COCPs Flashcards

1
Q

6 things to consider when starting COCPs

A

(1) generic vs brand (2) monophasic vs multiphasic (3) cyclic vs extended cycle vs continuous use (4) EE dose (5) progestin type (6) 21/7 vs 24/4

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2
Q

MOA

A

ovulation suppression (which improves with higher doses, shorter pill free intervals, continuous dose

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3
Q

Additional progestin effects

A

Endometrial decidualization and atrophy; thickening of cervical mucus; impairment of normal tubal motility and peristalsis

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4
Q

Contraindications (Category 4)

A

(1) Age 35+ and smoke 15+ cigs; (2) multiple RFs for CV disease; (3) HTN; (4) VTE (unless on anticoagulation); (5) known ischemic heart disease; (6) hx of stroke; (7) complicated valvular heart disease; (8) current BCA; (9) severe cirrhosis; (10) hepatocellular adenoma or malignant hepatoma; (11) migraine with aura; (12) DM > 20 years or with nephropathy, retinopathy, or neuropathy

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5
Q

Efficacy

A

perfect-use failure rate is 0.3 percent, the typical-use failure rate is ~ 7 %; not effected by progestin type, estrogen dose, or brand

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6
Q

Non-contraceptive benefits: R/T menses

A

(1) reduction in dysmenorrhea (2) reduction in pelvic pain r/t endometriosis (3) reduction of menorrhagia (4) reduction of PMS/PMDD symptoms, menstrual migraines, PCOS, AUB (5) regular menstrual cycles

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7
Q

Non-contraceptive benefits: R/T cancer reduction

A

(1) OCA including some hereditary forms; (2) endometrial cancer; (3) colorectal cancer

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8
Q

Non-contraceptive benefits: other

A

(1) reduction in risk of ectopic pregnancy; () reduction in risk of benign breast disease (3) reduction in development of new ovarian cysts (higher doses only) (4) reduction in moderate acne (5) reduction in hirsutism

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9
Q

Non-contraceptive benefits: R/T menopause

A

Reduced hot flashes and improved bone density, AUB

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10
Q

Side effects

A

VTE, VCV risk, cancer (cervical)

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11
Q

Estrogens

A

(1) Ethyinal estradiol (2) estradiol valerate (3) 17-beta estradiol (4) estetrol. Those other than EE appear to have less effect on hemostasis, fibrinolysis markers & lipids

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12
Q

Starting COCPs

A

(1) Can start day 1 of menses (2) If > first 5 days of LMP, BUC is needed for 7 days

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13
Q

Continuous

A

May use any monophasic 21/7 combination (eg, Amethyst [levonorgestrel 0.09 mcg-ethinyl estradiol 20 mcg]) by taking active hormone pills for 28 or more days continuously. Any progestin may be used, and higher doses of ethinyl estradiol may be used in some women.

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