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Clinical - Winter > 7 - EC & Barrier Methods > Flashcards

7 - EC & Barrier Methods Flashcards

1
Q

What are the indications for emergency contraception?

A
  • Unprotected sex when no contraceptive has been used

- Unprotected sex when contraceptive method may have failed

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2
Q

How long can sperm be viable in the female reproductive system?

A

Up to 5 days

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3
Q

When can a woman become pregnant (what part of the menstrual cycle)?

A

After she ovulates

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4
Q

When does emergency contraception stop pregnancy from occurring?

A

After intercourse but before implantation

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5
Q

Can emergency contraceptives be used as a regular contraception?

A

No, will decrease in efficacy w/ prolonged use

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6
Q

What is the active ingredient of the plan B pill?

A

Levonorgestrel (progesterone)

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7
Q

What is the mechanism of levonorgestrel?

A
  • Interferes w/ ovulation (prevents/delays ovulation if taken before it occurs)
  • Affects muscle contractility of fallopian tubes, impairing oocyte transport
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8
Q

Does levonorgestrel have any affect on implantation?

A

No

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9
Q

Will levonorgestrel harm an established pregnancy?

A

No

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10
Q

When is levonorgestrel ineffective?

A

If taken on day of ovulation or after ovulation

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11
Q

What are contraindications to levonorgestrel?

A
  • Pregnancy (won’t work, but won’t harm fetus)
  • Hypersensitivity to product or ingredient
  • Undiagnosed vaginal bleeding (*needs referral)
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12
Q

When is levonorgestrel most effective?

A

If taken less than 24 hours after intercourse

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13
Q

What are the weight restrictions for levonorgestrel? Does this mean we shouldn’t dispense to women of this weight?

A
  • Less effective in women weighing 165-176 pounds
  • Not effective in women over 176 pounds
  • Don’t withhold based on weight, but counsel on possible decreased effectiveness
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14
Q

What is the dosing of levonorgestrel in the plan B pill?

A

1.5 mg

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15
Q

How long after intercourse can levonorgestrel be taken?

A

Up to 72 hours

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16
Q

What are the side effects of levonorgestrel?

A
  • N/V
  • Cramps
  • Fatigue
  • Breast tenderness
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17
Q

What is the monitoring for levonorgestrel?

A

See physician if no period w/in 21 days and take a pregnancy test

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18
Q

What should be done if a woman vomits w/in 2 hours of taking a dose of levonorgestrel?

A
  • Contact health care provider (ex: pharmacist)

- Additional dose may be administered, based on judgement of HCP

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19
Q

What are the Rx emergency contraception options?

A
  • Copper IUD
  • Ulipristal acetate
  • Yuzpe method
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20
Q

Copper IUD is a good option for women _____

A

w/ BMI over 30

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21
Q

What is the most effective form of EC?

A

Copper IUD

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22
Q

How long after unprotected intercourse can a copper IUD be inserted?

A

Up to 7 days

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23
Q

How long can a copper IUD remain inserted?

A

Up to 30 months

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24
Q

What is the mechanism of the copper IUD?

A
  • Inflammatory reaction in uterus
  • Copper ions toxic to sperm and oocyte
  • Inhibits implantation
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25
Q

What is ulipristal acetate?

A

Selective progesterone receptor modulator

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26
Q

What is the mechanism of ulipristal acetate?

A

Inhibits/delays follicular rupture when given prior to LH surge

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27
Q

When is ulipristal acetate ineffective?

A

When given on day of LH surge (ovulation)

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28
Q

Is ulipristal acetate available OTC?

A

No, need an Rx

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29
Q

What is the dose of ulipristal acetate? When should it be taken?

A
  • 30 mg

- ASAP w/in 5 days of unprotected intercourse

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30
Q

What are the side effects of ulipristal acetate?

A
  • Nausea
  • Headache
  • Dysmenorrhea
  • Abdominal pain
  • Fatigue
  • Dizziness
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31
Q

Can ulipristal acetate be taken w/ other hormonal contraception?

A
  • Yes, but other contraception cannot be started until 5 days after taking ulipristal
  • Use backup contraception for 7 days after starting hormonal contraception, so 12 days from when ulipristal was taken
32
Q

What is always the last option for emergency contraception? Why?

A
  • Yuzpe method

- Cause N/V in 50% of px

33
Q

What is the yuzpe method?

A

2 doses of 100 mcg ethinyl estradiol and 0.5 mg levonorgestrel given 12 hours apart

34
Q

What is mifegymiso? What are its active ingredients? What is its mechanism?

A
  • Abortion pill (Rx)
  • Mifepristone which blocks progesterone production in uterus
  • Misoprostol (taken 24-48 hours after mifepristone) which induces contractions and causes a miscarriage
35
Q

What is the indication of mifegymiso?

A

Pregnancy termination up to 63 days measured from first day of last menstrual period

36
Q

What are the most common SE of mifegymiso?

A
  • Vaginal bleeding, sometimes heavy and prolonged uterine cramping
  • N/V, diarrhea
  • Headache, dizziness
37
Q

What are potential complications w/ mifegymiso?

A
  • Risk of infection and sepsis
  • Risk of prolonged heavy bleeding
  • Risk of incomplete abortion
38
Q

Only ___ based lubricants can be used w/ latex condoms

A

Water

39
Q

Does lubrication of male condoms w/ nonoxynol-9 (spermicide) result in
greater pregnancy or STI prevention?

A

No, so not recommended b/c of potential side effects

40
Q

Which types of condoms are recommended for people w/ latex allergies?

A

Polyurethane or polyisoprene

41
Q

What is a disadvantage to polyurethane condoms?

A

Doesn’t have as much stretch as latex, so breakage and slippage is more likely

42
Q

Are female condoms recommended to be used w/ male condoms?

A

No

43
Q

When is a new female condom required?

A

Each act of intercourse

44
Q

How should a female condom be removed?

A

Squeeze and twist outer ring before standing up to keep semen inside condom

45
Q

What are advantages to female condoms?

A
  • Can be inserted up to 8 hours prior to intercourse
  • Safe to use w/ latex sensitivity
  • No deterioration when exposed to oil based lubricants
  • Longer shelf life than male condoms
46
Q

What are disadvantages to female condoms?

A
  • Higher failure rate
  • Higher cost
  • Fit is affected by vaginal anatomy
  • Difficult to insert
47
Q

What is the substance used in spermicides?

A

Nonoxynol-9

48
Q

What can frequent use of spermicides cause?

A

Irritation and lesions on genital mucosa

49
Q

Do spermicides protect against STIs and HIV?

A

No

50
Q

When should spermicides be avoided?

A

Multiple acts of daily intercourse

51
Q

Where are spermicides applied?

A

Vaginally

52
Q

What are the different formulations of spermicides available?

A
  • Gels
  • Foams
  • Film
53
Q

How is spermicide foam used?

A

Insert 1 applicator-full no more than 1 hour prior to each act of intercourse

54
Q

How is a spermicide film used?

A
  • Inserted 15 mins up to 3 hours before intercourse

- One film used per act of intercourse

55
Q

What is a contraceptive sponge?

A

Small, disposable, polyurethane foam intravaginal device w/ nonoxynol-9

56
Q

How is a contraceptive sponge used?

A
  • Inserted up to 24 hours before intercourse
  • Must be left in vagina at least 6 hours after last act of intercourse
  • Should not remain in vagina for more than 30 hours (toxic shock syndrome, irritation, infection)
57
Q

What is the mechanism of a contraceptive sponge?

A
  • Physical barrier to sperm
  • Absorbs sperm
  • Contains spermicide
58
Q

What are advantages to the contraceptive sponge?

A
  • Low failure rate in nulliparous women
  • One size fits all
  • No need to change w/ repeated acts of intercourse
  • Can be used w/ male condoms
59
Q

What are disadvantages to the contraceptive sponge?

A
  • Contraindicated in those w/ allergies to spermicide
  • Difficult to remove
  • Increased chance of urinary infection
  • No protection from HIV
60
Q

Which diaphragms require sizing by an HCP? Do they require a prescription?

A
  • Milex wide-seal silicone Omniflex
  • Milex Arcing
  • Both require an Rx
61
Q

Which diaphragm doesn’t require sizing? Does it require a prescription?

A
  • Caya SILCS

- No Rx required

62
Q

How is a diaphragm used?

A
  • Insert up to 2 hours prior to intercourse
  • Remain in place for at least 6 hours after intercourse
  • Must be removed before 24 hours after initial insertion
  • Wash w/ warm water and mild soap
63
Q

Are cervical caps or diaphragms easier to insert?

A

Diaphragms

64
Q

Can diaphragms be used during menstruation?

A

Yes

65
Q

What are disadvantages to diaphragms?

A
  • Higher risk of UTIs
  • Requires practice to insert
  • Risk of toxic shock syndrome
66
Q

How long after intercourse can a pregnancy test provide a false negative result? Why?

A
  • Up to 17 days

- Sperm can remain viable in fallopian tubes for up to 5 days, and implantation takes another 6-12 days after ovulation

67
Q

What do pregnancy tests test?

A

Human chorionic gonadotropin (HCG)

68
Q

How long does it take for HCG to be detected in blood or urine?

A

6 to 8 days after conception

69
Q

What time of day is the highest concentration of HCG found?

A

Between 9 am and 12 pm

70
Q

When does HCG peak?

A

60 to 70 days after conception

71
Q

How many weeks pregnant would a woman be if a pregnancy test detected pregnancy on first day of missed period?

A

14 days (2 weeks) pregnant

72
Q

What can cause vaginal dryness?

A

Low estrogen levels

73
Q

What does a decrease in estrogen cause?

A
  • Thinning of vaginal tissue
  • Loss of collagen support
  • Increased vaginal pH
  • Reduced production of vaginal production even w/ sexual arousal
74
Q

When are vaginal lubricants used?

A

During intercourse for vaginal dryness, dyspareunia, and comfort w/ condom use

75
Q

When are vaginal moisturizers used?

A

On a routine basis, not immediately before intercourse

Clinical - Winter (24 decks)

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