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NAPLEX 2024 > 47. Contraception + Infertility > Flashcards

47. Contraception + Infertility Flashcards

1
Q

A normal menstrual cycle ranges from ____ days (average ___ days)

A

23-35 days
Avg 28 days

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2
Q

____ indicated that the next cycle has begun and is counted as day 1 of the cycle

A

Start of bleeding (menses)

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3
Q

Describe follicular phase of the menstrual cycle

A

Follicle stimulating hormone (FSH) spurs follicle development and causes estrogen to surge. Estrogen peaks by the end of the phase.
The surge in estrogen causes LH and FSH to increase

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4
Q

Describe ovulatory phase of the menstrual cycle

A

LH surger triggers ovulation 24-36hrs later

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5
Q

Describe luteal phase of the menstrual cycle

A

The start of ovulation begins the luteal (last) phase which lats ~14 days. Progesterone is dominant in this phase

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6
Q

Lutenizing hormone causes ___ development in the ovary

A

corpus luteum

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7
Q

The mid-cycle ___ surge results in the release of the oocyte (egg) from the ovary into the fallopian tube

A

Lutenizing hormone (LH)

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8
Q

The oocyte lives for ___ once released and sperm can survive for ~____

A

24 hrs
3 days

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9
Q

A person wishing to concieve should have intercourse when the LH surge is detected and for the following ____

A

2 days (based on sperm survival of ~3 days)

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10
Q

___ is released when a fertilized egg attaches to the lining of the uterus (called implantation)

A

Human chorinoic gonadotropin (hCG)

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11
Q

Detecting hCG in the urine or blood indicates___

A

pregnancy

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12
Q

When is hCT level highest for woman using pregnancy test?

A

First urine in the morning (hCT level is highest)

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13
Q

Folic acid requirements preconception and during pregnancy?

A

Preconception: 400mcg of dietary folate equivalents (DFE) per day
Pregnancy: 600 mcg DFE/day

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14
Q

A prompt return to fertility occurs when most contraceptives are d/c. The only reversible contraceptive method that has a delay in return to fertility is ____

A

Medroxyprogesterone INJECTION

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15
Q

T/F: male external condoms provide more STI/STD protection than female internal condoms

A

False - female internal condoms provide more protection
Condoms provide protection from some infections, female internal > male external condoms

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16
Q

___ is the only 100% effective way to prevent pregnancy and STDs

A

abstinence

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17
Q

Why do people keep track of body temp and cervical mucus?

A

To avoid pregnancy by abstaining from intercourse on days when a woman is fertile
Basal body temp is used to predict ovulation (normal 96-98ºF, ovulation 97-99ºF)), measure first think each morning

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18
Q

Temperature methods work best when done in conjunction with ____

A

tracking changes in the cervical mucus (color, texture, volume)

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19
Q

Barrier methods of contraception include ___

A

condums, diaphragms, caps, and shields

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20
Q

Condoms help protect against many STDs (only if ___ condoms, not ____)

A

latex or syntehtic condoms
not “natural” sheepskin

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21
Q

Only recommend ____-based lubricants

A

Water or silicone-based

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22
Q

Other contraceptive methods like foams, film, creams, suppositories, sponges, and jellies contain spermicide ___ (don’t use spermicide with anal sex)

A

nonoxynol-9

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23
Q

Hormonal contraceptives work by inhibiting the production of ____ which prevents ovulation

A

FSH and LH

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24
Q

The estrogen/progestin combination pills are called ____. Non-oral contraceptives that contain both estrogen and progestin are referred to as ____

A

Combination oral contraceptives (COCs)
Combined hormonal contraceptives (CHC)

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25
Q

Available hormonal contraceptive treatments include ___

A

Progestin-only (pill, injectable, implant, IUD)
Estrogen/progestin (pill, patch, vaginal ring)

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26
Q

FDA require that ___ be dispensed with oral contraceptives

A

Patient package insert (PPI)

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27
Q

Most COCs contain the estrogen ____ and progestin (e.g. _____)

A

Ethinyl estradiol (EE)
Norethindone, levonorgestrel (LNG), drospirenone)

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28
Q

____ COCs have same dose of estrogen and progestin throughout the pill pack

A

Monophasic

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29
Q

Biphasic, triphasic, and quadriphasic pill packs mimic ____

A

estrogen and progesterone levels during menstrual cycle

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30
Q

___ is a unique progestin that is used in some COCs to reduce adverse effects commonly seen with oral contraceptives. It is a mild ___ diuretic which decreases ______

A

Drospirenone
K-sparing diuretic
Bloating, PMS symptoms, and weight gain (also a/w less acne d/t anti-adronergic activity)

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31
Q

Progestins with low androgenic activity include ____

A

Drospirenone, norgestimate, desogestrel, and dienogest

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32
Q

COCs are used for other indications besides pregnancy prevention including ___

A

dysmenorrhea (cramps), PMS, acne (in females), anemia, peri-menopausal symptoms (hot flashes, night sweats), and menstrual-associated migraine ppx

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33
Q

The use of ___ to regulate menses is first line treatment for PCOS and endometriosis

A

COCs

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34
Q

COC Natazia and levonorgestrel-releasing IUD Mirena are indicated for ___

A

heavy menstrual bleeding (menorrhagia)

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35
Q

Progestin-only pills (POPS, mini pills) contain no estrogen and have 28 days of active pills in each pack. POPs prevent pregnancy by ____

A

suppressing ovulation, thickening the cervical mucus to inhibit sperm penetration and thinning the endometrium

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36
Q

Progestin-only pils are primarily used in women who are lactating because ____

A

estrogen decreases milk production

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37
Q

Progestin-only pills require good adherence; the pill must be taken within ____ of schedule time

A

3 hrs

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38
Q

Progestin-only pills are sometimes used for migraine ppx and are safe in women who have ___

A

migraines with aura (estrogen cannot be used with this type of migraine d/t risk of stroke)

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39
Q

Patches have the same side effects, contraindications, and drug interactions as COCs, but patches causes a higher systemic ___ exposure

A

Estrogen

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40
Q

Contraceptive patches should NOT be used in anyone with ___

A

high clotting risk (pts > 35yo who smoke, pts with cerebrovascular disease or past blood clots, postpartum pts)
Women with BMI≥30 (d/t increased risk of thromboembolism (Zulane, Zafemy) or decreased efficacy (Twirla))

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41
Q

Xulane and Zafemy may also be less effective in women who weigh > ____ lbs

A

> 198lbs

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42
Q

Depo-Provera is ____, a progestin that is given by ____ every ___

A

depot medroxyprogesterone acetate (DMPA)
IM or SC injection every 3 months

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43
Q

Extended cycle COCs involve ____ of active hormonal pills followed by 7 days of inactive or very low dose estrogen pills. With this schedule, bleeding occurs every ___

A

84 days of active hormonal pills
bleeding occurs every 3 months

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44
Q

___ is approved for continuous contraception (suppress menses altogether)

A

Amethyst

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45
Q

____ occurs commonly with continuous contraception (can lead to d/c). It is important to counsel pts that this typically resolves after ___

A

Spotting (breakthrough bleeding)
3-6 months

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46
Q

Contraceptive names: “lo” indicates ___ (ex. Loestrin)

A

≤ 35 mcg of estrogen (less estrogen = less estrogenic side effects)

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47
Q

Contraceptive names: “fe” indicates ___ (ex. Loestrin Fe)

A

Iron supp is included

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48
Q

Contraceptive nameS: “24” indicates ____ (ex. Minastrin 24 Fe)

A

Shorter placebo time 24 active + 4 placebo

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49
Q

Examples of monophasic COC pills

A

Junel Fe 1/20, Microgestin Fe 1/20, Sprintec 28, Loestrin 1/20, Yasmin 28
Loestrin 24 Fe, Yaz
Loestrine Fe

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50
Q

Examples of Biphasic, Triphasic COC pills

A

Tri-Sprintec

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51
Q

Example of quadriphasic COC pills

A

Natazia

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52
Q

Examples of extended cycle formulations

A

Seasonique

53
Q

Example of continuous COC pills

54
Q

Example of drospirenone containing formulations

A

Yasmin 28, Yaz

55
Q

Example of transdermal contraceptives

56
Q

Compare AUC for patches vs pills? Vaginal ring vs pills?

A

Patches higher AUC than pills
Vaginal ring lower AUC than pills

57
Q

Examples of Progesin-only pills

A

Errin, Camila, Nora-BE

58
Q

Contraceptive nameS: “nor” indicates ____

A

contains norethindrone

59
Q

Slynd contains ____ only

A

Drospirenone

60
Q

Depo-Provera contains ___ only

61
Q

Side effects of estrogen

A

Nausea
Breast tenderness/fullness, bloating, weight gain, increased BP (may all be d/t fluid retention)
Melasma (dark skin patches, most often on face)
Thrombosis (serious but rare)

62
Q

Reducing estrogen dose can reduce side effects but a dose too low will cause ___

63
Q

What estrogen formulation has higher risk of clotting risk

A

Higher estrogen dose or exposure (e.g. with Xulane transdermal patch) = higher clotting risk

64
Q

S/sx DVT, PE, and less common clots for pts on estrogen

A

ACHES
Abdominal pain that is severe (ruptured liver tumor or cyst, mesenteric or pelvic vein thrombosis, or pain could be d/t liver or gallbladder problems or ectopic pregnancy)
Chest pain (sharp, crushing, or heavy pain can indicate heart attack. SOB can indicate PE)
Headaches (sudden and severe with vomiting or weakness/numbness on one side could mean stroke)
Eye problems (blurry vision, flashing lights, or partial/complete vision loss can indicate blood clot in eye)
Swelling or sudden leg pain (DVT)

65
Q

Which progestin has a slightly higher risk of clotting and should not be used in women with clotting risk?

A

Drospirenone

66
Q

Why should dropirenone not be used with kidney, liver, or adrenal gland disease?

A

Can increased potassium

67
Q

Which progestin can cause loss in BMD? Can be important for teens and young women who are still accumulating bone mass, may require calc+vitD supp

A

Injectable depot medroxyprogesterone acetate

68
Q

If spotting persists and currently taking < 30mcg estrogen daily, what should you do?

A

increase estrogen dose

69
Q

If spotting persists and currently taking ≥ 30mcg estrogen daily, what should you do?

A

try a different progestin

70
Q

Boxed warnings for all estrogen-containing products

A

Do NOT use in women > 35yo who smoke d/t risk of serious CV events

71
Q

Boxed warning for estrogen + progestin transdermal patch

A

do not use in women with BMI≥30 d/t increased risk of thromboemobolism (Xulane, Zafemy) or decreased efficacy (Twirla)

72
Q

Boxed warning for Depo-Provera

A

Loss of BMD with long-term use

73
Q

Which conditions should pts NOT use estrogen

A

Hx of DVT/PE, stroke, CAD, thrombosis of heart valves of acquired hypercoagulopathies
Hx of breast, ovarian, or liver cancer, migraines with aura (esp if > 35yo)

Others: liver disease, uncontrolled HTN (>160/100), severe HA or migraines with aura (esp if > 35yo), diabetes with vascular disease, unexplained uterine bleeding

74
Q

Considerations for contraception selection: Acne or hirsutism

A

Use COC with progestin that has lower androgenic activity (norgestimate (Sprintec 28)) or none (drospirenone (Yaz, Yasmin))

75
Q

Considerations for contraception selection: Breastfeeding

A

Progestin-only or nonhormonal method

76
Q

Considerations for contraception selection: estrogen contraindication (including clotting risk)

A

Progestin-only or nonhormonal method

77
Q

Considerations for contraception selection: Migraine

A

If with aura, progestin-only or nonhormonal
If without aura, any

78
Q

Considerations for contraception selection: Fluid retntion/bloating

A

Choose product containing drospirenone

79
Q

Considerations for contraception selection: Heavy menstrual bleeding

A

COC Natazia and levonorgestrel-releasing IUD Mirena indicated
COCs with only 4 placebo pills (rather than 7) or continuous/extended regimens will minimize bleeding time

80
Q

Considerations for contraception selection: HTN

A

If BP uncontrolled, progestin-only or nonhormonal method

81
Q

Considerations for contraception selection: Mood changes/disorder

A

Monophasic COC - extended or continous with drospirenone is preferred

82
Q

Considerations for contraception selection: Nausea

A

Take at night, with food
Consider decreases estrogen dose or switching to progestin-only method, vaginal rin, or nonhormonal method

83
Q

Considerations for contraception selection: Overweight

A

Any method
Do NOT use DMPA if trying to avoid weight gain
Do not use contraceptive patch if BMI ≥ 30

84
Q

Considerations for contraception selection: Postpartum

A

Do not use CHCs for 3 weeks or for 6 weeks if pt has additional risk factors for VTE
Can use progestin-only or nonhormonal

85
Q

Considerations for contraception selection: Premenstrual dysphoric disorder

A

Choose product containing drospirenone (e.g. Yaz)
SSRI antidepressant may be needed

86
Q

Considerations for contraception selection: Spootting

A

If early or mid-cycle spotting occurs, estrogen may need to be increased
If later in cycle, progestin dose may be need to be increased

87
Q

Considerations for contraception selection: Wishes to avoid monthly cycle/menses

A

Use extended (91 day) or continuous formulations
Alternative: monophasic 28-day formulation and skip placebo

88
Q

Which contraceptive formulation has lower drug interaction risk?

A

Injection bc it bypasses first-pass metabolism and achieves higher serum ocnc

89
Q

Which abx are a/w DDIs that decrease hormonal contraception efficacy?

A

Rifampin, rifabutin
With rifampin, induction can be prolonged, back-up contraception method is needed for 6 weeks after rifampin is d/c

90
Q

Which anticonvulsants are a/w DDIs that decrease hormonal contraception efficacy?

A

Carbamazepine, oxcarbazepine, phenytoin, primidone,t opiramate, lamotrigine, barbituates, perampanel

91
Q

Which natural medicine are a/w DDIs that decrease hormonal contraception efficacy?

A

St. John’s wort

92
Q

What affect dose smoking have on contraception efficacy?

93
Q

Which transplant meds are a/w DDIs that decrease hormonal contraception efficacy?

A

Ritonavir-boosted protease inhibitors, bosentan (Tracleer), mycophenolate (Cellcept, Myfortic)

94
Q

Mavyret cannot be used with any formulation containing ethinyl estradiol d/t risk of ___

A

liver toxicity

95
Q

If COCs are started today or on sunday, how many days of back-up nonhormonal contraception is required?

96
Q

If COCs are started within 5 days after the start of the period, how many days of back-up nonhormonal contraception is required?

A

None, protection is immediate

97
Q

If progestin-only pills are started today, how many days of back-up contraception is required?

A

48 hrs (2 days)

98
Q

How many COC pills do you need to miss where back-up contraception is required?

A

more than 1 pill

99
Q

If missed COC pills/days are in the third week of the cycle, what should you do?

A

Omit the hormone-free week and start next package of pills right away without skipping any days
Back up contraception should be used for 7 days

100
Q

Pt missed 1 pill of COC (<48 hrs since last dose). What do you recommend?

A

Take ASAP and take next dose on schedule (even if that makes 2 pills in 1 day)
No back-up contraception required

101
Q

Pt missed 2 pill of COC (≥48 hrs since last dose). What do you recommend?

A

Take most recent missed pill ASAP (discard other missed pills) and take dose on schedule (even if that makes 2 pills in 1 day)
If during Week 3: Omit hormone-free week and start next pack
7 days of back-up contraception required

102
Q

Pt missed 1 pill of POPS (> 3 hrs past scheduled time). What do you recommend?

A

Take pill asap and take next dose on schedule
Back up contraception required x48 hrs

103
Q

Examples of hormonal IUDs

A

Mirena, Kyla, Kyleena, Liletta

104
Q

Example of copper-T IUD

105
Q

T/F: Paragard cooper-T IUD can be used for birth control only

A

False - Emergency contraception and/or regular birth control
Can be used up to 10 yrs but causes heavier menstrual bleeding and cramping, some prefer this nonhormonal method

106
Q

Which IUD is a non-hormonal option?

A

Copper-T IUD (Paragard)

107
Q

Example of implant contraceptive

A

Nexplanon (goes into the arm), releases progestin etonogestrel for 3 years

108
Q

Nexplanon releases progestin ___ for ___ years

A

etonogestrel for 3 years

109
Q

Which emergency contraception is most effective (99.9%)

A

Copper IUD (Paragard)

110
Q

Emergency Contraception (EC) options

A

Copper IUD (Paragard)
Ullipristal (Ella)
Levonorgestrel (Plan B One-Step)

111
Q

Emergency contraception ulipristal (Ella) is best used within ____ and levonorgestrel (Plan B) is best used within ___. Sooner EC is used, higher the efficacy

A

Ella = 5 days
Plan B = 3 days

112
Q

Plan B are packaged as one __mg tab of levonorgestrel

113
Q

T/F: Plan B requires 18yo or older to purchase OTC and can only purchase 2 at one time

A

False - no restrictions

114
Q

MOA of Plan B

A

Primarily works by preventing or delaying ovulation and thickens cervical mucus

115
Q

Primary side effect of Plan B and recommendation

A

Nausea
OTC antiemetic (1 hr prior to use)

116
Q

If pt vomits within ___ of taking Plan B, she should consider repeating the dose

117
Q

Ulipristal (Ella) is a chemical cousin of ____

A

mifepristone (Mifeprex) “abortion pill” or RU-486

118
Q

Compare Ulipristal vs mifepristone

A

Ulipristal lower potency and used to delay ovulation
Mifepristone used for pregnancy terminations and other non-contraceptive uses

119
Q

Ulipristal (Ella) is given as a single __mg dose. Requires Rx

120
Q

How is NuvaRing use?

A

Insert on first day of menstrual bleeding (if inserted on days 2-5 of cycle, back0up contraception should be used for 7 days)
Put in for 3 weeks, out for 1 week
If the ring is kept in for > 4 weeks, confirm no pregnancy, insert new ring, and use back-up contraception until new ring has been in place for 7 continuous days

121
Q

Infertility is defined as not being able to get pregnancy after ___ or longer of unprotected sex

122
Q

what are some options to induce ovulation in pts with infertility?

A

Clomiphene (selective estrogen receptor modulator SERM)
Letrozole (aromatase inhibitor)
Gonadotropin drugs - Menopur, Follistim AQ, Gonal-f, Pregnyl, Novarel, and Ovidrel

123
Q

MOA clomiphene

A

Acts like estrogen (acts as estrogen agonist/antagonist depending on type of tissue) , causes LH and FSH to surge&raquo_space; triggers ovulation

124
Q

Side effect Clomiphene

A

Hot flashes&raquo_space; clotting risk

125
Q

MOA Letrozole

A

aromatase inhibitor
suppresses estrogen to increase FSH&raquo_space; causes ovulation

126
Q

MOA gonadotropin drugs

A

Act as LH, FSH, or hCG (similar to LH)&raquo_space; causes ovulation

127
Q

Risk with fertility medications

A

Canc ause multiple eggs to be released&raquo_space; multiple births

128
Q

Gonadotropin drugs formulations

A

SC or IM injection

129
Q

Brand names of gonadotropin drug names include parts of the words ___

A

REPROduce, FOLLicle, GONadrotropin, PREGnancy, and OVary
Ex: Menopur, Follistim AQ, Gonal-f, Pregnyl, Novarel, and Ovidrel

NAPLEX 2024 (74 decks)

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