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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
How does obesity effect BC effectiveness?
Mixed evidence/safety
26
Where is the patch applied?
Buttocks Upper outer arm Lower abdomen Upper torso
27
Which hormones are in the patch?
Estrogen and progestin
28
How is the patch dosed?
1qweek x 3 weeks + 1 patch-free week
29
Who is the patch good for?
Non-adherent patients
30
Above what weight is the patch's efficacy potentially reduced?
90kg
31
How long is the patch effective for?
9 days | If wearing the patch for > 9 days, must use additional contraception for 7 days
32
What are the rules if the patch becomes detached?
< 24 hours apply new patch | > 24 hours apply new patch + additional contraception for 7 days
33
What drugs are in NuvaRing?
Estrogen and progestin
34
How is NuvaRing absorbed?
Through vaginal epithelium
35
How is NuvaRing used?
1qweek + ring free week
36
If a patient is using NuvaRing, what additional barrier contraception should not be used?
Diaphragm Sponge FemCap
37
What is an AE of NuvaRing?
Vaginitis
38
How long is NuvaRing good for outside of the fridge?
4 months
39
What are contraindications to not having estrogen in BC?
>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
What does the effectiveness of the POP depend on?
Cervical mucus thickened Endometrial atrophy Does not completely prevent ovulation
41
How should a POP be taken?
Same time daily
42
How long is the cervical mucus change maintained while on a POP?
<24 hours
43
What do you do if you missed your POP dose by 3+ hours?
Use additional form of contraception x48 hours
44
What are the positives of POPs?
Minimal effect on coagulation Do not worsen BP Does not impair milk production during lactation
45
What are the negatives of POPs?
Take at the same time daily | Irregular bleeding
46
What are the formulations of progestin injections?
Depo-Provera q3months IM | Depo-SubQ Provera q3months SQ
47
When is progestin injected?
Within 5 days of period onset
48
How soon is progestin injection effective?
Within 24 hours
49
What are the positives for progestin injections?
Minimal to no milk production impairment in lactation | Convenient schedule
50
What are the negatives for progestin injections?
Irregular bleeding Delayed ovulation after discontinuation Weight gain**** Loss of BMD (2 yr limit of therapy)
51
When are progestin implants placed?
In upper arm within 5 days of menses
52
How long are progestin implants effective?
3 years
53
How long should additional contraception be used upon placing the progestin implants?
7 days
54
What is a caution for progestin implants?
ABW > 30% greater than IBW
55
What are the AEs of progestin implants?
Irregular menstrual bleeding Weight gain (less than injections) Acne
56
What are the two types of IUDs?
Mirena, Liletta, Skyla (Levonogestrel IUD) | ParaGard (Copper IUD)
57
How long are liletta and skyla effective for?
3 years
58
How long is mirena effective for?
5 years
59
How long is ParaGard effective?
10 years
60
How does ParaGard work?
Copper has a spermicidal effect Thickens cervical mucus (similar to progestin) Prompts release of leukotrienes and and prostaglandins by enometrium
61
How long after unprotected sex is ParaGard good for?
Effective up to 5 days
62
When is ParaGard inserted?
At end of period (cervix is softer and dilated)
63
When is ParaGard inserted after childbirth?
6-8 weeks
64
How long should additional contraception be used after insertion of ParaGard?
1 month
65
When is the risk of ParaGard expulsion most likely to expel?
1st month
66
What are the positives of ParaGard?
Long term use No weight gain No decreased

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

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