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Therapeutics Humber > Contraception > Flashcards

Contraception Flashcards

1
Q

Efficacy of Methods :
1. Which are most effective (less than 1 pregnancy per 100 women in a year)?

  1. 6-12 pregnancies per 100 women in a year?
  2. 18 or more pregnancies per 100 women in a year?
A
  1. Implant (3 yrs of use), IUD (3-7 yrs), Sterilization
  2. injection, pill, patch, vaginal ring, diaphragm
  3. male condom, female condom, cervical cap, sponge, spermicide
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2
Q

Non Hormonal Contraceptives:
A,B,M,S,C,D,C,T

A

abstinence, behavioral methods, male and female condoms, spermicide, contraceptive sponge, diaphragm and cervical cap, copper IUD, tubal ligation /implant or vasectomy

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3
Q

Abstinence and Behavioral Contraception (basal body temp, cervical mucus, natural cycles app) :

Benefits?
Risks?

A

Easy to implement, no or low cost, no ae’s

High preg rates, must avoid intercourse

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4
Q

Barrier techniques :
(Condoms, diaphragms, cervical caps , sponges)

Benefits?
Risks?

A

Low method failure , low cost, low ae’s, STI protection w/condom

high use failure rates, requires correct use, requires consistency, latex allergy!

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5
Q

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 ___

A

maintenance, 10yrs, obese, SLE, APS

bleeding risk, menstrual flow, low platelets, PID, STI, wilson’s disease

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6
Q

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

A

LH , inhibs ovulation
motility
cervical mucus, penetration by sperm

endometrial lining, implantation

FSH, follicle develop,
endometrial lining,
menstrual bleeding

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7
Q

Name some Progestins (4)

A
  1. Norethindrone (oral)
  2. Drospirenone (oral)
  3. Levonorgestrel (emergency contraception)
  4. Medroxyprogesterone acetate (im injection)
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8
Q

Name some Estrogens (3)

A
  1. Ethinyl estradiol , usual dose 20-50 mcg/day
  2. Estradiol valerate (dose 1-3 mg/day)
  3. Estetrol
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9
Q

Cycle VAriations :

  1. monophasic
  2. Multiphasic .Missed pill?
  3. Alternative cycle
    -Any product can be taken __
A
  1. 21 days same active pills + 7 days off/placebo
  2. 21 days variable estrogen/progestin + 7 days placebo
    -Complicated missed pills instructions
  3. 84 + 7 day regimens
    24+4 day cycles : shorter periods
    28 day active, no inactive days

-continuously, skipping placebos

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10
Q

Initiating COC’s :
1. When can u start them?
2. Describe first day method
3. describe sunday start
4. describe quick start

  1. During these various start methods, how long should u use a back up method for?
  2. If you’re <5 days from onset of menstruation, is back up method required? What about >5 days from onset of menstruation?
A
  1. can start anytime if reasonably certain not pregnant
  2. day 1 of menstrual cycle
  3. 1st sunday after menstrual cycle begins
  4. start on office visit date
  5. Use back up method of contraception for at least 7 days after initiation

No back up
-Use back up for 7 days

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11
Q

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 __

A

99% efficacy rates
decr menstrual cramps and blood loss
-incr regularity

  • acne and PMDD
    -ovarian and endometrial
    -ectopic preg , PID
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12
Q

Category 4 : DONT USE COMBINED ORAL CONTRACEPTIVES

  1. Current ___ or history
    -___ mutations
    -Major surgery with prolonged __
  2. DM with ? (3)
  3. Current ___
  4. Pregnancy or post partum < __ days
  5. Severe decomp __ or acute __
  6. Migraines with __ any age
  7. Uncontrolled ___
  8. Smoking more than __ per day and age >= __
  9. Complicated __ ?
  10. History of cerebrovasc accident
  11. Complicated valvular heart disease, current history of ischemic heart disease
A
  1. DVT, PE
    -Thrombogenic
    -Immobilization
  2. Nephropathy, neuropathy, retinopathy
  3. breast cancer
  4. 21 days
  5. Cirrhosis, hepatitis
  6. aura
  7. htn (SBP >= 160 mmhg or DBP>=100 mmhg)
  8. 15 cigs, 35
  9. solid organ transplant
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13
Q

Age and Smoking :

Consider >35 yrs

  1. heavy smoker (more than 15 cigs a day), what category, what to avoid, and what to consider?
  2. Light smoker! (<15cigs/day)
  3. Non smoker or quit >1yr

Consider <35

  1. Heavy smoker, category, limit estrogen to, discontinue at ?
  2. Light smoker, category, use which dose?
  3. NONsmoker, Category, what to use?
A
  1. Category 4, avoid estrogen, consider progestin only
  2. Categ 3, extreme caution, close monitor, limit estrogen to 20 mcg/day
  3. Category 2, lowest effective estrogen dose
  4. categ 2, 20 mcg/day, age 35
  5. Categ 2, lowest effective estrogen dose
  6. Categ 1, safe !
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14
Q

Possible incr __ and __ risk in older individuals using COCs but there’s no incr cv risk if?

A

MI , VTE

-low dose formulations used in healthy, nonobese

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15
Q

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?

A

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

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16
Q

Common AE’s for Estrogen :

  1. If estrogen in excess (8)
  2. if deficiency? (4)

AE’s for Progestin :

  1. excess (8)
  2. deficiency(3)
A
  1. nausea, bloating, mucorrhea, melasma, htn, migraine, breast tenderness, edema
  2. BTB (early mid cycle pills 1-9), spotting, hypomenorrhea, amenorrhea
  3. incr appetite, weight gain, tiredness, depression, hypomenorrhea, acne, hair loss, hirsutism
  4. BTB (late cycle pills 10-21)
    -dysmenorrhea, hypermenorrhea
17
Q

DDI’s : reducing effectiveness of OCP’s

  1. Enzyme inducers such as (4)
    -This may cause?
  2. antibiotics (4)
  3. What drugs incr adverse effects of OCPs?
A
  1. rifampin (use additional nohormonal contraception for at least 7 days after discontinuation), phenytoin, carbam, SJW
  • break through bleeding or spotting
  1. ampicillin, peniccilin , tetracycline, bactrim
  2. P450 enzyme inhibitors such as ritonavir
18
Q

Transdermal Patch :
1. Xulane
-drug components
-AUC is higher for __
-Incr relative risk of __over COCs?

  1. 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 ?

A
  1. norelgestromin 150 mcg/day + EE 35 mcg/day
    ee
    -VTE
  2. 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

19
Q

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?

  1. Annovera
    Segesterone 150 mcg/day + EE 13 mcg/day
    -Use for how long? remove for ?
    -Reinsert within ?
    -Ring reused for how many cycles?
A
  1. 3 weeks, remove and discard. No ring for 1 week

-within 3 hrs
- backup method x7 days

  1. 3 weeks at a time, 1 week.
    -2 hrs
    -13 cycles (1 yr)
20
Q

Progestin Only Orals :

  1. Norethindrone
    -Dosage?
    -How long of a cycle?
    -If taken 3 hrs late what should u do?
  2. 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

A
  1. 0.35 mg/day
    -28 day cycle, no placebo
    -use backup for 48 hrs
  2. 4 mg/d
    -Slynd
    -24 days active drug, 4 days placebo
    -24+ hrs
    -back up for 7 days
    -acne, K, VTE
  3. Current breast cancer pt’s
21
Q

Progestin Injection

  1. Depot Medroxyprogest (DMPA)
    -DepoProvera dose?
    -DepoSubQ Provera dose?
    -No dose adj for __
    -No ___ or ___ effects ***
  2. Side effects? ** (5)
  3. If younger pt’s??
A
  1. 150 mg/mL IM q3 months
    -104 mg/.65 mL sq every 3 months

-body weight
-androgenic, estrogenic

  1. Injection site pain , bleeding irreg, amenorrhea, weight gain, headache
  2. short term bone loss
22
Q

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)

A

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

23
Q

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)

A
  1. 3 yrs
  2. 5 yrs
  3. 5 yrs

-irreg bleeding, decreases

-risk of uterine perforation, PID, ectopic preg

24
Q

What are the benefits to progestin only contraceptives? (4)

Risks?

A
  1. Ok in breastfeeding, if estrogen intolerant, longer term options, adherence issues are less
  2. Higher ectopic preg risk , DDI with CYP 450, Serum K with drospirenone, history of breast cancer, history of unexplained bleeding, SLE with antiphospholipids
25
Q

What are some side effects of Emergency contraception? (7)

A

N/V , irreg bleeding, headache, abdom pain, cramps, dizzy

26
Q

Emerg Contra : Levonorgestrel

Dose?
Available __
Take within ___ . Can take up to ___ but its less effective

A

1.5mg

OTC

72 hrs, 5 days after unprotec sex

27
Q

Emerg Contra : Ulipristal Acetate 30 mg
-Requires?
Take within how many hours?
Not recc if?

A

RX
120 hrs
breastfeeding

Therapeutics Humber (14 decks)

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