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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
Q

ADRs of POCs?

A
  1. Hungry, bloating, constipation
  2. Acne, hirsutism
  3. Depression
  4. Yeast infection
  5. Highereptopicpregnancy rates
  6. Irregular menses
  7. Minor lipid changes
  8. Increase in ovarian cysts
26
Q

Sx of progesterone def?

A
  1. Dysmenorrhea, menorrhagia
  2. Late cycle
27
Q

Drosperinone ADRs?

A

Increases blood clots
Increase K+ (CI with kidney, liver, adreanal dx)

28
Q

Examples of long acting progestins?

A
  1. Medroxyprogesterone acetate (depo-provera)
  2. Progestin implants (Nexplanon)
  3. Levonorgestrel IUD
29
Q

Medroxyprogesterone

Admin, Advantages, ADRs, BBW

A

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
Q

DMPA Counseling?

A
  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
Q

Fertility counseling for DMPA?

A
  1. Restoration takes 10 months
  2. Not recommended for those who want to get pregnant soon
32
Q

Nexplanon

Drug, Admin, Fertility return, ADR, Concerns

A

Etonogestrel
Admin: 3Y
FR: 30 days after removal
ADR: Menstrual irregularities, cramps, headache
Concerns: Efficacy is reduced in women 130% of IBW

33
Q

Nexplanon Counseling?

A

Irregular bleeding

34
Q

Levonorgestrel IUD

Brand, Admin, Indication, Fertility return

A

Mirena
Admin: 8Y
Indication: Heavy menstrual bleeding
FR: Immediate

35
Q

Main synthetic estrogen products?

A

1. Ethinyl estradiol
2. Mestranol
3. Estradiol valerate

36
Q

Estrogen ADRs?

A
  1. N/V (Take w food at HS)
  2. Breast tenderness
  3. Weight gain
  4. High BP
  5. MI/Stroke/DVT/PE risk
37
Q

CI of estrogen?

A
  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
Q

Indications for COC?

A
  1. Prevent pregnancy
  2. Acne (Ortho Tri Cyclen, YAZ)
  3. PM dysphoric disorder (YAZ)
39
Q

Types of prescribed COC?

A
  1. EE and norgestimate (Ortho tri cyclin, sprintec, triness): acne
  2. NuvaRing (etonogestrel/ethinyl estradiol)
  3. Norethindrone acetate and ethinyl estradiol (Junel, Loestrin)
40
Q

What is monophasic?

A

Same amount of estrogen and prostin for 21 days and 7 day placebos

41
Q

What is biphasic?

A

fixed dose of estrogen, 2 different progestin dose, dose changes once

42
Q

What is triphasic?

A

varying dose of estrogen, progestin with 3 distinct phases (dose changes twice)

43
Q

What is the purpose for using mulitphasic COCs?

A

Intended to mimic estrogen and progestrone levels during menstrual cycle

44
Q

What is the difference between seasonale and seasonique?

A

Seasonale: 3M
* 84 active days/ 7 inactive (placebo)

Seasonique:
* 84 active days/7 days low dose estrogen (decrease bleeding)

Levonorgestrel/ethinyl estradiol

45
Q

What is amethyst?

A

Ethinyl estradiol and levonorgestrel

  1. Continuously taken for 365 days per year
  2. No withdrawal bleeding, but spotting is common
46
Q

Xulane

Counseling, Admin, CI

A

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
Q

Ring formulations

Porducts, Counseling

A

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)

``

48
Q

Benefits of using COC?

A
  1. Relieve menstration sx
  2. Improve menstrual regularity
  3. Endometriosis
  4. Improve acne
  5. Reduce ovarian cyst (PCOS)
48
Q

When should you intiate OC?

A
  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
Q

What are the starting doses of OCs?

A

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
Q

What is first day method?

A

Start Today aka quick start:
1. Best practice
2. 7 days back up

50
Q

What is Sunday start method?

A

Sunday start:
1. After onset of period
2. 7 day back up

Advantage will not have periods on theweekends
Disadvantages refill days usually fallduring the weekend. Patient needs toplanfor this

51
Q

Common DDIs with OC?

A
  1. Rifampin (Antibiotics)
  2. Anticonvulsants
  3. St John Wort
  4. Ritonavir
52
Q

COC considerations with age?

A

> 35Y: low dose of estrogen (<50 mcg)

Adolescenents start low

53
Q

COC considerations for smoking?

A

Women should not smoke as it increases risk of MI

54
Q

COC considerations for HTN?

A

CI >160/100

55
Q

COC considerations for migraines?

A

Initiate POP due to increased risk of stroke in women with migraine and aura

56
Q

Missed POP?

A

POP: if no within the3 hourwindow
1. take the pill asap
2. use back up for 48hrs
3. consider emergency contraceptive if the women has had unprotected sexwithin the last 5 days

57
Q

What are common ADRs of COCs?

A

Abdominal pain
Chest pain (SOB)
Headaches
Eye problems
Severe leg pain

58
Q

Fertility return OCs?

A

The average delay in ovulation after discontinuing OCs is 1 to 2 weeks.

Amenorrhea over 6 months -> Refer to MD

59
Q

Examples of emergenct contraception?

A
  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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