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Board Study Topics > 00 Contraception > Flashcards

00 Contraception Flashcards

1
Q

What is the Follicular Phase?

A

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

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2
Q

What is the Luteal Phase?

A

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

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3
Q

What is Ethinyl Estradiol?

A

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

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4
Q

What are the different concentrations of Estrogen?

A

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

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5
Q

What side effects can too much estrogen cause?

A

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

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6
Q

Which hormone causes withdrawal bleeding?

A

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

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7
Q

Which generation Progestin has increased risk for spotting?

A

1st gen

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8
Q

Which generation Progestin has the highest potency?

A

2nd and 3rd gen

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9
Q

Which generation Progestin causes more Androgenic activity?

A

2nd gen

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10
Q

Which generation Progestin has higher risk of thrombosis?

A

3rd gen

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11
Q

Which generation Progestin are spironolactone derivatives?

A

4th gen

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12
Q

What side effects can too much Progestin cause?

A

Breast tenderness, HA, Fatigue, Mood changes

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13
Q

What does too much Androgen cause?

A

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

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14
Q

How do Biphasic combination pills usually work?

A

Usually increased progestin at the end of the month

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15
Q

How do Triphasic combination pills usually work?

A

Doses of estrogen or progestin change weekly

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16
Q

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

A

Progestin

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17
Q

What is unique about Estrostep Fe?

A

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

18
Q

What are the 4 products FDA approved for Acne?

A

Ortho Tri Cyclen, Estrostep Fe, Yaz, Beyaz

19
Q

What i s unique about Mircette?

A

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

20
Q

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

A

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

21
Q

What is important to know about Yasmin and Yaz?

A

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

22
Q

What is important to know about Beyaz?

A

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

23
Q

What is important to know about Safyral?

A

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

24
Q

What is unique about Seasonale?

A

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

25
Q

How is Seasonique different than Seasonale?

A

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

26
Q

How does Estradiol Valerate compare to EE?

A

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

27
Q

What is Dienogest?

A

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

28
Q

What is unique about Natazia?

A

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

29
Q

What is “Day 1 Start”?

A

Day 1 of menstruation. No BUM needed, protection immediate

30
Q

What is “Sunday Start”?

A

Sunday after menses starts, BUM x7 days

31
Q

What is “Anytime Start”?

A

Jump start. Protection requires 7 days of active pills

32
Q

Why is it important to note when BTB takes place?

A

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

33
Q

Whats important to know if you see Norethindrone 0.35mg?

A

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

34
Q

What are Mini Pills?

A

Progestin only (Micronor, Errin, Camila, Jolivette)

35
Q

What should you remember if you see someone on Lipitor?

A

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

36
Q

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

A

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

37
Q

What is Ortho Evra?

A

Combination patch, applied once weekly

38
Q

What is Depo-Provera?

A

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

39
Q

What is Mirena?

A

IUD, lasts 5 years

40
Q

What is Implanon?

A

Subdermal rods effective for 3 years

41
Q

What is Ella?

A

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

42
Q

Which progestins cause androgenicity?

A

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

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