Contraception

Question 1

what contraceptives protect against endometrial cancer?

Answer 1

CHC, depot, non medicated IUCs

Question 2

what contraceptives protect against ovarian cancer?

Answer 2

CHC

Question 3

how soon after a hysteroscopic tubal sterilization or vasectomy do you need to check for completion?

Answer 3

3 mo

Question 4

what are the potential side effects of a diaphragm?

Answer 4

UTIs, vaginal irritation, recurrent yeast infections

Question 5

when should you not prescribe COCs in women >35?

Answer 5

if they smoke

this increases their risk for cardiovascular risk

Question 6

what tests do you need before prescribing COCs?

Answer 6

blood pressure

pregnancy

Question 7

what test do you need before prescribing a diaphragm or cervical cap?

Answer 7

bimanual exam

Question 8

when should you not prescribe COCs to a woman > 35?

Answer 8

if they smoke,
will increase cardiovascular risk
if they have a migraine w/ aura
will inc. risk of stroke

Question 9

what is the main mechanism of COCs?

Answer 9

inhibit ovulation

Question 10

what does the estrogen component of a COC do?

Answer 10

suppresses FSH release, stabilizes endometrium

Question 11

what does the progesterone component of a COC do?

Answer 11

increases mucus thickness and keeps implantation from happening

Question 12

is levonorgestrel prescribed for emergency contraception

Answer 12

yes

Question 13

what is the initial recommended estrogen treatment?

Answer 13

low dose,

Question 14

what can higher doses of estrogen cause?

Answer 14

inc. risk of DVT/PE and stroke

Question 15

what can a lower dose estrogen cause?

Answer 15

spotting or breakthrough bleeding

Question 16

which generation of progesterone has a higher rate of DVT? what is the name?

Answer 16

3rd gen

Norgestimate

Question 17

what are extended cycle COCs good for? what commonly happens with them

Answer 17

endometriosis, PMDD, lifestyle reasons

breakthrough bleeding

Question 18

side effects of COCs

Answer 18

breakthrough bleeding, N, wt gain, mood swings, breast tenderness, headaches, acne, facial hair growth

Question 19

what COC health risks are increased with smoking?

Answer 19

VTE, stroke, MI

Question 20

what are the health risks with COCs?

Answer 20

VTE, stroke, MI, inc. triglycerides, cervical neoplasias

Question 21

what doubles the risk of cervical neoplasia?

Answer 21

> 5 years on COCs

Question 22

who is at increased risk of stroke on COCs?

Answer 22

women with migraines + aura

Question 23

what should obese women be prescribed?

Answer 23

progestin only, IUDs, barriers, sterilization

Question 24

what class of drugs can lower the contraceptive blood levels if taken at the same time?

Answer 24

antiepileptics

use DMPA or IUD

Question 25

what antibiotic causes dec. COC hormone levels?

Answer 25

rifampin

Question 26

what can you safely prescribe for systemic lupus erythematous patients?

Answer 26

progestin only options | especially if they have vascular/renal dz, anitphospholipid ABs

Question 27

what is the MOA of progestin only contraceptives?

Answer 27

suppress ovulation thicken cervical mucus alter tubal motility altering endometrium

Question 28

what contraception can breast feeding mother use?

Answer 28

progestin only or IUDs

Question 29

contraindications for progesterone only?

Answer 29

pregnancy, carcinoma of the breast/genitals, undiagnosed vaginal bleeding sever hepatic dysfunction

Question 30

when should you use progesterone only

Answer 30

migraines, >35 w/ smoking and obesity, hx of DVT, cardiac dz, cerebrovascular dz, HTN, systemic lupus, hypertriglyceridemia

Question 31

why must you adhere to the strict criteria of progesterone only?

Answer 31

does not effectively suppress ovulation, so if not adhered to properly can dec the efficacy

Question 32

what are the side effects of progesterone only

Answer 32

spotting, ovarian cysts, breast tenderness, irregular bleeding

Question 33

what are the side effects of depo?

Answer 33

menometrorrhagia, wt gain, bone loss

Question 34

what does the black box warning for depo say?

Answer 34

inc. risk of bone loss | do not use depo for more than 2 years

Question 35

what are the side effects of the ring?

Answer 35

vaginitis, leukorrhea, spotting, HA, nausea

Question 36

when is the patch less effective?

Answer 36

in obese women

Question 37

what is the biggest risk with the patch?

Answer 37

2 fold inc. in DVTs

Question 38

what are the 4 options for emergency contraception?

Answer 38

progestin only (plan B) ulipristal copper IUD estrogen and progestin (higher doses)

Question 39

what is the moa of ulipristal? and who is it good for?

Answer 39

bind to progesterone receptors so inhibits ovulation and alters endometrium good for obese patients

Question 40

what are the adverse effects of IUDs

Answer 40

perforation, expulsion, infections

Question 41

what is the contraindication of a copper IUC?

Answer 41

wilsons dz, copper allergy

Question 42

what do you have an inc. risk of with IUDs?

Answer 42

ectopic pregnancy