Contraception Flashcards

Question

What are negative aspects of progestin only pills

Answer 1

40% of women still ovulate Higher risk ectopic pregnancy May cause irregular and unpredictable bleeding

Answer 2

Gastric bypass ischemic heart disease Rifampin therapy

Answer 3

can string them together to avoid periods all together (normal to have some breakthrough bleeding) Cheapest option 92% effective

Answer 4

``` >35 smoker HTN Dyslipidemia DM Migraines breast cancer thromboembolism obesity SLE ```

Answer 5

If <35: level 2 (green) If >35 and <15x day: level 3 (pink) If >35 and >15x day: level 4 (red)

Answer 6

<21 days: level 4 (red) 21-42 days w/ VTE RF: level 3 (pink) 21-42 days w/o VTE RF: level 2 (green) >42 days: level 1 (green)

Answer 7

<10 min after delivering placenta: level 2 10 min after placenta-4 wks PP: level 2 >4 weeks: level 1 Puerperal sepsis: level 4

Answer 8

Caziant or Cyclessa: estrogen to prevent HA during menses | Tilia Fe or Tei-legest Fe (iron)

Answer 9

Encourage patients to use condoms to prevent STDs | Extensive history and safety concerns with using high dose estrogen

Answer 10

No existing med conditions: 35 mcg or less of EE/ 0.5mg Norethindrone (1 gen) Teens, Underweight, >35, perimenopausal: 20-25 mcg EE Non-adherence: 35+mcg Oily skin, acne, hirstism: low androgenic dose

Answer 11

Monophasic

Answer 12

extended cycle regimens (eliminate/reduce # of periods per year)

Answer 13

``` N/v tender breasts weight gain acne, oily skin depression, fatigue MC**breakthrough bleeding Vaginal irriation (ring) application site rxn (transdermal) ```

Answer 14

``` ACHES! Abdominal pain Chest pain Headaches Eye problems Severe leg pain ```

Answer 15

``` vision loss, proptosis, diplopia unilateral numb, weak, tingle hemoptysis slurred speech severe ttp, swelling, or palpable cord on leg hepatic mass ```

Answer 16

``` no menses spotting breast mass RUQ pain midepigastric pain Migraine galactorrhea jaundice depression pruritis uterus increase in size ```

Answer 17

if breakthrough bleeding occurs past 6 months

Answer 18

typically on first sunday after menstrual cycle begins (weekend free periods) can also do quickstart and start today -either way, use another method of contraception for first 7 days (for whole first cycle to be even safer)

Answer 19

nothing! no adverse effects to fetus because they're just hormones simply stop taking the pill once you find out

Answer 20

if mom is hypercoagulable (effects of lactation) in first 21 days, risk for VTE is higher if you absolutely need contraception, use progesterone only if breastfeeding: avoid for first 24 days if you have RF, 30 days everyone else No restriction after 42 days

Answer 21

minimize risk of DVT: low dose estrogen min. nausea, breast ttp, vascular HA: low estrogen dose min. spotting/bleeding: high dose estrogen/progestin min androgen effects: 3 gen progestin avoid dyslipidemia: 3 gen progestin

Answer 22

Nexplanon (etonorgestrel) Mirena, Liletta, Kyleena, Skyla: levonorgestrel (2 gen) Paragard (copper IUD)

Answer 23

LARC aka IUD's | Skyla is smaller and good for teens or women with a smaller uterus

Answer 24

``` anatomic abnormalities Hx breast, cervical, or endometrial cancer PID post-abortion postpartum pregnant pelvic TB STD unexplained vaginal bleeding ```

Answer 25

5 year IUD that reduces bleeding, can shrink fibroids, and reduce endometriosis 99% effective 7 days after insertion

Answer 26

10 year copper IUD that can be off label for emergency contraception Great for women >35 and a smoker 99% effective immediately but, causes more menstrual bleeding

Answer 27

SLE w/ thrombocytopenia | Wilson's disease (in theory) 2/2 copper

Answer 28

single rod good for 3 years | may cause irregular bleeding patterns but 99% effective

Answer 29

cirrhosis | ischemic heart disease

Answer 30

``` irregular menses insertion complications expulsion PID -must council on STD prevention! ```

Answer 31

birth control shot good for those w/ sickle cell dz, older smokers, or seizure pts 97% effective BUT can cause: weight gain, irregular menses, bone loss (reverses after stopping shot)- hirsutism, acne, depression

Answer 32

current breast cancer

Answer 33

``` cirrhosis breast cancer in last 5 years DM with microvascular dz CVD uncontrolled HTN SLE unexplained vaginal bleeding women close to menopause (less time to reverse osteoporosis) ```

Answer 34

one patch, good for 3 weeks and remove for the 4th week- do NOT wear over breasts +/- nausea if placed on abdomen 92% effective

Answer 35

high risk VTE skin condition obesity

Answer 36

intravaginal ring placed in for 3 weeks, out for 1 (35 days of meds in each)- use tampon applicator to help place Can decrease frequency of BV 92% effective

Answer 37

intact hymen | -if it falls out, rinse and re-insert

Answer 38

``` pill-to-pill: none pill-to-ring: none pill-to-patch: 1 day pill-to-implant: 4 days pill-to-copper IUD: 5 days pill-to-shot: 1 week pill-to-hormone: 1 week ```

Answer 39

``` n/v (less if using progesterone only) irregular bleeding (menses onset 1 week early) ```

Answer 40

screen for pregnancy! if already pregnant, it will not harm the fetus

Answer 41

High dose progesterone that creates an environment not conducive to fetus implantation or stops/delays ovulation- BUT- not harmful to a fetus Must take within 72 hours of unprotected intercourse- the earlier, the less chance of pregnancy

Answer 42

``` Plan B one step next choice one dose Next choice Levonorgestrel generic -available OTC in US now! ```

Answer 43

Selective progesterone receptor modulator- delays ovulation Rx only as single dose (30mg) taken w/in 5 days (120 hrs) of unprotected intercourse

Answer 44

timing of administration relative to menstrual cycle

Answer 45

microchip! remote controlled contraception | very similar to an implant, but it is said to last 16 years