Chapter 65 Birth Control Flashcards
What is the purpose for birth control?
Interferes with the reproductive process of gametogenesis to nidation (fertilized ovum implantation)
What are common pharmacological methods of contraceptions?
- Oral contraceptives
- Etonogestrel implants
- Injectable medroxyprogesterone acetate
- Intrauterine devices
- Vaginal rings
- Transdermal patches
What are non-pharm methods of contraception?
- Surgical sterilization (tubal ligation, vasectomy)
- Mechanical devices (condom, diaphragm, cervical cap)
- Avoiding intercourse during periods of fertility
(calendar method, temperature method, cervical
mucus method)
What are things to consider when picking a birth control method?
Safety, effectiveness personal preference
What safety considerations should you have regarding birth control selection?
Combination oral contraceptives (OCs) should be avoided by women
with certain cardiovascular disorders, as well as by women over 35 years
old who smoke.
Women who are not in a mutually monogamous relationship, and hence
are at risk for a STD, should not use an IUD
What is the MOA of oral contraceptives? What two types?
Inhibition of GnRH/FSH by negative feed back to
hypothalamus and pituitary
Two types: Combo OC pills: Estrogen and progestin
OR
Progestin only OCs
What are the side effects of oral contraceptives? ACHES?
Abdominal pain
Chest pain
Headaches (severe)
Eye problems (blurry vision)
Swelling and aching in the upper and lower legs
Could be a sign of liver, gallbladder dz, stroke, blood clot, incrasing BP, or heart dz.
Notify provider immediately if these occur while taking OCs.
Combination OCs drug interactions?
Associated meds that elevate potassium should be avoided by patients on
Yasmin® (ethinyl estradiol 30mcg/drospirenone 3mg)
Beyaz® (ethinyl estradiol 20mcg/drospirenone
3mg/levomefolate calcium 0.451mg)
YAZ® (ethinyl estradiol 20mcg/drospirenone 3mg)
Non-contraceptive benefits of OC?
Decrease ovarian cancer, endometrial cancer, PID, anemia, low iron, reduced cramps, lighter/shorter periods
Drugs and herbs that reduce the effects of OCs?
Any antiepilepitc drugs, St Johns wart, Rifampin, Ritonavir
Drugs whose effects are decreased by OCs?
Warfarin (who would have thought), Insulin, oral hypoglycemics
How would you dose combo OCs?
- 28-day-cycle schedules
- Extended cycle and continuous schedules
What happens if you miss a dose of OC?
1 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
- 1 or 2 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; use an
additional form of contraception for 7 days - 3 or more pills missed second or third week: Follow instructions given for missing 1 or 2 pills; also, use an
additional form of contraception for 7 days
Progestin only oral contraceptions
DO NOT cause thromboembolic disorders or any other a/es associated with OCs
Slightly safer than combo OCs
May cause irregular bleeding
Safer for Bfing
MUST BE USED CONTINUOUSLY
Progestin only OCs - “The Mini pill” does not contain what?
No estrogen
Less effective than combo OCs
May cause breakthrough bleeding
**ADHERENCE IS IMPORTANT”” as missing a dose by 3 hours constituents a missed dose and requires a backup method
Progestin OCs are good for individuals who have what comorbidities?
CV issues such as HTN, smoke, or is older than 35 y/o w/ other issues
Transdermal contraceptive patch “Ortho Evra” is admin how? Not useful with what weight category?
Once a week for 3 weeks, followed by 1 week off to permit normal menstruation
> 185 lbs
Vaginal contraceptive ring (NuraRing) is used when?
1x each month; left in place for 3 weeks than removed a new ring is inserted 1 week later with a 1 week break between
Can see withdrawal bleeding during the break week
Long acting contraceptives, most effective option? What side effect?
Subdermal etonogestrel implants [Nexplanon®] with irregular bleeding as a/e.
Intrauterine devices (IUDs) can be placed when? Replaced when?
Placed within 7 days of onset menses
Replaced any phase of the menstrual cycle
Spermicides are what? Are used effectively with what device?
Chemical surfactant that kills sperm by destroying the cell membrane
Use with a diaphragm or condom (or both) increases efficacy
What two medication is used for medical abortion? How?
Mifepristone (RU 486) with misoprostol –> Blocks uterine progesterone receptors
Prostaglandins
In obstetrics, prostaglandins are indicated for:
* Induction of abortion
* Cervical ripening before induction of labor
* Control of postpartum hemorrhage this can be lifesaving!
What medication is considered to be emergency contraception?
PLAN B (cue Megan Thee Stallion!!!!) r/t unwanted pregnancy, SA, failed contraception and is implemented after intercourse:
2 high-dose tablets of levonorgestrel (progestin)
Need to take first tablet within 72 hours after intercourse and the second tablet 12 hours after taking the
first dose
Let the patient know that significant nausea is expected
