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FNP boards > Contraception > Flashcards

Contraception Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Examples of combined hormonal contraceptives

A
  • Combined oral contraceptive
  • Patch (ortho evra, xulane)
  • Vaginal ring (nuvaring)
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2
Q

How do combined hormonal contraceptives achieve contraceptive effect?

A

Via progestin and estrogen

  • Progestin inhibits ovulation by suppressing LH → thickens endocervical mucus and thins endometrium
  • Estrogen inhibits FSH and LH → alters endometrial cellular structure
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3
Q

Noncontraceptive benefits of combined hormonal contraceptive use

A
  • Lower rates of benign breast tumors
  • Dysmenorrhea
  • Decreased rates of endometrial, ovarian, colon cancers
  • Acne, hirsutism, ovarian cysts
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4
Q

Absolute contraindications for combined hormonal contraceptive use

A
  • Current breast cancer
  • Postpartum <21 days
  • Acute hepatitis, hepatic adenoma
  • Migraine with aura
  • Major surgery with prolonged immobilization
  • Age >35 years and smoking >15 cigarettes/day
  • Hypertension (>160/100)
  • History of DVT/PT
  • Known thrombotic mutations
  • History of ischemic heart disease or stroke
  • Moderate or severely impaired cardiac function
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5
Q

Combined hormonal contraceptive adverse effects

A
  • Reports of breakthrough bleeding in first 3 months
    • Usually due to inconsistency of use (should be taken within the same 4 hour period every day)
  • Nausea
    • If vomiting occurs within 2 hours of taking pill, retake the dose
  • Interaction with antiepileptics
    • Phenytoin, carbamazepine, topiramate, primidone
  • Decreased absorption for patients with history of bariatric surgery
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6
Q

What should be done if a woman misses her COC pill within 12 hours of the time it should have been taken?

A

Take today’s pill immediately

  • No additional or emergency contraception needed
  • Continue with the rest of the pack
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7
Q

What should be done if the woman misses one COC pill for more than 12 hours but only one pill is missed?

A

Take today’s pill immediately

  • No additional or emergency contraceptive needed
  • Continue with the rest of the pack
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8
Q

What should be done if more than one COC pill is missed in a day?

A

Take today’s pill and the last forgotten pill now (two in one day)

  • Use emergency contraception if she had unprotected sex in the last 7 days
  • Use condoms or abstain from sex for 7 days
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9
Q

What population of patients would benefit from progestin-only pills versus combined oral contraceptives?

A
  • Risk factors for atherosclerotic CVD
  • Vascular disease
  • Prolonged history of DM (>20 years)
  • History of migraine with aura
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10
Q

True/false: Progestin only pills and DMPA (depo provera) do not alter the quality or quantity of breast milk

A

True - can be helpful option for nursing mothers

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11
Q

DMPA (depo provera) is best suited for what type of patients?

A

Those who do not wish a pregnancy for at least 18 months

  • Resumption of fertility frequently delayed by 6-12 months after d/c
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12
Q

DMPA (depo provera) patient education

A
  • May experience amenorrhea
  • Weight gain (about 11 pounds after 3 years of use
  • Loss of bone density (should not receive therapy any longer than 2 years)
    • Calcium supplementation
    • Weight bearing exercises
    • Vitamin D supplementation
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13
Q

Examples of long acting reversible contraception (LARC)

A
  • IUDs
    • Cu-IUD (paragard)
    • Levonorgestrel releasing IUD → mirena, skyla, liletta
      • Helpful for women with menorrhagia
  • Progestin implants (Nexplanon)
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14
Q

Absolute contraindications of use for LNG-IUDs and cu-IUD (paragard)

A
  • Pregnancy
  • Current PID
  • Current purulent cervicitis or chlamydia infection or gonorrhea
  • Unexplained vaginal bleeding
  • Cervical cancer
  • Distorted uterine cavity
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15
Q

Examples of non hormonal contraceptive methods

A
  • Diaphragm
  • Spermicides
  • Cervical cap
  • Contraceptive sponge
  • Condoms
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16
Q

True/false: Diaphragm use during intercourse should always be coupled with spermicides

A

True - should be removed no sooner than 6 hours after intercourse

  • Should not be recommended to women with history of recurrent UTI
    • Spermicides increase risk of UTI
17
Q

True/false: Cervical caps need to be prescribed by a trained health care provider

A

True - should remain in place for at least 6 hours with spermicide but no longer than 48 hours

  • Not to be used during menstruation
18
Q

How would a patient insert a contraceptive sponge?

A

Foam-like insert embedded with spermicide should be inserted up to 24 hours prior to intercourse

  • Remains in place for at least 6 hours but no longer than 30 hours after intercourse
  • Should not be used during menstruation
19
Q

True/false: With all emergency contraceptive methods, menstrual bleeding should be expected within 3-4 weeks of using EC

A

True - If none occurs, a pregnancy test should be done

20
Q

Examples of progestin-only emergency contraception

A

Plan B, Plan B one step, next choice, next choice one dose

  • Taken within 72 hours of unprotected sex but can be effective up to 120 hours postintercourse
21
Q

What is ulipristal acetate (ella)?

A

Progesterone agonist/antagonist emergency contraceptive

  • Unlike LNG EC, remains effective when administered immediately before ovulation around time of LH surge
  • Can be used up to 5 days (120 hours) since unprotected sex
  • Repeat dose if vomiting occurs within 3 hours
  • Only available through prescription
22
Q

Can the copper IUD (paragard) be used as emergency contraception?

A

Yes - can be inserted within 5 days after unprotected sex

  • Cannot be inserted in women with STI or history of cervicitis

FNP boards (20 decks)

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