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PR3152 Study Deck - Pharmacotherapeutics > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the two mechanism of actions for contraceptions?

A

Inhibits viable sperm from coming into contact with mature ovum

Preventing fertilized ovum from successfully implanting in endometrium

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2
Q

What are the advantages and disadvantages of using male condoms? Are there any contraindications associated?

A

CI: Those allergic to latex or rubber

Advantages: STD protection
Disadvantage: High user failure rate; poor acceptance and potential breakage

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3
Q

What are the advantages and disadvantages of using female condoms? Are there any contraindications associated with its use?

A

CI: Allergy to polyurethane, and history of toxic shock syndrome

Advantages: STD protection, inserted ahead of time
Disadvantages: Poor acceptance to ring hanging out of vagina, high user failure rate

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4
Q

What are the advantages and disadvantages of using cervical caps and diaphragm with spermicide? Are there any contraindications associated with its use?

A

CI: Allergic to latex or rubber, recurrent UTI, History of TSS, Abnormal gynecological anatomy

Advantages: Low cost and reusable
Disadvantages: High user failure rate, less protection against STI, Increased risk of UTI and cervical irritation

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5
Q

What is the mechanism of action of progestins in contraceptions?

A

Thicken cervical mucus to prevent sperm penetration, slow tubal motility: delaying sperm transport and inducing endometrial atrophy: preventing fertilized egg from reaching endometrium

Also blocks LH surge and thus prevents ovulation

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6
Q

What is the mechanism of action in adding estrogen to COC?

A

Suppress FSH release and preventing ovulation

Stabilize endometrium lining to provide cycle control

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7
Q

When is a low dose of estrogen preferred?

A

Adolescents
Underweight
Age > 35 years
Peri-menopausal
Few side effects

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8
Q

When is a high dose of estrogen preferred ?

A

Obesity
Weight > 70.5kg
Early-mid cycle breakthrough bleeding
Tendency to be non-adherent

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9
Q

When is 4th generation progestins preferred?

A

Acne, oily skin and hirustism

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10
Q

What are some advantages and disadvantages of using drosperinone?

A

Advantages: Anti-mineralcorticoid, Anti-androgenic action, Reduced water retention, Decreases acne

Disadvantages: Hyperkalemia, thromboembolism, bone loss

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11
Q

Why is cyproterone not recommended for monotherapy in COC?

A

Increased risk of thromboembolism

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12
Q

When should I consider increasing dose of progestins?

A

Late cycle breakthrough bleeding
Painful menstrual cramping

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13
Q

What are the types of COC? Describe how they are different

A

Monophasic: Contains same amount of estrogen and progesterone
- less confusing, less complicated miss dosed instructions

Multiphasic: Contains variable amount of estrogen and progesterone
- Lesser progestin overall thus lesser side effects

Conventional COC: Contains 21 day active pills and 7 days placebo OR 24 active pill and 4 days placebo
- Including active pills help decrease hormone fluctuations and side effects

Extended cycle COC: 84 active pills and 7 day placebo
- Convenient and lesser periods

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14
Q

How can a dose be initiated? Is backup contraception then needed for each type of initiation?

A

First day of menses; no need for backup contraception

Sunday start (allow weekend free menstrual period); require backup contraception for at least 7 days

Quick start; require backup contraceptive for at least 7 days and until next menstrual period

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15
Q

List out the non-contraceptive benefits of taking COC.

A

Relief from menstrual related problems
Improve menstrual regularity
Acne
Decrease ovarian cyst, ectopic pregnancy, pelvic inflammatory disease, endometriosis, uterine fibroids and benign breast disease
Decrease risk of endometrial and ovarian cancer

PCOS

Iron deficient anemia

Premenstrual dysphoric disorder

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16
Q

What are the factors to consider before choosing a COC for patient?

A

Hormonal content required

Convenience

Adherence

Tendency for oily skin, acne, hirsutism

Medical conditions such as premenstrual syndrome, dysmenorrhea

Early/late bleeding

Cramping

How regular menses is

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17
Q

What are the 3 major adverse effects of taking COC?

A

Breast cancer
Venous thromboembolism
Ischemic heart disease and myocardial infarction

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18
Q

If patient highlights breast cancer history, when should I avoid prescribing COC?

A

Age more than 40y

Family history / risk of breast cancer

Current / recent history of breast cancer within 5 years

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19
Q

How does estrogen lead to an increased risk of VTE?

A

Increase hepatic production of factor VII, X and fibrinogen of coagulation cascade

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20
Q

What are some risk factors associated with increase VTE risk?

A

Age more than 35 years old
Smoking
Obesity
Family history of VTE
Immobilization
Cancer

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21
Q

What can I consider doing for those with increased VTE risk?

A

Lower dose of estrogen with older progestin

Use progestin only contraceptives

Use barrier method

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22
Q

What are some risk factors of ischemic stroke or myocardial infarction to highlight for those on COC?

A

Age
Hypertension
Migraine headache with aura
Obesity
Dyslipidemia
Smoking
Prothrombotic mutation

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23
Q

Which risk factors is of utmost importance in preventing ischemic stroke / MI? What can I do instead?

A

Migraine headache with aura

Can consider progestin only methods or barrier contraceptives

24
Q

What are the absolute contraindications where COC use should be avoided?

A

Current breast cancer or recent breast cancer within 5 years

History of DVT / PE or acute DVT or patients with preexisting DVT and are on anticoagulant therapy

Major surgery with prolonged immobilization

< 21 days postpartum

Thrombogenic mutations

Migraine with aura

SBP > 160mmHg and DBP > 100 mmHg

HTN with vascular diseases

Current or history of ischemic heart disease

Cardiomyopathy

Smoking more than 15 sticks a day and age more than 35 years old

History of cerebrovascular disease

25
Q

List the minor adverse events that can occur

A

Breakthrough bleeding, acne, bloating, nausea and vomiting, headache, menstrual cramps and breast tenderness or weight gain

26
Q

How should I counsel patients on their experience for minor adverse effects?

A

To persevere COC use for 2-3 months before changing product unless patient is experiencing serioud adverse effects

27
Q

What can I do to help with breakthrough bleeding? HINT consider when is breakthrough bleeding occurring.

A

Early / mid cycle bleeding: Increase estrogen content

Late cycle bleeding: Increase progestin

28
Q

What can I do for acne upon taking COC?

A

Change to less androgenic progestin and consider increase estrogen

If patient is on progestin only pills, consider changing to COC

29
Q

What can I do for patients who complain of bloating upon taking COC?

A

Decrease estrogen and consider changing to drospirenone (4th gen progestin)

30
Q

What can I do for patients who complain of nausea and vomiting upon taking COC?

A

Decrease estrogen and take pills at night.
Change to progestin only products

31
Q

What to do if patient complains of headache for their COC?

A

Exclude migraine with aura

Use extended cycle / continuous cycle

32
Q

What to do if patient complains of getting menstrual cramps after taking COC?

A

Increase progestin content or change to extended cycle/continuous

33
Q

What to do if patient complains of breast tenderness or weight gain after taking COC?

A

Keep estrogen and progestin as low as possible

34
Q

What are the 3 drug drug interactions to consider for COC? What is the mode of action?

A

Rifampicin: Alter gut flora, alter metabolism and cause lesser active drug

Anticonvulsants: decreases free serum concentration of estrogen and progesterone

HIV Antiretrovirals: act as protease inhibitors

35
Q

What is the inter relationship of COC and drug drug interactions?

A

Lower the dose of hormones, increased risk of interaction compromising efficacy

36
Q

What can you advice patients who take Rifampicin and are planning to start on OCS?

A

Take backup contraceptives for at least 7 days

37
Q

What should I enquire if patient complains of a missed dose?

A

How long ago the missed dose was

38
Q

If patient missed one dose less than 48h ago, what can she do?

A

Take missed dose immeadiately and continue rest of the pack. DO NOT need backup contraceptives

39
Q

IF patient missed 2 or more consecutive doses, what can she do?

A

Take missed dose immediately and discard the other missed doses

Finish the rest of the pack

Take backup contraceptives for at least a week.

40
Q

If patient missed her COC dose on the last week of cycle, what can she do?

A

Finish remaining active pills in current pack and skip hormone free interval

Start new pack and use backup contraceptives for at least 7 days

41
Q

What are other options to consider beside COC and barrier protective method?

A

Progesterone only pills
Transdermal contraceptives
Vaginal ring
Progestin injection
IUD
Subdermal progestin

42
Q

What are some indications for progesterone only pills?

A

Breastfeeding
Intolerant to estrogen
Conditions that preclude estrogen

43
Q

What are some contraindications for progesterone only pills?

A

Current or recurrent history of breast cancer

Poor adherence

44
Q

Is back up contraception needed for progesterone only pills? What should I consider before initiating?

A

Consider when is patient starting on pills. If starting within 5 days of menses, no need backup contraception. If starting on other days, need back up contraception for 2 days.

45
Q

If dose of POP is later than 3 hours, what do I advice the patient?

A

Back up contraception for 2 days

46
Q

What is the dose of transdermal contraception?

A

Once weekly for 3 weeks followed by patch free week.

47
Q

What is the dose for vaginal ring? Is product placement important here?

A

Use for 3 weeks and discard

Product placement not as important since drug absorption is what matters

48
Q

Why are vaginal rings and transdermal contraceptives not recommended?

A

Increased exposure to VTE

49
Q

What are the potential issues of using progestin injections?

A

Delayed return of fertility

Variable breakthrough bleeding

Weight gain and short term bone loss

Need to avoid older women and those with osteoporosis risk factors

50
Q

Is progestin injection a long term solution? Why?

A

No
Requires evaluation for more than 2 years use

51
Q

What is the mode of action for IUD?

A

Inhibit sperm migration
Damage ovum
Damage and disrupt transport of fertilized ovum

52
Q

List the contraindications associated with IUD

A

Pregnancy
Current STI
Undiagnosed vaginal bleeding
Malignancy of GI
Uterine abnormalities
Uterine fibroids

53
Q

What is the difference between progestin IUD and copper IUD?

A

Menstrual frequency: Progestin IUD has decreased menstrual flow while copper IUD has heavier bleeding

Concomitant conditions:
Progestin IUD preferred for those with concomitant menorrhagia while copper IUD preferred for those with concomitant amenorrhea

Duration of use:
Progestin IUD use for 5 years while copper IUD for 10 years

Mode of action: Progestin IUD causes endometrial suppression and mucus thickening

Copper IUD can be used as emergency contraceptive

54
Q

What are the advantages and disadvantages of long acting reversible contraception?

A

Advantages: Effects are reversible

Disadvantages: Invasive

55
Q

What is a subdermal progestin implant and what are the adverse drug reactions associated?

A

Single 4cm implant containing progestin that can cause irregular bleeding pattern as an adverse drug reactions.

PR3152 Study Deck - Pharmacotherapeutics (10 decks)

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