Contraception Flashcards
if patient would like to become pregnant in the next year or is okay with becoming pregnant, what is the recommendation?
400mcg folic acid daily and screen for health concerns
what is the most common form of contraception in the US?
permanent contraception
which form of contraception is most effective?
LARCs (IUDs)
what are reasons why you would not start someone on either Cu-IUD or LNG-IUD?
distorted uterus, cervical cancer, endometrial cancer, or evidence/suspicion of intrauterine disease
which form of contraception is the only type that can be used with current or past breast cancer?
Copper-IUD
which form of contraception is the only type contraindicated with breastfeeding/DVT/PE?
CHC
which contraceptives should not be used in diabetes +vascular disease?
injection and CHC
which contraceptive should not be used if pt experiences migraines with aura?
same as if pt is over 35 and smokes?
CHC
the contraceptive choice project showed significant reduction in teen births and abortions
.
Etonogestrel Implant—
progestin-only
effective for 3 years
causes lighter to no periods since it prevents ovulation and thins endometrial lining
SE: irregular bleeding
T/F an etonogestrel implant requires 3 weeks post-removal before fertility returns
false, immediate return
T/F etonogestrel implant has studied efficacy for 5 years, but is not FDA approved for this duration of therapy
true
when should etonogestrel implant not be used?
undiagnosed abnormal bleeding
history of breast. cervical, and uterine cancer
acute liver disease or tumor
what is levonorgestrel IUD indicated for?
what are the 4 types available and their length of use?
what type of contraception is it?
contraception
heavy menstrual bleeding
EC? (not FDA approved)
Mirena: 8 years
Liletta: 8 years
Kyleena: 5 years
Skyla: 3 years
Progestin-only
LNG-IUD should not be used with active, possible, or very recent? why?
pelvic inflammatory disease
IUD increases risk of infection or vaginal bleeding, same risks with PID
how long does the Cu-IUD work for?
common SE?
contraindications?
LNG-IUD should not be used with active, possible, or very recent?
10 years
bleeding
Wilson’s disease or allergy to any component of ParaGard, or severe anemia
PID
IUD counseling: PAINS stands for?
Period late - abnormal bleeding
Abnormal pain, or pain with intercourse
Infection exposure - abnormal vaginal discharge
Not feeling well - fever, chills
String missing, shorter or longer
what does DMPA stand for?
what are the 2 formulations?
counseling points?
depot medroxyprogesterone acetate
IM: 150mg, SubQ: 104mg
back-up needed for 1st week post first shot or if more than one week late
shot required every 12-15 wks
comes as a suspension that needs to be shaken vigorously for 1 min before administering
what are the DMPA concerns with BMD?
reduces BMD, pts should be taking calcium and exercising regularly
what are the benefits of CHCs?
decreased ovarian, endometrial, and colon cancer
reduce ectopic pregnancy, anemia, acne, and menstrual abnormalities
CHCs are contraindicated with?
current/history of breast cancer
severe cirrhosis and acute hepatitis
gallbladder disease
risk factors for clotting when taking CHCs?
CVD
smoking, DM, HTN/ BP over 140/90, HLD
history of stroke, DVT, or PE
migraine with aura
age over 35
when is it okay to consider prescribing CHC postpartum?
after 42 days
what are the AEs with CHCs? (ACHES)
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
which drugs interact and reduce the effectiveness of CHCs and POPs?
carbamazepine
oxcarbazepine
phenytoin
topiramate
phenobarbital
primidone
felbamate
which drug requires larger doses if taken with CHCs?
lamotrigine
what are the dosages of ethinyl estradiol?
what is the most typical starting dose?
what is the risk of too low of a dose? too high of a dose?
10, 20, 30, 35, and 50 mcg
20 mcg
increased risk of breakthrough bleeding. increased clot risk
what are the dosages of estradiol valerate?
1, 2, and 3 mg
what dosage does Mestranol come as? what is the equivalent ethinyl estradiol dose?
50 mcg
35 mcg
list the progestin-only BCs
norethindrone
ethynodiol
levonorgestrel
norgestrel
medroxy-progesterone
norgestimate
norelgestromin
desogestrel
etonogestrel
drospirenone
dienogest
segesterone
ulipristal
Q&A:
do COCs cause weight gain?
depression?
decrease milk supply during breastfeeding?
do progestins have a clot risk?
no
no, but monitor underlying depression
possibly at beginning of milk production
no
when is back-up contraception needed for starting:
injectable
COC
POP
inj: if 7 days after menses started, use back-up for 7 days
COC: if 5 days after menses, back-up for 7 days
POP: if 5 days after menses, back-up for 2 days
what are estrogenic SEs of CHCs?
nausea
breast tenderness
HAs
breakthrough bleeding
severe, but rare thromboembolic events
what are progestogenic SEs of CHCs?
tiredness
mood swings
breakthrough bleeding
lighter flow
if a patient is complaining of BTB:
check smoking status—
positive: counsel on quitting
negative: refer to PCP, can increase EE to 30-35 mcg and change progestin
recommendations for late/missed CHC?
if missed dose up to 48 hours, take pill asap and continue taking at same time, even if you have to take 2 pills on the same day. additional/emergency contraception not typically needed.
if missed dose over 48 hours, take first missed pill asap, discard other missed pills, and take remaining pills at the usual time. use back-up contraception for 7 days.
if pills missed during last week don’t take placebo pills and start new pack with hormonal pills
what are the benefits of using COCs with no placebo interval?
no period, treats PMDD, good for overweight pts
what is in lo loestrin fe?
10mcg EE + 0.1mg levonorgestrel
what is in estrostep?
1mg norethindrone + stepped estrogen
what is in mircette?
desogeestrel 0.14 + 20 mcg EE
what is in safyral?
drospirenone 3mg + EE 30mcg + 451mcg levomefolate
POPs are used mainly after?
giving birth
what comes in the package for norethrindrone?
28 active pills
what comes in the package for drospirenone?
24 active + 4 placebo
what to do if pt misses a dose of norethindrone?
considered missed if over 3 hours late. take missed pill and then continue at regular time. use backup for 48 hours
what to do if pt misses a dose of drospirenone?
if only 1 missed pill- resume as prescribed, no backup needed
if 2 or more missed pills- take last dose plus next dose and use backup for 7 days
what are the advantages of POPs?
no clotting risk
less HA risk
good for pts that have heavy menstrual bleeding
what is the OTC POP?
Norgestrel 0.075mg
what is in the Xulane patch?
Twirla patch?
pts over what bodyweight have lowered efficacy w/ xulane and twirla?
counseling points?
EE 35mcg + Norelgestromin
EE 30mcg + levonorgestrel
Xulane: over 90kg
Twirla: over 92kg
-should not be used continuously
-have pt set a calendar reminder to switch weekly
-SEs similar to COCs, can cause skin irritation
what to do if pt misses a patch during:
week 1
week 2/3
week 4
week 1: apply asap and must use backup for 7 days. new “day 1”
week 2/3: less than 48 hours: apply new patch, no backup necessary. same “patch change day”
over 48 hours: apply new patch and new cycle, must use back-up for 7 days. new “patch change day” and “day 1”
week 4: no back-up necessary, start next cycle on usual patch day
what is in the NuvaRing/EluRyng?
duration per ring?
how long can it be removed for (so pt can have sex)
how long is it stable at room temp?
EE 15mcg + Etonogestrel
3-4 wks
3 hours
4 months… but keep in fridge
Annovera (ring)
duration per ring?
1 year (13 cycles) (placed 3 wks then removed for 1 wk)
vaginal ring counseling?
-similar to CHCs, can cause vaginal irritation
-accuracy not req. for placement
-can be kept in during sex, tampons, and medications
-pt should set a calendar reminder to change w/ EE + Etonogestrel
recommendations with delayed insertion of ring?
less than 48 hours: insert ASAP, no additional contraception needed, emergency contraception not usually needed
over 48 hours: insert ASAP and keep until ring removal day. use back-up contraception for 7 days. emergency contraception should be considered
if removed during third week, finish the third week with ring inside and start new ring immediately without the 4th week removal interval
what are the different EC methods?
Yuzpe regimen
Levonorgestrel (planB)
Ulipristal (Ella)
Copper IUD
T/F EC can be used up to 120 hours after intercourse
true
EC counseling:
-can delay start of next menses
-N/V, HAs, and breast tenderness
-check for pregnancy if no normal menses within 3 wks
T/F obese women have a 3x greater risk of pregnancy
true
which is the best/most effective EC?
Cu-IUD
which contraceptives if considering EC due to late/missed dose cannot use UPA as EC?
CHCs and ring
