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OBGYN > CONTRACEPTION > Flashcards

CONTRACEPTION Flashcards

1
Q

10 Absolute Contraindications for Combined Hormonal Contraception (Estrogen)

A

• < 4 weeks post partum if breastfeeding
• <21d postpartum (0 breastfeeding)
• Smoker + >35 yo
• HTN (>160/100)
• CVA/CAD
• Valvular disease
• Acute VTE
• Hx of VTE w/ 0 anticoagulants
• Major sx w/ prolonged immobilization
• Thrombophilia
• SLE w/ +/unknown APA
• Current breast CA
• Migraine w/ aura
• DM with retinopathy/neuropathy/nephropathy
• Cirrhosis or liver tumor

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2
Q

4 Absolute Contraindications for Combined Hormonal Contraception (Progestin)

A

• Unexplained vaginal bleeding
• Current breast CA
• Severe cirrhosis
• Pregnant

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3
Q

3 Risks for Combined Hormonal Contraception

A

• VTE (3-4 fold increase in risk; AR 1.5/1000)
• MI / Stroke (greater w/ >50mcg)
• Breast CA (minimal)

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4
Q

5 Benefits for Combined Hormonal Contraception

A

• Menstrual:
o Cycle regulation & ↓ menstrual flow - > ↓Anemia
o ↓Dysmenorrhea / Pelvic Pain
o ↓PMS
o ↓ perimenopausal symptoms
• ↓acne / hirsutism
• ↓risk of ovarian / endometrial CA
• ↓fibroids / benign breast disease / ovarian cysts

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5
Q

5 side effects for Combined Hormonal Contraception

A

• Irregular Bleeding (1st 3 cycles) (12%)
• Nausea (7%)
• Wt gain (5%)
• Mood (5%)
• Breast Tenderness (4%)

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6
Q

Failure rate for Combined Hormonal Contraception (typical vs. perfect use)

A

o Typical: 9%
o Perfect Use: 0.3%

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7
Q

Give 3 delivery methods for Combined Hormonal Contraception

A

Combined oral contraception
Combined patch
Combined Ring

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8
Q

Give 3 examples of combined OCPs and their estrogen levels

A

Very Low: LOLO 10 mcg
Low: Alesse 20 mcg
Standard: Marvelon, 30 mcg

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9
Q

Give 3 examples of classes of medications that decrease the effectiveness of OCP’s

A

Anticonvulsants (phenytoin, phenobarbitol)
Antiretrovirals
Antibiotic (only Rifampin)

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10
Q

What is the mechanism of action for combine hormonal contraception?

A

Prevents ovulation (suppresses gonadotropin secretion)
Prevents implantation (causes endometrial atrophy)
Prevents sperm transportation (causes viscous cervical mucus plug)
Fallopian secretions

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11
Q

List 3 strategies to initiate OCPs

A

R/o Pregnancy
1st Sunday of Period
If started >/5 days from LMP, use backup x 7 days

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12
Q

Do OCPs: cause cancer, need to take pill breaks, affect fertility, cause birth defects, be used over the age of 35, cause acne?

A

Does NOT cause cancer
NO need for pill breaks
Does NOT affect fertility
Does NOT cause birth defects
CAN be used over the age of 35
Does NOT cause acne

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13
Q

Describe 2 strategies for continued combined hormonal contraception use and the benefit

A

Continue combined hormone until breakthrough bleed, then take 4 day break
4 packs (84 days)
Decreases menstrual symptoms

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14
Q

What specific measurement do you take when initiating OCPs?

A

Blood Pressure

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15
Q

Management if delayed taking OCP in < 24 hrs in ANY week

A

Take 1 active pill ASAP
Continue taking 1 pill daily until the end of the pack

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16
Q

Management If 1 or more missed pills in first week:

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack

Back up x 7d*

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17
Q

Management If less than 3 pills missed pills during second or third week

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack

start new cycle of OCP without a hormone-free interval

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18
Q

Management if 3 or more consecutive doses/days of OCP missed during second or third week

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack
start new cycle of OCP without a hormone-free interval
Back-up contraception for 7 days
Consider EC

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19
Q

Initiation strategy of Combined Patch (Evra)

A

R/o Pregnancy
1st Sunday of Period
If started >/5 days from LMP, use backup x 7 days

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20
Q

How is the Combined Patched used, where is it placed, how is it stored, is it okay to shower and exercise with?

A

1 patch / w x 3 weeks
1 week off
Place on buttocks / deltoid / lower abdomen / upper torso
DO NOT Keep in fridge
Okay for showering / exercise

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21
Q

What is the failure rate of the combined patch? What decreases the efficacy?

A

Typical: 9%
Perfect Use: 0.3%
Efficacy affected if weight >/ 90 kg

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22
Q

What are 3 side effects of the combined patch (in addition to side effects of combined hormonal contraception)

A

20% mild local rxn
increased breast tenderness
increased n/v
dysmenorrhea

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23
Q

What is an advantage of the combined patch compared to OCPs other than convenience

A

Less breakthrough bleeding

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24
Q

How is the Combined Ring (Nuvaring) used, how is it stored?

A

Insert x 3 weeks
1 week ring free
DONT Store in fridge

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25
Q

What is the failure rate of the combined ring?

A

Typical: 9%
Perfect Use: 0.3%

26
Q

List 3 side effects of the combined ring

A

Foreign body sensation
Leukorrhea
Expulsion
Coitus issues

27
Q

List 3 advantages of the combined ring compared to OCPs

A

Decreased N / V
Decreased Mood lability
No weight gain
Decreased acne

28
Q

3 absolute contraindications to progestin only contraception

A

Unexplained vaginal bleeding
Current breast cancer
Pregnant

29
Q

Mechanism of action of progestin only contraception

A

Alters cervical mucus plug
Partial ovulation suppression

30
Q

6 Indications for use of progestin only contraception

A

> 35 yo smoker
Migraine H/A
Breastfeeding
Endometriosis
Anti-convulsant use
Sickle Cell

31
Q

2 risks of progestin only contraception

A

Delayed fertility by 9 mo
Reversible decreased BMD

32
Q

3 side effects of progestin only contraception

A

Menstrual disturbance
Weight gain (4 kg)
Mood disturbance

33
Q

benefits of progestin only contraception

A

Amenorrhea
Decreased endometrial cancer
Decreased PMS
Decreased Pelvic pain
Decreased PID
Decreased vasomotor symptoms
Decreased in myomas

34
Q

Benefits of progestin oral contraception

A

Amenorrhea (10%)

35
Q

Timing when initiating and use of progestin only oral contraception

A

1st day of menstrual cycle
If stated after >7 days of LMP, use back up x 7 d
Take same time daily within 3 hours
NO PILL FREE DAYS

36
Q

How to manage irregular bleeding with progestin only oral contraception

A

r/o other cause of irregular bleeding
NSAIDS
Change to cOCP
Supplement with estrogen

37
Q

Failure rate of progestin only oral contraception

A

o Typical: 9%
o Perfect Use: 0.3%

38
Q

C/i to Progestin Implant

A

Pregnant
Undiagnosed abnormal Vaginal bleed
Breast CA
Liver disease
Liver tumor, cancer
VTE

39
Q

Risks / Side Effects of Progestin Implant

A

Pain
Bleeding
Hematoma
Paresthesia
Infection
Scaring
Migration
VTE
Irregular bleed
Ectopic
VTW
Liver disease
H/A
Weight gain
Breast / Abdo pain

40
Q

Rx of Progestin Implant

A

28 d postpartum
5 days after T1 abortion

41
Q

Timing / Use of progestin injection

A

Q 12 weeks
Start within first 5 days of period or rule out pregnancy and use back up

42
Q

Failure rate of progestin injection

A

<1%
6% with typical use

43
Q

risks / side effects of progestin injection

A

Wt. Gain
Mood changes
Irregular bleeding
Reversible BMD decrease
Delayed return of fertility

44
Q

List 2 types of Intrauterine System

A

Hormonal - Levonogestrel (LNG-IUS)
Non-Hormonal - Copper

45
Q

Absolute c/i of IUS

A

Pregnancy
Puerperal sepsis
Immediate Post septic abortion
Recent PID
Recent STI (w/in 3 mo)
Distorted uterine anatomy
Unexplained Vaginal Bleeding
Ovarian / Cervical Ca
Progestin +ve Breast Cancer (LNG-IUS)

46
Q

Benefits of IUS

A

Decreased menstrual flow (LNG-IUS)
Decreased dysmenorrhea (LNG-IUS)
Decreased endometrial CA (ALL IUS)

47
Q

Risks of IUS

A

Pain
Perforation (2.6/1000)
PID (1st 20 dys)
Expulsion
Failure -> ectopic

48
Q

Side Effects of IUS

A

Irregular Bleeding (Copper, decreased with LNG)
Pain
Progesterone Side Effects:
Mood
Weight Gain
Menstrual Disturbance

49
Q

CPS recommended 1st line contraception for pediatrics

A

IUS

50
Q

IUS: Can you keep it in while treating PID? Does it cause infertility?

A

Yes
No

51
Q

When can an IUS be inserted. What are the risks of inserting while menstruating? What if inserting > 7 d from LMP? When should follow up be? Should U/S be used?

A

Anytime
Increased risk of infection, expulsion
Use backup x 7d
F/u 4-12 w post insertion
Routine U/S not required

52
Q

Failure rate of IUS

A

Typical: 0.2-0.8
Perfect: 0.2-0.6

53
Q

Management of lost string w/ IUS

A

r/o pregnancy.
Spec Exam – if 0 string order U/S
If negative U/S order pelvic XRAY

54
Q

Management of pregnancy w/ IUS

A

Removed IUS
r/o ectopic

55
Q

Management of amenorrhea w/ IUS

A

r/o pregnancy
Determine position

56
Q

Management of STI / PID w/ IUS

A

No need to remove while treating unless no improvement after 72 hrs

57
Q

Most effect form of emergency contraception

A

Copper IUD - almost 100% effectiv

58
Q

how long post coitus can a copper IUD be inserted

A

Up to 7 days if no c/I, reasonable certainty pt is not pregnant

59
Q

Second line emergency contraception

A

Hormonal

60
Q

List 3 types of hormonal emergency contraception

A

Uliprisal acetate (first line)
Plan B (levonorgestrel)
Yuzpe method

61
Q

S/e of hormonal emergency contraception, treatment of side effects

A

Nausea
Vomiting
Dizziness
Take an antiemetic

OBGYN (21 decks)

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