl estradiol-dropirenone (Yasmin)dropirenone (Yasmin) Drospirenone is related to Drospirenone is related to
spironolactone (a diuretic)spironolactone (a diuretic) Causes less bloating and less Causes less bloating and less
weight gainweight gain May cause weight loss due to May cause weight loss due to
excess water lossexcess water loss
ethinyl estradiol-ethinyl estradiol-norelgestromin (Ortho-norelgestromin (Ortho-Evra)Evra) Transdermal contraceptiveTransdermal contraceptive Suppresses gonadotropinsSuppresses gonadotropins A new patch is applied every 7 A new patch is applied every 7
days for 3 weeks then the 4days for 3 weeks then the 4thth week is patch freeweek is patch free
Some Oral Some Oral Contraceptive Contraceptive InteractionsInteractions AntibioticsAntibiotics AnticonvulsantsAnticonvulsants AntifungalsAntifungals BenzodiazepinesBenzodiazepines BronchodilatorsBronchodilators CorticosteroidsCorticosteroids Lipid-lowering agentsLipid-lowering agents TCAsTCAs
Emergency Emergency ContraceptionContraception
In great demandIn great demand
Patients want them to be Patients want them to be available OTCavailable OTC
DiscussionDiscussion
What is one of the arguments What is one of the arguments for emergency contraceptives for emergency contraceptives being OTC?being OTC?
DiscussionDiscussion
What is one of the arguments for What is one of the arguments for emergency contraceptives being emergency contraceptives being OTC?OTC?
Answer:Answer: After making a After making a doctor’s appointment and then doctor’s appointment and then going to the get the prescription, going to the get the prescription, sometimes it is too late to take sometimes it is too late to take the medicationthe medication
Contraceptive Contraceptive AgentsAgentsEmergency Emergency ContraceptivesContraceptives
levonorgestrel (Plan B)levonorgestrel (Plan B) norgestrel (Ovrette)norgestrel (Ovrette)
Drug List
Home Pregnancy TestsHome Pregnancy Tests
Critical organ systems develop in Critical organ systems develop in the first month which is affected the first month which is affected byby– Mother’s dietMother’s diet– Environment (smoking)Environment (smoking)– MedicationsMedications– Consumption of alcoholic beveragesConsumption of alcoholic beverages
Home Pregnancy TestsHome Pregnancy Tests
Based on detecting human Based on detecting human chorionic gonadotropin (HCG)chorionic gonadotropin (HCG)
Levels can be measured as early Levels can be measured as early as 6-8 days after conceptionas 6-8 days after conception
Results are given within 1-5 Results are given within 1-5 minutesminutes
Tests are better than 95% Tests are better than 95% accurateaccurate
Drugs Used at BirthDrugs Used at Birth
Often no drugs are necessary for Often no drugs are necessary for delivery, but in some cases they delivery, but in some cases they areare
To restart laborTo restart labor To decrease uncontrolled To decrease uncontrolled
bleedingbleeding
Drugs Used at Drugs Used at BirthBirth
methylergonovine (Methergine)methylergonovine (Methergine) oxytocin (Pitocin)oxytocin (Pitocin)
Drug List
oxytocin (Pitocin)oxytocin (Pitocin)
Natural hormone that stimulates Natural hormone that stimulates uterine contractionsuterine contractions
Drug should be used as a last Drug should be used as a last resortresort
oxytocin’s Side Effectsoxytocin’s Side Effects
For the womanFor the woman:: VomitingVomiting Irregular heart Irregular heart
raterate TachycardiaTachycardia Postpartum Postpartum
bleedingbleeding
For the child:For the child: BradycardiaBradycardia ArrhythmiasArrhythmias JaundiceJaundice
Sexually Transmitted Sexually Transmitted DiseaseDisease
Refer to Figure 14.7 for the Refer to Figure 14.7 for the structural anatomy of the male structural anatomy of the male and female genital systems and female genital systems
GonorrheaGonorrhea
Most commonly reported STDMost commonly reported STD Caused by Caused by Neisseria gonorrhoeaeNeisseria gonorrhoeae
that attaches to mucosal cells in:that attaches to mucosal cells in:– Oropharyngeal areaOropharyngeal area– EyeEye– JointsJoints– RectumRectum– Male and female genitaliaMale and female genitalia
GonorrheaGonorrhea
If untreated, it can cause If untreated, it can cause systemic infection includingsystemic infection including– The heart, meninges, eyes, pharynx, The heart, meninges, eyes, pharynx,
and jointsand joints Eye infections occur most often in Eye infections occur most often in
newborns and can cause newborns and can cause blindnessblindness
SyphilisSyphilis
Caused by Caused by Treponema pallidumTreponema pallidum Incubation averages three weeksIncubation averages three weeks Infection develops in 3 stages:Infection develops in 3 stages:
– Primary stagePrimary stage– Secondary stageSecondary stage– Tertiary stageTertiary stage
Primary-Stage Primary-Stage InfectionInfection Small, hard-based sore develops Small, hard-based sore develops
at site of infectionat site of infection May be painless and patient may May be painless and patient may
be unawarebe unaware Fluid in the sores is highly Fluid in the sores is highly
infectiousinfectious Bacteria enters the bloodstream Bacteria enters the bloodstream
and lymphatic systemand lymphatic system
Secondary-Stage Secondary-Stage InfectionInfection Produces skin rashes, patchy hair Produces skin rashes, patchy hair
loss, malaise, and mild feverloss, malaise, and mild fever Symptoms subside after a few Symptoms subside after a few
weeks and disease becomes weeks and disease becomes latentlatent
After 2-4 years of latency, the After 2-4 years of latency, the disease is usually no longer disease is usually no longer infectiousinfectious
Tertiary-Stage Tertiary-Stage InfectionInfection Occurs after an interval of at least Occurs after an interval of at least
10 years10 years Lesions appear as a rubbery mass Lesions appear as a rubbery mass
in many organs and sometimes in many organs and sometimes the skinthe skin
May cause extensive damageMay cause extensive damage
Congenital SyphilisCongenital Syphilis
Crosses the placenta into the Crosses the placenta into the fetusfetus
Results in neurologic damage if Results in neurologic damage if pregnancy occurs during the pregnancy occurs during the tertiary stagetertiary stage
Pregnancy during primary or Pregnancy during primary or secondary stage is likely to secondary stage is likely to produce a stillborn childproduce a stillborn child
Genital HerpesGenital Herpes
Caused by herpes simplex virusCaused by herpes simplex virus Lesions appear after 1 week of Lesions appear after 1 week of
incubationincubation Infectious vesicles appear and Infectious vesicles appear and
heal within 2 weeksheal within 2 weeks Virus becomes latent until Virus becomes latent until
reactivated reactivated
CandidiasisCandidiasis
Caused by Caused by Candida albicansCandida albicans Yeast-like fungal infection that Yeast-like fungal infection that
can cause infection in genital can cause infection in genital area of men and women and the area of men and women and the mouth (thrush)mouth (thrush)
Can cause itching and a thick, Can cause itching and a thick, yellow, cheesy dischargeyellow, cheesy discharge
VaginitisVaginitis
Caused by Caused by Gardnerella vaginitisGardnerella vaginitis Results from interaction between Results from interaction between
this organism and anaerobic this organism and anaerobic bacterium in the vaginabacterium in the vagina
Symptoms: frothy discharge with Symptoms: frothy discharge with fishy odor and vaginal pH of 5 to fishy odor and vaginal pH of 5 to 66
VaginitisVaginitis
May also be caused by May also be caused by Trichomonas Trichomonas vaginalisvaginalis
Normally found in both sexes, but Normally found in both sexes, but causes infection if vaginal pH causes infection if vaginal pH changeschanges
Causes profuse yellowish or cream-Causes profuse yellowish or cream-colored discharge with a colored discharge with a disagreeable odor, irritation, and disagreeable odor, irritation, and itchingitching
Agents for STDsAgents for STDs
acyclovir (Zovirax)acyclovir (Zovirax) azithromycin (Zithromax)azithromycin (Zithromax) ceftriaxone (Rocephin)ceftriaxone (Rocephin) clotrimazole (GyneLotrimin, clotrimazole (GyneLotrimin,
Mycelex)Mycelex) doxycycline (Doryx, Vibramycin)doxycycline (Doryx, Vibramycin)
Drug List
Agents for STDsAgents for STDs
erythromycinerythromycin fluconazole (Diflucan)fluconazole (Diflucan) ketoconazole (Nizoral)ketoconazole (Nizoral) metronidazole (Flagyl)metronidazole (Flagyl) miconazole (Monistat)miconazole (Monistat)
Drug List
Agents for STDsAgents for STDs
penicillin G benzathine (Bicillin L-A)penicillin G benzathine (Bicillin L-A) spectinomycin (Trobicin)spectinomycin (Trobicin) tetracycline (Sumycin)tetracycline (Sumycin) tioconazole (Vagistat-1)tioconazole (Vagistat-1) valacyclovir (Valtrex)valacyclovir (Valtrex)
Drug List