GLUCOCORTICOIDS AND MINERALOCORTICOIDS. Corticosteroids Adrenal glands produce glucocorticoids and...

GLUCOCORTICOIDS AND GLUCOCORTICOIDS AND MINERALOCORTICOIDSMINERALOCORTICOIDS

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


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


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


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

Hydrocortisone acetateHydrocortisone acetate

PrednisolonePrednisolone

Prednisolone Prednisolone

Becotide = BeclomethBecotide = Beclometh((beclomethasone beclomethasone dipropionatedipropionate))

KenalogKenalog((triamcinolone acetonidetriamcinolone acetonide))

FluocinarFluocinar – – SinaflanSinaflan – – SinalarSinalar((Fluocinole acetonideFluocinole acetonide))

Dexamethasone Dexamethasone

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!


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

Sites of Action of the Sites of Action of the EstrogensEstrogens

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


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


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


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


erythromycinerythromycin fluconazole (Diflucan)fluconazole (Diflucan) ketoconazole (Nizoral)ketoconazole (Nizoral) metronidazole (Flagyl)metronidazole (Flagyl) miconazole (Monistat)miconazole (Monistat)

Drug List


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

GLUCOCORTICOIDS AND MINERALOCORTICOIDS. Corticosteroids Adrenal glands produce glucocorticoids and...

Documents

Transcript of GLUCOCORTICOIDS AND MINERALOCORTICOIDS. Corticosteroids Adrenal glands produce glucocorticoids and...