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IPFC 1 Final > Contraception 2: Non-oral contraceptives > Flashcards

Contraception 2: Non-oral contraceptives Flashcards

1
Q

What are the contents in transdermal patch (evra)
Administration?
Location?

A

Estradiol 35mcg + 200mcg norelgestromin/day

Admin:
- Once weekly for 3/4 weeks
- Not for patients over 90kg

Location:
- abdomen, arm, or buttocks
NOT breast/pelvic area

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2
Q

What are advantages of transdermal patches?

A
  • increased estrogen exposure
  • Lower rates of BTB/spotting
  • Patch can maintain ovulation inhibitory levels for 9 days (in case you forget to take it off after day 7)
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3
Q

What are disadvantages of transdermal patches?

A
  • More breast discomfort/pain
  • NV
  • dysmenorrhea
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4
Q

When should a new patch be applied?

A
  • If a patch becomes loose
  • lifts off or falls off 24hr+
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5
Q

If a patch is detached 24hr+ during week 1 or unsure how long, what do you do?

A
  • Apply a NEW patch
  • back-up contraception for 7 days
  • Consider EC
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6
Q

If a patch is detached less than 3 days during week 2/3, what do you do?

A
  • Apply a NEW patch
  • Start a NEW cycle of 3 patches with no HFI
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7
Q

If a patch is detached 3+ days during week 2/3, what do you do?

A
  • Apply a NEW patch
  • Start a NEW cycle of 3 patches with no HFI
  • Backup contraception for 7 days
  • consider EC
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8
Q

What are the contents of the NuvaRing?
Administration?

A

Etonogestrel 0.120mg/ ethinyl estradiol 15ug per day

Administation
- remain in vagina for 3 weeks (can be used with/without ring-free period
- reinsert within 3 hours
- Can work up to 4 weeks

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9
Q

If the ring is delayed insertion 24hr+ or removed more than 3 hours during week 1 or unsure how long, what do you do?

A
  • Insert ring asap
  • back-up contraception for 7 days
  • Consider EC
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10
Q

If the ring is removed less than 3 days in week 2/3, what do you do?

A
  • Insert ring asap
  • Start a NEW CYCLE with a NEW RING with no HFI
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11
Q

If the ring is removed more than 3 days in week 2/3, what do you do?

A
  • Insert ring asap
  • Start a new cycle with a new ring with no HFI
  • Backup contraception for 7 days
  • Consider EC
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12
Q

Explain the administration of medroxyprogesterone acetate (depo-provera)
Dose?
Start therapy?
Backup how long?

A
  • IM every 3 months at doses of 150mg
  • Start therapy within 5 days of menstrual bleeding
  • Use backup contraception for the first 2 weeks after injection
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13
Q

What are some adverse effects of Depo-provera?
Most common reason for stopping?
Infertility?
Risk factors?

A

ADRs
- headaches, dizziness
- weight gain
- depression, decreased libido

Most common (after 9-12 months)
- excessive bleeding and amenorrhea

Infertility lasts 6-12 months after stopping

Risk factor
- increases risk of osteoporosis (avoid use in patients at risk of this)

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14
Q

What happens if your last injection was between 13-14 weeks ago?

A

Give next injection asap

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15
Q

What happens if you your last injection was 14+ weeks and you had sex within 5 days ago and preg test is negative

A
  • Give EC
  • Take injection asap
  • Back-up contraception for 7 days
  • Take preg test 3 weeks later
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16
Q

What happens if you your last injection was 14+ weeks and you had sex more than 5 days ago and preg test is negative

A
  • Take injection asap
  • Back-up contraception for 7 days
  • Take preg test 3 weeks later
17
Q

What happens if you your last injection was 14+ weeks and you did not have sex and preg test is negative

A
  • Give next injection ASAP
  • Back-up contraception for 7 days
18
Q

What are the primary and secondary MOA of IUD/IUS?
How long are they effective for?

A

Primary: prevention of fertilization
- impaired sperm transport
- Morphological changes in endometrium
- Thicken cervical mucous

Secondary mechanism
- inhibit implantation
- inhibit of ovulation

Effective for 5 years

19
Q

What can copper IUD be used for?

A

Emergency contraception up to 7 DAYS AFTER unprotected sex

20
Q

What is the first line option for canadian youth

A

IUDs/IUS

21
Q

What are the adverse effects of IUD vs IUS
Bleeding?
Pain/dysmenorrhea?
Hormonal?
Functional ovarian cysts?

A

Bleeding
- Copper IUD inc bleeding
- IUS decreases bleeding

Pain
- Copper IUD: occurs in 6% of women
- IUS: reduced pain

Hormonal
- Only IUS: low incidence of depression, acne, headache, breast tenderness

Functional ovarian cysts occur in up to 30% of IUS users

22
Q

What are risks associated with IUD/IUS

A

Uterus perforation (hole in uterus), risk of:
- inexperienced operator
- Immobile uterus
- Postpartum insertion

23
Q

What is the contraceptive implant?
How long does it last?
Content?

A

Etonogestrol (nexplanon)
Lasts for 3 years (effective up to 4-5 years)
Contains:
- Extended release 68mg etonogestrel –> delivers 70mcg/day
- 15mg of barium sulfate

** must be able to feel it all times
- remove it if you don’t feel it

24
Q

What are benefits of associated with COC use?

A

Endometrial cancer
Ovarian cancer
Colorectal cancer

Menstrual symptoms
Pelvic inflammatory disease
Benign breast disease
Acne
Osteoporosis

25
Q

What are risks/uncertainty associated with COC use?

A
  • Gallbladder disease
  • Cervical cancer risk/uncertain
  • Breast cancer = uncertain

Cardiovascular
- hypertension
- venous thromboembolism
- stroke
- MI
- Dyslipidemia

26
Q

What medical conditions are acceptable risks to start COC (4)

A

Diabetes (if no other CV risks)
Dyslipidemia (if LDL is <41, no other risk factors)
Obesity
Family history of breast cancer (not current, or personal)

27
Q

What anti-seizure drugs are contraindicated with COC and POP

A

Carbamazepine
Phenytoin
St. John’s wort
Ritonavir
Oxcarbazepine

28
Q

Which medications are its clearance affected by COCs and POPs

A

Amitriptyline
Caffeine
Cyclosporine
Diazepam
Phenytoin

29
Q

OC interactions with drugs that induce liver enzymes

A

If drugs that induce liver enzymes is stopped
- Additional contraception for 4 weeks after

POP users should user backup contraception if on these types of drugs

IPFC 1 Final (13 decks)

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