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REI Stuff > contraception > Flashcards

contraception Flashcards

1
Q

Perfect Use vs Typical Use

A

COC 0.3/8.7
POP 0.5/3
Mirena 0.1/0.1 - best
Cu IUD 0.6/1
Implanon 0.05/1
DMPA 0.3/0.3
Withdrawal 4/18.4
Condom Male 2/17.4

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2
Q

Lap sterilization

A

unipolar/bipolar coag
fislhie clip (yung parang ipit lang na walang teeth –> best, titanium)
silastic/yoon (yung ring na rubber)
hulka (yung may teeth na plastic)

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2
Q

types of BTL

A

Pomeroy
Irving
Uchida

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3
Q

best vasectomy reversal

A

if within 3 yrs from procedure

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4
Q

predictors of success reversal BTL

A

age at reversal
4cm remaining tube

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5
Q

OCP VTE risk

A

low dose OCP regardless of progestin has inc vte risk in the first to second yr

risk inc with age and weight

estrogen inc clotting factors while progestin no effect

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6
Q

OCP MI/Stroke

A

no inc risk regardless of age if nonsmoker and EE<50mcg

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7
Q

OCP and cancers

A

(-) endom Ca
(-) ovarian Ca
(-) colorectal
+ cervical – inc CIS
+ liver Ca – hepatocellular ca
+ breast CA – uncertain

(-) = protective
+ = inc risk

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8
Q

DMPA special indication

A

sickle cell disease
seizure disorder

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9
Q

DMPA disadvantages

A

must ensure PT negative or else IUGR associated neonatal death

9 month delay to ovulation

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10
Q

PID highest in IUD

A

20 days after insertion

can be inserted post partum
but if not inserted due to infection, 4-5weeks post partum

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11
Q

DMPA backup

A

if not started during menses, backup x 7 days

can be late for up to 2 weeks

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12
Q

Diaphragm/cap/sponge/female condom

when to insert

A

6/6/24/8

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13
Q

Diaphragm/cap/sponge/female condom

duration post coitus

A

6/8/6/6

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14
Q

Diaphragm/cap/sponge/female condom
max

A

24/48/30/8

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15
Q

1st generation estrane

A

norethisterone, lynestrenol, norethyndronel, ethynodiol diacetate

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16
Q

1st generation pregnane

A

MPA, megace

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17
Q

2nd generation

A

levonorgestrel, norgestrel

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18
Q

3rd generation

A

gestodene, norgestimate, desogestrel, etonogestrel, norelgestromin

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19
Q

4th generation estrane

A

dienogest
drosperinone

20
Q

4th generation pregnane

A

nomegestrol acetate
nesterone
trimgestrone

21
Q

19-nortestosterone hormones

androgenic, progestational, estrogenic

inc insulin resistance, dec glucose tolerance

A

norethindrone
norethyndronel
ethyndronel diacetate
lynestrenol

22
Q

extended regimen

A

24 day products to:
decrease ovarian activity
dec breakthrough bleeding

23
Q

greatest incidence of breakthrough bleeding

A

first 3 months 10-30%

24
Q

patch backup algorithm

A

week 1 - backup x 7 days

week 2/3 - <48 hrs - no backup
week 2/3 - >48 hrs - backup x 7 days

week 4 - kebs

25
Q

MOA OCP

A

Progestin - inhibit LH surge - no ovulation

Estrogen - stabilize endometrium to prevent BB + inhibit FSH so no dominant follicle + help inc LH receptors

26
Q

MOA OCP progestin

A

atrophy EM
thickens cervical mucus
alters tubal secretion/peristalsis
prevents ovulation

27
Q

max length of protection of breastfeeding

A

10 weeks

28
Q

LAM (bellagio consensus)

A

no menses
baby <6 months
exclusive breastfeeding (>5 feedings >65mins/day)

98% efficacy

29
Q

when to start breastfeeding

A

miscarriage
<12 weeks - start immediately
>12 weeks - after 3 weeks

FT/PT/SVD/CS
no BF - after 3 weeks (POP), 7 weeks (COC)
BF - 3 months

30
Q

postpill amenorrhea

A

0.7-0.8%

31
Q

MOA breakthrough bleeding

A

decidualized/atrophic EM = EM fragility

fluctuations of estrogen levels associated with estrogen growth and demise

32
Q

Treatment for BB in OCPs

A

1) estrogen x 7 days regardless of day in cycle

2) stop pill x 1 week then restart

3) switch to extended regumen 24 days

33
Q

heavy smokers

A

> 15 sticks

34
Q

POP MOA

A

thickens cervical mucus and EM hostile to implantation

gonadotropins not suppressed consistently

must be given same time daily

22hrs wear off effects, 24 hrs = sperm penetration

35
Q

major cause of d/c pills

A

breakthrough bleeding

36
Q

backup algorithm POP

A

> 3 hrs late = backup x 48 hrs
if missed pill, drink pill = backup x 48 hrs
if 2 or more missed, (-) menses = do PT

37
Q

backup algorithm OCPs

A

1 pill missed - take as soon as possible, no backup

2 pills missed:
week 1/2 - take 2 pills, backup x 7 days
week 3 - start new pack, backup x 7 days

week 3 missed pills = start new pack + backup x 7 days

38
Q

Yuzpe

A

4 pills 12 hours apart x 2 doses

best if within 72 hours

39
Q

EC

A

Yuzpe

Ovral - EE 30mcg + 0.15mg LNG
Alesse EE 20mcg + 0.10mg LNG = 5tabs q12 x 2 doses
Nordette - EE 30mcg + 0.15mg LNG = 4 tabs q12 hrs x 2 doses

Plan B 0.75mg LNG q12 x 2 doses
Plan B 1step 1.5mg x 1 dose

Mifepristone 600mg

Ullipristal Acetate 30mg

Copper IUD

40
Q

MOA IUD copper

A

spermicidal intrauterine environment

41
Q

MOA EC

A

delays ovulation and prevents fertilization

does not prevent implantation/not abortifacent

42
Q

MOA IUD Mirena

A

spermicidal
inhibit implantation, sperm capacitation, penetration, survival

43
Q

in bariatric patients

A

transvaginal route
pregnancy not allowed within 18months from surgery

44
Q

ileostomy patients

A

pills absorbed in small intestine so pwede

maabsorb pa din

45
Q

DMPA and sickle cell disease

A

inhibition of
sickling and improvement in anemia in patients with sickle cell disease

46
Q

absolute CI OCPs

A

1.
2.
Thrombophlebitis, thromboembolic disorders (including a close family history, parent or sibling, suggestive of an inherited susceptibility for venous thrombosis), cerebral vascular disease, coronary occlusion, or a past history of these conditions, or conditions predisposing to these problems.
Markedly impaired liver function or liver cancer. Steroid hormones are contraindicated in patients with hepatitis until liver function tests return to normal.
3. History of coronary heart disease or cerebrovascular disease. 4. Migraine headaches with aura.
5. Diabetes mellitus with vascular disease.
6. Known or suspected breast cancer.
7. Undiagnosed abnormal vaginal bleeding.
8. Known or suspected pregnancy.
9. Smokers over the age of 35.
10. Severe hypercholesterolemia or hypertriglyceridemia. 11. Uncontrolled hypertension.
12. Breast-feeding and less than 21 days postpartum. 13. Surgery with prolonged nonmobility.
14. History of peripartum cardiomyopathy.

47
Q

relative CI OCPs

A
  1. Migraine headaches without aura 2. Controlled hypertension
  2. Gestational diabetes
  3. Diabetes mellitus
  4. Seizure disorders
  5. Obstructive jaundice in pregnancy
  6. Sickle cell disease or sickle C disease 8. Gallbladder disease
  7. Mitral valve prolapse
  8. Systemic lupus erythematosus
  9. Hyperlipidemia
  10. Smoking younger than 35
  11. Hepatic disease

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