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Therapeutics > Contraception > Flashcards

Contraception Flashcards

1
Q

What is GnRH?

A

Causes the release of FSH and LH from the pituitary

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2
Q

What is FSH?

A

Follicle stimulating hormone, which stimulates the maturation of follicles in the ovaries

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3
Q

What is Estrogen? (Estradiol)

A

Stimulates thickening of the endometrium
Suppresses FSH
Signals LH

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4
Q

What is LH?

A

Luteinizing hormone which stimulates and triggers ovvulation

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5
Q

What is progesterone?

A

Makes endometrium favourable for implantation
Signals the hypothalamus and pituitary to stop FSH and LH production

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6
Q

What are the phases of menstrual cycle?

A

Day 1: First day of period
Days 1-4 Increase FSH leading to follicle growth/development

Days 5-7
One follicle becomes dominant and estrogen productions occurs
Increase production of thin water cervical mucous

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7
Q

What is the Fertile window?

A

When we see the highest amounts of LH and FSH

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8
Q

What hormone causes the stimulation of the pituitary to release a mid cycle surge of LH?

A

Estrogen levels

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9
Q

How long after LH surge does ovulation occur?

A

28-32 hours

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10
Q

What is the luteal phase?

A

Released ovum travels through fallopian tubes and to the uterus

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11
Q

If implantation occurs what happens to the corpus luteum?

A

Corpus luteum continues to produce progesterone

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12
Q

If not implantation occurs what happens to the corpus luteum?

A

It deteriorates and stops producing progesterone

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13
Q

What occurs from the luteal phase to follicular phase?

A

Progesterone levels decrease and the endometrial lining is shedding leading to release of GnRH to start the cycle again

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14
Q

What are the 4 contraception methods?

A

Hormonal
Barrier
Permanent
Natural family planning

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15
Q

What are the two forms of estrogen available in hormonal contraceptives?

A

Ethinyl estradiol (EE)
Estetrol

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16
Q

What are progestins?

A

These are progesterone like structures that are synthetic hormones that activate progesterone receptors

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17
Q

How many generations of progestins are there?

A

4 where each generation is thought to be a bit better then the previous

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18
Q

What is the main role of estrogen and progestion?

A

To provide a negative feedback which inhibits ovulation

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19
Q

What does estrogen do?

A

It suppresses release of FSH

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20
Q

What does progestin do?

A

Suppresses release of LH and FSH
Thickens cervical mucus
Changes endometrial lining

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21
Q

What are the categories of hormonal contraception?

A

Combined
Progestin-only
Long-acting reversible contraception

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22
Q

What is phasic formulations of OC?

A

Biphasic. Fixed E, Increased P

Triphasic Fixed or variable EE, Increased P

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23
Q

What is extneded dosing?

A

Planned Hormone free interval where we continue taking oral contraception for 84 days then go 7 days of either 10mg EE or HFI

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24
Q

When is the most effective day to start the pill?

A

Day 1 of period

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25
Q

If you start the pill not on day one what is important?

A

Use backup birth control for the first 7 days to suppress ovulation

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26
Q

What is the typical failure rate of OC?

A

3-8%

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27
Q

What are the common counselling components that you should tell patients starting the pill?

A

First 3 months
Breakthrough bleeding
Breast tenderness
Nausea

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28
Q

What dose of estrogen led to nausea?

A

> 50mcg

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29
Q

How do we decrease breast tenderness S/E?

A

Decrease estrogen

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30
Q

What do we do in patients who experience break through bleeding?

A

Increase dosages of EE/P, if greater then 6 months consider other causes such as STI

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31
Q

What are some other potential adverse effects of taking the pill?

A

Weight Gain
headache and migraine
Mood changes
Acne

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32
Q

What are the potential benefits of being placed on BC?

A

Improve menstrual symptoms and PMS symptoms

Decrease incidence of endometriosis
Ovarian cancer
Osteoperosis

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33
Q

When do we usually see contraceptive failures?

A

Missed pills of less then 20mcg estrogen

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34
Q

What is the risk of venous thromboembolism with taking OC?

A

Risk is 2-3x higher than in non user

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35
Q

What are other risks that contribute to VT?

A

Increase risk with age
Increase risk with smoking and estrogen combination

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36
Q

What leads to an increased risk of MI and stroke?

A

Estrogen >50mcg day, >35 yrs, smoking, HTN, other CVD

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37
Q

What is the acronym ACHES

A
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38
Q

What are the three main types of potential drug interactions with BC?

A

enterohepatic circulation of oral contraceptives
Drugs that induce metabolism of oral contraceptives
drugs that have their metabolism altered by oral contraceptives

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39
Q

What enzyme induces and increases metabolism of BC?

A

CPY450 3A4

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40
Q

What medications are CYP450 3A4 inducers?

A

Anticonvulsants
Anti-infectives
Herbals

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41
Q

Which anticonvulsants increase metabolism of OC?

A

Carbamezapine, phenytoin

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42
Q

What anti-infectives increase metabolism of OC?

A

rifampin

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43
Q

How do we manage medications that increase metabolism of OC?

A

Increase Estrogen levels of OC
Used extended dosing
use alternative to interacting drug or other methods of birth control

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44
Q

What is the anti-convulsant that we need to be aware of with OC?

A

Lamotrigine as OC significantly decreases levels

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45
Q

If someone has migraine with aura what are we worried about?

A

Increased risk of blood clots with OC. directly CI

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46
Q

What hypertension level is CI with OC?

A

160/100

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47
Q

How long after post partum is OC CI?

A

3-6 weeks due to increase VTE, AND we want to establish breast feeding

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48
Q

What is the efficacy of the patch?

A

typical use is 8%

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49
Q

How long does a patch last?

A

7 days

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50
Q

If you apply patch other then day 1 what should be councelled?

A

7 days of back up contraception

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51
Q

Where can patches be applied?

A

upper arm, buttocks, lower abdomen, upper torso

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52
Q

What can occur in the first 2 cycles of patch usage?

A

Increased spotting

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53
Q

What weight is the patch deemed less effective?

A

> 90kg and increase risk of blood clots

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54
Q

What is the nuvaring?

A

Inserted vaginally

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55
Q

What is the effectiveness of the ring?

A

8% failure rate

56
Q

How long does the ring last for?

57
Q

Does the ring need to be present during sex?

A

No, it can be removed but needs to be re-inserted afterwards

58
Q

If the ring is not inserted day 1 what needs to be councilled?

A

7 days backup contraception

59
Q

What are the AE of intravaginal contraception

A

vaginitis
foreign body sensation
problems during sex

60
Q

What is the storage of intravaginal ring?

A

storred in pharmacy fridge
Stable for 4 months at room temp

61
Q

What is Norethindrone?

A

This is a Progeestin only pill

62
Q

What is Norethindrone MOA

A

Alters cervical mucus and endometrium

63
Q

Why would we use Norethindrone vs other combined OC?

A

In cases that Estrogen is contraindicated such as blood clots, smoker, obese, migraines

and breast feeding since it does not effect milk

64
Q

What is Drospirenone?

A

Newer Progestin only pill that has similar indications

65
Q

What is the MOA of drospirenone?

A

Its primarily used to supresse ovulation

66
Q

What is the disadvantage of Norethindrone?

A

It has a very small usage window

67
Q

Does Norethindrone have a HFI?

68
Q

How long should backup birth control be used for with Norethindrone?

A

2 days but we would most likely council 7

69
Q

With drospirenone how long is backup BC needed?

70
Q

What are the AE from Progestin only?

A

Irregular bleeding
Headache
Bloating
Acne
Breast tenderness
Potential to increase K+

71
Q

What is an issue with drosperinone in terms AE?

A

Potential to increase potassium levels

72
Q

What is Progestin only pill CI?

A

Liver disease
Breast Cancner
DI with anti-convulsants

73
Q

What is Depo?

A

This is a fairly high dose progestion only injection which prevents ovulation by suppressing LH/FSH surge

74
Q

What is the MOA of Depo?

A

Increase viscosity of cervical mucous

Prevents ovulation by suppressing LH/FSH Surge

75
Q

What is the typical effectiveness of depo?

76
Q

How often is depo given?

A

ever 12 weeks (3 months)

77
Q

If depo is injected day 1-5 is backup Contraception required?

78
Q

If Depo is injected after day 5 how long does backup methods need to be used?

79
Q

What are the adverse effects of Depo?

A

Unpredictable bleeding in first months

Hormonal associations of acne, headaches, nausea, decreased libdo

Weight gain

May decrease bone mineral density

Delayed fertility

80
Q

How long after the usage of depo can fertility take to be resume?

81
Q

What are the benefits of injectable contraception?

A

No estrogen
Few drug ineractions
Amenorrhea in 60% of cases at 12 months

Adherence is generally not an issue

82
Q

What is injectable contraception contraindicated in?

A

Breast cancer
Uncontrolled hypertension/stroke/IHD
Liver disease

83
Q

What is the black box warning on depo?

A

Loss of BMD with increased duration and usage of depo

84
Q

How long does a copper intrauterine device last?

A

3-10 years product dependant

85
Q

What is the MOA of copper IUD?

A

Copper is released and produces an inflammatory reaction that is toxic to sperm and makes sperm transport difficult and possibly prevents implantation

86
Q

What is the effectiveness of copper IUD?

A

Failure rate = 0.6%

87
Q

What is the 2 main “IUD” that are hormone based?

A

Intra uterine system where it delivers a consistent supply of levonorgestrelW

88
Q

What is the MOA of IUS?

A

Thickens cervical mucus to prevent sperm transport and permeability
Alters endometrial lining to prevent implantation
Can suppress ovulation in some individuals

89
Q

What are the AE of IUD and IUS?

A

Increase bleeding and cramping in first few months but usually subsides

Rare perforations

Pelvic inflammatory disease

90
Q

What are IUD/IUS contraindicated?

A

Pregnancy
Breast, cervical, endometrial cancner
STI or pelvic infection within 3 months
See eligibility chart

91
Q

What is Nexplanon?

A

This is an implantable contraception done by physician

92
Q

How long does Nexplanon last?

93
Q

What is the MOA of nexplanon

A

Inhibits ovulation
Changes cervical mucus

94
Q

What is the effectiveness of nexplanon

A

99% effectiveness

95
Q

What are the AE of nexplanon?

A

bleeding irregularities
Headache
Weight increase
Breast pain

96
Q

when nexplanon is inserted what should be communicated

A

Inserted day 1-5 no backup

After day 5 we need to use back up contraception ofr 7 days

97
Q

What is the mian usage of condoms

A

Decreases the risk of pregnancy and STIs

98
Q

Which condom material does not protect against STIs?

99
Q

What is the failure rate of external condoms?

A

Perfect =3%
Typical = 14%

100
Q

What is the failure rate of internal condom?

A

Perfect = 5%
Typical use= 20%

101
Q

What are the two permanent contraceptions?

A

Tubal ligation
Vasectomy

102
Q

What is the billings method?

A

Identify fertile period by recognizing change in consistency and volume of cervical mucus

103
Q

What is the calendar method of natural family planning?

A

Chart menstrual cycle over 6-12 cycles

Determine fertile period

104
Q

What is considered the fertile period?

A

Between days 7-20

105
Q

What is lactational amenorrhea method?

A

Physiological infertility from breastfeeding caused by hormonal suppression of ovulation

Breast feeding
Baby <6 months oold
Period hasnt returned

106
Q

What is considered pregnancy?

A

Begins wit the implantation of fertilized ovum. Where implanationa occurs 6-14 days after fertilization

107
Q

How long is UPA or Ela’s window of unprotected sex?

A

120 hours (5 days)

108
Q

How long is the LNG approved window?

A

72 hours Plan B

109
Q

What is the copper IUD approved window?

A

up to 7 days

110
Q

When is the time period that pregnancy is the greatest risk?

A

5 days before ovulation to 1 day after

111
Q

What is the most effective form of emergency contraception?

A

Copper IUD and it is effective up to 7 days after unprotected intercourse

112
Q

What is the dosage of progestin in Ela?

113
Q

What is the MOA of Ela/UPA?

A

Sits on progesterone receptor and prevents ovulation

Prevents/delays ovulation
Must be given before or during the peak

114
Q

What is the MOA of Levonorgestrel?

A

Delays ovulation
May inhibit sperm/Oa travel

115
Q

When can LNG/Plan B be given?

A

Between day 1 and before the LH surge (Generally days 12-13)

116
Q

When can UPA be fiven?

A

Just a little bit after the LH peak has occurred and before ovulation

117
Q

What is the AE of Oral EC?

A

N/V, cramps fatigue, headache, breast tenderness

118
Q

What is some other clinical considerations with UPA?

A

UPA is excreted in breastmilk hence you need to discard the milk for one week after using the dose

119
Q

If using BC because of a missed hormal contraception what is preferred?

A

LNG since progestin may block UPA from working

120
Q

How long after taking UPA must you wait to start hormnoal contraception again?

A

5 days, then you need to use backup brith control untill 7 days after use

121
Q

What BMI is LNG and UPA less effective?

A

LNG = >=25
UPA 25-30 (Preferred if BMI between)

Copper IUD needs to be used if BMI >30

122
Q

How long after day one can an IUD be placed?

A

After the LH surge

123
Q

If you have UPI within 24 hours/early in cycle what is preferred?

A

Copper IUD or UPA or LNG

124
Q

If you had UPI within the past 12-24 hours before mid cycle what is preferred

A

Copper IUD or UPA or LNG

125
Q

If you had UPI 24-36 hours ago mid cycle what is preferred

A

Copper IUD or UPA

126
Q

if you had UPI 72-120 hours ago past mid-cycle what is preferred?

A

Copper IUD

127
Q

What should people consider if they are interested in long acting reversible contraception?

A

Copper IUD

128
Q

How long after taking LNG can OC be taken?

A

same or next day but backup contraception must be taken for 7 days

129
Q

How long after taking UPA can OC be taken?

A

5 days, and backup contraception for 7 days (12 days total) of backup

130
Q

When after the removal of copper IUD can you start hormonal contraception?

A

7 days before removal and then backup contraception for first 7 days

OR

Keep the IUD

131
Q

What are the CI of using EC?

A

There are no evidence based absolute contraindications to oral EC except pregnancy and allergy to product components

132
Q

What is the CI with the usage of IUD?

A

Pregnancy
Unexplained vaginal/uterine bleeding
Copper allergy
Active pelvic infection

133
Q

What is Mifegymiso?

A

This is an oral tablet that is used for abortion it starts uterine contraction

134
Q

How long post pregnancy can mifepristone be taken?

135
Q

Mifegymiso dosage

136
Q

What is the age of consent

A

16 years

14 or 15 if partner isn’t >5 years older

12 or 13 if partner isn’t >2 years older

Therapeutics (10 decks)

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