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Clinical Therapeutics 2 > Contraception 2 > Flashcards

Contraception 2 Flashcards

1
Q

what days is menstruation in the menstrual cycle

A

days 1-7

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2
Q

what days is follicular/proliferative phase in the menstrual cycle?

A

days 7-13

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3
Q

what day is ovulation in the menstrual cycle?

A

day 14

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4
Q

what day is luteal/secretory phase in the menstural cycle?

A

days 15-28

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5
Q

what should every 18-50 y/o be asked?

A

do they want to get pregnant in the next year?

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6
Q

what is efficacy and safety class 1?

A

no restriction

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7
Q

what is efficacy and safety class 2?

A

benefits > risk

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8
Q

what is efficacy and safety class 3?

A

risk > benefits

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9
Q

what is efficacy and safety class 4?

A

don’t use

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10
Q

what are the contraception options from most effective to least effective?

A

emergency contraception > sterilization > long-acting (LARC) > hormone contraception > mechanical barriers > periodic abstinence

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11
Q

what are the 3 ways of preventing contraception?

A

preventing ovulation, preventing fertilization, preventing implantation

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12
Q

what are the methods for preventing ovulation?

A

oral hormonal agents (combo, progestin only pills) vaginal insert, injectable, transdermal patch, nexplanon

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13
Q

how do the combined OCPs work to prevent ovulation?

A

prevent ovulation by inhibiting gonadotropin secretion thru an effect on both pituitary and hypothalamic centers

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14
Q

how does estrogen work in combined OCP?

A

suppresses FSH, which suppresses the development of a dominant follicle

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15
Q

what is needed to potentiate action of progestin?

A

estrogen

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16
Q

if there is less progestin, what occurs in the endometrium, the cervix, and the fallopian tubes?

A

atrophic glands in endometrium (thins uterus), thickens cervical mucus, impairs peristalsis in fallopian tubes

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17
Q

what does estrogen do to the endometrium to prevent what?

A

stabilizes the endometrium to prevent BTB

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18
Q

what dose of estrogen increases break BTB?

A

< 20

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19
Q

what 4 changes does estrogen excess cause?

A
  • breast cystic changes/tenderness
  • dysmenorrhea
  • chloasma (skin discoloration)
  • HTN
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20
Q

what 4 changes does estrogen deficiency cause?

A
  • spotting days 1-9
  • continuous bleeding and spotting
  • hypomenorrhea
  • atrophic vaginitis (menopause type sx’s)
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21
Q

how does progestin work in combined OCP?

A

suppresses LH secretion

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22
Q

what are the 1st generations of progestin?

A

norethindrone acetate, ethynodiol dictate, lynestrenol, noreethynodrel

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23
Q

what are the 2nd generations of progestin?

A

di-norgestrel, levonorgestrel

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24
Q

what are the 3rd generations of progestin?

A

desogestrel, gestodene, norgestimate

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25
Q

what are the unclassified progestins?

A

drospirenone, cyproterone acetate

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26
Q

what generation of progestin has the highest androgenic effect? what does this mean if patient has acne or hirsutism?

A

2nd generation (di-norgestrel, levonorgestrel)

means don’t use 2nd gen progestins if pt has acne or hirsutism

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27
Q

what generation of progestin has the lowest androgenic effect? what does this mean if patient has PCOS or acne/hirsutism?

A

3rd generation (desogestrel, gestodene, norgestimate)

means 3rd gen is good for PCOS symptoms

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28
Q

what 5 changes does progestin excess cause?

A
  • increased appetite
  • depression
  • fatigue
  • libido decreased
  • weight gain (non-cyclic)
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29
Q

what 4 changes does progestin deficiency cause?

A
  • BTB days 10-21
  • delayed withdrawal bleeding
  • dysmenorrhea
  • hypermenorrhea
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30
Q

what are the 6 formulations of combined OCPs?

A

monophasic, biphasic, triphasic, 4-phasic, monthly, continuous/extended formularities

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31
Q

what is the monophasic formulation of combined OCPs?

A

SAME dose of estrogen and progestin in active pills

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32
Q

what is the biphasic formulation of combined OCPs?

A

same amount of estrogen each day, progestin INCREASES HALFWAY through pack

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33
Q

what is the triphasic formulation of combined OCPs?

A

varying doses of estrogen +/- progestin every 7 days

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34
Q

what is the 4-phasic formulation of combined OCPs?

A

varying doses of estrogen AND progesterone throughout pack

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35
Q

are the biphasic, triphasic, and 4-phasic formulations of combined OCPs more/less effective than one another?

A

No, they are equally effective

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36
Q

what is the monthly formulation of combined OCPs?

A

21 days of hormones, 7 days of placebo

OR

24 days active, 4 days placebo

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37
Q

when do you get your period with the monthly formulation of combined OCPs?

A

every 28 days

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38
Q

what are the monthly formulation of combined OCPs names?

A

Yaz, Yasmin, loestrin-24, femcon

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39
Q

what effect does the monthly formulation of combined OCPs have?

A

decreases BTB and shorter period

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40
Q

what are the continuous/extended formulations of the combined OCPs? names?

A

longer active pills, less number of periods/year

Seasonale/Seasonique (4 periods/year)
Lybrel (full year of active pills -> NO PERIOD)

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41
Q

what are the continuous/extended formulations of the combined OCPs good for?

A

menorrhagia, anemia, dysmenorrhea, endometriosis, menstrual HA, PMDD

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42
Q

what formulation of combined OCP do you NOT get your period?

A

Lybrel (full year of active pills)

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43
Q

what formulation of combined OCP do you only get your period 4x/year?

A

seasonale/seasonique

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44
Q

what are adrs of combined OCPs?

A

VTE risk d/t estrogen, breast tenderness, nausea, bloating, BTB, DDI with phenytoin and Rifampin

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45
Q

what 2 medications interact with combined OCPs?

A

phenytoin and Rifampin

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46
Q

if patient has BTB on combined OCPs, what do you tell them?

A

it takes 90 days

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47
Q

how do you manage androgenic side effects hormonal OCPs?

A

select 3rd gen progestin, low dose norethindrone or ethynodiol dictate

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48
Q

how do you manage irregular, heavy, painful menses adr of hormonal OCPs?

A

increase progestin or decrease estrogen

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49
Q

how do you manage hirsutism or acne adr of hormonal OCPs?

A

increase estrogen or decrease androgen/progestin

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50
Q

how do you manage BTB, spotting (days 10-28) adr of hormonal OCPs?

A

increase progestin

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51
Q

how do you mange high risk thrombosis adr of hormonal OCPs?

A

decrease estrogen

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52
Q

how do you manage amenorrhea adr of hormonal OCPs?

A

increase estrogen

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53
Q

how do you manage breast tenderness/swelling adr of hormonal OCPs?

A

decrease estrogen

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54
Q

how do you manage BTB, spotting (days 1-9) adr of hormonal OCPs?

A

increase estrogen

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55
Q

how do you manage nausea adr of hormonal OCPs?

A

take with food at night or decrease estrogen or increase progestin

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56
Q

what are the 8 contraindications of combined OCPs?

A

(1) >35 and smoking
(2) multiple RF’s for arterial CVD (older age, smoking, DM, HTN)
(3) HTN >160/100
(4) VTE, thrombogenic mutations, hx of stroke
(5) ischemic heart disease
(6) migraine w/aura at any age (increased risk of stroke)
(7) current breast cancer
(8) impaired liver fxn

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57
Q

what MUST you obtain from the patient before prescribing any combo OCPs?

A

BP and BMI (height and weight)

also hx and pe

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58
Q

what are the 3 different ways to start combo OCPs?

A

quick start, Sunday start, first day start

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59
Q

what is the quick start method of combo OCPs?

A

most preferred, highest retention

start the same day you rx BUT reasonably exclude pregnancy

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60
Q

what is the most preferred/high retention way to start combo OCPs?

A

quick start method

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61
Q

for how many days must the pt use back up contraception when doing quick start for combo OCPs?

A

if >5 days from last period

62
Q

what is the Sunday start method of combo OCPs? what are you avoiding in this method?

A

start Sunday after period begins

avoiding withdrawal bleed on weekend

63
Q

for how many days must the pt use back up contraception when doing Sunday start method of combo OCPs?

A

backup for 7 days

64
Q

what is the first day start method of combo OCPs?

A

start on 1st day of period, NO BACKUP

65
Q

what must you always follow-up on with the pt when they are on combo OCPs?

A

BP, assess for changes in health, adrs

66
Q

what are the progestin only pills?

A

pack of 28 active pills taken continuously

67
Q

what is the MOA of the progestin only pills?

A

thickens cervical mucus, suppresses ovulation, thin endometrium

68
Q

what is the ONLY formulation of the progestin only pills?

A

Norethindrone

69
Q

what are the advantages of the progestin only pills?

A
  • rapid acting
  • back-up method for only 2 days
  • common use postpartum period (good if pt is breastfeeding b/c no estrogen)
70
Q

if pt is breastfeeding and want to be on OCP, which one should they be on?

A

progestin only pills

71
Q

wha are the disadvantages of the progestin only pills?

A

short half-life -> MUST TAKE AT THE SAME TIME EVERY DAY w/in 1 HOUR!!!

irregular bleeding patterns, not effective at suppressing follicular cysts b/c no estrogen

72
Q

when must the pt take their progestin only pills?

A

MUST TAKE AT THE SAME TIME EVERY DAY w/in 1 HOUR!!!

73
Q

what cysts are the progestin only pills not effective at suppressing and why?

A

not effective at suppressing follicular cysts b/c no estrogen

74
Q

what is the vaginal insert method for preventing ovulation? dosing?

A

nuvaring (ethinyl estradiol and etonogestrel)

dosing: monthly
- ring in for 3 weeks, ring free for 1 week (get period this time)

75
Q

what are the advantages of the nuvaring?

A

start whenever, no daily pill, less BTB

76
Q

if don’t put nuvaring in on 1st day of period what may the pt need to use?

A

back up contraception

77
Q

what is a disadvantage of the nuvaring?

A

increased vaginal discharge

78
Q

what is the injectable method for preventing ovulation? dosing?

A

Depo-provera (medroxyprogesterone acetate)

dosing: every 90 days (2 week grace period)

79
Q

what is the MOA of Depo-provera?

A

suppresses gonadotropins to inhibit ovulation

80
Q

when can you start Depo? when must you use back up contraception?

A

start anytime BUT if >7 days from last period should use back up contraception

81
Q

what is the advantage of Depo?

A

progestin only

82
Q

what are disadvantages of Depo?

A

weight gain

return of fertility is delayed (6-12 months for period to return)

bone loss d/t the lack of estrogen

83
Q

if adolescent pt is taking Depo as contraception, what should they also be taking with it and why?

A

should be taking vitamin D and calcium supplements b/c Depo lacks estrogen (it’s only progestin)

84
Q

what is the transdermal patch of preventing ovulation? dosing?

A

Ortho Evra (combo of estrogen and progestin)

weekly dosing

85
Q

where can you put Ortho Evra (transdermal patch) on your body?

A

butt, abdomen, upper outer arm, upper torso

NOT BOOBS

86
Q

what is the BBW for Ortho Evra?

A

BBW for smoking (increased clot risk)

87
Q

disadvantages of Ortho Evra?

A

BBW for smoking (increase clot risk), less effective in obese women, skin irritation

88
Q

what is Nexplanon? what’s it’s MOA?

A

long-acting reversible contraception (LARC)

MOA: suppresses ovulation and inhibits fertilization

89
Q

how long does Nexplanon last?

A

3 years (slow release of progestin - etonogestrel)

90
Q

disadvantages of Nexplanon?

A

irregular bleeding, scarring

91
Q

what are 4 methods to prevent fertilization?

A

abstinence, periodic abstinence, barrier methods/mechanical barriers, sterilization

92
Q

what is the only method of contraception that is 100% preventing BOTH pregnancy and STIs?

A

abstinence

93
Q

what are the 3 methods of periodic abstinence?

A

coitus interruptus, fertility awareness based methods, lactational amenorrhea method

94
Q

what is fertility awareness based method of periodic abstinence?

A

tracking cycle and avoiding intercourse during women’s likely fertility

95
Q

what are the 4 methods of fertility awareness based method of periodic abstinence?

A

(1) standard days method
(2) cervical mucus method (avoid when increased cervical mucus)
(3) basal body temp method
(4) symptothermal method

96
Q

what days during standard days method is woman most fertile and thus should not have intercourse?

A

days 8-19

97
Q

what is the basal body temp method?

A

basal body temp increases slightly during ovulation -> don’t have intercourse during this time

98
Q

what is the symptothermal method?

A

combo of basal body temp method and cervical mucus method

99
Q

what is lactational amenorrhea method of periodic abstinence?

A

means have high prolactin levels when breastfeeding, which inhibits LH/follicular maturation -> no ovulation

100
Q

what are the 3 requirements of anovulation (specifically if using lactational amenorrhea method of periodic abstinence as contraception)?

A

< 6 months post part, exclusively breastfeeding, amenorrhea

101
Q

what are the most popular AND most effective forms against STIs?

A

male condoms

102
Q

what are the barrier methods of contraception (prevent fertilization)

A

male condoms, female condoms, diaphragm, cervical cap, sponge, spermicides

103
Q

when can a male not use male condoms?

A

latex allergy

104
Q

when can female condoms be placed?

A

before intercourse

105
Q

are female condoms latex free?

A

yes!!!

106
Q

how does a diaphragm work?

A

covers cervix to prevent fertilization

107
Q

what increases efficacy of diaphragm?

A

using spermicide with it

108
Q

what is required to use diaphragm or cervical cap?

A

pelvic exam and measurement, must also refit after pregnancy

109
Q

how long does diaphragm last?

A

up to 2 years

110
Q

what barrier methods for contraception DON’T protect against STIs?

A

diaphragm, cervical cap, sponge, spermicides

111
Q

what must you use with the cervical cap?

A

spermicide

112
Q

what are advantages of the cervical cap?

A

reusable

113
Q

what does the sponge contain?

A

spermicide

114
Q

what is barrier method (besides female and male condoms) DOESN’T require pelvic exam/fitting?

A

sponge

115
Q

disadvantages of the sponge?

A

SULFA ALLERGY, no STI prevention, ONE TIME USE

116
Q

what barrier method has a sulfa allergy?

A

sponge

117
Q

what are spermicides?

A

chemicals that stop sperm from moving

118
Q

what are the 2 methods of female sterilization?

A

Essure and Tubal ligation

119
Q

what is Essure?

A

female sterilization method

coils cause scarring of fallopian tubes

120
Q

what is required after 3 months of Essure procedure?

A

HSG

121
Q

when can tubal ligation (method of female sterilization) be done?

A

postpartum (right after giving birth)

122
Q

what are the 3 ways of doing tubal ligation? which way is the M/C and most effective and which way has the highest risk of failure?

A

Electrocoagulation (M/C, most effective)

Tubal excision (salpingectomy)

Clips/rings (highest risk of failure)

123
Q

what cancer does female sterilization protect against?

A

ovarian cancer

124
Q

what are disadvantages of female sterilization?

A

permanent

if pregnancy happens, more likely to be ectopic

125
Q

what is a difference b/w female and male sterilization?

A

male is reversible, female isn’t

126
Q

what must men get that got a vasectomy 3 months post procedure? and what do they need to use for these 3 months?

A

semen analysis (and need to use back up for 3 months)

127
Q

what method prevent implantation?

A

intrauterine device (IUD)

128
Q

what is the M/C worldwide long-acting reversible contraception (LARC)?

A

IUD

129
Q

efficiency of IUDs are similar to what other form of contraception?

A

sterilization

130
Q

what are misconceptions of IUDs?

A

risk of PID, ectopic pregnancy, infertility

131
Q

what are 5 C/Is to IUDs?

A

(1) distortion of uterine cavity (didelphys)
(2) active infection
(3) undo uterine bleeding
(4) pregnancy
(5) postpartum sepsis

132
Q

what are the 2 types of IUDs?

A

hormonal and non-hormonal (copper IUD)

133
Q

what chemical is in the hormonal IUD?

A

levonorgestrel (progestin)

134
Q

what are the names of the hormonal IUDs and how long do each of them last?

A

Skyla (3 years), Liletta (4 years), Mirena (5 years), Kyleena (5 years)

135
Q

what is the MOA of Skyla, Liletta, Mirena, Kyleena (hormonal IUDs)?

A

prevent implantation

  • cervical mucus change and endometrial atrophy
  • inhibits binding of sperm and egg
136
Q

what must be done before inserting Skyla, Liletta, Mirena, of Kyleena (hormonal IUDs)? at what time can they be put in?

A

bimanual and cervical inspection prior to implantation (make sure uterus isn’t anteverted, retroverted)

make sure pt isn’t pregnant

can be put in immediately postpartum

137
Q

if Skyla, Liletta, Mirena, or Kyleena (hormonal IUDs) are malpositioned are they still effective? what about the copper IUD?

A

if the hormonal IUDs are malpositioned they are STILL effective

BUT copper IUD isn’t effective if malpositioned

138
Q

disadvantage of Skyla, Liletta, Mirena, Kyleena (hormonal IUDs)?

A

irregular spotting

139
Q

what is the name of the copper IUD?

A

paragard

140
Q

what is the MOA of paragard?

A

prevents implantation by enhancing cytotoxic inflammatory response w/in endometrium

141
Q

what can paragard also be used as that the hormonal IUDs can’t be?

A

emergency contraception

142
Q

disadvantages of paragard?

A

heavy period, dysmenorrhea

143
Q

what are options for emergency contraception?

A

Coper IUD (Paragard) - MOST EFFECTIVE

Pills (Progestin only M/C, but can take combo pills too)

Ulipristal selective progesterone receptor modulator pill

144
Q

emergency contraception is offered to any women up to how many days after unprotected sex?

A

5 days

145
Q

what is the MOST EFFECTIVE form of emergency contraception?

A

Paragard (copper IUD)

146
Q

what is Plan B?

A

levonorgestrel (1 pill)

147
Q

what is Ulipristal selective progesterone receptor modular?

A

type of emergency contraception that you need rx for

changes the way progesterone works, so don’t use another form of hormonal contraception b/c it will make it less effective

NEED TO WAIT 7 DAYS BEFORE RESTARTING HORMONAL CONTRACEPTION AND WILL NEED NON-HORMONAL BACK-UP IN THE MEANTIME

148
Q

when is it ok for postpartum women to have sex again?

A

6 weeks postpartum

149
Q

what are the progesterone only methods of contraception? when can you use these postpartum?

A

progestin only pills, Depo, Nexplanon, hormonal IUDs

can use these if breastfeeding

150
Q

when is a postpartum woman at increased clot risk if begin taking combo OCPs?

A

5/6 weeks postpartum -> avoid estrogen

151
Q

when can a postpartum woman begin taking combo OCPs again?

A

> 5/6 weeks postpartum if NOT breastfeeding

Clinical Therapeutics 2 (11 decks)

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