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Pharm III > Contraception > Flashcards

Contraception Flashcards

1
Q

Unintended pregnancy

A

Mistimed, unplanned or unwanted pregnancy at the time of conception
Typically occurs from inconsistent or incorrect use of effective contraceptives

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2
Q

Non-hormonal contraceptive methods

A 
Periodic abstinence
Barrier methods
-Condom: male and female
-Diaphragm
-Cervical cap
-The last two barrier methods are prescriptions bc they need to be fitted
Spermicide
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3
Q

Combined hormonal contraceptives

A 
Combined oral contraceptives
Patch
-Ortho Evra
-Xulane
Vaginal ring
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4
Q

Progestin only contraceptives

A 
Progestin only pills
Long-acting injectable
-Depo-Provera (DMPA)
Implant
-Nexplanon
IUD 
-Mirena
-Kyleena
-Skyla
-Liletta
-ParaGard
--Copper IUD
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5
Q

Progesterone MOA

A 
Main contraceptive component
Blocks LH surge
Thickens cervical mucus
Slows tubal motility
Induces endometrial atrophy
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6
Q

Estrogen MOA

A

Suppresses FSH release which helps block LH surge
Primary role:
-Stabilizes endometrial lining
-Cycle control

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7
Q

Benefits of CHCs

A 
Pregnancy prevention
Improvement in menstruation-related issues
Reduced risk of:
-Endometrial and ovarian cancer
-Endometriosis
-Ovarian cysts
-Ectopic pregnancy
-PID
Treat acne
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8
Q

Risks of CHCs

A 
Alters lipid metabolism
-Progestin increases LDL, estrogen does opposite, net neutral
Increases BP
-Take baseline and monitor throughout therapy
Increased risk of:
-Breast CA?
-CVD
--MI and CVA
-VTE
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9
Q

Pt interview

A 
Menstrual hx
-Regularity and cycle length
-Light or heavy menses
PE
-Height
-Wt
-BP
Pt preference
-Contraceptive hx
-Planning on conceiving
-Adherence
Monogamous relationship
-No hormonal contraceptive protects against HIV or STDs
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10
Q

R/o pregnancy

A

No s/sx of pregnancy and meets one of the following:
Less than or equal to 7 days after the start of normal menses
Not had sexual intercourse since start of last nl menses
Correctly and consistently using a reliable form of contraception
Less than or equal to 7 days after spontaneous or induced abortion
Within 4 wks postpartum
Fully or nearly fully breastfeeding

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11
Q

Category 4 CIs

A

Unsafe, benefits don’t outweigh risks

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12
Q

Category 3 CIs

A

Risks probably still outweigh benefits

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13
Q

Category 2 CIs

A

Benefits outweigh risk, but there is still risk

A lot of category 2s apply to pt, still may not be the best product for them

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14
Q

Category 1 CIs

A

Go right ahead!!

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15
Q

What is in a category 4?

A

Age >35 yo and currently smoking greater than or equal to 15 cigarettes/day
Complicated solid organ transplant
Complicated valvular heart dz
Current breast CA
Hx of CVA
Hx of VTE with high risk for recurrence
Ischemic heart dz
Known thrombogenic mutations
Major surgery with prolonged immobilization
Malignant hepatoma or hepatocellular adenoma
Migraine HAs with aura
Severe cirrhosis
SLE with pos or unknown antiphospholipid antibodies
Uncontrolled HTN or HTN with vascular dz

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16
Q

What is part of a category 3?

A

Acute viral hepatitis
Age >35 yo and currently smoking <15 cigarettes/day
DM with vascular dz or DM >20 yrs duration
Hx of breast CA, but no evidence of dz for 5 yrs
Hx of cholestasis related to CHC use
Hx of VTE with low risk for recurrence
Hx of malabsorptive bariatric sx (oral therapies only)
Hx of HTN
IBD with increased risk for VTE
Multiple RFs for atherosclerotic CVD
MS with prolonged immobility
Superficial venous thrombosis
Symptomatic or medically treated gallbladder dz
Taking meds that induce liver enzymes and reduce efficacy of CHCs

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17
Q

Drug interactions of CHCs

A 
Increase hepatic metabolism of CHCs:
Carbamazepine, phenytoin, primidone, topiramate, oxcarbazepine
Barbiturates
Protease inhibitors
-Fosamprenavir
Rifampin
Decreased by CHCs: lamotrigine
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18
Q

CHC use postpartum- not breastfeeding

A

Can use progestin only options immediately
Avoid first 3 wks
-Category 4
Avoid first 6 wks if risk factors for VTE
-Category 3

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19
Q

CHC use postpartum- breastfeeding

A 
Can use progestin only options immediately
Avoid first 3 wks
-Category 4
Avoid during days 21-30
-Category 3
Avoid during days 30-42 if RFs for VTE
-Category 3
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20
Q

How do combined oral contraceptives differ from each other?

A

Based on individual hormones and doses of hormones, number of active pills, phases

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21
Q

Estrogens- hormones

A

Ethinyl estradiol (EE)
Mestranol
-Less potent than EE
Estradiol valerate

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22
Q

Progestins 1st gen

A

Ehynodiol diacetate
Norethindrone
Norethindrone acetate

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23
Q

2nd gen progestins

A

Levonorgestrel

Norgestrel

24
Q

3rd gen progestins

A

Desogestrel

Norgestimate

25
Q

4th gen progestins

A

Dienogest

Drospirenone

26
Q

Drospirenone

A

Structurally related to sprironolactone
-3 mg of drospirenone = 25 mg of spironolactone
Antimineralcorticoid and antiandrogen effects
-May result in less wt gain

27
Q

AEs of drospirenone

A

Hyperkalemia

Jury is out on increased VTE risk

28
Q

Usual regimen of combined oral contraceptives

A

21 active pills

7 placebo

29
Q

Extended cycle regimens, combined oral contraceptives

A

24 active pills, 4 placebo
26 active pills, 2 placebo
84 active pills, 7 placebo

30
Q

Continuous cycle regimen, combined oral contraceptives

A

Always active pills

Skipping placebo pills

31
Q

When would you want to utilize extended or continuous cycle regimens for combined oral contraceptives?

A 
Decrease menses
Anemia
Dysmenorrhea
Endometriosis
Menstrual migraines
Desire for decreased menses
32
Q

Monophasic combined oral contraceptives

A

Same levels throughout cycle

Preferred regimen

33
Q

Biphasic combined oral contraceptives

A

Hormones change once during cycle

34
Q

Triphasic combined oral contraceptives

A

Hormones change twice during cycle

35
Q

Four-phasic combined oral contraceptives

A

Hormones change three times during cycle

36
Q

Initial dosing of combined oral contraceptives

A 
Pts without comorbid conditions
EE 20-35 mcg
Older progestin
-Levonorgestrel
-Norethindrone
37
Q

Counseling for combined oral contraceptives

A 
Adherence
Adverse effects
-Usually improve after first 3 mos
D/c therapy if experience ACHES
Abdominal pain
Chest pain
HAs
Eye problems
Severe leg pain
Missed dose management
Starting therapy
38
Q

Monitoring and f/u

A 
No routine f/u required
Advise f/u when:
-Experiencing adverse effects
-Want to change contraceptive method
-Need to replace or remove contraceptive method
Assess at routine visits
-BP
-Changes in health status
-Pt satisfaction
-Wt
39
Q

AEs of excess estrogen in CHCs

A 
Bloating
Breast tenderness
HA
Nausea
Dysmenorrhea
Menorrhagia
40
Q

AEs of excess progestin in CHCs

A 
Acne
Bloating
Breast tenderness
Changes in mood
HA
Fatigue
Hirsutism
Increased appetite
Oily skin 
Wt gain
41
Q

AEs of estrogen deficiency in CHCs

A

Amenorrhea
Decreased libido
Early or mid-cycle breakthrough bleeding
Vasomotor sx

42
Q

AEs of progestin deficiency in CHCs

A

Dysmenorrhea
Menorrhagia
Late cycle breakthrough bleeding

43
Q

What is the #1 reason pts stop their contraceptives?

A

Breakthrough bleeding

44
Q

How to manage estrogen excess in combined oral contraceptives

A 
Decrease estrogen
Consider progestin only methods
Avoid patch
Consider vaginal ring
For dysmenorrhea
-Consider extended cycle or continuous cycle
-Consider NSAIDs
45
Q

How to manage estrogen deficiency in combined oral contraceptives

A

Increase estrogen

46
Q

How to manage progestin excess in combined oral contraceptives

A

Decrease progestin
For acne, oily skin or hirsutism:
-Consider less androgenic progestin

47
Q

How to manage progestin deficiency in combined oral contraceptives

A 
Increase progestin
Consider progestin only methods
For dysmenorrhea:
-Consider extended cycle or continuous cycle
-Consider NSAIDs
48
Q

Patch

A

Releases EE 35 mcg and norelgestromin 150 mcg per day
-Warning regarding increased exposure to estrogen: increased VTE risk?
Same CI and precautions as CHCs
Avoid in pts weighing >90 kg
-Decreased efficacy

49
Q

Counseling for the patch

A 
Apply to abdomen, buttocks, upper torso, or upper arm
New patch each week for three wks
-Patch free 4th wk
Adverse effects similar to CHCs
-Skin irritation
50
Q

Vaginal ring

A 
Releases EE 15 mcg and etonogestrel 12 mg per day
-Inserted and left in place for 3 wks
-Removed for 1 wk
Same CIs and precautions as CHCs
Adverse effects similar to CHCs
-FB sensation
-Vaginal sx
51
Q

Advantages of CHCs

A 
Highly effective
Protect against endometrial and ovarian CA
Favorable effects on bone mass
Fertility returns quickly after stopping
-Approximately 1-2 wks
Menstrual cycle benefits
52
Q

Disadvantages of CHCs

A

Adverse effects
-Breakthrough bleeding: common during first 3-6 mos
DO NOT protect against HIV or STDs
Efficacy dependent on adherence

53
Q

Role of progestin only therapy

A

Breastfeeding
Pts who do not tolerate estrogen containing contraceptives
Pts with medical conditions in which estrogen is not recommended
-Category 4 and 3

54
Q

Progestin only pills

A

No placebo, 28 days of norethindrone 0.35 mg
Decreased efficacy compared to CHCs
Needs to be taken same time every day
-Missed dose >3 hrs, use backup contraception for 2 days

55
Q

When to avoid progestin only pills

A

Breast CA
Hx of malabsorptive bariatric surgery
Malignant hepatoma or hepatocellular adenoma
Severe cirrhosis
SLE with pos or unknown antiphospholipid antibodies

56
Q

DIs- progestin only pills

A

Increased hepatic metabolism due to:
Carbamazepine, phenytoin, primidone, topiramate, oxcarbazepine
Barbiturates
Rifampin

Pharm III (8 decks)

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