Chapter 51: Birth Control

Question 1

BC

Answer 1

Interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)

Question 2

BC methods: pharm

Answer 2

Pharmacologic methods of contraception
Oral contraceptives
Etonogestrel implants
Injectable medroxyprogesterone acetate
Intrauterine devices
Vaginal rings
Transdermal patches

Question 3

Nonpharm BC methods

Answer 3

Surgical sterilization (tubal ligation, vasectomy)
Mechanical devices (condom, diaphragm, cervical cap)
Avoiding intercourse during periods of fertility (calendar method, temperature method, cervical mucus method)

Question 4

Considerations for selecting BC

Answer 4

Effectiveness
Safety
Personal preference

Question 5

Oral BC MOA

Answer 5

Inhibition of ovulation

Question 6

Classifications of oral BC

Answer 6

Combination oral contraceptives (OCs) -Estrogen and progestin
Progestin-only OCs (“mini-pills”)

Question 7

3 major subgroups of combo BC

Answer 7

Monophasic
Biphasic
Triphasic

Question 8

Combo BC ADR

Answer 8

Thromboembolic disorders
Hypertension
Cancer
Stroke in patients with migraine
Teratogenic effects
Abnormal uterine bleeding
Use in pregnancy and lactation
Benign hepatic adenoma
Glucose intolerance
Other adverse effects

*pt education and close follow up

Question 9

Noncontraceptive benefits of OCs

Answer 9

Decrease risks of ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease, iron deficiency anemia, and acne

Favorable effect on menstrual cycles
Diminished cramps; lighter, shorter, more predictable flow

Question 10

Combo OC drug interactions

Answer 10

Rifampin
Ritonavir
Antiepileptic drugs
St. John’s wort

*pt education

Drugs whose effects are decreased by OCs
Warfarin
Insulin
Oral hypoglycemics

Drugs whose effects are increased by OCs
Several agents, including theophylline, tricyclic antidepressants, diazepam, and chlordiazepoxide

Question 11

Dosing schedule of BC

Answer 11

28-day-cycle schedules
Extended cycle and continuous schedules

Mono estrogen and progesterone levels remain constant
Biphasic, triphasic, quad simulate th ovarian production of estrogens and progesterones

Question 12

Missed dose of BC : 28 day cycle schedule

Answer 12

One or more pills missed first week: Take one pill as soon as possible (ASAP) and continue with the pack; use an additional form of contraception for 7 days
One or two pills missed second or third week: Take one pill ASAP and continue with active pills in the pack; skip placebo pills and go straight to a new pack once all the active pills have been taken
Three or more pills missed second or third week: Follow instructions given for missing one or two pills; also, use an additional form of contraception for 7 days

Question 13

Missed dose of BC: Extended cycle and continuous schedules

Answer 13

Up to 7 days can be missed with little or no increased risk of pregnancy, provided the pills had been taken continuously for the prior 3 weeks

Question 14

Progestin-Only Oral Contraceptives

Answer 14

Camila, Errin, Heather, Jolivette, Ortho Micronor, Nor-QD, and Nora-BE

Do not cause thromboembolic disorders, headaches, nausea, or most of the other adverse effects associated with combination OCs

Slightly safer than combination OCs

Progestin-only preparations are less effective

More likely to cause irregular bleeding

Question 15

Combination Contraceptives with Novel Delivery Systems: Transdermal contraceptive patch [Ortho Evra]

Answer 15

Transdermal contraceptive patch [Ortho Evra]
Application: Once a week for 3 weeks, followed by 1 week off (to permit normal menstruation)
Adverse effects: Breast discomfort, headache, local irritation, nausea, menstrual cramps

Question 16

Combination Contraceptives with Novel Delivery Systems: nuvaring

Answer 16

Vaginal contraceptive ring [NuvaRing]
One ring is inserted once each month, left in place for 3 weeks, and then removed; a new ring is inserted 1 week later. During the ring-free week, withdrawal bleeding occurs
Most common adverse effects: Vaginitis, headaches, upper respiratory infection, leukorrhea, sinusitis, weight gain, and nausea

Question 17

Long acting contraceptives: nexplanon

Answer 17

Subdermal etonogestrel implants [Nexplanon]
Among the most effective contraceptives available
Adverse effect: Irregular bleeding
Effective for 3 years
4 cm rod that contains 68mg of edoestrogenol which is a synthetic progestin
Inserted between bicep and tricep in nondominant arm

Question 18

Long-acting contraceptives: depot

Answer 18

Depot medroxyprogesterone acetate (MPA)
Injected intramuscularly (IM) or subcutaneously (subQ), protects against pregnancy for 3 months or longer
Adverse effects: Menstrual irregularities, bone loss, weight gain

Question 19

Long0acting contraceptives: IUD

Answer 19

Intrauterine devices (IUDs):
Among the most reliable forms of reversible birth control
Examples: Copper T 380A [ParaGard], Levonorgestrel-releasing intrauterine system [Mirena]
Placed within 7 days of onset of menses
Replacement can be inserted during any phase of the menstrual cycle
ParaGard can remain in place for 10 years
Mirena can remain in place for 5 years
Women need to check their strings

Question 20

Long-acting contraceptives: spermicides

Answer 20

Chemical surfactants that kill sperm by destroying their cell membrane
Gel, jelly, suppository, vaginal film, and contraceptive sponge
All formulations can be purchased without a prescription
When used alone, only moderately effective
Use with a diaphragm or condom increases efficacy

Question 21

Drugs for medical abortion

Answer 21

Mifepristone (RU 486) with misoprostol
Blocks uterine progesterone receptors

Adverse effects:
Bleeding
Cramping
Nausea
Vomiting
Diarrhea
Headache

Question 22

Prostaglandins

Answer 22

Misoprostol, carboprost, dinoprostone

In obstetrics, prostaglandins are indicated for:
Induction of abortion
Cervical ripening before induction of labor
Control of postpartum hemorrhage