Contraception Flashcards
2 first generation progesterones
megestrol acetate medroxyprogesterone acetate (depo)
2 second generation progesterones
aka estranges
norethindrone
ethynodiol
3rd generation progesterone
norgestrel, levonorgestrel
desogestrel
norgestimate
dienogest
**less androgenic effects
nonsteroidal progesterone
drospirenone
what is drospirenone derived from?
spironolactone
worry about K+ levels with drospirenone
how does progesterin work?
makes secretions viscous - prvt sperm get into uterus
prvts LH surge - no ovum released
decrease tubal motility
thins endometrium - lowers implantation probability
4 progestin metabolic effects
increased insulin secretion + peripheral resistance
increase lipase
increased fat deposition
increased LDL, HDL
when is progesterone indicated?
pregnancy maintance
dysfunctional uterine bleeds
post meno pause HRT
contraception
CI progestin
migrane severe DVT or PE unexplained bleeding breast cancer liver dz that is active
progestin ADR
acne, hirsutism, high LDL, insulin resistance
Vaginal bleed
DVT
Depo - bone loss
estrogen MOA
inhibits FSH release - fertilization does not actually happen
prvts follicle development which = ovulation
enhances LH surge
estrogen helps most with __
cycle control - timing
good for ipt with irregular cycles
10 contraindications OCP
- H/o: stroke, clot, thrombophlebitis, VTE, valvular heart dz
- DM with vascular involvement
- migraine with aura
- uncontrolled HTN
- major surgery with prolonged immobilization
- breast cancer
- liver dz
- age is over 35 - smoking more than half pack
- pregnant (breast feed less than 6 wks post birth)
- thrombogenic mutations
if there is a drug interaction with OCP use __
backup method
drug interactions OCP
- rifampin - lowers OCP efficacy
- phenobarb, phenytoin, carbamazepine (AED)
- use IUD, DMPA, implant instead - ABX? tetracycline, PCN
estrogen contraceptive adr
HA, breast tenderness
DVT clot
N
progesterone adr
acne hirsutism
if too much estrogen
can get dysmenorrhea, menorrhagia or uterine growth
- lower OCP, IUD, IUD, etend cycle
estrogen deficiency
early cycle BTB - increase dose
if see amenorrhea
suggests low estrogen -
check for pregnancy then higher OCP
see high appetite, weight gain, bloating
progestin excess
progestin deficiency =
late cycle BTB
nuvaring is
etonogestrel
insert vaginally leave for 3 weeks
minipill
progestin only pill - norethindrone
POP is ___ with breastfeeding
OK
POP timeline
most take dose at same time (within 3 hours) or = late
depo provera is a___injection
medroxyprogesterone acetate
____ is safest 30 days after delivery in breast feed women
Depo-Provera : medroxyprogesteone acetate injection
DMPA ADP
worry about depression
low BMD
implants use
etonogestrel - same as nuva ring but under skin
___ may be less effective for obese
implants
ADR implant
irregular bleeding
HA, vaginitis, weight gain, acne, breast and abdominal pain
***NO BONE AFFECT
before IUD do what?
pelvic exam
STI testing
YUZpe
high dose birth control pill: ee and levonorgestrel
one dose within 72 hours, then 12 hours
yuzpe adr
N/V
Ulipristil Acetate MOA
selective progesterone modulator
inhibits or delays ovulation
inhibits folliculogenesis and rupture
UA directions
take within 120 hours unprotected
ADR: HA/N/ acne, dizzy fatigue
plan B
levonorgestrel
MOA: plan b
inhibit/delay ovulation
prevents fertilization
*impairs sperm transport and corpus luteum function
may inhibit implantation
___ has higher ectopic risk
levonorgestrel
always get ___ before emergency contraception
pregnancy test
RU-486
mifepristone
moa mifepristone
progesterone and cortisol receptor antagonist
other RU-486 indications
control hyperglycemia secondary to Cushings syndrome who cant have surgery or meds fail
misoprostol is given 2 days after mifepristone why?
to empty uterus
cramps dizz N/V diarrhea abdominal pain
*follow up within 2 wks to confirm end of pregnancy
watch sepsis sx
