00 Contraception

Question 1

What is the Follicular Phase?

Answer 1

Days 1-14: FSH dominant w/ LH surge on day 14 for ovulation. LH initiates estrogen production

Question 2

What is the Luteal Phase?

Answer 2

Days 14-28: Ruptured follicle = corpus luteum (secretes progesterone, estradiol and androgens). E and P peak at mid-luteal phase; FASH and LH levels decline

Question 3

What is Ethinyl Estradiol?

Answer 3

Estrogen. Almost always fixed dose EXCEPT: Mircette, Estrostep Fe

Question 4

What are the different concentrations of Estrogen?

Answer 4

Usually 20-35mcg. Low: 10-30, High: 50 (Ovcon 50)

Question 5

What side effects can too much estrogen cause?

Answer 5

Nausea, Breast tenderness, Increase in BP, Melasma (patch pigmentation spots), HA

Question 6

Which hormone causes withdrawal bleeding?

Answer 6

Progestin discontinuation after 3rd week (i.e. placebo week)

Question 7

Which generation Progestin has increased risk for spotting?

Answer 7

1st gen

Question 8

Which generation Progestin has the highest potency?

Answer 8

2nd and 3rd gen

Question 9

Which generation Progestin causes more Androgenic activity?

Answer 9

2nd gen

Question 10

Which generation Progestin has higher risk of thrombosis?

Answer 10

3rd gen

Question 11

Which generation Progestin are spironolactone derivatives?

Answer 11

4th gen

Question 12

What side effects can too much Progestin cause?

Answer 12

Breast tenderness, HA, Fatigue, Mood changes

Question 13

What does too much Androgen cause?

Answer 13

Increased appetite (leading to weight gain). Acne. Oily skin. Hirsutism. Increased LDL/decreased HDL

Question 14

How do Biphasic combination pills usually work?

Answer 14

Usually increased progestin at the end of the month

Question 15

How do Triphasic combination pills usually work?

Answer 15

Doses of estrogen or progestin change weekly

Question 16

In Triphasic combination pills, what is the main hormone changing?

Answer 16

Progestin

Question 17

What is unique about Estrostep Fe?

Answer 17

Its the only triphasic pill where the Estrogen component is the one changing

Question 18

What are the 4 products FDA approved for Acne?

Answer 18

Ortho Tri Cyclen, Estrostep Fe, Yaz, Beyaz

Question 19

What i s unique about Mircette?

Answer 19

Contains estrogen 10mcg x5 days during placebo to help with menstal migraines (not a 7 day placebo, don’t skip these pills)

Question 20

Why is Lo Loestrin Fe (and Lo Minastrin Fe) not recommended 1st line?

Answer 20

Very low Estrogen (10mcg), causing lots of BTB. Reserved for patients who have issues with estrogen SEs

Question 21

What is important to know about Yasmin and Yaz?

Answer 21

Spironolactone derivatives. 3mg drospirenone = 20-25mg spironolactone. Monitor potassium levels

Question 22

What is important to know about Beyaz?

Answer 22

Contains folic acid derivative. Caution with antifolate drugs (i.e., MTX)

Question 23

What is important to know about Safyral?

Answer 23

Contains folic acid derivative. Caution with antifolate drugs (i.e., MTX)

Question 24

What is unique about Seasonale?

Answer 24

Combination pill x84 days with 7 days placebo. Only 4 periods/year

Question 25

How is Seasonique different than Seasonale?

Answer 25

Both combination the same x84 days, but Seasonique has EE 10mcg x7 days afterwards to decrease BTB while Seasonale is placebo x7 days

Question 26

How does Estradiol Valerate compare to EE?

Answer 26

EV may be better tolerated and less impact on lipid and clotting parameters

Question 27

What is Dienogest?

Answer 27

Resembles Drospirenone, No anti-mineralocorticoid activity (no K sparing --> no K monitoring)

Question 28

What is unique about Natazia?

Answer 28

Estradiol valerate (EV)/Dienogest. 4 phasic, need back up method x9 days once started

Question 29

What is "Day 1 Start"?

Answer 29

Day 1 of menstruation. No BUM needed, protection immediate

Question 30

What is "Sunday Start"?

Answer 30

Sunday after menses starts, BUM x7 days

Question 31

What is "Anytime Start"?

Answer 31

Jump start. Protection requires 7 days of active pills

Question 32

Why is it important to note when BTB takes place?

Answer 32

First 10 days, may need to increase estrogen dose. Last 11 days, may need to increase progestin dose

Question 33

Whats important to know if you see Norethindrone 0.35mg?

Answer 33

ALWAYS going to be a Progestin only pill if you see this strength

Question 34

What are Mini Pills?

Answer 34

Progestin only (Micronor, Errin, Camila, Jolivette)

Question 35

What should you remember if you see someone on Lipitor?

Answer 35

Combo may increase OC levels by 20-30%, Consider lower dose of OC

Question 36

What should you remember i you see someone on an Anticonvulsant?

Answer 36

Increased OC metabolism, leads to decreased OC action. Recommend OC with 50mcg EE

Question 37

What is Ortho Evra?

Answer 37

Combination patch, applied once weekly

Question 38

What is Depo-Provera?

Answer 38

Injectable given Q3 months, may result in osteoporosis (significant decrease in BMD)

Question 39

What is Mirena?

Answer 39

IUD, lasts 5 years

Question 40

What is Implanon?

Answer 40

Subdermal rods effective for 3 years

Question 41

What is Ella?

Answer 41

Ulipistal Acetate: RX ONLY. Emergency contraceptive more effective at days 3-5

Question 42

Which progestins cause androgenicity?

Answer 42

Norgestrel, Levonorgestrel > Norethindrone, Ethynodiol > Desogestrel (increased DVT), Norgestimate