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RDS Test 1 > B8.012 Contraception > Flashcards

B8.012 Contraception Flashcards

1
Q

what imparts a greater risk than any method of contraception?

A

pregnancy

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2
Q

method of emergency contraception with ethinyl estadiol

A

100 mcg within 72 hours of intercourse
inhibits ovulation, disrupts follicle development, interferes with maturation of corpus luteum
does NOT prevent implantation of fertilized egg (not abortive)
best results within 12 hrs

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3
Q

other emergency methods of contraceptions

A

0.75 mg levonorgestrel (plan b, next step, one step)
ulipristal
copper IUD

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4
Q

0.75 mg levonorgestrel

A

2 pills 12 hr apart or a single dose
up to 72 hours after intercourse
OTC for age >17

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5
Q

ulipristal

A

slightly more effective, can use up to 120 hours
prescription needed
binds to progesterone receptors and delays ovulation

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6
Q

copper IUD insertion for emergency contraception

A

within 7 days of intercourse
prevents fertilization, but also blocks implantation of fertilized egg
10 years of BC

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7
Q

general principle about emergency methods of contraception

A

better if available

**write script in advance if someone wants it

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8
Q

components of precontraceptive evaulation

A 
history
pregnancy test (if indicated)
BP, weight, BMI
chlamydia screen
pap/pelvic if >21
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9
Q

is a pap/pelvic required for BC?

A

no
not for anyone <21
if you want an IUD there will be a pelvic exam and cervical inspection prior to insertion

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10
Q

when is a pregnancy test NOT indicated

A

<7 days after start of normal menses
no intercourse since last menses
correctly using reliable method
<7 days after spontaneous or induced abortion
<4 weeks post partum
breastfeeding and amenorrheic and <6 months post partum

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11
Q

sterilization methods

A

tubal ligation and vasectomy

failure rates <1%

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12
Q

advantages of sterilization

A

permanent
cost effective over time
safe

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13
Q

disadvantages of sterilization

A

permanent
expensive up front
no STI protection

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14
Q

intrauterine device

A

inhibits sperm motility
prevents implantation
approval rate 98%
20x more effective than OCPs with no increased risk of thromboembolism

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15
Q

IUD options

A 
copper TCu-380A
levonorgestrel releasing devices: thins uterine lining, less bleeding
mirena
skyla
liletta
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16
Q

copper IUD

A

no hormone
more bleeding/cramping than others
good for 12 years

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17
Q

mirena

A

good for 7 yeas
20 mcg/day
good choice for breastfeeding moms

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18
Q

skyla

A

good for 3 years
smaller than mirena
14 mcg/day

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19
Q

liletta

A

good for 4 years
19 mcg/day
available for $75 for low income women

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20
Q

insertion of IUD

A

at end of menses or 6-8 wks after childbirth
no harm to future fertility
can be inserted immediated after childbirth

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21
Q

risks of IUD

A

uterine rupture

infection

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22
Q

side effects of IUD

A

copper: increased bleeding and cramping
LNG: amenorrhea or spotting

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23
Q

contraindications to IUD

A 
pregnancy
undiagnosed vaginal bleeding
unresolved pap/suspected cancer
active genital infection
distorted uterine cavity
high risk for STI
decreased resistance to infection
wilson's/ copper allergy
sickle cell: increased bleeding
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24
Q

etonogestrel implant

A

nexplanon
subQ progesterone
thickens cervical mucus, prevents endometrial thickening, suppresses ovulation
lowest failure rate for reversible contraception

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25
Q

insertion of nexplanon

A

1st 5 cays of cycle or immediately postpartum

good 24 hours to 5 years

26
Q

side effects of nexplanon

A

heavy menses
amenorrhea
spotting
weight gain

27
Q

medroxyprogresterone (depo shot)

A

inhibits ovulation by decreasing gonadotropins
thickens cervical mucus
dose 150 mg IM every 3 months
pregnancy rate 1/100 women

28
Q

who is the depo shot good for

A

chronic medical problems
sickle cell (decreases crises)
forgets pills or cant take estrogen

29
Q

side effects of depo shot

A 
amenorrhea
spotting
weight gain
bone loss
hair loss
nausea
delayed return to fertility
depressed mood
30
Q

black box warning on depo shot

A

should be used for >2 years only if other methods are inadequate
loss of bone density

31
Q

contraindications to depo shot

A 
thromboembolic or liver disease
stroke
vaginal bleeding/pregnancy
MI
breast cancer
severe hypertension
32
Q

combo OCPs

A 
estrogen/progesterone pills
estrogen is usually ethinyl estradiol
-high dose: 50 mcg
-low dose: 15-35 mcg
multiple types of progesterone
may be started at any time id reasonably certain that patient is not pregnant
33
Q

when should you not use combo OCPs

A

first 4-6 weeks postpartum, even longer if breastfeeding

34
Q

progesterone types of OCPs

A

1st gen: norethindrone
2nd gen: levonorgestrol, norgestrel
3rd gen: norgestimate, desogestrel
4th gen: drospirenone

35
Q

1st gen progesterone OCPs

A

norethindrone

lowest rate of thromboembolism

36
Q

2nd gen progesterone OCPs

A

levonorgestrel, norgestrel

most start with these, best tolerated

37
Q

3rd gen progesterone OCPs

A

norgestimate, desogestrel

less androgenic, longer half life, less metabolic effects on carbohydrates and lipids

38
Q

4th gen progesterone OCPs

A

drospirenone
spironolactone analogue, less bloating
increased risk for VTE

39
Q

mechanism of action of OCPs

A 
negative feedback to HP axis
-inhibits mid cycle LH surge
-prevents ovulation
thickens cervical mucus
slows fallopian tube motility
make uterus inhospitable
pregnancy rate 5/100 women
highest failure rates in 15-24 year olds
40
Q

benefits of OCPs

A

protective against ovarian/uterine cancer
fewer ectopics
relieve dysmenorrhea
increase bone mass
decrease acne
decrease fibrocystic breast disease/ breast pain
decrease PID
decrease functional ovarian cysts, fibroids
decrease iron deficiency anemia
may decrease RA
improve symptoms of PCOD (hirsutism)

41
Q

risks/side effects of OCPs

A 
serious risks rare
VTE
-greatest in first 2 years
-increased risk with drospirenone
stroke and MI
-risk in smokers >35
-HTN important additive risk
-smokers with migraine have 6x stroke risk
NO proves risk for breast cancer
increase in chlamydia infections
decrease in PID
42
Q

drugs that cause OCP failure

A

rifampin
anticonvulsants
griseofulvin
HIV meds

43
Q

minor side effects of OCPs

A 
headache
breakthrough bleeding
amenorrhea
decreased libido
acne
breast tenderness
nausea
erythema nodosum
44
Q

contraindications for OCPs

A 
smokers >35
migrain w aura
migraine without aura but with other risk factors
thromboembolic disorders
cerebral vascular disease
poorly controlled HTN
cancer
-breast
-endometrial
-liver tumors
45
Q

pills w decreased number of cycles

A

seasonale / seasonique / jolessa / quasense
-active pills for 84 days then 7 or 4 days of inactive
-4 periods per year
lybrel/ quartette
-active pills for entire year
-expect breakthrough bleeding and/or amenorrhea

46
Q

transdermal hormones

A

transdermal patch to trunk or upper outer arm weekly for 3 weeks of cycle
3x risk thromboembolism
lower efficacy in obese women

47
Q

vaginal ring

A

insert into vagina and stays for 3 weeks of cycle
can remove for intercourse
ethinyl estradiol 15 mcg and estonogestrel 120 mcg
more vaginal discharge

48
Q

progestin only “minipill”

A

affects cervical mucus viscosity, fallopian tube mobility, endometrial thickness
does not reliably inhibit mid cycle LH surge (not good)
good w breast feeding
more spotting, acne, hirsutism, oily skin

49
Q

specific uses for progestin only contraceptives

A

sickle cell disease
coronary artery disease
SLE (lupus)
people w risk factors that preclude them from using combined OCPs

50
Q

barrier methods

A 
condoms
diaphragm
cervical cap
vaginal pouch
sponge
spermicides
51
Q

condoms

A

44% of sexually active women use

pros: accessible, STI protection, erectile enhancement, prevent sperm allergy, inexpensive
cons: reduced sensitivity, interruption, decreased pleasure, latex allergy, breakage

52
Q

diaphragm

A

latex cup with flexible rim, holds spermicide and covers cervix
repeated intercourse requires more spermicide, must remain in place for 6 hours
15/100 pregnancy rate

53
Q

diaphragm advantages

A

no systemic side effects
prevents STIs
decreases risk of cervical dysplasia

54
Q

diaphragm disadvantages

A

interruption
latex or spermicide allergy
inability to correctly insert
increased incidence of UTIs

55
Q

vaginal pouch

A

long thin polyurethane sheath with flexible ring for cervix and outer ring for labia
stronger than latex
may insert up to 8 hours prior to intercourse
20/100 preg rate

56
Q

vaginal pouch advantages

A

good protection for both partners
does not require erect penis
can use oil based lubricants

57
Q

vaginal pouch disadvantages

A

cumbersome

may be used only once

58
Q

sponge

A

soft sponge like device, slightly smaller in diameter than diaphragm
16-32/100 pregnancy rate

59
Q

spermicides

A

foam, creams, gels, films
may be used alone or with barrier method
failure rate 6-21%

60
Q

spermicide advantages

A

over the counter
good back up method
add lubrication
quickly inserted

61
Q

spermicide disadvantages

A

allergies, increased yeast infections

pregnancy rate 30/100

RDS Test 1 (22 decks)

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