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Pharm II- Exam 2 > contraception > Flashcards

contraception Flashcards

1
Q

what other uses do contraception have?

A

Prevent pregnancy
Prevention of STDs (w/ condoms)

Improvements in menstrual cycle regularity (w/ hormonal contraceptives)

Improvements in certain health conditions (with oral contraceptives [OCs])

Management of perimenopause

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2
Q

Methods of contraception?

A

periodic abstinence, barrier tecniques, spermicides, spermicides-implanted barrier technique, hormonal contraception

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3
Q

what are spermicides?

A

contain nonoxynol-9, are chemical surfactants that destroy sperm cell walls and act as barriers that prevent sperm from entering the cervical os

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4
Q

what is a Spermicides-implanted barrier technique?

A

vaginal contraceptive sponge contains 1 g of the spermicide nonoxynol-9

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5
Q

what is preferable: mineral oil based vaginal drugs formulations OR water-soluble lubricants?

A

water soluble!

Mineral oil-based vaginal drug formulations (ie, Cleocin, Premarin, and Monistat), lotions, or lubricants can decrease the barrier strength of latex

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6
Q

Why are condoms w/spermicides no longer recommended?

A

bc they provide no additional protection against pregnancy or STDs and may increase vulnerability to HIV

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7
Q

contraindications to female condoms (prelubricated)

A

Allergy to polyurethane

History of TSS

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8
Q

Advantages/disadvantages to male condoms

A

A: inexpensive, STD protection including HIV

D: High user failure rate (only 1x use)
Poor acceptance,
Possibility of breakage
Efficacy decreased by oil-based lubricants,
Possible allergic reactions to latex in either partner

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9
Q

Advantages/disadvantages to female condoms

A

A: Can be inserted just before intercourse or ahead of time
STD protection, including HIV
Not to be simultaneously with condoms

D: High user failure rate than male condoms (only 1x use),
Dislike ring hanging outside vagina,
Cumbersome

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10
Q

contraindications to diaphragm w/spermicide

A

Allergy to latex, rubber, or spermicide

Recurrent UTIs
History of TSS
Abn gynecologic anatomy

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11
Q

Adv/disadvantages to diaphragm w/spermicide

A

A: Low cost
Decreased incidence of cervical neoplasia
Some protection against STDs

D: High user failure rate,
Decreased efficacy with increased frequency of intercourse+,
Increased incidence of vaginal yeast UTIs, TSS#,
Efficacy decreased by oil-based lubricants
Cervical irritation

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12
Q

diaphragm w/spermicide can be inserted when? and left in how long?

A

6 hrs before and 6 hrs afterward but leaving in 24hrs NOT recommended d/t TSS

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13
Q

cervical cap (FemCap) contraindications (nonhormonal contraception)

A

Allergy to spermicide

History of TSS
Abnormal gynecologic anatomy

Abnormal papanicolaou smear

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14
Q

Adv/disadvanages to

A

A: Low cost
Latex-free,
Some protection against STDs,
FemCap reusable for up to 2 years

D: High user failure rate,
Decreased efficacy with parity, cannot be used during menses

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15
Q

how long can a cervical cap remain in place?

A

for multiple episodes of intercourse without adding more spermicide but should not be worn for more than 48 hours at a time to reduce the risk of TSS

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16
Q

what forms of contraception do NOT protect against STD’s like HIV

A

Diaphragms and cervical caps

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17
Q

contraindications to spermicides alone? (nonoxynol-9

Films, foams, gels, suppositories, sponges, and tablets)

A

allergy to spermicide

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18
Q

disadvantages to spermicides alone? (nonoxynol-9

Films, foams, gels, suppositories, sponges, and tablets)

A

High user failure rate, must be reapplied before each act of intercourse, may enhance HIV transmission, no protection against STDs, not promoted by WHO or CDC

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19
Q

contraindications to Sponge (Today)+

1gm nonoxynol-9?

A

Allergy to spermicide,

recurrent UTIs, history of TSS, Abnormal gynecologic anatomy

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20
Q

disadvantages to Sponge (Today)+

1gm nonoxynol-9?

A

High user failure rate, decreased efficacy with parity, Cannot be used during menses, No protection against STDs

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21
Q

Pt education for sponge use?

A

insert 6hrs before use, provides protection for 24hrs, leave in place at least 6hrs before removal but no longer than 24-30 d/t TSS

do NOT reuse

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22
Q

what are the most effective reversible family planning methods?

A

implants and IUDs

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23
Q

what are permanent means of sterilization?

A

hysterectomy, vasectomy

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24
Q

____ should always be used to reduce the risk of STI’s?

A

codoms

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25
Q

possible sxs in the early cycle?

A

irritability, depression, bleeding, lower abd. pain, N/D, libido changes, nose bleeds

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26
Q

possible sxs in the late cycle?

A

bloating, breast tenderness, wt. gain, eyes swollen, acne, dc, pain, constipation, swollen ankles

sxs of pregnancy*

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27
Q

secondary source of estrogen in men and women is where?

A

fat tissue

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28
Q

what hormone is MCly measured for nonpregnant women?

A

estrogen

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29
Q

what hormone is measured only during pregnancy

A

estradiol

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30
Q

what hormone may be measured in women who have gone through menopause?

A

estrone

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31
Q

hormonal contraceptives contain a combo of…

A

estrogen and progestin or a progestin alone

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32
Q

other hromonal contraceptives aside from oral forms?

A

Transdermal patch

Vaginal contraceptive ring

Long-acting injectable

Implantable

Intrauterine contraceptives

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33
Q

older high dose formulations of hormonal contraceptives were assoc. w/

A

vascular, embolic vents, cancers, and significant SE’s

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34
Q

how do combined hormonal contraceptives (CHCs) work?

A

primarily before fertilization to prevent conception

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35
Q

_____ provide most of the contraceptive effect?

A

progestins

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36
Q

MOA of progestins?

A

*progestins block the LH surge therefore inhibiting ovulation

by thickening cervical mucus to prevent sperm penetration,
slowing tubal motility and delaying sperm transport,
inducing endometrial atrophy

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37
Q

MOA for estrogens

A

suppress FSH release from the pituitary, which may contribute to blocking the LH surge and preventing ovulation

primary role of estrogen in hormonal contraceptives is to stabilize the endometrial lining and provide cycle control

helps thicken cervical mucus

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38
Q

what are the 3 synthetic estrogens found in hormonal contraceptives?

A
  1. Ethinyl estradiol (EE)
  2. Mestranol:
    must be converted by the liver to EE before it is pharmacologically active. Is 50% less potent than EE
  3. Estradiol valerate
39
Q

Most combined OCs, transdermal patch, and vaginal ring contain…

A

estrogen at doses of 20 to 50 mcg of EE

40
Q

Mestranol is 50% less potent than…

A

EE

41
Q

progestins differ w/respect to…

A

inherent estrogenic, antiestrogenic, and androgenic effects

42
Q

androgenic activity is dep. upon variables:

A
  1. the presence of sex hormone (testosterone) binding globulin (SHBG-TBG)
  2. androgen:progesterone activity ratio
43
Q

if the amnt of SHBG-TBG is decreased, free testosterone levels ___ and androgenic side effects are ____

A

increase

more prominent

44
Q

1st generation progestin characteristics

A

well tolerated, but lower doses have more breakthrough bleeding

e.g. Norethindrone

45
Q

2nd generation progestin characteristics

A

long half life (in implant/IUD), more androgenic activity- better for libido, worse for hirsutism/acne/lipids

e.g. Levonorgestrel

46
Q

3rd generation progestin characteristics

A

same progestational activity with decreased androgenic activity

e.g. Desogestrel

47
Q

4th generation progestin characteristics

A

anti-androgenic properties

e.g. Drospirenone

48
Q

Progestin only must be taken…

A

at same time every day (3hr window)

49
Q

if taken ___ hrs late, pts should use backup method of contraception for ___hrs

A

3

48

50
Q

Minipills put you at higher risk for…

A

ectopic pregnancy

51
Q

Minipills (progestin only) characteristics

A

may not block ovulation, used post-partum, less effective than combo OC’s,

52
Q

minipills (progestin only)

A

assoc. w/irregular and unpredictable menstrual bleeding

53
Q

contraindications w/minipills (progestin only)

A

gastric bypass, ischemic heart disease, Rifampin therapy

54
Q

what is the cheapest contraceptive upfront?

A

Combined Oral Contraceptives (COC) or Combined Hormonal Contraceptives (CHC) or Oral Contraceptive Pill (OCP)

92% effective w/usual use

55
Q

what does “stringing” packs of any brand COC, CHC, or OCP’s together mean?

A

skipping the placebo w/the BCP’s

56
Q

what are some special considerations for using COC, CHC, or OCP’s?

A

Women older than 35 yrs, smoking, HTN
Dyslipidemia, DM
Migraine HA’s, breast CA, Thromboembolism, Obesity, Systemic Lupus Erythematosus

57
Q

CHC practice pearls

A

Excessive/deficient amounts of estrogen and progestin are related to the MC ADE’s

Important concern regarding the use of CHCs is the lack of protection against STDs

Encourage patients to use condoms for prevention of STDs

Extensive history of safety concerns traditionally related to high dose estrogen tablets

58
Q

what is the recommended dose for OC?

A

35mcg or less of EE and less than 0.5mg of norethindrone

59
Q

Nonadherence to OCs increases risk of pregnancy which may be greater in women taking OCs containing…

A

less than 35mcg of EE

60
Q

what pt population can take oral contraceptive?

A

Adolescents, underweight women (less than 50 kg [110 lb]), women older than 35 y/o, and those who are peri-menopausal

61
Q

which is preferred: monophasic or multiphasic?

A

monophasic

62
Q

Extended-cycle OCs either eliminate or reduce the number of menstrual cycles per year, leading to…

A

less premenstrual sxs, dysmenorrhea and menstrual migraines

63
Q

Extended-cycle regimens may be beneficial for women with symptoms such as…

A

dysmenorrhea, severe premenstrual syndrome, or menstrual migraines

64
Q

ADE’s of combined hormonal contraception?

A 
Nausea/vomiting
Breast tenderness
Weight gain
Acne, oily skin
Depression, fatigue
Breakthrough bleeding/spotting
Application site reaction (transdermal)
Vaginal irritation (vaginal ring)
65
Q

when do you need to immediately discontinue CHC’s?

A 
"ACHES"
abdominal pain
chest pain/SOB
Headaches, CVA, or incr. BP
Eye problems
Severe leg pain (thromboembolic process)

unilateral numbn/weakness, hemoptysis, slurring speech, hepatic mass/TTP, slurring speech

66
Q

OC ADE pearls

A

Many sxs occurring with early OC use: N, bloating, breathrough bleeding (okay for 2-3mo’s)

MC adverse effect = irregular bleeding

expect w/in first 6mo’s

if irregular bleeding persists longer than 6 mo’s –> the estrogen or progestin content may need to be adjusted

67
Q

when to start OC’s

A

traditional is sunday but consider quick start (today)

instruct to still use backup contraceptive for 7 days

68
Q

concerns for postpartum use of CHC’s?

A

Mother’s hypercoagulability and the effects on lactation

first 21d postpartum d/t risk of thrombosis

if required –> progestin-only

breastfeeding –> avoid for 42 days if VTE risk or 30d w/out RF’s

69
Q

why would you select a product w/lower dose estrogen?

A

To minimize risk of thrombosis, nausea, breast TTP, vascular HA’s

70
Q

why would you select a pill w/higher dosage of estrogen or a progestin w/great potency?

A

to minimize spotting or breakthrough bleeding

71
Q

how can you minimize androgens effects?

A

use 3rd generation progestin, low-dose norethindrone or ethynodiol diacetate

72
Q

how can you avoid dyslipidemia?

A

3rd generation progestin, low-dose norethindrone or ethynodiol diacetate

73
Q

what is the 1st line for sexually active adolescents?

A

Long Acting Reversible Contraception (paraguard, nexplanon, mirena, liletta, kyleena)

74
Q

contraceptive use unacceptable health risk factors:

A 
Anatomic abnormalities
History of breast, cervical or endometrial cancer (initiation vs continuation)
PID
Post abortion
Postpartum 
Pregnancy
Pelvic TB
STDs
Unexplained vaginal bleeding
75
Q

Benefits of Mirena

A

approved for 5 yrs, reduces bleeding, shrinks fibroids and reduces endometriosis, 99% effect (7 days after administration)

76
Q

how long is the paragard (copper T) approved for?

A

10yrs

77
Q

contraindications for paragard?

A

SLE (with thrombocytopenia)

Wilson’s Disease

78
Q

how long is a nexplanon approved for?

A

3 yrs

79
Q

contraindications for nexplanon (implanon)

A

cirrhosis, ischemic heart disease

80
Q

ADE’s for Levonorgestrel IUD

A

Menstrual irregularities

Insertion-related complications

Expulsion

Pelvic inflammatory disease

81
Q

copper IUD effect on periods?

A

irregularities typically heavier

82
Q

Depo-Provera can cause…

A

wt. gain and irregular menses even after stopping shot but bone losses do reverse

83
Q

Depo-provera (DMPA) is good for which types of pt’s?

A

sickle cell, older smokers, seizures

84
Q

contraindications for depo-provera?

A

Current breast cancer

85
Q

DMPA ADE’s

A

Menstrual irregularities, Wt gain

Acne, Hirsutism, Depression, Decreased bone density

86
Q

Transdermal patch use and pt education?

A

one patch per wk, 3 wks on and 1 wk off

do NOT wear over breasts

can cause N if placed over abd

87
Q

contraindications for transdermal patch

A

higher risk for VTE, skin conditions, obesity

88
Q

Vaginal ring pt. education and use?

A

3 weeks in/ 1 week out, 35 days of medication in each ring

Can use tampon applicator to help with insertion

Rinse and reinsert if comes out

89
Q

contraindication w/vaginal ring?

A

intact hymen

90
Q

common adverse effects for emergency contraception…

A

N/V, irregular bleeding

screening prior or after pregnancy not recommended

91
Q

TorF: if pregnant an emergency contraceptive can cause harm to the fetus.

A

False. No harm.

92
Q

Emergency contraceptives like Plan B one step or Next choice need to be taken w/in…

A

3 days or 72hrs

93
Q

MOA for emergency contraception

A

is inhibiting or delaying ovulation

94
Q

what is ulipristal (ella)?

A

Selective progesterone receptor modulator with mixed progesterone agonist and antagonist properties

emergency contraception (120hr window)

Pharm II- Exam 2 (4 decks)

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