Contraception Flashcards
FDA medical abortion protocol
Approved up 70 days from LMP:
Day 1: Mifeprex (mifepristone) 200 mg p.o.
After 24 - 48 hrs: Misoprostol 800 mcg buccally (cheek pouch)
7 - 14 days after mifeprex: follow up visit with provider
Most effective emergency contraception
Copper IUD placed within 5 days of unprotected intercourse or ovulation (if known)
0-1 out of 1000 will get pregnant
Ulipristal acetate (UPA)
30 mg
Prescription only emergency contraception
Give ASAP or within 5 days
Prevents or delays ovulation as long as its before LH peak
- selective progesterone receptor modulator
May be ineffective if weight > 194 lbs
More effective than levonorgestrel (LNG) over the counter because works even after LH surge
May delay onset of menses
Contraceptive counseling. What is the BRAIDED acronym?
- Benefits of method
- Risks of method (all major/minor risks, and related uncertainties); be sure to include consequences of method failure
- Alternatives to the method (including abstinence and no method)
- Inquiries about the method are the client’s right and responsibility
- Decision to withdraw from using the method without penalty
- Explanation of the method in a format that is understandable to the client
- Documentation that the caregiver has ensured understanding of each of the preceding six points, usually by use of a consent form
Progestin-Only Pills (POPs)
*Method of Action
Progestin-Only Pills (POPs)
● Ovulation is inhibited in a variable proportion of cycles
● Cervical mucus thickened and decreased
● Activity of cilia in fallopian tube is reduced
● Endometrium is altered (may inhibit implantation)
Combined Oral contraceptives (COCs)
*Method of Action
Combined Oral contraceptives (COCs)
Progestin….
● Suppressing the release of gonadotropin releasing hormone (GnRH) from the hypothalamus
● Suppressing the surge of LH (luteinizing hormone)
● Thickens cervical mucus
Estrogen….
● Suppressing the release of FSH from the pituitary
What is the ACHES acronym and what is useful for?
For CHC users, life-threatening signs:
A: Abdominal pain → mesenteric or pelvic vein thrombosis → abdominal pain with nausea, vomiting, weakness
C: Chest pain → pulmonary embolism or MI → cough (possibly blood), chest pain, SOB, left arm and shoulder pain, weakness
H: Headache → stroke → headache, weakness, numbness, visual problem, sudden intellectual impairment
E: Eye problems → retinal vein thrombosis → headache, complete or partial loss of vision
S: Severe leg pain → thrombophlebitis → swelling, redness, heat, tenderness in thigh or lower leg, calf pain
What other medications/herbs do COC’s interact with?
Herbs:
St. John’s wort
Orlistat
Prescription medications:
Some anticonvulsants (decrease steroid amount)
■ Carbamazepine, felbamate, lamotrigine, oxcarbazepine phenobarbital, phenytoin, topiramate
Rifampin (antibiotic) and griseofulvin (anti fungal)
■ Reduce potency of COC
May increase effect of theophylline (asthma), diazepam (valium) , and lithium
Long acting progesterone injection method of action?
Suppresses ovulation by inhibiting LH and FSH surge, thickens cervical mucus blocking sperm
entry into female upper reproductive tract, slows tubal and endometrial mobility, and causes thinning of the endometrium
Plan B
Levonorgestrel (LNG) - OTC if > 17 years old
- FDA approved for up to 72 hrs after sperm exposure
- Off label up to 120 hours (5 days)
- If given in follicular phase - shortens menstrual cycle by 7 to 10 days
- Do pregnancy test if menses delayed by 1 week
Plan B 1-Step: LNG 1.5 mg 1 tab po x 1
Plan B 2-Step: LNG 0.75 mg 1 tab po q 12 x 2 (or 2 tabs po x 1)
No difference in efficacy or side effects 1 step vs 2 step
Yuzpe Method of Emergency Contraception
Large dose of COCs with combo of 0.2 mg estradiol. and 1 mg levonorgestrel or 2 mg norgestrel
- almost any COC can be used: calculate # of pills to reach dose above and give in 2 divided doses 12 hrs apart
- Not popular due to side effects: N/V, etc
Criteria to be reasonably sure patient isn’t pregnant
≤7 days after the start of normal menses
≤7 days after spontaneous or induced abortion
≤4 weeks postpartum
Fully/nearly fully breastfeeding, amenorrheic, and <6 months postpartum
No sexual intercourse since the start of last normal menses
Correctly and consistently using a reliable method of contraception
Contraindications to CHC
Either a 3 or 4 on the MEC
- Smoking and age > 35 years
- Migraine with aura
- HTN ( > 140/90 mmHG) or vascular disease
- Ischemic heart disease
- History of DVT or clotting disorders
- Postpartum < 21 days (anyone), < 30 days if breastfeeding, or < 42 days if any risk for VTE
- Current breast cancer (and generally hx of breast cancer)
- Certain anticonvulsants and lamotrigine
- Antibiotics/fungals - rifampin and griseofulvin
- Only 1 antiretroviral (Fosamprenavir)
- Severe decompensated cirrohsis
- Diabetes > 20 years or diabetes with vascular disease or
nephropathy/retinopathy/neuropathy - Symptomatic gallbladder disease or hx of cholestasis
- Hx of bariatric surgery - pills contraindicated due to
malabsorption - Systemic Lupus Erythematosus (SLE) with positive or
unknown ANA
