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SG F3 E5 > Contraception 1 > Flashcards

Contraception 1 Flashcards

1
Q

A woman must meet 1 of which 6 criteria in order to be reasonably certain that she is not pregnant in order to give birth control

A
  • < 7 days after start of normal menses
  • No sex since LMP
  • Has been correctly and consistently using reliable method of contraception
  • Is < 7d after spontaneous/induced abortion
  • W/in 4 weeks postpartum
  • Breastfeeding, is amenorrheic and <6months postpartum
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2
Q

If reasonable certainty that patient is not pregnant is unmet, what 2 things should you consider doing

A
  • Emergency contraception then start on chronic contraception
  • Consider urine preg test/qualitative HCG
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3
Q

If reasonable certainty that patient is not pregnant is unmet, can you still start contraception? When should you follow up

A
  • Benefits exceed risk even with uncertainty (EXCEPT FOR IUD)–> Start contraception
  • F/U for preg test in 2-4 weeks
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4
Q

What are the 3 MOAs of contraception?

  1. Inhibit ovulation
  2. Prevent sperm from reaching egg
  3. Inhibit implantation
A
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5
Q

What are the 3 combined hormonal contraception options

A

COCs

Transdermal patch

Vaginal ring

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6
Q

What are the 2 long acting reversible contraception options

A
  • IUDs (copper and levonorgestreal)
  • Etonogestrel implant
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7
Q

What are the 3 least effective contraceptive methods

A

Fertility-awareness based methods

spermicide

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8
Q

What are the 4 MOST effective contraception options

A

Implants (i.e. Nexplanon)

Vasectomy

Female sterilization

IUDs (copper/levonorgestrel)

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9
Q

Standard days Method is for women with menstrual cycles from ____ - ____ days long

A

26-32

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10
Q

When should a woman abstain from sexual intercourse on the Standard Days method

A

Days 8-19

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11
Q

How long must you monitor cycles for the Calendar method?

A
  • For women that dont have regular menses:
  • Monitor cycles x6 months
  • Avoid sex during fertile period
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12
Q

When should a patient avoid sex if using the Cervical Mucus/Two Day Method?

What is the “Peak Day”?

A
  • “Peak” day= last day of “stretchy”, clear mucus
  • Abstinence from time of any cervical secretion until 4d after peak day
  • If no secretions x2 days- ok to have sex
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13
Q

When should you abstain from sex if using the Basal Body Temperature method?

A

from end of menstrual period until 3d after temp increase (0.5-1.0degF= ovulation)

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14
Q
A
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15
Q

Which 2 fertility awareness methods/natural family planning have the LOWEST typical use failure rate?

A
  • Standard Days (12%)
  • Two Day Method (13.7%)

(Calendar, Symptothermal and post-ovulation all have a typical use failure rate of 25%)

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16
Q

Which type of male condom is 2.5-5x more likely to slip or break than latex?

A

Polyurethane

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17
Q

What type of lubricants should be avoided with male condoms

A

oil/petroleum based lubricants

18
Q

How long must female barrier methods (cervical caps, diaphragm, female condoms, sponge, spermicides) stay in place for after sex?

A

>6hrs but no longer than 24

19
Q

Which contraceptive method increases risk for HIV transmission and is therefore contraindicated for those that are HIV+ or at high risk for HIV?

A

Spermicide

20
Q

Which contraception method increases risk of UTI?

A

Diaphragm

21
Q

Which patient population shoud the transdermal patch not be used in

A

women > 198lbs

22
Q

What is the MOA of combined hormonal contraception? (4)

A
  • Prevent ovulation (90-95% of MOA)
  • Thickening of cervical mucus
  • Thin, atrophic endometrium
  • Tubal motility slowed
23
Q

Combined hormonal contraception: No back up needed if start in first __days of bleed

A

5

24
Q

Combined hormonal contraception: Monitoring

What is the only test needed prior to starting

A

Blood pressure

No routine f/u needed

25
Q

Which contraceptive method has the following pros:

  • Decreased blood loss, cramps and more predictable menses
  • Decreased acne, hirsutism
A

Combined hormonal contraception

26
Q

KNOW

What are the 8 limitations (contraindications) of combined hormonal contraceptives?

A
  1. Breast cancer
  2. Severe HTN or vascular dz
  3. Complicated DM (or DM >20yrs)
  4. Heart dz
  5. Migraine with aura
  6. Seizure disorder
  7. Liver/gallbladder diseases
  8. >15 cigs/day (esp when >35y/o)
27
Q

What should you tell a pt that has missed 1 pill

A

Take missed pill ASAP

Take next pill as usual

28
Q

What should you tell a patient to do if she has missed 2+ pills

A
  • Tke most recent missed pill ASAP
  • Remaining pills should be continued at usu. time
  • Backup x7 days
  • +/- emergency contraception
29
Q

How long should a pt use backup contraception if they have missed 2+ pills

A

7 days

30
Q

What should you tell a patient if missed pills were in the last week of hormonal pills?

A

Omit the hormone free interval by finishing hormone pills in current pack and starting new pack the next day

31
Q

When should Progestin pills be started?

No back up is needed if started when?

A

Can be started at any time

No back up if started in first 5 days of bleed

32
Q

POPCORN

What is the MOA of progestin pills

A
  • Thickens cervical mucus (main MOA)
  • Thin, atrophic endometrium
  • Suppresses ovulation (sometimes)
  • slows sperm motility
33
Q

What are 2 side effects of progestin only pills

A
  1. Increased spotting/bleeding
  2. Intermittent Amenorrhea
34
Q

POPCORN

When is a progestin only pill considered a missed pill?

A
  • after a 3 hour delay
  • Vomitting or diarrhea that occurs w/in 3 hrs of taking POP
35
Q

What are 3 instances when a patient should not be prescribed Progestin only pills?

A
  • Breast cancer
  • Liver disease
  • Meds that increase hepatic clearance (anticonvulsants, rifampin, griseofulvin, St. Johns Wort)
36
Q

What should you advise your patient to do if they have missed a Progestin only pill (3 hours late or V/D w/in 3hrs of taking)

A
  • Take another pill, use backup x2 days
  • consider emergency contraception
37
Q

Progestin only injectables:

  • When can they be initiated?
  • No back up needed if started when?
A

Start any time

No back up if started in first 7d of bleed

38
Q

Progestin only injectables should be repeated how often

A

q 13 weeks

39
Q

What are the 2 side effects of Progestin only injectibles that most commonly the cause of patients discontinuing use

A
  • Heavy bleeding/spotting
  • Weight gain
40
Q

Which contraceptive option can cause a decrease in bone mineral density, especially in adolescents

A

Progestin only injectables

(reversable if discontinued)

41
Q

How long can it take to resume normal ovulation after discontinuing Progesin only injectables?

A

1 year

42
Q

What 6 medical conditions would cause you to not want to prescribe Progestin only injectables?

A
  • Breast cancer
  • Severe HTN
  • Heart disease
  • Vascular disease
  • Migraine with aura
  • Liver diseases

SG F3 E5 (23 decks)

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