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PHRM 825 > Contraception > Flashcards

Contraception Flashcards

1
Q

Role of Estrogen in Contraception

  • Suppress ___ production
  • prevent ___ follicle
  • increase sex hormone ___ globulin (SHBG)
  • increase binding of free ___
A
  • FSH
  • dominant
  • binding
  • androgens
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2
Q

Role of Progestin in Contraception

  • Prevent ___ surge
  • inhibit ___
  • Thicken cervical ___
  • atrophy of ___
  • lessen ___
A
  • LH
  • ovulation
  • mucus
  • endometrium
  • bleeding

inhibits sperm’s swimming ability and implantation

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3
Q

Not enough estrogen

  • Breakthrough bleeding ___ in the cycle
  • ___ menses
  • vaginal ___
  • spotting
  • no ___ bleeding
A
  • early
  • light
  • dryness
  • withdrawal
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4
Q

not enough progestin

  • breakthrough bleeding ___ in cycle
  • no ___bleeding
  • ___ menses
A
  • late
  • withdrawal
  • heavy
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5
Q

Levonorgestrel has high progestational activity and high ___ activity

A

androgenic

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6
Q

Implant - Etonogestrel (Nexplanon)

  • more than ___ effective
  • left in place for up to ___ years
  • if inserted > 5 days after start of period, use backup method for ___ days
  • Return of fertility: may be delayed or rapid return within ___ weeks
A
  • 99%
  • 3 years
  • 7 days
  • 6 weeks
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7
Q

Implant - Etonogestrel (Nexplanon)

Serious SE:
* ___ changes
* headaches
* acne

Common SE:
irregular bleeding for ___ months

A
  • mood
  • 6-12
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8
Q

Levonorgestrel IUD

  • more than ___ effective
  • left in place for ___ years (based on each IUD)
  • use back up method for ___ days after insertion
  • Benefits: ___or lighter periods, safe to ___, lower risk of ___ cancer
  • Return of fertility: ___
A
  • 99%
  • 3-7 years
  • 7
  • amenorrhea, breastfeed, uterine
  • immediate
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9
Q

Levonorgestrel IUD

Serious SE: (all about insertion)
* uterine ___
* expulsion
* infection

Common SE:
* spotting for first ___ months
* periods may become ___ or less ___
* cramping with insertion

A
  • perforation
  • 3-6
  • lighter or less frequent
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10
Q

Copper IUD (Paragard)

  • More than ___ effective
  • left in place for ___ years
  • no backup method needed, effective ___
  • Benefits: lower risk of __ cancer, safe to ___
A
  • 99%
  • 10+
  • immediately
  • uterine, breastfeed
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11
Q

Copper IUD (Paragard)

Serious SE:
* uterine ___
* expulsion
* infection

Common SE:
* cramping with insertion
* spotting for the first ___ months
* periods may become ___

A
  • perforation
  • 3-6 months
  • heavier
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12
Q

Levonorgestrel Brands/Strengths/Duration

Mirena; ___ mg; ___ years
Skyla; ___ mg; ___ years
Liletta; ___ mg; ___ years
Kyleena; ___ mg; ___ years

A
  • 52 mg, 7 years
  • 13.5 mg, 3 years
  • 52 mg, 6 years
  • 19.5 mg, 5 years
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13
Q

Depo Shot

  • ___% effective
  • ___ mg IM or ___ mg SC
  • every __ months
  • Quick Start: start today and use backup for __ days
  • Next Period: start within ___ days of period
  • Benefits: lower risk of ___ cancer, safe to ___, lighter and less ___ periods
    Late dose:
  • > 15 weeks + unprotected sex, use ___
A
  • 94%
  • 150 mg; 104 mg
  • 7 days
  • 7 days
  • uterine, breastfeed, painful
  • Emergency contraception
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14
Q

Depo Shot

Serious SE:
* ___ bone density
* ___ bleeding

Common SE:
* ___ gain
* changes in ___, mood, or headaches
* spotting or ___

Return of fertility: possible ___ of return

A
  • lower
  • heavier
  • weight
  • acne
  • amenorrhea
  • delay
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15
Q

COC

  • ___% effective
  • E + P
  • Quick Start: start today, if 5 days after ___ use backup for 7 days
  • Next period: start within ___ days of period
  • wait 5 days to start is ___ is used
  • Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods

Late dose:
* 1 pill: take ASAP and take next pill at usual time
* 2 or more pills: take 1 ASAP, take next pill ay usual time, use backup for ___ days

A
  • 91%
  • period
  • 5 days
  • Ella
  • acne, ovarian/uterine, regular
  • 7 days
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16
Q

COC

Serious SE:
* Blood ___
* stroke

Common SE:
* nausea
* spotting
* ___ discomfort
* Change in __
* headaches

Return of fertility: ____

A
  • clots
  • breast
  • mood
  • immediate
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17
Q

Very low dose EE range

A

20-25 mcg

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18
Q

Low dose EE range

A

30-35 mcg

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19
Q

High dose EE range

A

50 mcg

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20
Q

Mini-Pill (POP-Norethindrone)

  • ___% effective
  • must be taken with ___ hours of the same time every day
  • no ___ in the pack
  • same starting methods as COC
  • Benefits: Safe to ___, lack of ___ related SE
  • Return of Fertility: ___
A
  • 91%
  • 3 hours
  • placebo
  • breastfeed
  • estrogen
  • immediate
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21
Q

Mini-Pill (POP-Norethindrone)

Late Dose
* if more than 3 hours late: take pill ASAP and use backup for ___ days
* miss 1 or more pills, take 1 ASAP, take next pill at usual time, and use backup for ___ days

A

2 days

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22
Q

Mini-Pill (POP-Norethindrone)

Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy

Common SE:
* spotting and menstrual changes more common than ___

A
  • headaches
  • heavy
  • ectopic
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23
Q

POP-Drospirenone 4mg (Slynd)

  • ___% effective
  • ___ placebos in the pack
  • same starting info as COC
  • same late dosing info as COC
  • Benefits: safe to ___, lack of __ related side effects
  • return of fertility: ___
A
  • 91%
  • 4
  • breastfeed, estrogen
  • immediate
24
Q

POP-Drospirenone 4mg (Slynd)

Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy
* ___kalemia

Common SE:
* spotting and menstrual changes more common than ___

A
  • headaches
  • heavy
  • ectopic
  • hyperkalemia
  • COC
25
Q

Ring - EE and Etonogestrel (Nuvaring, Eluryng)

  • ___% effective
  • E + P (releases ___ mcg of ___ per day)
  • left in place for 3 weeks and removed for ___ week
  • new ring inserted after ___ days
  • Quick Start: Start today, if more than ___ day after period, use backup for 7 days
  • Next Period: start ___ day of period
  • wait ___ days if Ella is used
  • Benefits: improved ___, lower risk for ___ cancer, more ___, light, less painful periods
  • return of fertility: ____
A
  • 91%
  • 15 mcg, EE
  • 1 week
  • 7 days
  • 1 day
  • first
  • 5 days
  • acne, ovarian/uterine, regular
  • immediate
26
Q

Ring - EE and Etonogestrel (Nuvaring, Eluryng)

Serious SE:
* Blood ___
* stroke

Common SE:
* nausea
* spotting
* ___ discomfort
* chanhes in ___
* headaches

A
  • clots
  • breast
  • mood
27
Q

Ring - EE and Etonogestrel (Nuvaring, Eluryng)

Late Dose:
* out for over 3 hours; reinsert and use backup for ___ days
* in for over ___ weeks; remove ring, put in new ring and use back up for 7 days

A
  • 7 days
  • 4 weeks
28
Q

Reusable Ring - Segestrone and EE (Annovera)

  • ___% effective
  • E + P (releases ___ mcg of ___ per day)
  • left in place for ___ weeks, removed for 1 week
  • wash with mild ___ and warm water
  • Quick Start: start today, if more than 5 days after period, used backup for 7 days
  • Next period: start on days ___ of period
  • Wait 5 days if ___ is used
  • Benefits: Improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods, can use one device up to ___ times
  • Return of fertility: ___
A
  • 97%
  • 13 mcg, EE
  • soap
  • 2-5
  • Ella
  • acne, ovarian/uterine, regular, 13x
  • immediate
29
Q

Reusable Ring - Segestrone and EE (Annovera)

Late Dose:
* out for more than 2 hours: reinsert and use backup for ___ days

A

7 days

30
Q

Reusable Ring - Segestrone and EE (Annovera)

Serious SE:
* blood ___
* stroke

Common SE:
* headache/___
* infection/___
* N/V

A
  • clots
  • migraine
  • candidiasis
31
Q

Patch - Norelgestromin and EE (Xulane, Zafemy)

  • ___% effective
  • may be less effective if over ___ lbs
  • caution with BMI over ___ (still used clinically)
  • E +P (releases ___ mcg of ___ per day)
  • patches can be applied to arm, ___ , back , or ___
  • new patch every __ weeks, patch free for ___ days
  • same starting info as COC
  • Benefit: improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods
  • Return of fertility: ___
A
  • 91%
  • 198 lbs
  • 30
  • 35 mcg, EE
  • butt, abdomen
  • 3 weeks, 7 days
  • acne, ovarian/uterine, regular
  • immediate
32
Q

Patch - Norelgestromin and EE (Xulane, Zafemy)

Late Dose:
* off over ___hours: apply new patch, backup for 7 days
* On over ___ days: apply new patch; backup for 7 days

A
  • 24 hours
  • 9 days
33
Q

Patch - Norelgestromin and EE (Xulane, Zafemy)

Serious SE:
* blood ___ (more estrogen than most COC)

Common SE:
* nausea
* spotting
* ___ discomfot
* ___ irritation
* change in ___
* headaches

A
  • clots
  • breast
  • skin
  • mood
34
Q

Patch - Levonorgestrel and EE (Twirla)

  • ___% effective
  • less effective as ___ increases
  • E + P (releases ___ mcg of ___ daily)
  • same administartion location as other patches
  • new patch every __ weeks, patch free for ___ days
  • Next Period: start on ___ day of period, use back up for the first 7 days of first cycle
  • wait ___ days is Ella is used
  • Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods, ___ risk of blood clots
  • Return of Fertility: ___
A
  • 91-96%
  • BMI
  • 30 mcg, EE
  • first
  • 5 days
  • acne, ovarian/uterine, regular, lower
  • immediate
35
Q

Patch - Levonorgestrel and EE (Twirla)

Late Dose:
* off less than __ hours: apply new patch, no backup needed
* off greater than ___ hours: apply new patch and start and use backup for 7 days

A

24 hours

36
Q

Patch - Levonorgestrel and EE (Twirla)

Serious SE:
* Blood ___

Common SE:
* nausea
* spotting
* increased ___
* ___ irritation
* changes in ___
* headaches

A
  • clots
  • weight
  • skin
  • mood
37
Q

Some Contraindications of COC

  • < ___ days postpartum
  • Venous ___
  • ___ and vascular disease
  • migraine ___ aura
  • ___ cancer
  • BP > ___
  • smoking over ___ cigs over the age of ___
  • stroke
A
  • 21 days
  • thromboembolism
  • diabetes
  • with
  • breast
  • 160/100 mmHg
  • 15 cigs, 35 years old
38
Q

T or F: antibiotics and COC is controversial, and backup should be recommended

A

Truw

39
Q

T or F: Amethyst is the only pack with no placebo pills that is FDA approved

A

True

skipping the placebo pills of other COCs is off label

40
Q

POP contraindication

current ___ cancer

A

breast

41
Q

T or F: For transgender men, testosterone treatment alone is enough to prevent pregnancy

A

FALSE; Testosterone use may decrease fertility but, can still lead to pregnancy

use contraceptives and estradiol to stop menses altogether

42
Q

T or F: CHC is controversial for use in transgender men due to the presence of estrogen

A

True; progestin only would be a better option

43
Q

T or F: Ella can only be used once per cycle

A

True

44
Q

emergency contraception types (3)

A
  • PlanB
  • Ella
  • Copper IUD
45
Q

Emergency Contraception

Copper IUD
* interferes with ___ viability and function
* Most effective EC across all ___

A
  • sperm
  • BMIs/weight
46
Q

Emergency Contraception

Ulipristal Acetate
* inhibits ___ and leads to follicular ___
* effective up to ___ days; better efficacy than LNG up to ___ lbs
* effective after ___ surge has begun
* interaction with ___ contraception
* ___ only

A
  • ovulation, rupture
  • 5 days, 194 lbs
  • LH
  • hormonal
  • rx
47
Q

Emergency Contraception

Levonorgestrel
* inhibits ___
* available ___ (not interaction with other methods)
* may be less effective over ___ lbs (BMI of ___)
* labled for ___ hours

A
  • ovulation
  • OTC
  • 165 lbs, 25
  • 72 hours
48
Q

Mifepristone (Mifeprex)

  • Selective ___ receptor modulator (SPRM)
  • Anti___
  • decidual ___
  • cervical __
  • increased uterine ___
  • prostaglandin ___
A
  • progesterone
  • progesterone
  • necrosis
  • softening
  • contractility
  • sensitivity
49
Q

Misoprostol (Cytotec)

  • Prostaglandin ___ analogue
  • cervical ___
  • uterine ___
A
  • E1
  • softening
  • contractions
50
Q

Medication abortion dosing

Mifepristone: ___ mg po for 1 dose
Misoprostol: ___ mcg buccally 24-48 hours later. (2x ___ mcg tablets in each cheek for 30 mins)

A
  • 200 mg
  • 800 mcg, 200 mcg
51
Q

Medicaltion abortion counseling points

bleeding and cramping is to be expected but contact your doctor if:
* more than ___ pads/ hour for 2 consecutive hours
* blood clots larger than a ___
* chills and fever greater than ___ or ___ for over 4 hours
* most severe pain is ___ after misoprostol

A
  • 2 pads
  • lemon
  • 101 degrees, 100.4 degrees
  • 2.5-4 hours
52
Q

Irregular Bleeding - Pills

  1. take pill at the same time each day
  2. ibuprofen ___ mg po ___ for 5 days
  3. ___ acid 500 mg po TID for 5 days
  4. change pill formulation
A
  • 800 mg, TID
  • Mefenamic
53
Q

Irregular Bleeding - Implant/IUD

  1. ibuprofen ___ mg po ___ for 5 days
  2. ___ acid 500 mg po TID for 5 days
  3. Combined pill with ___ for 1 cycle
  4. EE ___ mcg daily for ___ days
A
  • 800 mg, TID
  • Mefenamic
  • levonorgestrel
  • 50 mcg, 21 days
54
Q

Heavy/Prolonged Bleeding

  1. ibuprofen ___ mg po ___ for 5 days when bleeding starts
  2. EE ___ mcg daily for ___ days (or ___ pills)
  3. ___ acid 1500 mg po TID for 3 days, then ___. mg po daily for 2 days when bleeding starts
A
  • 800 mg, TID
  • 50 mcg, 21, combined
  • Tranexamic, 1000 mg
55
Q

Headaches and Nausea

Headaches
* pain relievers
* if during hormone free week, consider __ use
* if headaches get worse or are more often, seek evaluation

Nausea
* take pill at ___ or with ___
* if beginning of cycle, consider ___ use or ___ cycle

A
  • extended
  • bedtime, food
    *continuous, extended
56
Q

breast tenderness and acne

Breast Tenderness
* wear supportive bra
* hot/col compress
* pain relievers
* consider product with lower dose of ___

acne
* topical
* try different formulation of pills
* switch from implant/IUD to ___

A
  • estrogen
  • COC
57
Q

Mood changes

  • ___ cycle if changes during hormone free week
  • refer if major ___
A
  • continuous
  • depression

PHRM 825 (49 decks)

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