Contraception Flashcards
What phase of the menstrual cycle does menstruation occur?
Follicular phase
What phase of the menstrual cycle does ovulation occur?
Luteal phase
During the menstrual cycle what stimulates the LH and FSH surge (ovulation)?
The surge in estrogen during proliferation
What hormone builds up the endothelium lining during the luteal phase?
Progesterone
Which contraception is the MOST effective?
Implant (nexplanon)
IUD
Dospirenone
Progesterone component of COC has mild potassium sparing diuretic effects to decrease bloating and weight gain
Help with other symptomd because of the anti-androgenic effects (less acne)
SE: increased POTASSIUM
higher risk of clots
do NOT use with kidney,liver, or adrenal gland disease
What is the purpose of using COC in PCOS?
To help regulate menses
1st line treatment in PCOS!
What is the treatment for endometriosis?
COC
What is the most ideal population to take progestin only pills if they don’t have clot risk?
Breast feeding patients
***estrogen will decrease milk production :(
Sometimes used for migraine prophylaxis (safe with migraines with aura!)
What contraception formulation has a higher systemic estrogen exposure?
Patch (Xulane)
- less effective if > 198 lbs
**do NOT use in patients > 35 years old who smoke!!!!!
A patient wants to take continued COC and not have a period anymore. What COC is approved for this?
Amethyst
What is COC extended cycle?
84 days of active hormonal pills (3 months) followed by 7 days of very low dose estrogen ===== bleeding will occur every 3 months
What are some examples of progestin only pills?
Errin
Camila
Nora-BE
“norethindrone”
A female patient wants to try a extended cycle COC. What would you recommend?
Seasonique
EE + LNG
What are the ADRs of estrogen?
Nausea
Breast tenderness
Bloating
Weight gain
increase BP
Melasma (dark patches on skin)
Serious: thrombosis!!!!!
What is the signs of DVT/PE?
ACHES
Abdominal pain
Chest pain
Headache
Eye problems
Swelling
What are the ADR of progestin?
breast tenderness
headache
fatigue
A patient on Loestrin comes to your women’s health clinic complaining of breakthrough bleeding. What is your recommendation?
Increase daily estrogen dose, increase to a non “Lo” contraception
A patient on Sprintec comes complaining of breakthrough bleeding. What would your recommedation be?
Since the patient is already receiving > 35 mcg per day of estrogen… try switching the progestin product
Sprintec (norgestimate) - switch to Junel (norethindrone)
Yaz (Drospirenone)
Seasonique (Levonorgestone)
When should you NOT use combined contraceptives?
-Women > 35 years who smoke
-history of DVT/PE, CAD, thrombosis or hypercoagulopathies
- history of breast, ovarian, or liver cancer
-women with migraines with aura
A patient comes into your pharmacy on Yasmin complaining of nausea. What would your recommendation be?
DECREASE estrogen component of birth control
- switch to “lo” COC
What medications must you watch out for that may decrease the efficacy of hormonal birth control?
Antibiotics (rifampin)
Anticonvulsants (carbamazepine, topiramate, lamotrigine, primidone)
St. John’s wor
Smoking!!!!!!
Ritonavir
Colesevelam (Welchol)
Byetta
A patient was just diagnosised with hep C and was put on Mavyret. Other medications include: Junel and Altace. What major problem do we have with this new medication?
Junel is COC with estrogen. Estrogen in combo with Mavyret ===== LIVER TOXICITY
When do POP start having full pregnancy protection as you start?
48 hours after
