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Pharmacology > Contraception > Flashcards

Contraception Flashcards

1
Q

Female reproductive cycle review

A

28 days; 2 phases-
Day 1= first day of menseS
Two phases:
FOLLICULAR
D 1-14
Anterior pituitary releases FSH which causes eggs to begin to mature
(Usually 5-7 eggs maturing but only 1 or 2 dominant follicles)
» follicles secrete estrogen which PROMOTES GROWTH OF UTERINE LINING» when estrogen levels reach a certain point LH is secreted from anterior pituitary, finalizing follicle development and OVULATION OCCURS!
LUTEAL PHASE
D 14-28 (ovulation until menses)
Site of ovulation becomes Corpus Luteum and secretes progesterone for an impending pregnancy until placenta could take over (ie about 10 weeks)
If no fertilization, there is a loss of feedback and CL DEGRADES
» lack of progesterone&raquo_space; shedding of uterine lining

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2
Q

Types of hormonal contraception

A 
1. OCPs-
COCs (combined oral contraceptives)
Monophasic
Biphasic
Triphasic
-progestin only "mini pill"
2. IUD (mirena)
3. Other progestin-only implants (Depo Provera, Implnanon)
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3
Q

Oral contraceptives: combined OC’s almost always contAin ethinyl estradiol (EE), and a progestin.
EE is always the same but the difference in progestins…

A

…is the androgen in activity
Aka: how much does it behave like testosterone
More androgenic= more acne, bloating, hirsuitism
Newer progestins have less androgenic activity

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4
Q

OC’s: How do they work?

A
  • combined estrogen / progestin work to suppress release of FSH and LH; without ovulation pregnancy cannot occur
    1. Estrogen: suppresses LH AND FSH/speed ovum transport, decreasing fertilization time
    2. progestin: in its ovulation by suppressing release of LH, THICKEN CERVICAL MUCUS (ie barrier), and creates a more hostile environment for implantation
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5
Q

OC’s 4 types and main points on each

A
  1. Monophasic : 1 level of hormone for cycle
  2. Biphasic: 2 combos of estrogen/ progestin
  3. Triphasic: 3 “ “ “” “”
    Tripahsic: Has many different forms, either progestin or estrogen may increase or stay same
    Progestin only: constant level of progestin
    estrogen is almost always EE, but the type of progestin changes
    Progestins are all derivatives of testosterone-
    Either an estrane or a gonane does not describe pharmacological activity
    Exception = drosperinone. A derivative of aldosterone.
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6
Q

OC’s - how to pick one, how to dose

A

*start with low dose» lowest risk side effects
(Low dose pills have 18-25 mcg EE, normal pills have 30-50 mcg)
**triphasic mimics normal cycle, so good place to start

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7
Q

Low dose pill better for:

A 
History of common migraines (no aura)
Uterine fibroids
HX heavy menses
HTN
FIbrocystic blasts
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8
Q

If pt weighs more than 160#, how to dose:

A

Need pill with higher amounts estrogen and progesterone

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9
Q

If triphasic causes untoward side effects like mood swings, try…

A

Monophasic for extended cycle regimens:
Menses q 3 mo
84 days of EE/progestin
(seasonique, seasonale,Lybrel)

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10
Q

Are hormones variable in mono, bi and tri phasic? y / n

A

Hormones are viable with these preparations**

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11
Q

There are generations of progestins. The third gen, gonane, “Desogestrel/ Norgestimate,” is….

A

Least adrenergic; increased risk for blood clots

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12
Q

Progestin only pills are good choices for:

A
  1. Breastfeeding women( estrogen can decrease supply but not likely progestin)
  2. Women with HX blood clots
  3. HX of classical migraines
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13
Q

Some items to emphasize with Progestin only pills:

A
  • *must be taken same time every day- no room for error. If miss pill, use back up pill
  • there are no placebo pills
  • most women have irregular spotting but no menses
  • amenorrhea common
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14
Q

Some name of progestin- only:

A

Norethidrone (Micronor, Camila, Errin, Jovlivette)

norgestrel (overette)

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15
Q

How to start OC’s: quick start

A

Quick start=
Patient starts that day regardless of cycle
Needs back up method until next menses
Higher risk for breakthrough bleeding first month

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16
Q

How to start OC’s: First Day Start

A

Pt starts first pill first day of next cycle

No back up method needed (good for someone unlikely to use back up method)

17
Q

How to start OC’s: Sunday start

A

pt starts first Sunday after period starts

Need back up birth control for 7 days

18
Q

OC’s

Follow up, pt counseling

A

Follow up in 3 months after start
Ask about side effects and breakthrough bleeding
Note- side effects decrease with use
Encourage pt to try for at least one month in order to choose better pill if need be

19
Q

OC’s

breakthrough bleeding

A

For BB early in cycle day 1-10 or no mense during placebo week» need more estrogen support

For BB later in cycle day 10-21» need more, or a different type of progestin

20
Q

Risks of OC’s

A
  1. Increased migraine severity
  2. Increased risk CVA
  3. Headaches
  4. Blood clots
  5. HTN
  6. Mood changes
  7. Gallbladder disease
  8. Acne
  9. Bloating
  10. Hair loss / hirsuitism
21
Q

Benefits of OC’s

A

Overall very safe
Decreased menstrual bleeding so decreased risk anemia
Decreased cramping
Predictable cycle

22
Q

Contraindications of OC’s

A
  1. HX CV ischemia - MI, CVA
  2. A fib
  3. Heart failure
  4. Previous blood clot
  5. Ovarian/ breast CA
  6. Smoker > 35 yo
  7. Pregnant
  8. Uncontrolled HTN
  9. Liver tumors / disease
  10. Undiagnosed vaginal bleeding
  11. HX classical migraine (I.e., with AURA)
23
Q

Danger signs on OCS

A 
A: abdominal pain ( hepatic/ gallbladder)
C: chest pain (PE)
H: H/a ( CVA)
E: eye problems
S: swelling in legs / aching in LE (DVT)
24
Q

OC’s and CA RISK

A

Overall decrease risk (ovarian, endometrial) but NOT GIVING TO PTS with CA
40-80% less risk ovarian ca than with nonusers
Protective benefit most clear with monophasics
50-60% less risk endometrial cancer
* risk also decreases with increased length of use
Protective benefit continues 20years after last use
* slight increased risk cervical cancer
**ocs not clearly linked to increased risk breast cancer!
Breast cancer Dx in OC’s users tended to be less advanced more localized

25
Q

Depo Provera: benefits

A

Benefits:

  • progestin only so CAN USE in women with classical migraine, ?blood clots
  • minimal drug iteractions
  • high compliance (only given every 3 mo)
26
Q

Depo Provera : risks

A
  • weight gain
  • decreased bone density (worse with longer use)
  • decreases HDL AND increases LDL AND TCHOL
    • not recommended to use more than 2 yr
27
Q

Nuva Ring - how it works, how to use

A

Lower dose/ bypasses 1 st pass effect
Absorbed via vaginal mucosa
Tampons do not affect absorption
Ring left in 3 weeks (can be left in 4 weeks but might not have a period)

28
Q

Nuva Ring - how to start, what to do if mess up

A

Start within 5 days LMP
NO BACK UP METHID NEEDED
(But if left in more than 4 weeks, check a pregnancy test prior to rein steering new ring)
Can be removed for up to 3 hours with no back up birth control
BUT! If out more than 3 hours,»7 days back up method needed

29
Q

Nuva ring benefits

A

Convenient
Effective
Less chance of breakthrough bleeding

30
Q

Nuva Ring risks

A

Vaginitis
Same as OC’s
(Has estrogen)
Some PTS complain it is uncomfortable

31
Q

Depo Provera - how it works, how to give

A

SubQ progesterone only
When admin withi 5 days of LMP IMMEdiately effective
- given every 3 months
- if dose is missed must get pregnancy test!

32
Q

Who is Depo Provera not ideal for?

A

For anyone wanting to conceive within 1-2 years

33
Q

Ortho Evra THE PATCH- how admin, how it works, high

and low points

A

= transdermal form of contraception, thought to be easier than pill but still easily reversible
- worN 3 weeks/ 1 week off
- higher levels of EE - no first pass effect
$$$ can be pricey
-can be visible
-can come off early

34
Q

Implanon: how given, how it works,other tidbits

A

-implanted rod (upper arm) containing etonogestrel
- inserted within 5 days LMP
**contraception =3 years
Side effects: weight gain, acne, mood changes
Rarely migrates

35
Q

IUDS: the what the how et

A

Copper wire inserted causes local inflammation to prevent implantation
- can have spotting after insertion,increased cramping
Mirena is plastic - causes some inflammation but also a trophies uterine lining and suppresses LH AND Ovulation
* 5 year life/ most women become ammenhorreic
Either IUD CAN CAUSE PERF esp with insertion
-expulsion can occur too, encourage women to check for strings
-placed within 5 days LMP Then effective immediately

36
Q

Give an overview of the contraceptives

A
  1. The pill (monophasic, bi, tri)
  2. Patch/ Nuva Ring
  3. Deposit shot
  4. IUD
  5. Emergency contraception

Pharmacology (17 decks)

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