Transcript Chapter 13 lesson 1 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
13
Gynecologic and Obstetric
Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. Describe the difference between
monophasic, biphasic, triphasic, and fourphasic oral contraceptive drugs.
2. When given the name of a well-known OBGYN generic drug, identify its trade name.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Learning Objectives
3. When given the generic and trade names of
an OB-GYN drug, identify what drug
category it belongs to and what disease it is
used to treat.
4. When given an OB-GYN drug category,
identify several generic and trade name
drugs in that category.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Learning Objectives
11.When given an ending common to several
generic drugs, identify the related drug
category.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Pregnancy occurs at the moment that
an ovum is fertilized by a
spermatozoon.
• Drugs used to prevent pregnancy
 Change the hormonal environment of
the female reproductive tract so that a
mature ovum is not produced or
released by the ovary
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Drugs used to prevent pregnancy
 Kill spermatozoa
 Keep a fertilized ovum from implanting
in the endometrium
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Oral contraceptives or birth control pills
 Exert a hormonal influence to prevent
pregnancy
 99% effective if taken as directed
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
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Drugs Used to Prevent Pregnancy
• Oral contraceptives or birth control pills
 Change the hormonal environment of
the female reproductive tract
 Divided into three groups
• Monophasic
• Biphasic
• Triphasic
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Oral contraceptives or birth control pills
 Contain a combination of the hormone
drug categories
• Progestins
• Estrogen
 Doses
• Fixed
• Varied
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 13–1 Contraceptive choices. This young adult female has requested
information about birth control during her annual checkup. Her gynecologist is explaining
how oral contraceptive drugs act on the ovaries and uterus to prevent pregnancy. The
gynecologist will also tell her about the medical advantages and disadvantages of oral
contraceptive drugs as compared to other types of contraception, such as the T-shaped
Mirena contraceptive device that she is holding. Source: Image Point Fr/Shutterstock
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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In Depth
• Normally, the anterior pituitary gland
secretes follicle-stimulating hormone
(FSH), which stimulates a follicle in the
ovary to develop a mature ovum.
• FSH also causes the follicle to secrete
estradiol, the primary female hormone.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• Estradiol causes the endometrium to
proliferate and thicken.
• Later, the anterior pituitary gland also
secretes luteinizing hormone (LH),
which causes the follicle to rupture and
release the mature ovum (ovulation).
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• If the ovum is not fertilized, the corpus
luteum disintegrates and progesterone
production stops.
• When this happens, the uterine lining
sloughs off in the process of
menstruation.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• LH also causes the corpus luteum (the
remainder of the ruptured follicle) to
secrete estradiol and progesterone.
• If the ovum is fertilized, the corpus
luteum continues to secrete
progesterone to prepare the
endometrium to accept the fertilized
ovum.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• Oral contraceptive drugs supply
hormone drugs from the progestins and
estrogen categories to suppress the
release of FSH and LH from the anterior
pituitary gland and so a mature ovum
is never developed or released.
• Without an ovum, spermatozoa from
the male have nothing to fertilize.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• Oral contraceptive drugs also cause
changes in the cervical mucosa and
endometrium that inhibit spermatozoa
or keep a fertilized ovum from
implanting in the endometrium.
• All of these actions work together to
prevent conception and pregnancy.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• Oral contraceptive drugs can have
serious adverse effects, such as blood
clots, stroke, and heart attack, because
of their estrogen content.
• Because of these risks, most physicians
choose to prescribe an oral
contraceptive drug that contains 35
mcg of estrogen or less in each tablet.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Alert
• The risk of these adverse effects
increases significantly for patients who
are older than 35 years of age and who
smoke.
• All oral contraceptive drugs also carry
the warning that they do not protect
against sexually transmitted diseases,
including HIV.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs
 One (mono-) phase of treatment
 Each hormone tablet of the pill pack
have fixed doses of:
• Progestin
•
•
•
•
Levonorgestrel
Norethindrone
Norgestrel
Norgestimate
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs
 Each hormone tablet of the pill pack
have fixed doses of:
• Estrogen
• Ethinyl estradiol
• Mestranol
 In a 21-day pill pack, there are 21
hormone tablets.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs
 In a 28-day pill pack, there are only 21
hormone tablets and 7 inert sugar
tablets to complete a 28-day menstrual
cycle.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs






Alesse
Brevicon
Demulen
Desogen
Loestrin
Lo/Ovral
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs






Lybrel
Modicon
Norinyl
Ortho-Cept
Ortho-Cyclen
Ortho-Novum
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Monophasic oral contraceptive drugs





Ovcon
Ovral
Seasonale
Yasmin
YAZ
Understanding Pharmacology for Health Professionals, 5th Ed.
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Figure 13–2 Gianvi drug box. This monophasic oral contraceptive drug contains 3 mg
of the progestins drug drospirenone and 0.02 mg of the estrogen drug ethinyl estradiol.
This is identical to the hormone doses in Beyaz, Loryna, and YAZ. Ocella, Yasmin, and
Zarah also contain drospirenone, but in a different amount. According to the FDA, oral
contraceptive drugs that contain drospirenone have a higher risk of causing blood clots.
Note the package warning on Gianvi that says that this drug "does not protect against
HIV infection (AIDS) and other sexually transmitted diseases." This is true for all oral
contraceptive drugs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 13–3 Yasmin drug box and pill packs. All of the tablets in this 21-day pill
pack look the same because this is a monophasic oral contraceptive drug that has a fixed
dose of a progestins drug and a fixed dose of an estrogen drug in each hormone tablet.
There are no inert sugar tablets. The patient simply stops taking the drug when the pill
pack is empty and waits 7 days before beginning another pill pack. Source: Edd
Westmacott/Alamy
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• Some women prefer a 21-day pill pack,
while others prefer the 28-day pill pack
because of the consistency of taking a
pill every day.
• Studies show that nearly 50 percent of
women would prefer not to menstruate
at all.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• Lybrel was the first oral contraceptive
drug to eliminate menstrual periods.
• It comes as a 28-day pill pack in which
every tablet contains fixed doses of a
progestin and an estrogen.
• There are no tablets without hormones,
and so the endometrium remains intact
and menstruation does not occur.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Focus on Health Care
• YAZ is the only oral contraceptive drug
that is approved by the FDA for treating
acne and premenstrual dysphoric
disorder.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Alert
• There are many different trade names
of oral contraceptive drugs.
• Some (but not all) include numbers
after the trade name, and it is
important to understand what those
numbers mean.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Drug Alert
• A monophasic oral contraceptive drug
has one (mon/o-) phase of treatment
with fixed amounts of hormones.
• For some monophasic oral
contraceptive drugs, the doses of a
progestin and an estrogen are
designated by two numbers following
the trade name of the drug.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Alert
• For example, the trade name drugs
Norinyl 1 + 35 and Ortho-Novum 1/35
contain 1 mg of a progestin drug and
35 mcg of an estrogen drug in each
tablet.
• The trade name Ovcon-35 indicates
only the amount of the estrogen drug
in each tablet.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• A biphasic oral contraceptive drug has
two (bi-) phases with changing doses of
a progestin but a fixed dose of an
estrogen.
• For some biphasic oral contraceptive
drugs, this is reflected in the trade
name of the drug.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• For example, Ortho-Novum 10/11
provides 35 mcg of an estrogen for all
21 days, but the dose of a progestin
changes from 0.5 mg for the first 10
days, followed by 1 mg for the last 11
days.
• A triphasic oral contraceptive drug has
three (tri-) phases of varying doses of
hormones.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• For example, the trade name OrthoNovum 7/7/7 shows that there are
three phases of differing hormone
doses and that each phase lasts for 7
days.
• Other triphasic oral contraceptive drugs
(Ortho-TriCyclen, Triphasil) have the
prefix tri- in their trade names to
indicate the three phases.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Prevent Pregnancy
• Biphasic oral contraceptive drugs
 Two phases of hormone tablets in each
pill pack
• Phase one provides fixed doses of:
• Progestin (desogestrel, levonorgestrel,
norethindrone)
• Estrogen (ethinyl estradiol)
• Phase two
• Increased dose of progestin
• Same dose of estrogen
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
continued on next slide
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Drugs Used to Prevent Pregnancy
• Biphasic oral contraceptive drugs




LoSeasonique
Mircette
Ortho-Novum 10/11
Seasonique
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Drug Alert
• These two oral contraceptive drugs
sound very much alike:
 Seasonale
 Seasonique
• Seasonale is a monophasic oral
contraceptive, while Seasonique is a
biphasic oral contraceptive.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Alert
• These drugs are made by the same
drug manufacturer.
• They are unique in that their hormone
tablets are taken continuously for three
28-day cycles (84) tablets, followed by
7 inert tablets.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• This means that the patient has a
menstrual period only 4 times a year,
as opposed to every month when
taking other oral contraceptive drugs.
• These drugs are known as extendedregimen oral contraceptive drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• Their trade names make reference to
the four seasons of the year, with
menstruation occurring just once each
season.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Prevent Pregnancy
• Triphasic oral contraceptive drugs
 Three phases of hormone tablets in
each pill pack
 Phase one provides fixed doses of:
• Progestin (desogestrel, levonorgestrel,
norethindrone, norgestimate)
• Estrogen (ethinyl estradiol)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Prevent Pregnancy
• Triphasic oral contraceptive drugs
 Phase two
• Either one or both of the hormone doses
increases in each hormone tablet.
 Phase three
• Either one or both of the hormone doses
increases or decreases in each hormone
tablet in the pill pack.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Prevent Pregnancy
• Triphasic oral contraceptive drugs






Cyclessa
Estrostep
Ortho-Novum 7/7/7
Ortho Tri-Cyclen
Tri-Norinyl
Triphasil
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 13–4 Tri-Cyclen box. The trade name of this drug clearly indicates that this is
a triphasic oral contraceptive drug. It has three different cycles or phases of doses of
hormones. It is packaged as a blister strip containing 21 tablets, one each day for 21
days. The package says that this drug is also used to treat moderate acne vulgaris.
Source: Helen Sessions/Alamy
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Prevent Pregnancy
• Four-phasic oral contraceptive drugs
 Four phases of hormone tablets
 Phases last for different lengths of times
and provide different hormone drugs in
different doses.
 Natazia (dienogest, estradiol valerate)
 Quartette (levonorgestrel, ethinyl
estradiol)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Other hormone contraceptive drugs
 Provide daily fixed doses of a progestin
and estrogen
 NuvaRing
• In the form of a ring that is inserted in
the vagina
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Other hormone contraceptive drugs
 OrthoEvra
• Transdermal patch that is applied to the
skin
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 13–5 Ortho Evra contraceptive drug. This drug is in the form of a
transdermal patch that is 20 cm2. Each box contains three patches (or "transdermal
systems," as this drug company refers to them).
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nuva Ring and Ortha Evra Video
Click on the screenshot to view a video on the Nuva Ring and Ortha Evra patch.
Return to Directory
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• The first oral contraceptive pill was
introduced in 1960.
• Ortho Evra, introduced in 2001, was
the first transdermal patch
contraceptive drug.
 It is produced by the same drug
company that introduced the very first
oral contraceptive drug in 1931.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• NuvaRing, introduced in 2001, was the
first contraceptive vaginal ring.
 It is a flexible, clear, 3-inch polymer
ring that is inserted into the vagina for
3 weeks of every month.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Prevent Pregnancy
• Progestins-only contraceptive drugs
 Only contain a progestin
(norethindrone, norgestrel)
 Slightly less effective
• Than combination oral contraceptive drug
• Particularly if a patient forgets to take
even one daily tablet
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Prevent Pregnancy
• Progestins-only contraceptive drugs
 Contain no estrogen
• Risk of blood clots avoided
• Other adverse effects of estrogen are
avoided.
 Useful for mothers who have just given
birth and want to breastfeed
• Drug does not interfere with milk
production
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Prevent Pregnancy
• Progestins-only contraceptive drugs





Camila
Errin
Heather
Jolivette
Ortho Micronor
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
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Drugs Used to Prevent Pregnancy
• Progestins-only contraceptive drugs
 Implant
• Inserted under the skin
• Within a T-shaped device that is inserted
into the uterus
• Contraceptive effects last from one to
five years depending on the amount of
drug in the device.
• Etonogestrel (Implanon, Nexplanon)
• Levonorgestrel (Mirena)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 13–6 Mirena device. This device contains a progestins drug that acts as a
contraceptive when it is implanted within the uterus. Source: Image Point
Fr/Shutterstock
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Prevent Pregnancy
• Progestins-only contraceptive drugs
 Taken orally but only after unprotected
intercourse to prevent pregnancy
• Levonorgestrel (Plan B, Plan B One-Step)
• Ulipristal (Ella)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Controversy
• In 2013, the FDA approved Plan B OneStep for unrestricted sales as a
nonprescription drug available to any
woman, regardless of age.
• Pharmacists no longer need to have
persons prove that they are 17 years of
age or older before purchasing this
over-the-counter drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• The herb St. John's wort, which is often
taken for depression, can cause serum
hormone levels to decrease in patients
taking oral contraceptive drugs, and
this increases the chance of pregnancy.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved