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Endocrine Module > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the additional benefits of contraception treatment?

A
  1. Prevention of STIs (condoms)
  2. Prevention of ovarian and endometrial cancer (contraception/HT)
  3. Treatment of acne and hirsutism (HC)
  4. Treatment of menstruation-related problems (HC)
  5. Management of perimenopausal symptoms (HC)
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2
Q

What are the Non-Hormonal Contraceptive Methods?

A
  1. Periodic Abstinence
  2. Condoms
  3. Diaphragms
  4. Cervical Caps
  5. Sponges
  6. Spermicides
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3
Q

What are the Hormonal Contraceptive Methods?

A
  1. Oral
  2. Transdermal
  3. Vaginal Ring
  4. Injectable/Implantable Progestin
  5. IUDs
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4
Q

How does the pill work?

A

STOPS OVULATION, thins uterine lining, thickens cervical mucus

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5
Q

Does the pill stop the ability to get pregnant?

A

No, just decreases the ability

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6
Q

How does Estrogen control the cycle?

A
  1. Stabilizes endometrial lining
  2. Provides cycle control
  3. Suppresses FSH release from pituitary
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7
Q

What are the two synthetic forms of estrogen?

A

Ethinyl Estradiol and Mestranol

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8
Q

How does Progestin provide Contraceptive Effect (ANTI-Ovulary)?

A
  1. Thickens cervical mucus
  2. Slows tubal motility of sperm
  3. Induces endometrial atrophy
  4. Blocks LH surge and secretion of FSH
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9
Q

What occurs with ALL testosterone derived progestins?

A

Bind to the androgen receptor and retain some androgenic activity

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10
Q

What are the qualities of first generation oral HC?

A

Norethindrone/Ethynodiol Dictate/Norethindrone Acetate
Estrogenic, Progestational, and Androgenic

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11
Q

What are the qualities of second generation oral HC?

A

Levonorgestrel/Norgestrel
Progestational and Androgenic

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12
Q

How is second gen different from first gen oral HC?

A

Second is more potent, longer t1/2, and more androgenic

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13
Q

What are the qualities of third generation oral HC?

A

Norgestimate/Desogestrel
Progestational and Androgenic

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14
Q

How is third gen different from second gen oral HC?

A

Less androgenic, higher risk of VTE, otherwise same

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15
Q

What are the qualities of fourth generation oral HC?

A

Drospirenone
Progestational

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16
Q

What is special about Drospirenone?

A

Have antimineralocorticoid and antialdosterone activity, higher risk of VTE

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17
Q

What are the forms of Non-Oral HC?

A

Transdermal Patch, Vaginal Ring, Depot Injection, Long Acting Implantable Progestin, and Intrauterine Device

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18
Q

What are things to know about the Transdermal Patch HC?

A

NONOBESE PATIENTS
>90kg or BMI >30 DO NOT USE
New patch Q3 wks, apply abdomen/butt/upper torso/upper arms

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19
Q

What are the concerns with Transdermal Patch HC?

A

Increased risk of VTE, 60% more estrogen

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20
Q

What happens if you forget to change the patch after 3 weeks?

A

Patch releases hormone for 9 days, if you change by the 9th day over, NO backup method needed, if NOT backup for 7 DAYS

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21
Q

What are the things to know about the Vaginal Ring HC?

A

NuvaRing = 3 week period
Annovera = resusable for 1 yr
Insert before 5th day of menstrual cycle, keep in for 3 wks, then remove for 1 wk

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22
Q

What are the concerns with Vaginal Ring HC?

A

Increased VTE Risk
No danger with inserting it too far, cervix will prevent it from traveling up

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23
Q

What happens if you the ring falls out for more than 3 hrs?

A

Use Back-Up contraceptive and insert a new ring

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24
Q

How long does it take to return to fertility for Oral, Transdermal, and Vaginal HC?

A

2 weeks

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25
Q

What are the things to know about the Depot Injection HC?

A

Inhibits ovulation for 14 weeks
Must be injected within 5 days of onset of menstrual bleeding, repeat injection every 3 months

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26
Q

What are the concerns with Depot Injection HC?

A

Breakthrough bleeding
Weight Gain
Decreased bone mineral density by 3-7%

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27
Q

What happens if you miss a dose of depot injection?

A

Should do pregnancy test before reducing and use back-up method for 7 days

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28
Q

How long does it take to return to fertility for Depot Injection HC?

A

10-18 months

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29
Q

How long can you take Depot Injection HC?

A

2 years due to osteoporosis risk

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30
Q

What are the things to know about the Long Acting Implantable Progestin?

A

Lasts 3 years
100% effective but reduced in women >130% of their IBW

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31
Q

What are the concerns with Long Acting Implantable Progestin?

A

Bleeding, no impact on BMD

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32
Q

How long does it take to return to fertility for Long Acting Implantable Progestin?

A

30 days

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33
Q

What are the things to know about Intrauterine Device HC?

A

Copper Wrapping or Progestin Reservoir
Minimal systemic absorption

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34
Q

What are the concerns with Intrauterine Device HC?

A

Pelvic Inflammatory Disease PID with Paragard Copper IUD

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35
Q

How long does it take to return to fertility for Intrauterine Device HC?

A

Immediate upon removal

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36
Q

How long does each IUD Last/

A

Paraguard (Copper): 10 yrs
Mirena: 8 yrs
Sjyla: 3 yrs
Liletta: 6 yrs
Kyle’s: 5 yrs

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37
Q

What are the Absolute Contraindications to CHC?

A
  1. H/O thromboembolism or thrombophilia
  2. H/O vascular disease
  3. Diabetes with vascular involvement (nephro/retino/neuro)
  4. Migraine HA with Focal Aura
  5. Uncontrolleed HTN >160/90
  6. Uncontrolled Dyslipidemia
  7. Breast Cancer
  8. Acute or Chronic Hepatocelluar Disease
  9. Age >36 & Smoking >15 cig/day
  10. Breastfeeding Women <6 wks POSTpartum
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38
Q

What are the Relative Contraindications to CHC?

A
  1. Multiple risk factors for CVD
  2. Migraine HA w/o aura in women >35
  3. Cirrhosis, mild
  4. Symptomatic gallbladder disease
  5. Postpartum <3 wks and NOT breastfeeding
  6. Breastfeeding <6 months POSTpartum
  7. Commonly used drugs that induce liver enzymes
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39
Q

What are the commonly used drugs that induce liver enzymes and reduce efficacy of CHC (relative CI)?

A
  1. Rifampin
  2. Phenytoin
  3. Carbamazepine
  4. Barbiturates
  5. Primidone
  6. Topiramate
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40
Q

What drugs may cause OC Failure?

A

Anticonvulsants
Antimicrobials
Griseofluvin
NNRTIs
Protease Inhibitors
Rifampin
St. John’s Wort

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41
Q

What drugs may INCREASE OC Activity?

A

Acetaminophen
Erythromycin
Fluoxetine
Fluconazole
Fluvoxamine
Grapefruit
Nefazadone
Vitamin C

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42
Q

OC can decrease clearance of what drugs?

A

Amitriptyline
Benzos
Caffeine
Cyclosporine
Imipramine
Phenytoin
Selegiline
Theophylline
Corticosteroids

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43
Q

OC can decrease efficacy of what drugs?

A

Lamotrigine

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44
Q

What do Anticonvulsants do to CHC and how to fix it?

A

Decrease contraceptive effect
At least 50 mcg EE, second method of contraception, or IUD

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45
Q

What does Griseofluvin do to CHC and how to fix it?

A

Decrease effect on contraception
Second method of contraception or IUD

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46
Q

What does NNRTI/Protease Inhibitors do to CHC and how to fix it?

A

Increase/Decrease contraceptive effect
IUD

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47
Q

What does Rifampin do to CHC and how to fix it?

A

Decrease effect of contraception
Second method of contraception or IUD

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48
Q

What does Atorvastatin do to CHC and how to fix it?

A

Increases contraceptive effect
Norgestimate and EE

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49
Q

Is estrogen and progesterone affected by Antibiotics?

A

Progesterone = No
Estrogen = potential

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50
Q

How long does Post-OC Amenorrhea last?

A

No longer than 6 months

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51
Q

What should be done if you miss 1 active OC pill LESS than 24 hrs later?

A

Take 1 active pill ASAP then continue the remaining pills at the usual time

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52
Q

What should be done if you miss 1 or MORE active OC pill MORE than 24 hrs later?

A

Take 1 active pill ASAP, then take remaining pills at the usual time, skip placebo week and start new pack
Use 7-day backup method
Consider emergency contraception if unprotected in last 5 days

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53
Q

What is Periodic Abstinence?

A

Avoidance of intercourse during the days of the menstrual cycle when conception is likely to occur based on fertility awareness methods

54
Q

What are Spermicides and the primary ingredient?

A

Chemical surfactants that destroy sperm cell walls and acts as a barrier that prevent sperm from entering the cervix
Nonoxynol-9

55
Q

What are the CIs of Spermicides?

A

Should not be used in women at high risk for HIV or women who are HIV infected (increase transmission)

56
Q

What is a Vaginal pH Regulator and the Product in this category?

A

Designed to maintain vaginal pH within the range of 3.5-4.5% and impair sperm motility
Phexxi Vaginal Gel

57
Q

What are the concerns with Phexxi Vaginal Gel?

A

Must be administered up to 1 hr prior to intercourse
A/E: burning, pruritus, discharge, UTI

58
Q

What are the advantages to barrier methods?

A

Temporary/Intermittent/Long Term Contraception
Provide Immediate Protection
NO systemic AE
NO delay in return to fertility

59
Q

Do you have to reapply spermicides and vaginal pH regulators before each act of intercourse?

60
Q

What is the Male Condom?

A

Single use, mechanical barrier preventing direct contact of the vagina with semen/infectious secretions

61
Q

What are the advantages of the male condom?

A

STI protection including HIV and most effective barrier method

62
Q

What is the Female Condom?

A

Single use, pre lubricated, loose fitting synthetic nitrile sheath, closed at one end, with flexible rings at both ends

63
Q

What are the CI of the female condom?

A

Allergy to synthetic nitrile
History of Toxic Shock Syndrome

64
Q

What are the advantages of the female condom?

A

Latex free, inserted before intercourse or ahead of time 8hrs prior max, and STI protection

65
Q

What is the Diaphragm and what is it used with?

A

Reusable, dome shaped rubber cap with flexible rim to be used with SPERMICIDE

66
Q

What are the CIs of the Diaphragm?

A

Allergy to latex or spermicide
Recurrent UTIs
History of TSS
Abnormal gynecologic anatomy

67
Q

What is the advantage of the Diaphragm?

A

Resuable for 2 yrs and DECREASE incidence of cervical cancer

68
Q

What is the Cervical Cap and what is it used with?

A

Reusable non latex silicone cup that fits over the cervix and blocks sperm to the uterus, use with SPERMICIDE

69
Q

What are the CIs of the Cervical Cap?

A

Allergy to spermicide
History of TSS
Abnormal anatomy and pap smear

70
Q

What is the Sponge?

A

Single use, non latex pillow shaped SPERMICIDE imbedded with concave dimple

71
Q

What are the CIs of the Sponge?

A

Allergy to spermicide
Recurrent UTI
History of TSS
Abnormal anatomy

72
Q

What is the advantage of the Sponge?

A

When left in place, provides protection for 24 hrs, regardless of the frequency of intercourse

73
Q

What is Monophasic OC?

A

Same amount of estrogen and progestin for 21 days followed by 7 days of placebo

74
Q

What is Biphasic and Triphasic OC?

A

Contain variable amounts of estrogen and progestin for 21 days followed by 7 days of placebo

75
Q

Are Multiphasic pills better tolerated than Monophasic?

A

Not conclusive

76
Q

What are Combination OC extended cycle regimens designed for?

A

Reduce menstrual flow intensity and duration. Dysmenorrhea, Menorrhagia, and Menstrual HA

77
Q

What is the 24/4 Regimen?

A

24 days of estrogen/progestin and 4 days placebo
Equal to 21/7

78
Q

What is the 26/2 Regimen?

A

20 days estrogen/progestin
4 days estradiol only
2 placebo

79
Q

What is the Combination OC extended cycle regimen and the main AE?

A

84/7
Increase in bleeding irregularities

80
Q

What is the Combination OC Continuous regimen and the main AE?

A

21/7
Bleeding irregularities in the first 3 months

81
Q

What is the Progestin Only OC regimen and the main concern?

A

Progestin Only 28/7
Must be taken at the same time every day

82
Q

What happens when you take Norethindrone Progestin Only not at the same time every day?

A

If shaken >3 hrs late, use backup contraception for 48 hrs

83
Q

What is the EE concentration for Adolescents, Underweight <110 lbs, and Women >35 yrs old?

84
Q

What is the EE concentration for >90 kg?

85
Q

What is the EE concentration for Acne and Hirsutism?

A

LOW androgenic or antiandrogenic OC

86
Q

What is the EE for reduced or eliminated menstrual cycle/menstrual related symptoms?

A

Extended or Continuous Cycle OC

87
Q

What is the EE concentration for CI/precautions of Estrogen?

A

Progestin ONLY

88
Q

What is the First Sunday Start Method?

A

Take first pill on the first Sunday after menstruation begins

89
Q

What is the Quick Start Method?

A

Take first pill on the day of the office visit

90
Q

Which Start Method is more effective?

A

QUICK Start

91
Q

What A/Es results in Immediate DC of OC?

A

A: Abdominal Pain
C: Chest Pain
H: Headaches
E: Eye Problems
S: Severe Leg Pain

92
Q

If you have early or mid cycle spotting change to what?

A

Tricyclic with increased ESTROGEN

93
Q

If you have late cycle spotting change to what?

A

Tricyclic with increased PROGESTIN

94
Q

What is the recommendation for HC in Thromboembolism?

A

Do not use CHC in women history of thrombotic event
All other forms or contraception or Progestin ONLY

95
Q

What is the recommendation for HC in Migraines?

A
  1. Consider CHC in NONsmoking <35 urs NO Focal signs (2nd line)
  2. AVOID CHC in >35 yrs W/O AURA
  3. AVOID CHC in any age with AURA
  4. DC CHC IMMEDIATELY who develop margarin (w/ or w/o aura) while on CHC
  5. Other forms of contraception are appropriate
96
Q

What is the recommendation for HC in >35 yrs?

A
  1. Benefit vs. Risk
  2. CHC <35 mcg EE in NONsmoker and no Significant risk factors
  3. Other forms of contraception are appropriate
97
Q

What is the recommendation for HC in Smokers?

A
  1. <35 yrs may use CHC <35 mcg EE
  2. > 35 yrs NO CHC
  3. Other forms of contraception appropriate
98
Q

What is the recommendation for HC in HTN?

A
  1. CHC ok if <35 with well controlled HTN
  2. Other forms of contraception appropriate
99
Q

What is the recommendation for HC in Dyslipidemia?

A
  1. CHC and Progestin Only ok with Controlled dyslipidemia
  2. Alternative NON-hormonal contraception (barrier or copper IUD) with UNCONTROLLED dyslipidemia and additional risk factors
100
Q

What is the recommendation for HC in Postpartum?

A
  1. Progestin ONLY acceptable any time after delivery
  2. CHC may be initiated 3 wks post postpartum, must avoid <3 wks
101
Q

What is the recommendation for HC in Breastfeeding?

A
  1. Progestin ONLY used >3 wks postpartum
  2. CHC after >6 months postpartum
102
Q

What is the recommendation for HC in Obesity?

A
  1. HC in obese women still acceptable
  2. Avoid using CHC <35 mcg EE
  3. > 90 kg consider DMPA, IUD, or barrier
103
Q

What forms of contraception have the highest effectiveness with perfect/typical use?

A

Progestin Implantable, Copper IUD, and Levonorgestrel IUD

104
Q

What form of contraception have the worst effectiveness with perfect/typical use?

A

Spermicides Alone

105
Q

What is the ranking of cost effectiveness for contraception?

A

BEST: IUD, progestin implant, and progestin injection
MID: OC, vag ring, patch
WORST: barrier methods

106
Q

What is Emergency Contraception?

A

Prevent unwanted pregnancy after unprotected intercourse

107
Q

What is the mechanism of Levonorgestrel?

A

INHIBITION of Ovulation
Thickens cervical mucus, and altering endometrium

108
Q

What are the Progestin ONLY EC Products?

A

Plan B, Next Choice, and My Way

109
Q

What Combination OC takes 2 tablets/dose as EC?

110
Q

What Combination OC takes 4 tables/dose as EC?

A

Levlen, Levora, Lo/Ovral, Triphasil, Tri-Levlen, and Trivora

111
Q

What Combination OC takes 5 tablets/dose as EC?

A

Alesse and Levlite

112
Q

What is the recommended dosing/admin for EC?

A

1 DOSE at once within 72 hrs of unprotected intercourse

113
Q

In women >154 lbs for EC what is the concern?

A

Progestin Only may be less effective

114
Q

If you vomit within 1 hr of taking EC tablet what must you do?

A

Repeat EC dose

115
Q

What is the mechanism of Progesterone Agonist/Antagonist?

A

Prevents progestin from binding, postpone follicular rupture, DELAYS ovulation, alter endometrium

116
Q

What drug is Progesterone Agonist/Antagonist used for EC?

A

Ulipristal Acetate/Ella One: take 30 mg 1 tablet PO within 5 days of unprotected intercourse

117
Q

How does the Copper IUD serve as an EC?

A

Copper can prevent sperm from fertilizing an egg and may also prevent implantation of a fertilized egg

118
Q

What forms of contraception are non-prescription?

A

Male/Female condom, Sponge, Spermicide, Progestin Only EC

119
Q

Brand Name of Cervical Cap?

120
Q

Brand Name of Sponge?

121
Q

Brand Name of Monophasic OC 21/7?

A

Ovcon, Ovral, Necon, Yasmin, and Apri

122
Q

Brand Name of Triphasic OC 21/7?

A

Estrostep and Ortho Tri-Cyclen

123
Q

Brand Name Extended OC 24/4?

A

Loestrin-24 FE or YAZ

124
Q

Brand Name Extended OC 84/7?

A

Seasonale or Seasonique

125
Q

Brand Name Progestin Only OC?

A

Micronor or Ovrette

126
Q

Brand Name of Transdermal CHC patch?

127
Q

Brand Name of Vaginal CHC ring?

A

NuvaRing or Annovera

128
Q

Brand Name of Long Acting Injectable Progestin?

A

Depo-Provera
Depo-SQ-Provera

129
Q

Brand Name of Long Acting Implantable Progestin?

A

Implanon or Nexplanon

130
Q

Brand Name Copper IUD?

131
Q

Brand Name Levongrestrel IUD?

A

Mirena, Skyla, and Liletta

132
Q

Brand Name Progestin Only EC?

A

Plan B One Step or Next Choice One Dose

Endocrine Module (16 decks)

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