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OB > 11. Contraception > Flashcards

11. Contraception Flashcards

1
Q

Informed Consent Acronym

A

BRAIDED

Benefits
Risks
Alternatives
Inquiries
Decision
Explanation
Documentation
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2
Q

Natural Family Planning Methods (4)

A
  • Coitus interuptus (Withdrawal)
  • Periodic abstinence (NFP)
  • Cervical mucus method
  • Symptothermal method (Combo of all)
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3
Q

Two methods of periodic abstinence (NFP)

A
  • Rhythm method (Calendar method)

* Basal body temperature method

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4
Q

What is the rhythm method?
• Type
• Must have what?

A
  • Form of periodic abstinence

* Must have regular, predictable cycles

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5
Q

Basal body temperature method (3)

A

• Taken immediately after waking and before getting out of bed.
• Temps recorded on the graph to document trend
• Observe for Thermal shift
o Abstinence from day of temp drop x3days

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6
Q

Thermal shift with BBT (2)

A
  • Right before ovulation: Slight drop in temp

* With ovulation the temp rises 0.2-0.4*C

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7
Q

Outside factors that affect BBT

A
  • Alcohol
  • # of hours of sleep
  • Infection
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8
Q

When do you start observation for cervical mucus method?

A

Last day of the menstrual flow

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9
Q

Cervical mucus method: What are you looking for?

A

Spinnbarkheit

mucus thin and watery like egg whites prior to ovulation

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10
Q

What is the most effective method of NFP?

A

Symptothermal – a combo of all methods

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11
Q

Standard days method: Def

A

Standardized version of calendar method

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12
Q

Requirement for standardized days method

A

Must have a cycle of 26-32 days

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13
Q

When are the fertile days for the standardized days method

A

8-19 – avoid unprotected intercourse

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14
Q

Predictor test for ovulation: What is it testing for?

A

Detects LH surge prior to ovulation

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15
Q

Predictor Test for ovulation: Benefit

A

Not affected by illlness, emotional upset or physical activity

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16
Q

Pre-ovulation mucus characteristics (4)

A
  • Thick
  • Cloudy
  • Sticky
  • Slippery
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17
Q

Ovulation mucus characteristics (4)

A
  • Clear
  • Wet
  • Sticky
  • Slippery
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18
Q

Types of barrier methods (4)

A
  • Condoms (male and female)
  • Diaphragm
  • Cervical cap
  • Lea’s Shield / Fem Cap
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19
Q

Patient teaching: Male condom (3)

A
  • Must counsel about proper use / application
  • Apply the condom on the penis after it is erect and before intimate contact
  • Lubricants: Do not use petroleum-based products because they cause the condom to break
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20
Q

Male Condom side effects (2)

A
  • Irritation

* Allergy (latex)

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21
Q

Female condom patient teaching (3)

A
  • Female controlled
  • Can insert 8 hours prior
  • Must remove after
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22
Q

Female condom side effects (2)

A
  • Irritation

* Polyurethane

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23
Q

When would a patient need a new diaphragm (2)

A

o Requires fitting and refitting if excessive weight gain or loss (20%)
o Replace every 2 years

By Rx only

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24
Q

Diaphragm: Method

A

o Works by covering the cervix to prevent sperm from entering and killing sperm with spermicide application

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25
Q

Diaphragm insertion and removal (3)

A
  • Diaphragm is used every time you have intercourse
  • Must be left in place for six hours after intercourse
  • Check device for integrity
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26
Q

Diaphragm patient teaching

A

o Efficacy diminishes with increased frequency of intercourse

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27
Q

Cervical cap characteristics (4)

A

o No longer in US
o Fitting, use and efficacy similar to diaphragm
o Must use with spermicide
o Efficacy decreases with parity

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28
Q

• Other Cervical Barriers: Lea’s Shield, Fem Cap (6 characteristics)

A 
o	Use is similar to diaphragm, cap
o	Requires prescription
o	Femcap requires fitting
o	Reusable
o	Silicone
o	Use with spermicide
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29
Q

Contraceptive sponge (3 characteristics)

A

o Female controlled
o Available OTC
o Insertion and removal

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30
Q

Types of intravaginal spermicides (6 - don’t memorize)

A 
o	Foams
o	Tablets
o	Suppositories
o	Creams
o	Films
o	Gel
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31
Q

Spermicides – side effects (3)

A

o Irritations
o Rash
o Microlacerations

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32
Q

What is the most commonly used spermicidal chemical in the US?

A

N-9

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33
Q

Mechanism of N-9

A

o Surfactant that destroys the sperm cell membrane on the surface

34
Q

When must spermicide be used?

A

Just before intercourse

35
Q

How many different contraceptive formulations are available in the US?

A

More than 30

36
Q

What do hormonal contraceptives consist of?

A

Estrogen-progesterone or just progesterone

37
Q

Hormonal contraceptives: Mechanism of action (3)

A

o Estrogen suppresses production of FSH and LH, suppressing ovulation
o Endometrium remains thin
o Cervical mucus is thick

38
Q

Hormonal contraceptive contraindications: Cardiovascular / blood (4)

A

o Thromboembolitic Disorders
o Coronary artery or cerebral vascular disease
o Severe diabetes (with vascular involvement)
o Uncontrolled HTN

39
Q

Hormonal contraceptive contraindications: Hormonal (3)

A

o Breast cancer (estrogen positive tumors)

o Estrogen dependent tumors

40
Q

Hormonal contraceptive contraindications: Other things (3)

A 
o	Currently impaired liver function or liver tumor
o	Smoking (>35 y/o)
o	Migraines with neurologic symptoms
41
Q

Hormonal contraceptive contraindications: Related to childbearing

A 
o	Lactation (no combined contraceptive pills)
o	Pregnancy
42
Q

Possible side effects of Hormonal Contraceptives

A

• Estrogen excess

43
Q

What are the symptoms of estrogen excess? (8)

A
  • N/V
  • Dizziness
  • Edema
  • Increased breast size
  • chloasma
  • Visual changes
  • Hypertension
  • Vascular HA
44
Q

Sxs of estrogen deficiency (7)

A
  • Early spotting (days 1-14)
  • Hypomenorrhea
  • Nervousness
  • Vaginal dryness
  • Breast tenderness
  • Oily skin and scalp
  • Hiritruism
45
Q

Sxs of progesterone deficiency (3)

A
  • Late spotting (days 15-21)
  • Heavy flow with clots
  • Increased breast size
46
Q

Hormonal contraception warning signs (5)

A

A - Abdominal Pains

C - Chest pain

H - Headache

E - Eye changes

S - Severe leg pain

47
Q

Contraceptive warning signs: Abdominal pain

A

May indicate a problem with the liver or gall bladder

48
Q

Contraceptive warning signs: Chest pain

A

Chest pain or shortness of breath may indicate possible clot problems within the lung or heart

49
Q

Contraceptive warning signs: Headache (2)

A
  • May be sudden or persistent

* May be caused by CVA or HTN

50
Q

Contraceptive warning signs: Severe leg pain

A

May indicate a thromboembolitic process

51
Q

How are combined oral contraceptives packaged?

A

21 or 28 days

52
Q

When should you start taking oral contraceptives?

A

The first sunday after menses starts

53
Q

What causes failures with oral contraceptives?

A

Missed pills

54
Q

Side effects from oral bc (5)

A
  • Nausea
  • Breast tenderness
  • Fluid retention
  • Chloasma
  • Early spotting (lo estrogen)
55
Q

What is OrthoEvra

A

A transdermal contraceptive patch

56
Q

Transdermal Contraceptive patch - what is it?

A

Delivers continuous levels of hormones

57
Q

What is lunelle?

A

A combined monthly injection (IM)

58
Q

Lunelle - mechanism (2)

A
  • Works the same way as other combination hormonal contraceptives (pill, patch, ring)
  • Prevents ovulation so that no sperm can fertilize an egg
59
Q

Vaginal / nuva ring - patient counseling (3 components)

A

o The ring is thought to be as effective as oral contraceptives
o The first time the vaginal ring is used, it is inserted during the first five days of menstruation
o Effectiveness of a vaginal ring is lowered when taken with certain medications

60
Q 
Extended use regimens
•	When approved
•	Contents
•	Time frame
•	Brand name
A
  • Approved by the FDA in 2003
  • Contains both estrogen and progestin and is taken in 3-month cycles
  • 12 weeks of active pills followed by 1 week of inactive pills
  • Brand name: “Seasonale”
61
Q

Progestin only contraceptives - benefit

A

• Eliminates side-effects of estrogen

62
Q

Progestin only contraceptives: Mechanism of action (3)

A

o Inhibits ovulation
o Thickens and decreases the amount of cervical mucus
o Thinning endometrium

63
Q

What is Depo-Provera?

A

Injectable Progestin

64
Q

Emergency Contraception: Def

A

High doses of oral contraception taken to prevent ovulation or implantation

65
Q

Emergency Contraception: Effectiveness

A

75-89% effective

66
Q

2 protocols of emergency contraception

A
  • Split or single dose

- 72 or 120 hours

67
Q

Emergency contraception: Mechanism

A

High hormonal levels prevent or delay ovulation, thicken the cervical mucus and later the sperm transport in order to prevent fertilization.

68
Q

Emergency contraception – must be used before…

A

IMPLANTATION

69
Q

Intrauterine contraception – mechanism of action (3)

A

o Damages sperm in transit to tubes
o Uterine lining inhospitable
o Effect mucus and endometrial maturation

70
Q

Two types of IUDs

A

o Copper T: Approved for 10 years

o Progesterone based: Approved for 5 years

71
Q

Contraindications of IUDs (8)

A 
o	Not monogamous
o	Pregnant
o	HIV +
o	Undiagnosed vaginal bleeding
o	Pelvic infections
o	Recent endometritis
o	Uterine / cervical cancer
o	Allergy to copper
72
Q

What is Mirena?

A

A Type of IUD

73
Q

Mechanism of Mirena (4)

A
  • Thickens cervical mucus
  • Impairs sperm migration
  • Alters the endometrium to prevent implantation
  • Inhibits ovulation
74
Q

Mirena – Contraindications (3)

A
  • Breast cancer
  • Undiagnosed vaginal bleeding
  • Liver disease
75
Q

IUD Warning Signs

A 
P - Period Late
A - Abdominal Pain
I - Infection Exposure
N - Not feeling well
S - String missing / changes  in length
76
Q

Male / Female sterilization:

A

Female: Tubal Ligation
Male: Vasectomy

77
Q

Induced abortion - types

A

Elective or therapeutic,

Medical or surgical

78
Q

Medical abortion: Timing

A

7-9 weeks or earlier

79
Q

Surgical abortion: Types and Timing (3)

A
  • Manual Vacuum Aspiration (MVA) <14 weeks

* Dilation and evacuation (D+E) up to 20 weeks

80
Q

• Method (2 components)

A

o Complete abstinence during fertile period

o To determine fertile period, must record menses for 6 mo

81
Q

Rhythm method:

• How to calculate

A

How to calculate:
• Length of shortest cycle minus 18 days (start of fertile period)
• Length of longest cycle minus 11 days (end of fertile period)

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