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Therapeutics II > Block 5: Contraceptives > Flashcards

Block 5: Contraceptives Flashcards

1
Q

What is the treatment goal for contraception?

A
  1. Prevent pregnancy
  2. Provide health benefits
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2
Q

Describe the components of the menstrual cycle?

A
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3
Q

What are your types of hormonal contraceptives from least to most effective?

A
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4
Q

How can use fertility awareness-based methods?

A

Motivated couples

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5
Q

What are the disadvantages of fertility awareness alone?

A
  1. High preganacy rates
  2. Avoidance of intercourse for several days during each menstrual cycle
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6
Q

What makes barriers effective?

A

Requires motivation to use them consistently and correctly

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7
Q

What are the disadvantages of barrier methods?

A
  1. Higher failure rates
  2. Counseling and an advanced prescription for emergency contraception (EC) are recommended
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8
Q

What are exmaples of fertility awareness methods?

A
  1. Calendar-based methods
  2. Syptom-based methods
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9
Q

Male condoms

Advantages, Disadvanatges

A

A: STD Protection (latex and PU), cheap
D: Mineral oil, prelube spermacides decrease protection, latex allergy, breakage

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10
Q

Female condoms

Advantages, Disadvantages

A

A:
1. Protects from STDs

D:
1. Pregnancy rate is higher than using male condoms
2. Male and female condoms should not be used together

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11
Q

Diaphragms

Advantages, Disadvantages

A

A:
1. Low cost
2. The diaphragm may be inserted up to 6 hours before intercourse and must be left in place for at least 6 hours afterward
3. Efficacy is increased when it is used in conjunction with spermicidal cream or jelly.
4. Reusable

D:
1. Prescription
2. TSS

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12
Q

Cervical cap

Advantages, Disadvantages

A

A:
1. Filled with spermicide prior to insertion
2. Reduced TSS risk

D:
1. Failure rates with the cervical cap are higher
2. No STD protection
3. Prescription

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13
Q

Spermicides and Spermicide-Implanted Barriers

Advantages, Disadvantages

A

Nonoxynol-9, also comes in a sponge form

D:
1. No STD protection
2. Increase HIV transmission

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14
Q

Copper IUD MOA?

Advantages, Disadvantages

A

Paragard:
1. Copper inhibits sperm motility and acrosomal enzyme activation preventing sperm reaching fallopian tube
2. Sterile inflammatory reaction in endometrium phagocytizes sperm

A:
1. Most effective
2. Immediate return to fertility
3. 10 years+

D:
1. Heavier menstration and cramping
2. Risk for uterine perforation
3. Expensive

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15
Q

How should you counsel on IUD warning signs?

A

P = period being late (pregnancy)
A = abdominal pain (pregnancy)
I = infection exposure (STD)
N = not feeling well, having fever or chills (infection/uterine perforation)
S = strings (make sure still there or haven’t changed in length)

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16
Q

What are the pharm options of contraceptives?

A
  1. POP
  2. COC
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17
Q

What are synthetic progestrones?

A

Progestins

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18
Q

MOA of progestins?

A

Provides the most contraceptive effect
1. LH suppression (inhibits ovulation)
2. Cervical mucus thickening
3. Maintain endometrial lining

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19
Q

What is an example of OTC progestin?

A

Opill (norgestril 0.075mg)

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20
Q

What progestins have high androgen activity resulting in acne and hirsutism?

A

Norgestrel and Levonorgestrel

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21
Q

What progestins have increased thrombotic effects?

A

Drospirenone
Dienogest

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22
Q

Counseling points for progestins?

A
  1. Less effective and Increased irregular and unpredictable mentrual bleeding compared to COC
  2. Minipills must be taken QD at the same time QD (within 3 hrs)
  3. More than 3 hr, use back up contraception for 48 hrs
  4. 28 days
  5. Return to fertility is immediate
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23
Q

POC products?

A

Norethindrone 0.35mg (minipill)

Camila, Errin, Nora-BE

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24
Q

What are the advantages of POCs?

A
  1. Nursing mothers without affecting lactation
  2. DVT, PE, MI, stroke
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25
ADRs of POCs?
1. Hungry, bloating, constipation 2. Acne, hirsutism 3. Depression 4. Yeast infection 5. Higher eptopic pregnancy rates 6. Irregular menses 7. Minor lipid changes 8. Increase in ovarian cysts
26
Sx of progesterone def?
1. Dysmenorrhea, menorrhagia 2. Late cycle
27
Drosperinone ADRs?
Increases blood clots Increase K+ (CI with kidney, liver, adreanal dx)
28
Examples of long acting progestins?
1. Medroxyprogesterone acetate (depo-provera) 2. Progestin implants (Nexplanon) 3. Levonorgestrel IUD
29
Medroxyprogesterone | Admin, Advantages, ADRs, BBW
**Admin:** Q3M IM (150mg) or SC (104 mg) with 5 day onset * 1-7 of menstrual cycle: no backup method * Other days: back up for 7 days **Advantages:** 1. Women with epilepsy experience fewer seizures 2. Lactation 3. Reduce acne risk **ADR:** 1. Weight gain (CI: obesity) 2. Recurrent vulvovaginal candidiasis **BBW:** * >2Y use can reduce BMD * Increase glucose, LDL, decrease HDL
30
DMPA Counseling?
1. Q3M (12W) IM or SC 2. Irregeluar menstruation 3. If more than a week late, must get pregnancy test before getting next shot 4. Calcium and Vit D supple 5. Amenorrhoeic after 1 yr
31
Fertility counseling for DMPA?
1. Restoration takes 10 months 2. Not recommended for those who want to get pregnant soon
32
Nexplanon | Drug, Admin, Fertility return, ADR, Concerns
Etonogestrel **Admin:** 3Y **FR:** 30 days after removal **ADR:** Menstrual irregularities, cramps, headache **Concerns:** Efficacy is reduced in women 130% of IBW
33
Nexplanon Counseling?
Irregular bleeding
34
Levonorgestrel IUD | Brand, Admin, Indication, Fertility return
Mirena **Admin:** 8Y **Indication:** Heavy menstrual bleeding **FR:** Immediate
35
Main synthetic estrogen products?
**1. Ethinyl estradiol** 2. Mestranol 3. Estradiol valerate
36
Estrogen ADRs?
1. N/V (Take w food at HS) 2. Breast tenderness 3. Weight gain 4. High BP 5. MI/Stroke/DVT/PE risk
37
CI of estrogen?
1. DVT/PE Hx 2. MI/stroke Hx 3. Severe HTN 4. DM with vessel problems 5. Migraine with aura 6. ≥35 smoker ≥15 cigs/day **Use POP**
38
Indications for COC?
1. Prevent pregnancy 2. Acne (Ortho Tri Cyclen, YAZ) 3. PM dysphoric disorder (YAZ)
39
Types of prescribed COC?
1. EE and norgestimate (Ortho tri cyclin, sprintec, triness): acne 2. NuvaRing (etonogestrel/ethinyl estradiol) 3. Norethindrone acetate and ethinyl estradiol (Junel, Loestrin)
40
What is monophasic?
Same amount of estrogen and prostin for 21 days and 7 day placebos
41
What is biphasic?
fixed dose of estrogen, 2 different progestin dose, dose changes once
42
What is triphasic?
varying dose of estrogen, progestin with 3 distinct phases (dose changes twice)
43
What is the purpose for using mulitphasic COCs?
Intended to mimic estrogen and progestrone levels during menstrual cycle
44
What is the difference between seasonale and seasonique?
**Seasonale:** 3M * 84 active days/ 7 inactive (placebo) **Seasonique:** * 84 active days/7 days low dose estrogen (decrease bleeding) Levonorgestrel/ethinyl estradiol
45
What is amethyst?
Ethinyl estradiol and levonorgestrel 1. Continuously taken for 365 days per year 2. No withdrawal bleeding, but spotting is common
46
Xulane | Counseling, Admin, CI
Apply once weekly for 3 weeks (21 days) then allow for one week patch free **Admin:** Can be placed on upper arm/torso, buttocks, or stomach **CI:** High clotting risk, not effective >198lbs
47
Ring formulations | Porducts, Counseling
NuvaRing, Annovera 1. Insert once for 21 days, then allow for one week off 2. Annovera is reusable up to one year (Wash and store) ## Footnote ``
48
Benefits of using COC?
1. Relieve menstration sx 2. Improve menstrual regularity 3. Endometriosis 4. Improve acne 5. Reduce ovarian cyst (PCOS)
48
When should you intiate OC?
1. 5 days after use of the emergency contraceptive ulipristal acetate (using together may decrease effectiveness) 2. LARC can be started at the time of ulipristal acetate use
48
What are the starting doses of OCs?
**Start with low dose 30-35mcg and monophasic < 50kg start with 20 mcg** 1. 7 days of CHC to achieve contraception: back up for 7 days 2. COC 5 days of start of period: no back up 3. POP anytime: back up for 2 days
49
What is first day method?
Start Today aka quick start: 1. Best practice 2. 7 days back up
50
What is Sunday start method?
Sunday start: 1. After onset of period 2. 7 day back up **Advantage** will not have periods on the weekends  **Disadvantages** refill days usually fall during the weekend. Patient needs to plan for this 
51
Common DDIs with OC?
1. Rifampin (Antibiotics) 2. Anticonvulsants 3. St John Wort 4. Ritonavir
52
COC considerations with age?
>35Y: low dose of estrogen (<50 mcg) Adolescenents start low
53
COC considerations for smoking?
Women should not smoke as it increases risk of MI
54
COC considerations for HTN?
CI >160/100
55
COC considerations for migraines?
Initiate POP due to increased risk of stroke in women with migraine and aura
56
Missed POP?
POP: if no within the 3 hour window 1. take the pill asap 2. use back up for 48 hrs 3. consider emergency contraceptive if the women has had unprotected sex within the last 5 days 
57
What are common ADRs of COCs?
Abdominal pain Chest pain (SOB) Headaches Eye problems Severe leg pain
58
Fertility return OCs?
The average delay in ovulation after discontinuing OCs is 1 to 2 weeks. Amenorrhea over 6 months -> Refer to MD
59
Examples of emergenct contraception?
1. Copper-T IUD (Paragard) 2. Ella (Ulipristal) 30mg x1 dose 3. Plan-B One step (levonorgestrel) 1.5mg x 1 dose

Therapeutics II (30 decks)

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