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OB/GYN > Contraception > Flashcards

Contraception Flashcards

1
Q

What percent of all pregnancies are unintended?

A

50%

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2
Q

Of the unintended pregnancies, what percent occur in couples who practice some form of birth control?

A

47%

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3
Q

What is the most common form of birth control used?

A

Oral BC pills

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4
Q

What is the MOA of spermicides?

A

Physical and chemical barrier to immobilize and kill sperm

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5
Q

What is the most common spermicide used?

A

Nonoxynol-9

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6
Q

What is the failure rate of spermicides used alone?

A

high

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7
Q

What percent of the population uses condoms regularly?

A

15%

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8
Q

What are the disadvantages of condom use?

A

Unreliable protection against HSV and HPV

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9
Q

What are diaphragms and what should they be used with?

A

Fitted by the healthcare provider, and should be used with a spermicide

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10
Q

How long does a diaphragm have to be left in for after coitus to be effective?

A

6-8 hours

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11
Q

Why is there an increased risk of UTIs with diaphragm use?

A

Mechanical obstruction of the outflow tract

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12
Q

What is the failure rate of diaphragms?

A

15% in most, 5% in perfect use

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13
Q

What are cervical caps?

A

Caps over the cervix that has to be fitted by a provider

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14
Q

What is periodic abstinence?

A

Rhythm method–Deciding when to abstain from intercourse based on calendar calculations

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15
Q

What is the pregnancy rates with periodic abstinence? Why?

A

20%– hard to tell exactly when ovulating, especially after pregnancy

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16
Q

What is coitus interruptus? What is the most common reasons for failure?

A

Withdrawal method—sperm in preejactulate may contribute to failure

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17
Q

What is the MOA of progestin in hormonal contraception?

A

Inhibits ovulation and increases thickening of the cervical mucus

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18
Q

What is the MOA of estrogen in hormonal contraception?

A

Maintain the endometrium and prevent unscheduled bleeding

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19
Q

What are the three general types of formulations for oral hormone contraceptives?

A
  • Fixed dose combinations (E+P for 21 days)
  • Combination phasic (2,3,4 different amount of E+P)
  • Daily progestin
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20
Q

True or false: estrogen alone should never be used for contraception

A

True

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21
Q

What is Drospirenone?

A

Derived from 17-alpha spironolactone and resembles progesterone

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22
Q

What are the benefits of Drospirenone?

A

Anti-androgenic effects-blocks androgenic effects in the skin

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23
Q

What is the MOA of combination OC?

A

Prevent pregnancy by suppressing ovulation:progestational agent most effective

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24
Q

What is the MOA of Estrogen with BC pills? Progesterone?

A

Estrogen = Suppresses FSH secretion

Progesterone = suppresses LH, and inhibits ovulation.

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25
Q

Which increases cervical mucus thickness: progestin or estrogen

A

Progestin

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26
Q

What are the metabolic effects of hormonal contraception?

A

Estrogen component may cause n/v, breast TTP

-Weight gain by progestin

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27
Q

What is the effects on lipids of BC pills?

A

Insignificant difference in HDL and LDL cholesterol in low dose formulation

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28
Q

True or false: there are very small coagulation parameter changes with BC pills

A

True–unless there is an underlying procoagulation defect

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29
Q

What is the risk of having migraines with an aura, and BCP use?

A

Increases the risk of stroke

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30
Q

What is the rate of VTE, relatively?

A

Increased slightly, but WAY more common in pregnacny

31
Q

Combination OC should not be prescribed to women over the age of 35 who smoke. Why?

A

Increased risk of stroke

32
Q

Which increases the risk of a VTE more: pregnancy or OC pills

A

Pregnancy, by far

33
Q

Is there any significant risk reduction with breast cancer while taking BC pills?

A

None yet noted

34
Q

Is there any significant risk reduction with cervical cancer while taking BC pills?

A

No effect

35
Q

Is there any significant risk reduction with endometrial cancer while taking BC pills?

A

54% Reduction with 4 year use

36
Q

Is there any significant risk reduction with ovarian cancer while taking BC pills?

A

30% reduction after 1 year use

37
Q

Is there any significant risk change with liver adenomas/cancer while taking BC pills?

A

No increased risk

38
Q

What are the absolute contraindications of BC pills? (6)

A
  • Liver disease

- Anything that increases the risk for a clot

39
Q

What are the relative contraindications for BC pills?

A
  • heavy cigarette use
  • Undiagnosed genital tract bleeding
  • Planned surgery
  • Persistent HTN
40
Q

What are the drugs that interfere with OCP d/t p450 induction? (4)

A
  • Barbs
  • Sulfonamides
  • Cyclophosphamides
  • Rifampin
41
Q

What is the effect of OCP on blood loss with menstruation?

A

Decreases

42
Q

What is the effect of OCP on ovarian cysts?

A

Decreases

43
Q

What is the effect of OCP on the incidence of ectopic pregnancies?

A

Decreased

44
Q

What percent of women believe that OCs have serious health side effects?

A

50% ish

45
Q

Is there any benefit of taking a break from OC pills?

A

No

46
Q

What is the MOA of the nuva ring?

A

Inserted by pt–same as hormonal contraceptives

47
Q

What are the contraceptive patches?

A

Transdermal estrogen/progesterone

48
Q

What is the MOA of emergency contraception?

A

High dose of estrogen and progesterone given within 12 hours apart, and within 72 hours of coitus

49
Q

What are the side effects of emergency contraception?

A
  • n/v
  • Breast TTP
  • Migraines
50
Q

When is the window of effective emergency contraception?

A

Within 72 hours of coitus

51
Q

What is the depo shot?

A

150 mg Dose of medroxyprogesterone q 3 months

52
Q

What is the MOA of depo shot?

A

Inhibits ovulation, thins endometrium, and thickens cervical mucus (progesterone mediated effects)

53
Q

What is the major side effects of Depo shot?

A
  • Return of fertility may take a while
  • Irregular bleeding
  • Depression
54
Q

What are the long acting progesterone implants?

A

Nexplanon

55
Q

Is there an increase in HTN or thromboembolism with implantable progestin therapy?

A

No

56
Q

What is the effect of implantable progesterone on: ovulation pain

A

Decreases

57
Q

What is the effect of implantable progestin on: risk of Fe deficiency anemia

A

Decreased

58
Q

What is the effect of implantable progesterone on: s/sx of endometriosis and primary dysmenorrhea

A

Reduces

59
Q

How effective are IUDs?

A

Very

60
Q

Do IUDs have systemic metabolic effects?

A

No

61
Q

What is the MOA of the Cu IUD?

A

Produce a local, sterile, inflammatory rxn in the uterus

62
Q

Does effectiveness of IUDs occur before or after fertilization?

A

Before

63
Q

What are the two major side effects of IUDs?

A

Uterine bleeding

Uterine perforation

64
Q

Is there an increase in septic abortions with IUDs?

A

No

65
Q

Is there an increase in spontaneous abortion rate with IUDs?

A

Yes

66
Q

When does PID happen post IUD implantation?

A

3 weeks

67
Q

What is the bacteria that commonly causes an infection with IUDs?

A

Actinomyces isralies

68
Q

What are the contraindications of IUDs?

A

-Postpartum endometritis or infected abortion in past 3 months

69
Q

What is the most cost effective method of birth control?

A

IUDs

70
Q

Clinicians should provide anticipatory guidance with IUDs regarding what?

A

Bleeding patterns

71
Q

What is the failure rate of sterilization?

A

1% ish

72
Q

What is hysteroscopic sterilization?

A

Feeding tube through the fallopian tubes

73
Q

How is male sterilization performed?

A

vas deferens isolated and cut, and closed by ligation

74
Q

Is male sterilization immediately effective?

A

No– wait 14-20 days and check ejaculate

OB/GYN (33 decks)

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