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Men's and Women's Health > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the drug types in BC pills?

A

Estrogen + progestin

Progestin only

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2
Q

What drug form is used for estrogen?

A

Ethinyl estradiol

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3
Q

How does ethinyl estradiol prevent ovulation?

A

Suppresses the hypothalamic gonadotropin-releasing facors

Prevents FSH and LH secretion

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4
Q

How is ethinyl estradiol metabolized?

A

Hepatically

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5
Q

What is progestin?

A

Synthetic progesterone-like compound (levonorgestrel, norethindrone, norgestrel, etc)

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6
Q

How does progestin prevent ovulation?

A

Suppresses LH
Thicken cervical mucus
Endomtrium incapable of implantation

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7
Q

How is progestin metabolized?

A

Some hepatic metabolism

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8
Q

What is drosperinone?

A

Progestin

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9
Q

What class is drosperinone?

A

Aldosterone antagonism analog

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10
Q

What are the AE’s of 25mg spironolactone

A

Hyperkalemia, gynecomastia

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11
Q

Why does drosperinone not affect BP?

A

The estrogen offsets the BP effects from aldosterone antagonists

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12
Q

What drugs do we use caution with when taking drosperinone?

A

ACE/ARBs

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13
Q

Why do we put iron in BC?

A

For iron deficiency anemia

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14
Q

Why is folate added to BC?

A

In case of failed contraception to prevent neural tube defects

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15
Q

What are the types of four-phasic BC?

A

Initial high estrogen (dose reduction during proliferative/follicular phase)
Initial low progestin (Dose increase during secretory/luteal phase)

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16
Q

What antituberculosis agent interacts with BC?

A

Rifampin

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17
Q

What antifungal interferes with BC?

A

Griseofulvin

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18
Q

Which anticonvulsants interact with BC?

A

Most

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19
Q

Which abx interact with BC?

A 
Tetracycline
Doxycyline
Penicillins
Cipro
Ofloxacin
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20
Q

Which HIV meds interact with BC?

A

Telaprevir
Tipranavir
Elvitegravir

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21
Q

What are the “good” AEs for BC?

A 
Increased bone density
Reduced menstrual blood
Less pre-menstrual problems
Acne improvement
Improved pre-menstrual mood (Yaz)
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22
Q

What are the “bad” AEs for BC?

A

VTE, MI, Stroke (from estrogen)

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23
Q

When are oral contraceptives not recommended?

A

Women > 35 w/:
Uncontrolled HTN
DM + vascular disease
Smoking

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24
Q

When is thromboembolism risk increased when taking BC?

A

Protein C and S deficiency

HTN, obesity, DM, smoker, sedentary lifestyle

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25
Q

How does obesity effect BC effectiveness?

A

Mixed evidence/safety

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26
Q

Where is the patch applied?

A

Buttocks
Upper outer arm
Lower abdomen
Upper torso

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27
Q

Which hormones are in the patch?

A

Estrogen and progestin

28
Q

How is the patch dosed?

A

1qweek x 3 weeks + 1 patch-free week

29
Q

Who is the patch good for?

A

Non-adherent patients

30
Q

Above what weight is the patch’s efficacy potentially reduced?

A

90kg

31
Q

How long is the patch effective for?

A

9 days

If wearing the patch for > 9 days, must use additional contraception for 7 days

32
Q

What are the rules if the patch becomes detached?

A

< 24 hours apply new patch

> 24 hours apply new patch + additional contraception for 7 days

33
Q

What drugs are in NuvaRing?

A

Estrogen and progestin

34
Q

How is NuvaRing absorbed?

A

Through vaginal epithelium

35
Q

How is NuvaRing used?

A

1qweek + ring free week

36
Q

If a patient is using NuvaRing, what additional barrier contraception should not be used?

A

Diaphragm
Sponge
FemCap

37
Q

What is an AE of NuvaRing?

A

Vaginitis

38
Q

How long is NuvaRing good for outside of the fridge?

A

4 months

39
Q

What are contraindications to not having estrogen in BC?

A

> 35 yo + Smoker/DM + vascular disease
H/o VTE, major surgery with prolonged immobilization
CV dz, SBP > 160 mmHg or DBP > 100 mmHg, IHD, valvular heart disease
Breastfeeding/< 21 day postpartum
Breast cancer (excludes FH)
Severe cirrhosis, benign hepatocellular adenoma or malignant liver tumor
Migraines with aura

40
Q

What does the effectiveness of the POP depend on?

A

Cervical mucus thickened
Endometrial atrophy
Does not completely prevent ovulation

41
Q

How should a POP be taken?

A

Same time daily

42
Q

How long is the cervical mucus change maintained while on a POP?

A

<24 hours

43
Q

What do you do if you missed your POP dose by 3+ hours?

A

Use additional form of contraception x48 hours

44
Q

What are the positives of POPs?

A

Minimal effect on coagulation
Do not worsen BP
Does not impair milk production during lactation

45
Q

What are the negatives of POPs?

A

Take at the same time daily

Irregular bleeding

46
Q

What are the formulations of progestin injections?

A

Depo-Provera q3months IM

Depo-SubQ Provera q3months SQ

47
Q

When is progestin injected?

A

Within 5 days of period onset

48
Q

How soon is progestin injection effective?

A

Within 24 hours

49
Q

What are the positives for progestin injections?

A

Minimal to no milk production impairment in lactation

Convenient schedule

50
Q

What are the negatives for progestin injections?

A

Irregular bleeding
Delayed ovulation after discontinuation
Weight gain**
Loss of BMD (2 yr limit of therapy)

51
Q

When are progestin implants placed?

A

In upper arm within 5 days of menses

52
Q

How long are progestin implants effective?

A

3 years

53
Q

How long should additional contraception be used upon placing the progestin implants?

A

7 days

54
Q

What is a caution for progestin implants?

A

ABW > 30% greater than IBW

55
Q

What are the AEs of progestin implants?

A

Irregular menstrual bleeding
Weight gain (less than injections)
Acne

56
Q

What are the two types of IUDs?

A

Mirena, Liletta, Skyla (Levonogestrel IUD)

ParaGard (Copper IUD)

57
Q

How long are liletta and skyla effective for?

A

3 years

58
Q

How long is mirena effective for?

A

5 years

59
Q

How long is ParaGard effective?

A

10 years

60
Q

How does ParaGard work?

A

Copper has a spermicidal effect
Thickens cervical mucus (similar to progestin)
Prompts release of leukotrienes and and prostaglandins by enometrium

61
Q

How long after unprotected sex is ParaGard good for?

A

Effective up to 5 days

62
Q

When is ParaGard inserted?

A

At end of period (cervix is softer and dilated)

63
Q

When is ParaGard inserted after childbirth?

A

6-8 weeks

64
Q

How long should additional contraception be used after insertion of ParaGard?

A

1 month

65
Q

When is the risk of ParaGard expulsion most likely to expel?

A

1st month

66
Q

What are the positives of ParaGard?

A

Long term use
No weight gain
No decreased

Men's and Women's Health (3 decks)

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