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IDT Spring > Contraception > Flashcards

Contraception Flashcards

1
Q

if patient would like to become pregnant in the next year or is okay with becoming pregnant, what is the recommendation?

A

400mcg folic acid daily and screen for health concerns

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2
Q

what is the most common form of contraception in the US?

A

permanent contraception

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3
Q

which form of contraception is most effective?

A

LARCs (IUDs)

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4
Q

what are reasons why you would not start someone on either Cu-IUD or LNG-IUD?

A

distorted uterus, cervical cancer, endometrial cancer, or evidence/suspicion of intrauterine disease

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5
Q

which form of contraception is the only type that can be used with current or past breast cancer?

A

Copper-IUD

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6
Q

which form of contraception is the only type contraindicated with breastfeeding/DVT/PE?

A

CHC

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7
Q

which contraceptives should not be used in diabetes +vascular disease?

A

injection and CHC

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8
Q

which contraceptive should not be used if pt experiences migraines with aura?
same as if pt is over 35 and smokes?

A

CHC

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9
Q

the contraceptive choice project showed significant reduction in teen births and abortions

A

.

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10
Q

Etonogestrel Implant—

A

progestin-only
effective for 3 years
causes lighter to no periods since it prevents ovulation and thins endometrial lining
SE: irregular bleeding

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11
Q

T/F an etonogestrel implant requires 3 weeks post-removal before fertility returns

A

false, immediate return

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12
Q

T/F etonogestrel implant has studied efficacy for 5 years, but is not FDA approved for this duration of therapy

A

true

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13
Q

when should etonogestrel implant not be used?

A

undiagnosed abnormal bleeding
history of breast. cervical, and uterine cancer
acute liver disease or tumor

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14
Q

what is levonorgestrel IUD indicated for?
what are the 4 types available and their length of use?
what type of contraception is it?

A

contraception
heavy menstrual bleeding
EC? (not FDA approved)
Mirena: 8 years
Liletta: 8 years
Kyleena: 5 years
Skyla: 3 years
Progestin-only

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15
Q

LNG-IUD should not be used with active, possible, or very recent? why?

A

pelvic inflammatory disease
IUD increases risk of infection or vaginal bleeding, same risks with PID

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16
Q

how long does the Cu-IUD work for?
common SE?
contraindications?
LNG-IUD should not be used with active, possible, or very recent?

A

10 years
bleeding
Wilson’s disease or allergy to any component of ParaGard, or severe anemia
PID

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17
Q

IUD counseling: PAINS stands for?

A

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

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18
Q

what does DMPA stand for?
what are the 2 formulations?
counseling points?

A

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

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19
Q

what are the DMPA concerns with BMD?

A

reduces BMD, pts should be taking calcium and exercising regularly

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20
Q

what are the benefits of CHCs?

A

decreased ovarian, endometrial, and colon cancer
reduce ectopic pregnancy, anemia, acne, and menstrual abnormalities

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21
Q

CHCs are contraindicated with?

A

current/history of breast cancer
severe cirrhosis and acute hepatitis
gallbladder disease

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22
Q

risk factors for clotting when taking CHCs?

A

CVD
smoking, DM, HTN/ BP over 140/90, HLD
history of stroke, DVT, or PE
migraine with aura
age over 35

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23
Q

when is it okay to consider prescribing CHC postpartum?

A

after 42 days

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24
Q

what are the AEs with CHCs? (ACHES)

A

Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain

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25
Q

which drugs interact and reduce the effectiveness of CHCs and POPs?

A

carbamazepine
oxcarbazepine
phenytoin
topiramate
phenobarbital
primidone
felbamate

26
Q

which drug requires larger doses if taken with CHCs?

A

lamotrigine

27
Q

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?

A

10, 20, 30, 35, and 50 mcg
20 mcg
increased risk of breakthrough bleeding. increased clot risk

28
Q

what are the dosages of estradiol valerate?

A

1, 2, and 3 mg

29
Q

what dosage does Mestranol come as? what is the equivalent ethinyl estradiol dose?

A

50 mcg
35 mcg

30
Q

list the progestin-only BCs

A

norethindrone
ethynodiol
levonorgestrel
norgestrel
medroxy-progesterone
norgestimate
norelgestromin
desogestrel
etonogestrel
drospirenone
dienogest
segesterone
ulipristal

31
Q

Q&A:
do COCs cause weight gain?
depression?
decrease milk supply during breastfeeding?
do progestins have a clot risk?

A

no
no, but monitor underlying depression
possibly at beginning of milk production
no

32
Q

when is back-up contraception needed for starting:
injectable
COC
POP

A

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

33
Q

what are estrogenic SEs of CHCs?

A

nausea
breast tenderness
HAs
breakthrough bleeding
severe, but rare thromboembolic events

34
Q

what are progestogenic SEs of CHCs?

A

tiredness
mood swings
breakthrough bleeding
lighter flow

35
Q

if a patient is complaining of BTB:
check smoking status—

A

positive: counsel on quitting
negative: refer to PCP, can increase EE to 30-35 mcg and change progestin

36
Q

recommendations for late/missed CHC?

A

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

37
Q

what are the benefits of using COCs with no placebo interval?

A

no period, treats PMDD, good for overweight pts

38
Q

what is in lo loestrin fe?

A

10mcg EE + 0.1mg levonorgestrel

39
Q

what is in estrostep?

A

1mg norethindrone + stepped estrogen

40
Q

what is in mircette?

A

desogeestrel 0.14 + 20 mcg EE

41
Q

what is in safyral?

A

drospirenone 3mg + EE 30mcg + 451mcg levomefolate

42
Q

POPs are used mainly after?

A

giving birth

43
Q

what comes in the package for norethrindrone?

A

28 active pills

44
Q

what comes in the package for drospirenone?

A

24 active + 4 placebo

45
Q

what to do if pt misses a dose of norethindrone?

A

considered missed if over 3 hours late. take missed pill and then continue at regular time. use backup for 48 hours

46
Q

what to do if pt misses a dose of drospirenone?

A

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

47
Q

what are the advantages of POPs?

A

no clotting risk
less HA risk
good for pts that have heavy menstrual bleeding

48
Q

what is the OTC POP?

A

Norgestrel 0.075mg

49
Q

what is in the Xulane patch?
Twirla patch?
pts over what bodyweight have lowered efficacy w/ xulane and twirla?
counseling points?

A

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

50
Q

what to do if pt misses a patch during:
week 1
week 2/3
week 4

A

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

51
Q

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?

A

EE 15mcg + Etonogestrel
3-4 wks
3 hours
4 months… but keep in fridge

52
Q

Annovera (ring)
duration per ring?

A

1 year (13 cycles) (placed 3 wks then removed for 1 wk)

53
Q

vaginal ring counseling?

A

-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

54
Q

recommendations with delayed insertion of ring?

A

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

55
Q

what are the different EC methods?

A

Yuzpe regimen
Levonorgestrel (planB)
Ulipristal (Ella)
Copper IUD

56
Q

T/F EC can be used up to 120 hours after intercourse

A

true

57
Q

EC counseling:

A

-can delay start of next menses
-N/V, HAs, and breast tenderness
-check for pregnancy if no normal menses within 3 wks

58
Q

T/F obese women have a 3x greater risk of pregnancy

A

true

59
Q

which is the best/most effective EC?

A

Cu-IUD

60
Q

which contraceptives if considering EC due to late/missed dose cannot use UPA as EC?

A

CHCs and ring

IDT Spring (22 decks)

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