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Pharmacology > Contraception > Flashcards

Contraception Flashcards

1
Q

What are Goals of contraception

A

Prevent pregnancy

Prevention of STDs (with condoms)

Improvements in menstrual cycle regularity (with hormonal contraceptives)

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

Management of perimenopause

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2
Q

What do spermicides do?

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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3
Q

What are contraceptives use Barrier Techniques

A

Condoms
Diaphragms
cervical caps
Sponges

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4
Q

What is the method behind Spermicides-implanted barrier technique

A

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

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5
Q

When it comes to Male condoms what is potential downside they contain

A

Mineral oil-based vaginal drug formulations (eg, Cleocin, Premarin, and Monistat), lotions, or lubricants can decrease the barrier strength of latex, thus making water-soluble lubricants (eg, Astroglide and K-Y Jelly) preferable.

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6
Q

Why are condoms with spermicides no longer recommended?

A

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

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7
Q

Contrainditions for Male and Female condoms

A

Male: Allergy to latex or rubber

Female: Allergy to polyrethane

Or hx of TSS

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8
Q

What instructions must be followed when using a Diaphgragm with spermicides?

A

*May be inserted up to 6 hours before intercourse and must be left in place for at least 6 hours afterward

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9
Q

What does prolonged diaphragm placement cause

A

Placement for more than 24 hr can cause Toxic Shock syndrome

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10
Q

What are instructions when using Cervical cap?

What is the benefit behind using these

A

Can be inserted 6 hours prior to intercourse and should not be removed for at least 6 hours after intercourse.

It can remain in place 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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11
Q

What are special instructions for using Sponges and the benefit behind it

A

Sponge is moistened with water and inserted into the vagina up to 6 hours before intercourse. Provides protection for 24 hours, regardless of the frequency of intercourse during this time.

After intercourse, the sponge must be left in place for at least 6 hours before removal and should not be left in place for more than 24 to 30 hours to reduce the risk of TSS. Sponges should not be reused

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12
Q

Which pharacologic device seems to have the least amount of unintended pregnancy

A

Progestin-only implant

IUD

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13
Q

What are symptoms associated in the early menstrual cycle

A 
Irritability
Anxiety
Depression
Lower abd. pain
Back and leg pain
Headache
Diarrhea 
Inc. or Dec. libido
Infection
Nose bleeds
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14
Q

Signs and symptoms associated in the late menstrual cycle

A

Pregnancy symptoms

Weight gain
Bloating
Ankle swelling 
Breast fullness/tenderness
Pain
Constipation
Depression
Headache
Acne 
Discharge
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15
Q

What enzyme is key in making estrogen hormones

A

Aromatase

which then makes testosterone –> Estradiol

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16
Q

What hormones do hormonal contraceptives contain a combination of

A

Estrogen and progestin

OR progestin alone

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17
Q

What is the MOA of combined Hormonal contraceptives (CHCs)

Starting with progestins

A

Progestins provide most of the contraceptive effect

By thickening cervical mucus to prevent sperm penetration

Slowing tubal motility and delaying sperm transport

inducing endometrial atrophy

Progestins block the LH surge, therefore inhibiting ovulation

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18
Q

What is the MOA of Estrogens in combined Hormonal contraceptives

A

Estrogens

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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19
Q

What are the 3 Synthetic estrogens found in hormonal contraceptives in U.S.

A

Ethinyl estradiol (EE)

Mestranol–> must be converted by the liver to EE before it is pharmacologically active and is 50% less potent than EE

Estradiol valerate

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20
Q

What are the 1st Generation of Progestins?

A

Norethinidrone

well tolerated, but lower doses have more breakthrough bleeding

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21
Q

What are 2nd Generation Progestins?

What are its side effects

A

Levonorgestrel

Worse for hisutism

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22
Q

Which Progestins have the longest half life?

A

2nd Generation

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

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23
Q

What are 3rd generation Progestins?

A

Desogestrel

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24
Q

What are 4th generation Progestisn?

A

Drospirenone

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25
Q

Which progestin is closely related to Spirinolactone?

A

Drospirenone

26
Q

What special instructions are given with Progestin only contraceptives

A

Must be taken at the same time every day

3 hour window
If taken more than 3 hours late, patients should use a backup method of contraception for 48 hours

27
Q

Progestin only contraceptives put women at higher risks for what?

A

Ectopic pregnancies

28
Q

Why is Progestin only contraceptives best used for post partum?

A

Because estrogen containing pills cause thrombosis

29
Q

What are contraindications of Progestin only pills?

A

Gastric bypass
ischemic heart disease
Rifampin therapy

30
Q

Which generation of progestins are common in IUDs

A

Levonorgestrel

31
Q

When using CHC what should you stress patients also use to prevent STDs

A

Condoms

32
Q

Slides 24,25

Look up contraceptive recomendations for smokers

A

slide 24,25

33
Q

What amount of contraceptives are recommended in women with no coexisting medical condition?

A

OC containing 35 mcg or less of EE and less than 0.5 mg of norethindrone or an equivalent is recommended

34
Q

slide 29

A

slide 29

35
Q

Upon initiation what type is the preferred contraceptive that is recommended to start with?

A

Monophasic OC

36
Q

Who might extended cycle regimens be beneficial for? (no placebo pills)

A

Women with:

dysmenorrhea, severe premenstrual syndrome, or menstrual migraines

37
Q

What benefit do Extended-cycle OCs provide

A

eliminate or reduce # of menstrual cycles

leading to less
premenstrual symptoms,
dysmenorrhea and menstrual migraines

38
Q

What are complications from oral birth controls that you must discontinue

A

A.C.H.E.S.

Abdominal pain
Chest pain (SOB)
Headaches
Eye problems
Severe Leg pain
39
Q

If a patient is experiencing ADEs such as Breakthrough bleeding/spotting what is recommended?

A

Consider changing to a higher estrogenic dose

40
Q

To minimize nausea, breast tenderness or vascular headaches what should you advise for you patient

A

Select a product with lower dose of estrogen

41
Q

What is the MC adverse effect when taking OC

What should you tell patients who first experience these

A

Irregular bleeding

improve spontaneously by the third cycle of use after adjusting to the altered hormone levels

42
Q

If a patient wants to start OC today (Quick Start) what must be instructed to the patient

A

Instruct to use a second method of contraception (typically recommend condoms) for at least 7 days after initiation for maximum effectiveness

43
Q

What is recommended not to use in the first 21 days postpartum?

A

estrogen-containing hormonal contraceptives should be avoided (when the risk of thrombosis is higher),

44
Q

What is the concern of taking CHC postpartum?

A

Mothers hyper coagulability and the effects on lactation

45
Q

What type of oral contraceptives are acceptible post partum

A

Progestin only contraceptives

46
Q

What are Unacceptable health risks that you should not used contraceptives with

A 
Anatomic abnormalities
History of breast, cervical or endometrial cancer (initiation vs continuation)
PID
Post abortion
Postpartum 
Pregnancy
Pelvic TB
STDs
Unexplained vaginal bleeding
47
Q

What type of contraceptives are first line for sexually active adolescents

A

LARC

Long Acting Reversible Contraceptives

48
Q

What benefits does Mirena provide

A

Approved for 5 years (?good for 7)

Reduces bleeding

May also shrink fibroids and reduce endometriosis

99% effective, effective 7 days after insertion

49
Q

Which IUD can be used as a Emergency Contraception?

A

ParaGard (Copper T)

50
Q

What are contraindications for ParaGard (Copper T)

A

SLE (thrombocytopenia)

Wilson’s Disease

51
Q

Contraindications for using the IUD Nexplanon/Implanon

A

Cirrhosis

Ischemic Heart Disease

52
Q

What is ADE of taking Depo-Provera?

A

Weight gain

Irregular menses even after stopping shot

53
Q

Who are Transdermal patches contraindicated in?

A

High risk pt for VTE
Skin conditions
Obesity

54
Q

Do Emergency Contraceptions disrupt or harm an embryo if a women is pregnant?

A

No

55
Q

What is a common adverse effect if a women takes Emergency Contraceptions?

A

NV
Irregular bleeding

Menstrual period will occur again 1 week later

56
Q

What is the recommended choice for Emergency Contraceptions?

A

Levonorgestrel containing EC

57
Q

What is the time frame you have in order to take EC?

A

within 72 hours

58
Q

MOA of Progestin-only EC

A

Inhibits or delays ovulation

59
Q

Which EC can be taken up to 120 hours (5 days) after intercourse

A

Ulipristal (Ella)

60
Q

28 year old G1P0 female is pregnant and being counseled for postpartum family planning. She is not planning on breastfeeding. What options are available to her postpartum?

A

Progestin-only methods (pills, injectables, Implant)

61
Q

A 30 year old female has a history of migraine headaches with light sensitivity. She does not experience any visual warning signs for a coming headache. She is interested in starting contraception. What methods are safe for her to consider?

A

Combined hormonal methods (pill, patch, ring)

Pharmacology (12 decks)

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