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Therapeutics 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are contraceptive methods?

A

-condoms (male or female)
-diaphragm
-cervical sponge
-cervical cap
-spermicide
-FAM
-vaginal gel
-combined oral contraceptives
-progestin-only pills (POPs)
-DMPA
-LNG-IUD
-Cu-IUD
-implant
-emergency contraception

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2
Q

What is important to COLLECT during PPCP for contraception?

A

-age, sex, date of last menstrual period, desire for pregnancy
-medical history
-social history (tobacco, alcohol use, sexual history)
-current medications
-previous use of contraception
-blood pressure, height and weight

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3
Q

What information is required by the CDC to obtain before beginning contraception?

A

medical history, blood pressure

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4
Q

What are the goals of therapy for contraception?

A

-provide a method centered on patient’s needs (patient specific)
-limit adverse effects
-avoid use of methods that exacerbate other conditions

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5
Q

Describe: Lactic acid, citric acid, potassium bicarbonate (Phexxi)

A

-non-hormonal intravaginal contraception
- 88-93% effective
-insert contents of 1 prefilled applicator immediately before, or up to 1 hour before, vaginal intercourse
-adverse effects: vulvovaginal burning, vulvovaginal pruritis, bacterial vaginosis, urinary tract infection

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6
Q

What products can be found as combined hormonal contraception?

A

oral, vaginal ring, transdermal patch

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7
Q

What is the role of progestin in combined hormonal contraception?

A

-provides a majority of contraceptive effect
-thickens cervical mucus
-slows tubal motility
-delay sperm transport, endometrial atrophy
-blocks LH surge to prevent ovulation
-responsible for adrenergic side effects (most androgenic= 2nd gen, least androgenic= 4th gen)

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8
Q

What is the role of estrogen in combined hormonal contraception?

A

stabilize endometrial lining, cycle control

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9
Q

Contraindications for CHCs:

A

USMEC chart category 4
-blood pressure >=160/100
-postpartum <21 days
-migraines with aura
-smoking (35+ or 15+ cigs/day)
-current breast cancer
-DVT or pulmonary embolism

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10
Q

What is the black box warning for all CHCs?

A

avoid CHC in women >35 who smoke due to risk of serious cardiovascular events

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11
Q

Drug Interactions: CHCs

A

liver enzyme inducers, lamotrigine

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12
Q

How could CHC be initiated?

A

-quick start= start immediately (if >5 days since menses started, use backup for 7 days)
-day 1 start= start on day 1 of menses
-sunday start= start on sunday following menses (if > 5 days since menses started, use backup for 7 days)

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13
Q

How would you choose a combined oral contraception (COC)?

A

-start with 0.02-0.03-0.035 mg of EE (or equivalent) plus levonorgestrel or norgestimate
-patient preference (acne)
-insurance

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14
Q

What is extended cycling of COCs?

A

no placebo week
-benefits: improves dysmenorrhea, decreases menorrhagia, decreases menstrual headaches
-disadvantages: higher risk of BTB and spotting- especially first 3-6 months

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15
Q

What are the disadvantages of COCs?

A

-spotting especially during first 3 months
-side effects
-decreased libido
-compliance
-increased triglycerides
-no protection against STIs

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16
Q

What are the common adverse effects of COCs?

A

-break through bleeding (BTB)
-acne
-nausea, vomiting, diarrhea
-headaches
-breast tenderness
-weight gain

17
Q

What are the advantages of the vaginal ring?

A

-quick return to fertility
-better withdrawal bleeding/spotting pattern than COC
-potential for better compliance

18
Q

What vaginal ring can be reused for a whole year?

A

segesterone/EE (Annovera)

19
Q

Instructions for use: CHC transdermal patch

A

1 patch applied and changed weekly for 3 weeks on abdomen, upper arm, back, or buttock

20
Q

What are the disadvantages of transdermal patches?

A

-contraindicated with BMI of 30kg/m2 due to decrease effectiveness and increased risk of VTE
-increased risk of nausea, headache, and breast tenderness compared to COC
-skin irritation

21
Q

Dosing: Norethindrone

A

take daily, no placebo- may start at anytime but must use back-up contraception for 2 days if menses started >5 days

22
Q

What are the disadvantages of POP, Norethindrone?

A

missed dose is considered if taken >3 hours late- need back up for 48h

23
Q

Describe: Drospirenone (Slynd)

A

-24 active tabs, 4 placebo
-may start at anytime
-back-up needed if 2 or more consecutive days missed for 7 days
-no black box warning

24
Q

Contraindications: Drospirenone (Slynd)

A

renal impairment, adrenal insufficiency, progestin-sensitive cancer (BREAST CANCER), liver tumor, undiagnosed abnormal uterine bleeding

25
Q

What is the first OTC hormonal contraception?

A

norgestrel (Opill)- similar to norethindrone

26
Q

Describe: depot medroxyprogesterone acetate (DMPA)

A

-intramuscular injection given every 12 weeks
-avoid in breast cancer
-irregular menses for first 6 months
-return of fertility at least 10 months
-BLACK BOX WARNING: bone density loss, limit use to 2 years
-weight gain
-decrease menstrual pain, blood loss, endometrial cancer risk

27
Q

Describe: Implant Etonogesterel (Nexplanon)

A

-inhibits ovulation for first 2 years, but is used for 3
-extremely effective
-unpredictable bleeding may occur
-contraindication: breast cancer

28
Q

What are the options of intrauterine Devices (IUDs)?

A

-levonorgestrel IUDs
-copper IUD (non-hormonal)

29
Q

MOA: Levonorgestrel IUD

A

thickens cervical mucus, change uterotubal fluid to impair sperm and ovum migration, alters endometrium to prevent implantation
does not reliably impair ovulation

30
Q

What are the pros and cons of levonorgestrel IUD?

A

-pros: dysmenorrhea improvement, extremely effective, rapid return of fertility
-cons: increased spotting for first 3-6 months, expulsion/perforation, risk of infection for first 20 days

31
Q

Contraindications: Levonorgestrel IUD

A

-current breast cancer
-current pelvic inflammatory disease
-current purulent cervicitis, chlamydial or gonococcal infection
-unexplained vaginal bleeding

32
Q

MOA: Copper IUD (ParaGard)

A

inhibit sperm motility

33
Q

What are the pros and cons of Copper IUDs?

A

-pros: menses remain regular, very effective, long-lasting (10 years), rapid return to fertility
-cons: blood loss may increase, may cause dysmenorrhea, expulsion/perforation, risk of infection for first 20 days

34
Q

Contraindications: Copper IUD

A

-current pelvic inflammatory disease
-current purulent cervicitis, chlamydial or gonococcal infection
-unexplained vaginal bleeding

35
Q

What are the types of emergency contraceptions?

A

-levonorgestrel (Plan B One Step)
-ulipristal (ella)
-copper IUD (ParaGard)
-levonorgestrel IUD

36
Q

MOA: Levonorgestrel (Plan B)

A

inhibits ovulation (inhibit LH surge)- give within 72 hours after unprotected intercourse but may be given up to 120 (not as effective)

37
Q

MOA: Ulipristal (ella)

A

prescription only
selective progestin receptor modulator= delays or inhibits ovulation and delays follicular rupture must be given within 120 hours after unprotected intercourse

Therapeutics 1 (16 decks)

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