Contraception Flashcards
Efficacy of Methods :
1. Which are most effective (less than 1 pregnancy per 100 women in a year)?
- 6-12 pregnancies per 100 women in a year?
- 18 or more pregnancies per 100 women in a year?
- Implant (3 yrs of use), IUD (3-7 yrs), Sterilization
- injection, pill, patch, vaginal ring, diaphragm
- male condom, female condom, cervical cap, sponge, spermicide
Non Hormonal Contraceptives:
A,B,M,S,C,D,C,T
abstinence, behavioral methods, male and female condoms, spermicide, contraceptive sponge, diaphragm and cervical cap, copper IUD, tubal ligation /implant or vasectomy
Abstinence and Behavioral Contraception (basal body temp, cervical mucus, natural cycles app) :
Benefits?
Risks?
Easy to implement, no or low cost, no ae’s
High preg rates, must avoid intercourse
Barrier techniques :
(Condoms, diaphragms, cervical caps , sponges)
Benefits?
Risks?
Low method failure , low cost, low ae’s, STI protection w/condom
high use failure rates, requires correct use, requires consistency, latex allergy!
Copper IUD :
Benefits such as low __, can replace it every ___, emerg contraception, can be used if __, option for __ and ___
Risks such as incr __, higher ___, avoid in ___, insertion pain, delay if __/current ___, avoid in ___
maintenance, 10yrs, obese, SLE, APS
bleeding risk, menstrual flow, low platelets, PID, STI, wilson’s disease
Understanding Mechanism :
Progestin
-Suppresses __ which ___
-decr fallopian __
-Thickens ___ which will be less permeable to ___
-Alters ___, less suitable for ___
Estrogen
-Suppresses __, prevents ___
-Stabilizes ___, prevents __ and provides cycle control
LH , inhibs ovulation
motility
cervical mucus, penetration by sperm
endometrial lining, implantation
FSH, follicle develop,
endometrial lining,
menstrual bleeding
Name some Progestins (4)
- Norethindrone (oral)
- Drospirenone (oral)
- Levonorgestrel (emergency contraception)
- Medroxyprogesterone acetate (im injection)
Name some Estrogens (3)
- Ethinyl estradiol , usual dose 20-50 mcg/day
- Estradiol valerate (dose 1-3 mg/day)
- Estetrol
Cycle VAriations :
- monophasic
- Multiphasic .Missed pill?
- Alternative cycle
-Any product can be taken __
- 21 days same active pills + 7 days off/placebo
- 21 days variable estrogen/progestin + 7 days placebo
-Complicated missed pills instructions - 84 + 7 day regimens
24+4 day cycles : shorter periods
28 day active, no inactive days
-continuously, skipping placebos
Initiating COC’s :
1. When can u start them?
2. Describe first day method
3. describe sunday start
4. describe quick start
- During these various start methods, how long should u use a back up method for?
- If you’re <5 days from onset of menstruation, is back up method required? What about >5 days from onset of menstruation?
- can start anytime if reasonably certain not pregnant
- day 1 of menstrual cycle
- 1st sunday after menstrual cycle begins
- start on office visit date
- Use back up method of contraception for at least 7 days after initiation
No back up
-Use back up for 7 days
Whats the efficacy rate of COC’s in terms of non contraceptive aspects?
-How does it change menstrual cycle related problems?
-Improvement in ?
-Reduced risk of __ and __ cancer
-Reduced risk of __ and __
99% efficacy rates
decr menstrual cramps and blood loss
-incr regularity
- acne and PMDD
-ovarian and endometrial
-ectopic preg , PID
Category 4 : DONT USE COMBINED ORAL CONTRACEPTIVES
- Current ___ or history
-___ mutations
-Major surgery with prolonged __ - DM with ? (3)
- Current ___
- Pregnancy or post partum < __ days
- Severe decomp __ or acute __
- Migraines with __ any age
- Uncontrolled ___
- Smoking more than __ per day and age >= __
- Complicated __ ?
- History of cerebrovasc accident
- Complicated valvular heart disease, current history of ischemic heart disease
- DVT, PE
-Thrombogenic
-Immobilization - Nephropathy, neuropathy, retinopathy
- breast cancer
- 21 days
- Cirrhosis, hepatitis
- aura
- htn (SBP >= 160 mmhg or DBP>=100 mmhg)
- 15 cigs, 35
- solid organ transplant
Age and Smoking :
Consider >35 yrs
- heavy smoker (more than 15 cigs a day), what category, what to avoid, and what to consider?
- Light smoker! (<15cigs/day)
- Non smoker or quit >1yr
Consider <35
- Heavy smoker, category, limit estrogen to, discontinue at ?
- Light smoker, category, use which dose?
- NONsmoker, Category, what to use?
- Category 4, avoid estrogen, consider progestin only
- Categ 3, extreme caution, close monitor, limit estrogen to 20 mcg/day
- Category 2, lowest effective estrogen dose
- categ 2, 20 mcg/day, age 35
- Categ 2, lowest effective estrogen dose
- Categ 1, safe !
Possible incr __ and __ risk in older individuals using COCs but there’s no incr cv risk if?
MI , VTE
-low dose formulations used in healthy, nonobese
What’s associated with thromboembolism?
-Specifically, which progestins have a slightly higher risk
What are the serious AE’s? (ACHES)
If u experience any of these severe ae’s what should u do?
COC’s (estrogen, progestin)
3rd gen (desogestrel, norgestimate) and 4th gen (drospirenone)
-Abdominal pain, severe
-chest pain, SOB, coughing blood
-headaches, severe
-eye problems, vision loss
-severe leg/calf pain
STOP PILLS AND REFER TO CLINICIAN
Common AE’s for Estrogen :
- If estrogen in excess (8)
- if deficiency? (4)
AE’s for Progestin :
- excess (8)
- deficiency(3)
- nausea, bloating, mucorrhea, melasma, htn, migraine, breast tenderness, edema
- BTB (early mid cycle pills 1-9), spotting, hypomenorrhea, amenorrhea
- incr appetite, weight gain, tiredness, depression, hypomenorrhea, acne, hair loss, hirsutism
- BTB (late cycle pills 10-21)
-dysmenorrhea, hypermenorrhea
DDI’s : reducing effectiveness of OCP’s
- Enzyme inducers such as (4)
-This may cause? - antibiotics (4)
- What drugs incr adverse effects of OCPs?
- rifampin (use additional nohormonal contraception for at least 7 days after discontinuation), phenytoin, carbam, SJW
- break through bleeding or spotting
- ampicillin, peniccilin , tetracycline, bactrim
- P450 enzyme inhibitors such as ritonavir
Transdermal Patch :
1. Xulane
-drug components
-AUC is higher for __
-Incr relative risk of __over COCs?
- Twirla
-Drug components
-Reduced efficacy in BMI?
-CI if BMI is __bc of ?
APply once ___ for __ then 1 week of ?
Where?
If the patch is off for more than 1 day what should u do ?
- norelgestromin 150 mcg/day + EE 35 mcg/day
ee
-VTE - Levonorgestrel 120 mcg/day + EE 30 mcg/day
->=25 kg/m^2
->=30, higher vte risk
weekly, 3 weeks, no patch
abd, buttock, upper arm or torso
apply new patch and use backup for 7 days
INTRAVAG RINGS :
1. Nuvaring
-Etonogestrel 120 mcg/day + EE 15 mcg/day
Insert the ring vaginally for how long? and then what?
If you need to remove the ring u should reinsert it when ?
What happens if the ring is removed for over 3 hrs?
- Annovera
Segesterone 150 mcg/day + EE 13 mcg/day
-Use for how long? remove for ?
-Reinsert within ?
-Ring reused for how many cycles?
- 3 weeks, remove and discard. No ring for 1 week
-within 3 hrs
- backup method x7 days
- 3 weeks at a time, 1 week.
-2 hrs
-13 cycles (1 yr)
Progestin Only Orals :
- Norethindrone
-Dosage?
-How long of a cycle?
-If taken 3 hrs late what should u do? - Drospirenone
-dosage? brand name?
-How long of cycle?
-You technically miss a dose if its been how long?
-If 2 or more active pills are missed what must u do?
-Has less ___, but monitor __ , ___ and bone loss
For both, which patients fall into category 4 that u cannot use these in? Or any progestin only products
- 0.35 mg/day
-28 day cycle, no placebo
-use backup for 48 hrs - 4 mg/d
-Slynd
-24 days active drug, 4 days placebo
-24+ hrs
-back up for 7 days
-acne, K, VTE - Current breast cancer pt’s
Progestin Injection
- Depot Medroxyprogest (DMPA)
-DepoProvera dose?
-DepoSubQ Provera dose?
-No dose adj for __
-No ___ or ___ effects *** - Side effects? ** (5)
- If younger pt’s??
- 150 mg/mL IM q3 months
-104 mg/.65 mL sq every 3 months
-body weight
-androgenic, estrogenic
- Injection site pain , bleeding irreg, amenorrhea, weight gain, headache
- short term bone loss
Progestin Implant (Nexplanon)
-Active ingredient and dose
-Whats the release mech over the first month and by the third year?
-What is common ae? (2)
etonogestrel 68 mg, releases 60 mcg/day for first month, declines to 25-30 mcg/day by third year
bleeding irreg such as amenorrhea
-or prolonged bleeding over 14 days
Progestin IUDS :
For the following, state how long they would stay in you
1. Skyla
2. Kyleena
3. Mirena, liletta
Whats common? (1)
Whats there a risk of? (3)
- 3 yrs
- 5 yrs
- 5 yrs
-irreg bleeding, decreases
-risk of uterine perforation, PID, ectopic preg
What are the benefits to progestin only contraceptives? (4)
Risks?
- Ok in breastfeeding, if estrogen intolerant, longer term options, adherence issues are less
- Higher ectopic preg risk , DDI with CYP 450, Serum K with drospirenone, history of breast cancer, history of unexplained bleeding, SLE with antiphospholipids
What are some side effects of Emergency contraception? (7)
N/V , irreg bleeding, headache, abdom pain, cramps, dizzy
Emerg Contra : Levonorgestrel
Dose?
Available __
Take within ___ . Can take up to ___ but its less effective
1.5mg
OTC
72 hrs, 5 days after unprotec sex
Emerg Contra : Ulipristal Acetate 30 mg
-Requires?
Take within how many hours?
Not recc if?
RX
120 hrs
breastfeeding
