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Simmons NURP 501 Exam 1 > 1: Which Contraception? > Flashcards

1: Which Contraception? Flashcards

1
Q

List medications that are contraindicated or require backup methods of birth control when used with COCs.

A
  1. Hepatic enzyme inducers: Rifampin, rifapentine, rifamate, rifater, griseofulvin
  2. Anticonvulsants
  3. Antiretrovirals
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2
Q

Your patient comes in to discuss birth control options. She just had a baby 2 weeks ago and is breastfeeding.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She just had a baby 2 weeks ago and is breastfeeding.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

The non-IUD progestins are all category 2 until 30+ days when they become category 1 (Appendix 11-A) though the book (pg 235) states to wait until 6 weeks PP for BFing mothers. COC/P/R should wait 4-6 weeks (4 weeks without risk factors for VTE).

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3
Q

Your 37-year-old patient comes in to discuss birth control options. She just had a baby 1 month ago and is breastfeeding. The birth was vaginal and she recovered quickly. No history of PP hemorrhage or other bleeding. She does not smoke.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She just had a baby 1 month ago and is breastfeeding.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

COC/P/R are category 2 at 30-42 days PP in BFing women if they have no other risk factors for VTE (age >=35, previous VTE, thrombophilia, immobility, transfusion at birth, BMI >=30, PP hemorrhage, post-c-section, pre-eclampsia, smoking). Since she is 35+, they are a category 3/4 for her and progestin options are best. Since she is now 4 weeks PP, she is eligible for both IUDs, as well.

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4
Q

Your 23-year-old pregnant patient comes in to discuss birth control options. She wants to know her options for birth control immediately after birth, since she doesn’t plan to breastfeed and doesn’t want another child anytime soon. She admits she isn’t the best at remembing to take pills. In fact, that’s how she got pregnant.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 23-year-old pregnant patient comes in to discuss birth control options. She wants to know her options for hormonal birth control immediately after birth, since she doesn’t plan to breastfeed and doesn’t want another child anytime soon.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

A copper IUD is the only category 1 option, but must be inserted <10 minutes after placental delivery. Depo and the implant are both good options for immediately PP in women who are not BFing and don’t want to take pills.

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5
Q

Your 30-year-old post-abortion patient comes in to discuss birth control options. She ended the pregnancy in the 2nd trimester d/t genetic anomalies. She wants to know her options for birth control and whether her abortion affects her choices. She has no other risk factors.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 30-year-old post-abortion patient comes in to discuss birth control options. She ended the pregnancy in the 2nd trimester d/t genetic anomalies. She wants to know her options for birth control and whether her abortion affects her choices. She has no other risk factors.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In 2nd-trimester abortions, IUDs are category 2. All others are category 1. In 1st trimester, all forms of birth control would be appropriate (category 1). Immediate postseptic abortion, IUDs are category 4.

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6
Q

Your 38-year-old patient comes in to discuss birth control options. Her boyfriend is somewhat controlling and so condoms have become an issue. She’s like something she can use that he can’t control. She also wants to discuss smoking cessation. She knows it’s not good for her and she’s finally ready to try to quit.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 38-year-old patient comes in to discuss birth control options. Her boyfriend is somewhat controlling and so condoms have become an issue. She’s like something she can use that he can’t control. She also wants to discuss smoking cessation. She knows it’s not good for her and she’s finally ready to try to quit.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

Because she is over the age of 35, smoking is a contraindication to COC/P/R. While she may quit, at this point she is still smoking. If she were under 35, it would be a category 2.

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7
Q

Your patient comes in to discuss birth control options. She had gastric bypass surgery 3 years ago and has lost over 100 pounds. Her BMI is less than 30. She has a new boyfriend and knows she needs to start birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She had gastric bypass surgery 3 years ago and has lost over 100 pounds. Her BMI is less than 30. She has a new boyfriend and knows she needs to start birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

History of malabsorptive bariatric surgery negates all oral contraceptives. The patch and ring are still an option for combined. If it was restrictive surgery, instead of malabsorptive, then all birth control would be an option. The purely restrictive bariatric surgeries are called gastric banding or gastric stapling. The biliopancreatic diversion with or without duodenal switch (BPD-DS) is mainly a malabsorptive bariatric surgery. Gastric bypass surgery is a combination of both restriction and malabsorption.

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8
Q

Your 42-year-old patient comes in to discuss birth control options. She has diabetes and HTN.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 42-year-old patient comes in to discuss birth control options. She has diabetes and HTN.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

Multiple risk factors for CV disease make COC/P/R category 3/4 and Depo category 3. Risk factors include older age, smoking, DM, HTN.

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9
Q

Your patient comes in to discuss birth control options. She has adequately controlled HTN.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She has adequately controlled HTN.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

COC/P/R are category 3 for adequately controlled and category 3/4 for elevated levels and HTN with vascular disease. Other choices would be best.

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10
Q

Your patient comes in to discuss birth control options. She has a history of HTN. She was told COC/P/R wasn’t an option for her by her last provider, but she really wants to try them. You conduct a thorough history and find out she has pregnancy-induced HTN that has been controlled without medication since delivery. What do you tell her about COC/P/R?

A

You inform her that a history of PIH with normal blood pressure outside of pregnancy is not a contraindication for COC/P/R (category 2). She can choose any of the birth control options.

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11
Q

Your patient comes in to discuss birth control options. She has a history of a DVT but isn’t on anticoagulant therapy and has no risk factors for recurrence.

Which birth control(s) can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She has a history of a DVT but isn’t on anticoagulant therapy and has no risk factors for recurrence.

Which birth control(s) can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

COC/P/R is category 3/4 for history of DVT/PE, even with no risk factors.

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12
Q

Your patient comes in to discuss birth control options. She has a history of a DVT and has been on anticoagulant therapy for 3 months.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She has a history of a DVT and has been on anticoagulant therapy for 3 months.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

All options, except COC/P/R are category 2 and can be considered. COC/P/R is category 3/4. This is also true for an acute DVT/PE.

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13
Q

Your patient comes in to discuss birth control options. She has factor V Leiden mutation. She thinks she can’t take any hormonal birth control. You explain that isn’t correct, but that she does have some limitations.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She has factor V Leiden mutation. She thinks she can’t take any hormonal birth control. You explain that isn’t correct, but that she does have some limitations.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

COC/P/R is category 4 for known thrombogenic mutations (factor V Leiden, prothrombin mutation, protein S, protein C, and antithrombin deficiencies). Cu-IUD would be best, as it is category 1, but all the progestins are acceptable (category 2).

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14
Q

Your patient comes in to discuss birth control options. She tells you she has had both a stroke and ischemic heart disease.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She tells you she has had both a stroke and ischemic heart disease.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

For those with either current/hx of ischemic heart disease or stroke Cu-IUD is category 1. COC/P/R is category 4 and all others are category 2-3 for initiation and continuation. If just a stroke, then LNG-IUD would be category 2.

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15
Q

T/F Your patient comes in for birth control counseling. She has a family history of hyperlipidemia and she, herself, has PCOS. Since COC/P/R can be category 3 for hyperlipidemias, you know guidelines recommend hyperlipidemia screening if you plan to initiate COC use.

A

False. Screening is not necessary for safe use of contraceptive methods.

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16
Q

Your patient comes in to discuss birth control options. You know she has a risk for a-fib and currently has pulmonary HTN.

Which birth control can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. You know she has a risk for a-fib and currently has pulmonary HTN.

Which birth control can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In complicated valvular disease, COC/P/R is category 4. In uncomplicated it’s category 2.

17
Q

Your patient comes in to discuss birth control options. She is currently battling lupus but can’t remember her test results for antiphospholipid antibodies.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient comes in to discuss birth control options. She is currently battling lupus but can’t remember her test results for antiphospholipid antibodies.

What are her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In lupus with positive or unknown antibodies, Cu-IUD is category 1 and all others are category 3/4.

18
Q

Your 35-year-old patient comes in to discuss birth control options. She has migraines but no auras.

Which birth control(s) can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 35-year-old patient comes in to discuss birth control options. She has migraines but no auras.

Which birth control(s) can’t she use?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

For women 35 and older, any migraine is a contraindication (category 3/4) to COC/P/R use. Cu-IUD has the lowest risk (category 1). All others are category 2. In migraines with aura, at any age, COC/P/R is category 4.

19
Q

Your 35-year-old patient comes in to discuss birth control options. She has a history of epilepsy but is not on any medication currently.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 35-year-old patient comes in to discuss birth control options. She has a history of seizures.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

Epilepsy with no medication has no contraindications, but Depo helps with a reduction in seizures and is not affected by seizure medication. If she had to take medication at a later date, she would not need to change her birth control.

20
Q

Your 35-year-old patient with cervical cancer wants to discuss birth control options. She is awaiting treatment.

Which birth control(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 35-year-old patient with cervical cancer wants to discuss birth control options. She is awaiting treatment.

Which birth control(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

POPs are a category 1. All other non-IUD are a category 2. Initiation of both Cu and LNG-IUDs is category 4.

21
Q

Your 35-year-old patient with a history of breast cancer 10 years ago wants to know her birth control options.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 35-year-old patient with a history of breast cancer 10 years ago wants to know her birth control options.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

With both a history or current breast cancer, all hormonal birth control is category 3/4. Cu-IUD is category 1.

22
Q

Your 40-year-old patient with endometrial cancer wants to know her birth control options.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 40-year-old patient with endometrial cancer wants to know her birth control options.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

Initiation of IUDs in endometrial cancer is category 4.

23
Q

Your 23-year-old patient wants to know her birth control options. You’ve just recently completed a pelvic exam and noticed her uterine cavity is distorted.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 23-year-old patient wants to know her birth control options. You’ve just recently completed a pelvic exam and noticed her uterine cavity is distorted.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

IUDs should be avoided (category 4) in anatomic abnormalities that distort the uterine cavity.

24
Q

Your 28-year-old patient presents to the ER with PID. She has an IUD. She wants to know if it has to be removed.

A

No, so long as she responds to PID treatment within 48-72 hours. Otherwise, removal would need to be considered. Initiation in active PID is a category 4, however.

25
Q

Your 23-year-old patient arrives for her appointment. You have previously discussed birth control options and she wants to have an IUD placed. When you go to place it, you notice some white/yellow discharge and a friable cervix. Can you place the IUD?

A

No. While results of STI testing are not required for IUD placement, current purulent cervicitis, chlamydia, or gonorrhea makes IUD placement a category 4. However, IUDs do not need to be removed for STI treatment in patients who already have them.

26
Q

Your patient has been diagnosed with pelvic TB. She wants to know her options for birth control.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your patient has been diagnosed with pelvic TB. She wants to know her options for birth control.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In pelvic TB, IUDs are category 4 for placement and category 3 for continuation.

27
Q

Your 40-year-old patient is a well-controlled diabetic with no vascular diease. She was diagnosed at age 17 and has been doing well with diet, exercise, and medication since then. She’s here to discuss birth control.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 40-year-old patient is a well-controlled diabetic with no vascular diease. She was diagnosed at age 17 and has been doing well with diet, exercise, and medication since then. She’s here to discuss birth control.

Which one(s) should she avoid?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In DM with vascular disease or DM of more than 20 years’ duration, COC/P/R is category 3/4. Depo is category 3. Cu-IUD is the best at category 1. Others are category 2.

28
Q

Your 40-year-old patient used to be a heavy drinker. She stopped a few years ago, but has severe cirrhosis. She’s here to discuss birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 40-year-old patient used to be a heavy drinker. She stopped a few years ago, but has severe cirrhosis. She’s here to discuss birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In severe cirrhosis, everything except Cu-IUD is category 3 or 4. In mild cirrhosis, all options are category 1.

29
Q

Your 40-year-old patient has a liver tumor. She’s here to discuss birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your 40-year-old patient has a liver tumor. She’s here to discuss birth control.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

In malignant tumors, all are category 3-4 except Cu-IUD (category 1). In benign focal nodular hyperplasia, all are category 1-2, though Cu-IUD is the only category 1.

30
Q

Your HIV patient wants to discuss birth control options. While currently taking nucleoside reverse transcriptase inhibitors, she wants to make sure she chooses one that she won’t have to change if she starts taking Ritonavir-based meds.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD
A

Your HIV patient wants to discuss birth control options. While currently taking nucleoside reverse transcriptase inhibitors, she wants to make sure she chooses one that she won’t have to change if she starts taking Ritonavir-based meds.

What is her best option(s)?

  1. COC/P/R
  2. POP
  3. Depo
  4. Implant
  5. Cu-IUD
  6. LNG-IUD

Depo is category 1 and the implant is category 2. If she already had an IUD, they are category 2 for continuation only with all ARV therapy.

31
Q

Your patient calls to tell you she is taking antimicrobial therapy and wants to know how long she needs to use a back-up method of birth control. What do you tell her?

A

Only Rifampicin or Rifabutin therapy intereferes. It’s category 3 for COC and POP and category 2 for the implant. Otherwise, with antibiotics, antifungals, and antiparasitics, she is fine and doesn’t need a backup method.

Simmons NURP 501 Exam 1 (63 decks)

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