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A - NAPLEX > Chapter 47: Contraception & Infertility > Flashcards

Chapter 47: Contraception & Infertility Flashcards

1
Q

When is day one of the menstrual cycle counted

A

The start of menses (bleeding)

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2
Q

What is the follicular phase of the menstrual cycle

A

Surge in estrogen

which causes LH and FSH to increase

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3
Q

What is the ovulatory phase in the menstrual cycle

A

The LH surge triggers ovulation

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4
Q

Once the egg (oocyte) is released after the LH surge, the egg lives for how long

A

24 hrs

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5
Q

A person wishing to conceive can use a kit to detect LH. When should this person have intercourse

A

When the LH surge is detected and for the following 2 days

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6
Q

Which hormone indicates pregnancy

A

hCG

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7
Q

What time of day is the hCG level the highest & is the best time to use a pregnancy test

A

in the morning

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8
Q

Folic acid should be taken to help prevent birth defects of the brain and ____

A

spinal cord (neural tube defects)

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9
Q

The only reversible contraceptive method that has a delay in return to fertility is

A

the medroxyprogesterone injection

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10
Q

Barrier methods of contraception include

A

condoms

diaphragms

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11
Q

Which form of contraceptive can protect against many STDs

A

condoms (only if latex or synthetic)

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12
Q

What are the only types of lubricants to recommend to use with condoms to make them less likely to break

A

water or silicone-based (NOT OIL)

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13
Q

Foams, film, creams, suppositories, sponges and jelly contraceptives contain which spermicide

A

Nonoxynol-9

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14
Q

Hormonal contraceptives inhibit the production of which hormones

A

FSH

LH (which prevents ovulation)

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15
Q

Estrogen/progestin combination pills are called ___ and non-oral contraceptives that contain estrogen & progestin are called ___

A

COCs

CHCs

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16
Q

The FDA requires ___ to be dispensed with oral contraceptives

A

Patient Package Insert (PPI)

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17
Q

What are monophasic COCs

A

they have the same dose of E and P throughout the pill pack

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18
Q

What are biphasic, triphasic, and quadriphasic pill packs

A

they mimic the E and P levels during a menstrual cycle. The type of formulation (e.g., triphasic) refers to the number of times the amounts of the hormone change

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19
Q

COCs can be used for other indications besides pregnancy, such as

A

dysmenorrhea (menstrual cramps)

PMS (Premenstrual Syndrome)

acne in females

anemia, etc

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20
Q

What is the first line treatment for PCOS to regulate menses

A

COCs

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21
Q

What is first-line treatment for endometriosis

A

COCs

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22
Q

Which COC is a mild potassium-sparing diuretic which decreases bloating, PMS symptoms, and weight gain and also is associated with less acne

A

Drosperinone

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23
Q

POPs prevent pregnancy by suppressing ___

A

ovulation;

this thickens the cervical mucous to inhibit sperm penetration

and thinning the endometrium

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24
Q

POPs are primarily used in which patients

A

breastfeeding

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25
Q

What decreases milk production in lactating women

A

estrogen (which is why POPs are used)

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26
Q

POPs require

A

good adherence

the pill must be taken within 3 hours of the scheduled time

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27
Q

POPs are sometimes used for

A

migraine with aura ppx

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28
Q

The contraceptive patch should NOT be used in patients with

A

clotting risk factors

since it has higher systemic estrogen exposure

(do not use in women > 35 years who smoke)

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29
Q

Xulane patch is less effective in women > __ lbs

A

198

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30
Q

Depo-Provea is given IM or SC every ____

A

3 months

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31
Q

During week 4 of using COCs, what occurs

A

menses

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32
Q

Extended cycle COCs have __ days of active hormone pill

A

84 (bleeding occurs every 3 months)

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33
Q

Which brand of COCs is approved for suppressing menses altogether by taking continuous contraception

A

Amethyst

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34
Q

What is a common SE with continuous contraception?

Patients should be counseled that this typically resolves after how long

A

spotting (breakthrough bleeding)

Resolves after 3-6 months

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35
Q

Lo in the name of a COC indicates = __ mcg E

A

35

low E causes less estrogenic SE

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36
Q

“24” in the name of a COC indicates:

A

a shorter placebo time: 24 active + 4 placebo

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37
Q

Which brand of COC is an extended cycle formulation

A

Seasonique

period occurs every 3 months, so one period per season

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38
Q

Which COCs contain drosperinone

A

Yasmin and Yaz

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39
Q

Which brands of contraception are POPs

A

Errin

Camilla

Nora-BE

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40
Q

Side effects of estrogen

A

nausea

breast tenderness/fullness

bloating

weight gain

elevated BP

41
Q

COC formulations with less estrogen can lead to

A

breakthrough bleeding

42
Q

It is recommended to wait __ monthly cycles before changing the dose to see if spotting resolves with COCs

A

3

43
Q

Boxed warning for ALL estrogen-containing products (pills, ring, patch)

A

Do not use in women > 35 years old who smoke due to risk of serious CV events

44
Q

Boxed warning for estrogen + progestin transdermal patch

A

increased risk for VTE (DVT/PE) compared to COCs

45
Q

Boxed warning for Depo-Provera shot

A

Loss of bone mineral density with long-term use

46
Q

Do NOT use estrogen with these conditions

A
  • DVT/PE, stroke, CAD

- History of breast, ovarian, or liver cancer, migraines with aura

47
Q

If a patient experiences early or mid-cycle spotting, the dose of ___ should be increased & if they experience late-cycle spotting, the dose of ___ needs to be increased

A

Estrogen

Progestin

48
Q

Drosperinone can cause:

A

higher clotting risk

increased potassium - do not use with kidney, liver, or adrenal gland disease

49
Q

Patients taking Depo-Provera injection should be taking adequate

A

Calcium and vitamin D

50
Q

What are the common symptoms of a DVT/PE

A

Remember ACHES:

  • Abdominal pain that is severe
  • Chest pain
  • Headaches
  • Eye problems
  • Swelling or sudden leg pain
51
Q

If a patient has a concern for acne, which birth control should be selected

A

COC with lower androgenic activity (e.g., Sprintec)

or no androgenic activity (i.e., Yaz, Yazmin)

52
Q

If a patient is breastfeeding, which birth control should be selected

A

POPs

or

non-hormonal method

53
Q

If a patient has migraine with aura, which birth control should be selected?
What about without aura?

A
  • With: POPs or non-hormonal

- Without: any method

54
Q

If a patient has fluid retention, which birth control should be selected

A

drosperinone containing COC

55
Q

If a patient has heavy menstrual bleeding, which birth control should be selected

A

Natazia

or

IUD Mirena

56
Q

If a patient has HTN, which birth control should be selected

A

POP or non-hormonal method

57
Q

If a patient has a mood disorder, which birth control should be selected

A

monophasic COC

extended cycle or continuous with drosperinone is preferred

58
Q

If a patient has nausea, which birth control should be selected

A

can decrease E dose

59
Q

If a patient is overweight, which birth control should NOT be used

A

DMPA (can cause weight gain)

Depot medroxyprogesterone acetate (DMPA)

60
Q

If a patient is postpartum, which birth control should be selected

A

POPs or nonhormonal medthod

61
Q

If a patient has PMDD, which birth control should be selected

  • Premenstrual Dysphoric Disorder
A

Yaz

Or

antidepressant

62
Q

Which birth control does NOT have drug interactions

A

injection (DMPA)

63
Q

Which drugs can DECREASE hormonal contraception efficacy

A
  • Antibiotics (rifampin, rifabutin) - backup method with rifampin for 6 weeks after rifampin is d/c
  • Anticonvulsants: carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, lamotrigine
  • St. John’s Wort
  • Smoking
  • Ritonavir
64
Q

Which drugs cannot be used with any formulation containing EE due to risk of liver toxicity

A

Hep C treatments

Technivie & Viekira Pak

65
Q

The “Start Today” method is the bet practice recommendation for starting COC & requires non-hormonal backup for ___ days

A

7

66
Q

The Sunday Start method starts the Sunday after onset on menstruation & is used if the pt prefers that menstruation occur during the week and is complete before the following weekend. It requires non-hormonal backup for ___ days

A

7

67
Q

T/F: If COC is started within 5 days after the start of period, non-hormonal backup is required for 7 days

A

False - no back-up method is needed

68
Q

When can POPs be started

A

Any time

69
Q

If more than ___ COC pills are missed, backup contraception is required for 7 days

A

1

70
Q

If 2 COCs are missed during week 3 of cycle, what should the patient do

A

Omit hormone-free week & start next pack of pills

71
Q

If patient misses a dose of POP and it has been > __ hours past the scheduled time, backup contraception is required for how long

A

3 hours

48 hours

72
Q

What is the brand name for the IUD

A

Mirena

73
Q

What is the brand name for the copper-T UD

A

Paragard

74
Q

The copper-T IUD can be used for:

A

Emergency contraception &/or regular birth control

75
Q

What is the birth control implant brand name

A

Nexplanon

76
Q

The birth control implant releases which hormone for how many years

A

etonogestrel for 3 years

77
Q

What is the most effective form of emergency contraception

A

copper IUD (Paragard)

78
Q

What are the 2 oral options of EC

A 
levonorgestrel (Plan B One-Step)
Ulipristal acetate (Ella)
79
Q

The oral options for EC can be used within __ days

A

5

80
Q

What is the dose of Plan B

A

one 1.5 mg tab of levonorgestrel

81
Q

Plan B reduces the risk of pregnancy by up to 89% when started within __ hours after unprotected sex

A

72

82
Q

What is the MOA of plan B

A

prevents or delays ovulation

and

thickens cervical mucus

83
Q

If a patient vomits within __ hours of taking Plan B, the dose should be repeated

A

2

84
Q

Which EC requires a prescription

A

Ulipristal (Ella) - it is a chemical cousin to mifepristone aka the “abortion pill”

85
Q

Ulipristal is indicated for up to __ days after unprotected intercourse

A

5

86
Q

Where can the contraceptive patch be placed

A

butt

stomach

upper arm or upper torso

87
Q

What days can the contraceptive patch be started

A

On day 1 or Sunday

88
Q

How long is NuvaRing kept in place

A

3 weeks & taken out for one week

89
Q

If NuvaRing is kept in place > __ weeks, backup contraception is needed

A

4

90
Q

Infertility is defined as not being able to get pregnant for how long after unprotected sex

A

1 year

91
Q

What is the first-line treatment for a woman with irregular or absent menstrual cycles

A

Clomiphene

92
Q

Clomiphene drug class

A

SERM

93
Q

Drugs that are SERMs act as ___ agonists in some tissues and ___ antagonists in other tissues

A

estrogen

estrogen

94
Q

The surge in LH from clomiphene triggers ovulation & commonly causes ___

A

hot flashes

95
Q

SERMs have a risk for

A

clotting

96
Q

Gonadotropins trigger ovulation by acting similar to __ & __

A

FSH

LH

97
Q

Infertility drugs are good in that they trigger ovulation, but they also have the risk of causing

A

release of multiple eggs and ↑ risk of multiple births

98
Q

Gonadotropin formulations

A

SC or IM

A - NAPLEX (83 decks)

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