Contraception

Question 1

fertile days of cycle

Answer 1

8-19

Question 2

two types of IUD

Answer 2

Copper

progestin levonorgestrel (3 and 5 year(

Question 3

LH surge ___ days before ovulation

dominant follicle develops on day ___

Answer 3

Lh surge 2 days before ovulation (tiggers meiosis)

dominant follicle on 5-7days

Question 3

Depot Caveats and side effects

Answer 3

unscheduled bleeding and ammenorrhea with continued use

reversible decrease in bone density (no fracture risk)

unaffected by hepatic enzyme inducing drugs

decreases siezure threshold and sickle cell crisis

Question 4

trasndermal patch caveats

Answer 4

less effective in body weight >90kgs

higher rate of VTE

Question 5

enzyme inducing anti-epileptics

Answer 5

phenytoin

carbamazepine

phenobarbital

primodone

topiramate (>200mg)

felbamate

vigabatron

Question 6

after ovulation oocyte retains potential for fertilization for

spem viable in tract for

Answer 6

12-24 hours

sperm viable for 120 hours

Question 6

hormonal emergency contraceptives + mechanistic requirements

Answer 6

Levonorgestrel - 72-120hours, effective only if 2-3d prior to LH peak

Ulipristal acetate - 120hrs - preventsfolciular rupture if before LH surge, delays follicular rupture for 24-48hr if taken on day of LH peak

Copper IUD

Question 7

mechanism of action for combined hormonal methods (estrogen + progestin)

Answer 7

prevent ovulaiton

thicken cervical mucus

Question 7

mechanism progestin only methods

Answer 7

ovulation suppressed in 50% of cycles

thickening of cervical mucus

possilbe prevention of implantation via thinning of endometrium

Question 9

enzyme inducing general medications (p450 3A4)

Answer 9

rifampin

griseofulvin

St johns wort

modafinil

some HIV protease inhibitors

Nevirapine (non-nucleoside reverse transcriptase inhibitor)

Question 10

caveats, progestin only pills

Answer 10

time dependent - daily dose consitency needed

unscheduled bleeding or spotting

Question 12

hematologic effets combined hormonal contraceptives

Answer 12

Increase 2 7 8 10 fibrinogen

decrease anticoag Protein S, anti-thrombin, tissue factor pathway inhibitor

induce resistance to activated protein C

Question 14

most reliable predictor of ovulation

Answer 14

LH surge

Question 15

Progestin mechanism of ovulation prevention

estrogen mechanism

Answer 15

progesstin: diminishs frequency of hypothalamic GnRH pulse frequency

inibits estrogen induced LH surge

estrogen supresses FSH preventing selection and emergence of dominant follicle

Question 16

transdermal patch mechanism

Answer 16

combined hormonal BC

ethinyl estradiol

norelegesstromin (active metabolite of norgestimate)

Question 17

Combined oral contraception formulations

Answer 17

estranes (norethinidrone-1stgen) (Norgestimate, Nesogestrel 2nd gen)

Gonanes - borgestrel, levonorgestrel (2nd gen)

sprironolactone analogue - drosprienone

Question 18

LH surge causes lutenization of ___ cells resulting in

Answer 18

luteinization of granulosa cells with increased progesterone and slowed estrogen synthesis

Question 19

LH promotes androgen production in the ___ cells

Answer 19

theca cells

Question 19

copper IUD mechanism

Answer 19

Cu ions reduce motility and viability of sperm

toxic to oocyte

prevent implantation (useful for emergency contraception)

Question 21

progestin only methods

Answer 21

Pills

Injection

implant

Question 22

androgens converted to estrogen by aromatase in _____ cells

Answer 22

granulosa cells

Question 23

vaginal ring mechanism

Answer 23

combined hormonal contraception

estradiol and etonogestrel (active metabolite of desogestrel)

Question 24

contradictions to IUD

Answer 24

pregnancy

PID within past 3 months

peurperal or post-partum sepsis within 3 months

Purulent cervicitis

undx abnormal bleeding

malignacy

Known uterine morphologic abnls

Question 25

contraindications to CHC

Answer 25

Hx of VTE, inherited or acquired thrombophilia
postpartum - 3-6wks
Hx of MI or CAD
Hx of cerebrovacular accident
smokers > 35
complicated diabetes or vascular disesase
severe HTN BP >160/100
MIgrane with aura
Liver disease
Hx
breast or endometrial cancer