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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
Which increases cervical mucus thickness: progestin or estrogen
Progestin
26
What are the metabolic effects of hormonal contraception?
Estrogen component may cause n/v, breast TTP | -Weight gain by progestin
27
What is the effects on lipids of BC pills?
Insignificant difference in HDL and LDL cholesterol in low dose formulation
28
True or false: there are very small coagulation parameter changes with BC pills
True--unless there is an underlying procoagulation defect
29
What is the risk of having migraines with an aura, and BCP use?
Increases the risk of stroke
30
What is the rate of VTE, relatively?
Increased slightly, but WAY more common in pregnacny
31
Combination OC should not be prescribed to women over the age of 35 who smoke. Why?
Increased risk of stroke
32
Which increases the risk of a VTE more: pregnancy or OC pills
Pregnancy, by far
33
Is there any significant risk reduction with breast cancer while taking BC pills?
None yet noted
34
Is there any significant risk reduction with cervical cancer while taking BC pills?
No effect
35
Is there any significant risk reduction with endometrial cancer while taking BC pills?
54% Reduction with 4 year use
36
Is there any significant risk reduction with ovarian cancer while taking BC pills?
30% reduction after 1 year use
37
Is there any significant risk change with liver adenomas/cancer while taking BC pills?
No increased risk
38
What are the absolute contraindications of BC pills? (6)
- Liver disease | - Anything that increases the risk for a clot
39
What are the relative contraindications for BC pills?
- heavy cigarette use - Undiagnosed genital tract bleeding - Planned surgery - Persistent HTN
40
What are the drugs that interfere with OCP d/t p450 induction? (4)
- Barbs - Sulfonamides - Cyclophosphamides - Rifampin
41
What is the effect of OCP on blood loss with menstruation?
Decreases
42
What is the effect of OCP on ovarian cysts?
Decreases
43
What is the effect of OCP on the incidence of ectopic pregnancies?
Decreased
44
What percent of women believe that OCs have serious health side effects?
50% ish
45
Is there any benefit of taking a break from OC pills?
No
46
What is the MOA of the nuva ring?
Inserted by pt--same as hormonal contraceptives
47
What are the contraceptive patches?
Transdermal estrogen/progesterone
48
What is the MOA of emergency contraception?
High dose of estrogen and progesterone given within 12 hours apart, and within 72 hours of coitus
49
What are the side effects of emergency contraception?
- n/v - Breast TTP - Migraines
50
When is the window of effective emergency contraception?
Within 72 hours of coitus
51
What is the depo shot?
150 mg Dose of medroxyprogesterone q 3 months
52
What is the MOA of depo shot?
Inhibits ovulation, thins endometrium, and thickens cervical mucus (progesterone mediated effects)
53
What is the major side effects of Depo shot?
- Return of fertility may take a while - Irregular bleeding - Depression
54
What are the long acting progesterone implants?
Nexplanon
55
Is there an increase in HTN or thromboembolism with implantable progestin therapy?
No
56
What is the effect of implantable progesterone on: ovulation pain
Decreases
57
What is the effect of implantable progestin on: risk of Fe deficiency anemia
Decreased
58
What is the effect of implantable progesterone on: s/sx of endometriosis and primary dysmenorrhea
Reduces
59
How effective are IUDs?
Very
60
Do IUDs have systemic metabolic effects?
No
61
What is the MOA of the Cu IUD?
Produce a local, sterile, inflammatory rxn in the uterus
62
Does effectiveness of IUDs occur before or after fertilization?
Before
63
What are the two major side effects of IUDs?
Uterine bleeding | Uterine perforation
64
Is there an increase in septic abortions with IUDs?
No
65
Is there an increase in spontaneous abortion rate with IUDs?
Yes
66
When does PID happen post IUD implantation?
3 weeks
67
What is the bacteria that commonly causes an infection with IUDs?
Actinomyces isralies
68
What are the contraindications of IUDs?
-Postpartum endometritis or infected abortion in past 3 months
69
What is the most cost effective method of birth control?
IUDs
70
Clinicians should provide anticipatory guidance with IUDs regarding what?
Bleeding patterns
71
What is the failure rate of sterilization?
1% ish
72
What is hysteroscopic sterilization?
Feeding tube through the fallopian tubes
73
How is male sterilization performed?
vas deferens isolated and cut, and closed by ligation
74
Is male sterilization immediately effective?
No-- wait 14-20 days and check ejaculate

OB/GYN (33 decks)

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