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OSD_Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

Type of estrogen seen in most COCs?

A

Ethinyl estradiol

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2
Q

Estrogen binds to what 2 binding proteins?

A

Sex-hormone-binding globulin & Albumin

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3
Q

What type of drug is Ethisterone?

What type of extra, metabolic effects does it have?

A

Progestin

Androgen-like effects b/c it was formed by a combo of Estrinyl & Testosterone

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4
Q

The main contraceptive effect of COCs is to suppress ___a___ secretion, thereby inhibiting ___b___.

A

a) gonadotropin
b) ovulation

**Specifically, steady, low, doses of estrogen and progestin inhibit the LH surge in the menstural cycle which inhibits ovulation.

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5
Q

What are the 3 main MOAs of COCs?

A
  1. Inhibiting ovulation
  2. Endometrial atrophy
  3. Thickens cervical mucus
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6
Q

Difference btwn Mono & Biphasic COC formulations?

A

Monophasic
– fixed amount of an estrogen and a progestogen in each active tablet

Biphasic/Triphasic
– varying amounts of the two hormones according to the stage of the cycle (usually fixed estrogen w/ increasing progestin according to time in cycle)

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7
Q

Levonorgestrel is a ___a___ that is structurally related to ___b___?

A

a) Progestin

b) Testosterone

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8
Q

Norethindrone is a ___a___ that is structurally related to ___b___.

A

a) Progestin

b) Testosterone

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9
Q

Ass’d risks w/ COC use?

A
  • Venous Thromboembolism (VTE)- risk increases w/ age & in those w/ other risk factors
  • Cervical ca- small inc after 5 yr use (likely due to ↑unprotected sex)
  • Primary liver cancer
  • MI- increased 3 fold if hypertension
  • CVA/ischemic – increase is 1.5-fold in normotensive non-smoking COC users & 3-fold in those with hypertension
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10
Q

Ass’d benefits of COCs aside from contraception?

A

Less menorrhagia/ dysmenorrhea

Reduction in
– Ovarian / endometrial Ca
– functional Ovarian cysts
– Benign breast lessions
– Symptomatic endometriosis
– Risk of Colon ca
– Thyroid dx

Improvement of acne (↓endogenous Testosterone via negative feedback)

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11
Q

Are COCs recommended for the prevention of colorectal cancer?

A

No, however a dec’d risk is ass’d when taking them.

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12
Q

Which is more common - Endometrial or Ovarian cancer?

Which is more deadly?

A

Endometrial = more common

Ovarian = more deadly

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13
Q

T or F?

When taken correctly, COCs are >99% effective

A

True

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14
Q

COC’s can interact with several medications, including what classes in general?

A

Antieleptics, antibiotics, & HIV medications

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15
Q

Most data indicate that the primary contributing factor to venous thromboembolism is _______ and that the various _____ components pose little risk.

A

Estrogen contributes to VTE.

Progestin is thought to pose little risk.

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16
Q

What type of contraceptive should be given to a woman w/ risk of venous thromboembolism?

A

Progestin only

Estrogen poses VTE risk

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17
Q

The risk for MI associated with COCs appears to be correlated with what 3 things?

A
  • Number of cigarettes smoked (biggest impact)
  • Age
  • Dose of estrogen in the formulation
18
Q

Women smokers should be put on what type of COCs to lower their risk of MI?

A

COCs w/ low doses of estrogen

19
Q

MOA of Estrogen in contraceptive pills? (2)

A

– Decreases FSH

– Increases progesterone receptors

20
Q

MOA of Progesterone in contraceptive pills? (4)

A

– ↓ LH
– ↓ tubal motility
– Opposes estrogens action on the endometrium
– Thickens cervical mucous

21
Q

Combined Estrogen/Progesterone MOA? (4)

A
  • Suppress GnRH midcycle surge
  • suppress ovulation
  • increase cervical mucus
  • impairs sperm motility
22
Q

Contraindications for Estrogen/Progesterone contraceptives?

A
  • Currently pregnant
  • Uncontrolled HTN, renal or liver disease
  • Current or <5yr ago breast cancer
  • Elevated risk for VTE (h/o VTE, known thrombophilia, CAD, stroke, post op from pelvic or orthopedic surgery)
23
Q

What is a Nuva ring?

A

Once a month birth control w/ Etonorgesterol/Ethinyl estradiol

  • Estrogen/progesterone transdermal absorption
  • Placed in vagina
  • May be out for 3 hours or less
  • Same advantages/risks as OCPs
24
Q

What is Ortho-Evra?

A

Weekly Patch similar to estrogen/progesterone OCPs

25
Q

Advantages & Disadvantages of combined birth control pills?

A

Advantages: effective, reversible, lighter and/or less frequent periods, decreased endometrial and ovarian cancer, inexpensive if generic, acne control

Disadvantages: requires daily use, irregular bleeding, initial nausea, effects on mood, decreased libido, VTE risk

26
Q

How to manage Nausea side effect of E/P contraception?

A

usually resolves, can try lower dose of estrogen

27
Q

How to manage Irregular Bleeding side effect of E/P contraception?

A

taking regularly, wait few months, can switch to higher estrogen

28
Q

How to manage Mood/Libido side effect of E/P contraception?

A

can try switching progesterone types

29
Q

Mirena - what is it? MOA? Length of efficacy?

A
  • Levonorgestrel containing IUD
  • MOA = inhibition of sperm transport & fertilization of ova, partial inhibition of ovulation
  • Effective at least 5 yrs
30
Q

Mirena - contraindications?

A
  • irregular uterine cavity
  • pregnancy
  • irregular bleeding with no work up

(ok for patients w/ inc’d risk of VTE b/c no estrogen)
(ok for nulliparous women, rule out cervicitis prior to placement)

31
Q

Nexplanon - what is it? MOA? Length of efficacy?

A
  • Etonogesterol subdermal implant
  • Effective at least 3 yrs
  • Requires providers to be certified
  • Increases cervical mucus, blocks ovulation
  • Unpredictable bleeding pattern
32
Q

Nexplanon - advantages? Disadvantages?

A

Advantages: Low hormone, very effective

Disadvantages: Variable bleeding pattern

33
Q

Mirena - Advantages & Disadvantages?

A

Advantages: low hormone, mostly local, very effective, decreased menstrual bleeding- as effective as ablation, 20% amenorrhea, reversible, decreased PID in long run

Disadvantages: irregular bleeding, expensive, rare risk of perforation requiring surgery, ovarian cysts, acne, increased PID at time of insertion x3wks

34
Q

Depo Provera - what is it? MOA?

A

IM or SQ injection Q3months depot medroxyprogesterone

MOA: decreases LH, endometrial lining thinning and thickened cervical mucous

35
Q

Depo Provera - AEs?

A

Weight gain

  • 5lbs 1st yr
  • 16.5lbs at 5yrs
  • Decreased bone density after 2yrs
  • Irregular periods
  • 70% amenorrhea at 9 months
36
Q

Progesterone only pill

A

MOA: increases cervical mucus, decreases sperm motility via changes in endometrium & tubal lining

  • Same amount of hormone daily, no drug free pills
  • Needs to be taken at same time daily to be effective
  • Less effective than estrogen/progesterone pills; more expensive
37
Q

What is “Coitus Interruptus”?

A

The Latin term for the pull-out method

38
Q

Ortho-Evra - AEs?

A
  • Possibly higher DVT risk than OCPs
  • Skin irritation
  • Not as effective if >198lbs
39
Q

Can you use the Progesterone only pill if breastfeeding?

A

Yes

40
Q

What can you consider if the patient can’t use estrogen due to increased risk of VTE (ie >35/smoking)?

A

Progesterone-only pill

41
Q

Progesterone-only pill - Contraindications?

A
  • Pregnant

- Irregular bleeding not worked up

42
Q

What is Adiana?

A
  • Catheter placed in tube via hysteroscopy
  • Radiofrequency heats tube, place insert
  • Wait 3 mo for scarring, needs HSG to confirm

OSD_Repro (15 decks)

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