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Primary Care 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

only method that protects from STDs

A

condoms

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2
Q

non-contraceptive health benefits from this method

A

hormonal contraceptives

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3
Q

obamacare and birth control

A

cost sharing preventative services, covers new plans sponsored by employers, plans purchased in individual market, coverage through medicaid

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4
Q

womens preventative services

A

well woman visits, gestational dm screen, HPV testing, STI counseling, HIV screening and counseling, breastfeeding support and supplies, domestic violence screening, all contraceptive methods and sterilization

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5
Q

methods for women contraception

A

sterilization surgery, implantable rod, copper IUD, progestin IUD, injection, patch, vaginal ring, oral contraceptive pills, oral progesterone pill, oral extended release pills, diaphragm with spermicide, sponge w spermicide, cervical cap w spermicide, female condom

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6
Q

pt characteristics to review before starting contraceptive

A

age, smoking, steroid use, excessive alcohol/drug use

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7
Q

medical hx before starting contraception

A

screen for cardiovascular issues, DVTs, medications, migraines, leg pain, skin changes, BMI, HTN. family hx of cardiac, stroke or PE, breast cancer, osteoporosis

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8
Q

obstetric hx

A

any pregnancies. live births, terminations, miscarriages. future childbearing plans

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9
Q

menstrual hx

A

last period. regularity of menses. length of menses. type of flow - number of pads, bleeding after sex, their belief about their period

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10
Q

how to exclude pregnancy

A

pregnancy test. questions if answer yes then they are not pregnant: have you abstained from intercourse since your last period? have you had a normal period this week? have you been using reliable contraception? have you had a miscarriage or abortion this week? have you had a baby within 4 weeks? baby within 6 months and fully/nearly fully breast feeding and not had a period since delivery

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11
Q

physical exam before contraceptive

A

BMI. blood pressure. consider a pap. bimanual exam and cervix inspection considered for IUDs. breast exam. well woman visit if possible

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12
Q

WHO eligibility category 1

A

no restriction on use of contraception

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13
Q

who stage 2

A

benefits outweigh risks of contraception

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14
Q

who stage 3

A

risks outweigh benefits

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15
Q

who stage 4

A

unacceptable health risk if used

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16
Q

stages if smoking

A

stage 3 less than 15 cigarettes each day, 4 if more than 15

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17
Q

stage 4 conditions

A

systolic > 160, hx or current DVT, surgery w prolonged immobilization, thrombogenic mutations, hx ischemic heart disease or stroke, heart valve disease, dm w vascular disease, migraine w aura — use progesterone only methods

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18
Q

dm and contraception

A

if well controlled can use any method. assess for changes in meds, bp, weight, lipids when choosing contraception. if vascular issues can use IUD, progestin only pills or implants

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19
Q

obesity and contraception

A

No hormones if bmi > 35 due to risk of cardiac issues. bariatric surgery can decrease absorption. eating disorders can reduce absorption. use hormones in women over 35 years old with caution d/t risk of VTE. body fat effects contraception due to absorption, increase liver enzyme metabolism and metabolic rate. transdermal less effective. those on the pill have higher pregnancy rates due to this. more difficult to insert IUDs

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20
Q

hyperlipidemia and contraception

A

category 2 or 3 depending on severity. use progestin only in those rated as a 2

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21
Q

sickle cell contraception

A

injectables reduce number of painful crises. reduces number of bleeding and improves hemoglobin levels

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22
Q

crohns and contraception

A

absorptive surface of intestines is poor due to inflammation, nausea and vomiting also decreased reliability of absorption. use injectable, patches or IUDs instead

23
Q

poc and contraception

A

combined oral contraception w progestin to regulate menses, acne, and protect against endometrial cancer

24
Q

liver meds and contraception

A

meds that affect the liver may reduce effectiveness of combined hormone medications and progesterone meds. lamotrigine - lamictal seizure med, hiv meds, tb meds will all affect progesterone only meds — injectables, mirena and non hormonal contraceptives are not affected

25
Q

barrier methods

A

barrier between sperm and egg. diaphragms inserted 1 hour before and 6 hours after sex

26
Q

cervical cap

A

blocks sperm from entering cervix

27
Q

sponge

A

absorbs sperm to prevent them from entering cervix

28
Q

the pill

A

combined oral contraception. two hormones: estrogen and progesterone. prevents ovulation by supression secretion of gonadotropins, thins uterus lining, thickens cervical mucosa. 3 week cycles, 7 day break. consider bmi and bp before prescribing.

29
Q

transdermal patch

A

same hormones as the pill and same action, risk factors also bmi and bp. hormones delivered via the derma but not on breast, same as pill 3 weeks on 2 weeks off

30
Q

Vaginal ring

A

same action and hormones as the pill, delivered via a flexible ring placed in the vagina for 3 weeks and removed 4 week

31
Q

side effects of pill, patch and ring

A

breast tenderness, spotting, nausea, mood swings, weight gain, headaches

32
Q

contradindications for pill, patch and ring

A

age over 35, bmi > 35, elevated bp, hx dvt/cva/hear disease, hyperlipidemia, migraines, gall bladder disease, hx breast cancer, post partum

33
Q

benefits of estrogen-progestin contraceptives

A

reduce dysmenorrhea, reduce pelvic pain, improves iron deficiency anemia, reduces ectopic pregnancy, decrease s/s of premenstual disorder, reduces risk of benign breast disease, reduce risk of ovarian cysts, reduce ovarian cancer d/t inhibited ovarian stimulation and endometrial cancer d/t progestin, reduce colorectal cancer, reduce moderate acne and hirsuitsm, regulates cycle

34
Q

progesterone only mini pill

A

just progestrone, thickens cervical mucosa and suppresses ovulation, taken daily, 3-12 hour window, can change bleeding pattern. side effects: acne, breast tenderness, weight changes, headache

35
Q

contraindications of minipill

A

current/past history of stroke, heart disease, liver disease, lupus, breast caner current or last 5 years

36
Q

depo provera

A

150mg medroxyprogesterone acetate - synthetic progesterogen. every 12 weeks deep IM into butt, suppresses ovulation, thickens cervical mucosa and makes endometrium atrophic. can change bleeding patterns or cause amenorrhea

37
Q

adverse effects of depo provera

A

nausea, back ache, breast discomfort, acne, depression, alopecia

38
Q

s/e depo

A

abnormal bleeding 1-2 years, amenorrhea, weight gain, delay in fertility, decreased bone mass

39
Q

IUD

A

sits in uterus, copper causes sperm dysfunction and prevent fertilization, periods longer and heavier, good if you dont want hormones, lasts for 5-10 years

40
Q

mirena

A

contains levonorgestrel sits in uterus, causes endometrial atrophy, ovulation is shorter and lighter, can cause amenorrhea, nuisance bleeding 3-6 months, lasts 5 years

41
Q

IUD patient prep

A

vaginitis 2. hight STI risk 3. gonorrhea 4 treat first. IUD may not be the best choice if at high risk for STI, dont remove IUD with an STI present

42
Q

IUD inserted when

A

the first 7 days of period, back up contraception is not needed. expulsion rate 2-10%

43
Q

emergency contraception IUD

A

copper

44
Q

cant find strings

A

common, use back up method, try to visualize strings, take a urine pregnancy test, if neg use cytology brush to find strings, refer to specialist for dilation and US

45
Q

contraindication for IUD

A

recently exposed to STI. hx PID. Irregular bleeding. cervical or endometrial cancer. uterus abnormalities

46
Q

progesterone only implant

A

subdermal rod, inhibitis ovulation and increases cervical mucosa, lasts for 3 years, can cause nuisance bleeding

47
Q

why rod is desirable

A

any migraine headaches, age > 35 + smoker + obese, hx thromboembolic disease, cardiac disease, cva, early postpartum, htn w vascular disease or htn older than 35, lupus w vascular disease, hypertriglyceridemia

48
Q

contraindications to rod

A

liver disease, liver tumors, cirrhosis, vaginal bleeding, breast cancer

49
Q

morning after pill

A

elevated dose of progesterone-like hormone (levonorgesterel). egg release can be prevented, fertilization could be prevented

50
Q

contraception > 35 years

A

Combination hormonal contraceptive are a concern in women over 35 w risk for MI, stroke, VTE, breast ca, bone density, osteoporosis

51
Q

breast cancer and contraception

A

family hx breast ca no restriction, current is level 4, last 5 years in remission is level 3

52
Q

osteoporosis

A

depo a/w decreased bone mineral density that can be reversed in young women, no restriction with older women. loss of estrogen first 3 years menopause is the cause.

53
Q

noncontraceptive benefits of contraception in >35

A

reduction in endometrial cancer, regulate periods, decrease blood loss, helps w hot flashes

54
Q

when to stop in healthy nonsmoking nonobese women

A

until age 55 when 96 percent of women are menopausal.

Primary Care 1 (6 decks)

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