Contraception

Question 1

Effects of this component of OCPs includes: inhibition of the midcycle surge/ovulation. Usual dose is 30-35mcg

Answer 1

ethinyl estradiol

Question 2

Can treat other problems including acnes, dysfunctional uterine bleeding, ovarian cysts, endometriosis

Answer 2

high dose estrogen pills

Question 3

Name the older, more androgenic progesterones that lower HDL. Dose is 0.15-1.0mg

Answer 3

Norethindrone, norethindrone acetate, levonorgestrel

Question 4

Name the newer, less androgenic progesterones. Have less effect on carbs/lipid metabolism, more effective at reducing hirsutism.

Answer 4

Norgestimate & desogestrel

Question 5

What is there an increased risk of with newer progestins?

Answer 5

thromboembolism

Question 6

Makes endometrium less suitable for implantation. Alters cervical mucus making it less permeable to penetration of sperm. Impairs normal tubal motility and peristalsis

Answer 6

progestins

Question 7

What forms of OCP have a cycle that is 24 days on, 4 days off?

Answer 7

drospirenone containing forms

Question 8

What is the timeframe for the extended cycle OCPs?

Answer 8

84 days on, 7 days off

Question 9

What pill formulation are lactating women usually given?

Answer 9

mini-pill

Question 10

How long must a patient continue a backup method until pill has taken effect?

Answer 10

7-14 days

Question 11

What is the Sunday start method?

Answer 11

start 1st Sunday after period

Question 12

What does education for 1-2 missed pills include?

Answer 12

If miss 1 pill still covered for birth control. If miss 2 pills in a row must use back up method for the rest of that cycle

Question 13

How does OCP therapy affect dysmenorrhea, Fe deficiency anemia, ectopic pregnancy, ovarian cancer, benign breast dz, endometriosis?

Answer 13

lowers the risk of developing these conditions

Question 14

Most common side effect of OCP that is independent of progestin

Answer 14

breakthrough bleeding

Question 15

What can you do to address breakthrough bleeding as a side effect?

Answer 15

add extra estrogen or switch to more estrogenic progestin

Question 16

Why is the risk of cervical cancer increased with OCP?

Answer 16

In HPV positive OCP users a metabolite of estradiol can act as a cofactor w/ oncogenic HPV

Question 17

What are women who get frequent migraines at risk of with concurrent OCP use?

Answer 17

cerebral thromboembolis

Question 18

What is the effect of drugs that increase liver microsomal enzyme activity on OCPs? Examples include Phenobarbitol, phenytoin, carbamazepine, barbituates, griesofulvin. st. john’s wort

Answer 18

accelerates OCP metabolism

Question 19

What effect do antibiotics such as rifampin, tetracycline, PCNs, cephalosporins have on OCP?

Answer 19

decrease OCP efficacy.

Question 20

Delivers 20 mcg estradiol and 150 mcg of norelgestromin daily. Delivers constant level of hormone. Ortho-Evra worn for 3 wks, 1 wk off for menses.

Answer 20

contraceptive patch

Question 21

Delivers 15 mcg estradiol and 120 mcg estonogestrel daily for 3 weeks intravaginally. Removed for 1 week then a new one is inserted

Answer 21

vaginal ring

Question 22

Inhibition of ovulation by inhibiting gonadotropin secretion. Inhibits follicular maturation. Thickens and decreases amount of cervical mucus. Creates thin, atrophic endometrium. Ovum transport may be slowed

Answer 22

Progestin only mechanism of action

Question 23

Indications for progestin only methods

Answer 23

htn, age >35 and smoker or obese, migraines, SLE

Question 24

Black box warning for Depo-provera

Answer 24

bone density decrease

Question 25

How long might fertility be delayed after stopping DMPA?

Answer 25

18 months after last injection

Question 26

Single rod with slow release of 68mg etonogestrel. Lasts for 3 years. Inserted in the upper arm subdermally in the office. Irregular bleeding was the primary reason of discontinuation

Answer 26

Implanon/Nexplanon

Question 27

How long is Mirena and Styla approved for?

Answer 27

Mirena 5 yrs and Styla 3 yrs

Question 28

Local progestin effect where endometrial concentration of levonorgestrel are 1000 x higher then seen w/ implant and blood levels are very low.

Answer 28

Intrauterine Contraception (IUC)- Mirena and Styla

Question 29

releases copper continuously into the uterine cavity; this interferes with sperm transport and prevents fertilization of ova

Answer 29

Paragard

Question 30

How long can Paragard remain in place?

Answer 30

10 yrs

Question 31

Type of birth control that the following patients are ideal candidates for: low risk of STIs, not planning pregnancy for 1 yr, want a reversible form of contraception and need to avoid estrogen

Answer 31

IUC

Question 32

A dome-shaped cup made of latex or silicone. Partially filled w/ spermicidal cream/jelly and then inserted into the vagina over the cervix must be left in the vagina for 6 to 8 hrs after intercourse, then needs to be removed

Answer 32

diaphragm

Question 33

CI for diaphragm

Answer 33

toxic shock syndrome

Question 34

Reusable, deep rubber cup that fits over the cervix, must be used with a spermicide has to remain in for 6-8 hrs can be left in place for up to 48 hours

Answer 34

cervical cap (FemCap)

Question 35

circular disk that contains 1000 mg of nonoxynol-9 and has attached loop for removal. moistened w/ tap water before insertion “one size” fits all; does not require a prescription, or fitting

Answer 35

sponge

Question 36

Lines the vagina and shields introitus providing physical barrier during intercourse. More problems with breakage, slippage and incorrect penetration

Answer 36

female condom

Question 37

Disadvantages include: irritation, yeast vaginitis, enhanced spread of HIV

Answer 37

spermacides

Question 38

Associated w/ subfertility, but can only be relied upon to prevent pregnancy when: The woman is < 6 months postpartum. She is breastfeeding exclusively. She is amenorrheic

Answer 38

lactation

Question 39

What dose of emergency contraceptive is available OTC without age restrictions?

Answer 39

The single 1.5 mg dose regimen

Question 40

Inhibiting or delaying ovulation. Interfering w/ fertilization or tubal transport. Preventing implantation by altering endometrial receptivity. Causing regression of the corpus luteum

Answer 40

emergency contraceptive

Question 41

How long are emergency conraceptives effective for?

Answer 41

up to 120hrs after the event

Question 42

Recommended for couples who desire permanent contraception or sterilization

Answer 42

vasectomy

Question 43

comparable to sterilization in terms of efficacy, but are non-surgical and reversible for women who request sterilization

Answer 43

LARC methods