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1. Pharm II > Contraception > Flashcards

Contraception Flashcards

1
Q

What are goals of contraception?

A
  • Prevent pregnancy
  • Prevent STDs (condoms)
  • Improve menstrual cycle
  • Improve health conditions
  • Manage perimenopause
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2
Q

What are methods of contraception?

A
  • Periodic abstinence
  • Barrier techniques
  • Spermicides
  • Spermicides-implanted barrier
  • Hormonal
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3
Q

What are 2 contraindications for female condoms?

A
  • Allergy to polyurethane

- Hx of TSS

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4
Q

What are contraindications of using a diaphragm w/ spermicide?

A
  • Allergy to latex, rubber, or spermicide
  • Recurrent UTIs
  • Hx of TSS
  • Abnormal anatomy
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5
Q

What are contraindications of using a cervical cap?

A
  • Allergy to spermicide
  • Hx of TSS
  • Abnormal anatomy
  • Abnormal pap
  • Menses
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6
Q

How do you use a cervical cap?

A

Insert 6 hrs prior to intercourse

Do not remove for at least 6 hrs after intercourse

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7
Q

Can a cervical cap remain in place for multiple episodes of intercourse?

A

Yes, but not for longer than 48hrs at a time

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8
Q

What are contraindications to using a sponge?

A
  • Allergy to spermicide
  • Recurrent UTIs
  • Hx of TSS
  • Abnormal anatomy
  • Menses
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9
Q

What form of contraception can increase the transmission of HIV?

A

Spermicides

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10
Q

How do you use a sponge?

A

Moisten w/ water & insert up to 6hrs prior to intercourse

Do not remove for at least 6hrs after intercourse

Do not leave in for longer than 24-36hrs

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11
Q

Describe the hierarchy of contraception methods.

A

Implant > LNG > Copper T > injectable > pill, patch, ring > diaphragm, sponge (nullparous) > male condom > female condom > withdrawal > sponge (parous), fertility awareness > spermicide

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12
Q

What s/s are seen EARLY in the menstrual cycle?

A 
Irritability, anxiety, depression
Bleeding 
Lower abd, back, & leg pain  
HA, dizziness
N/D
Changes in libido 
Infection
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13
Q

What s/s are seen LATE in the menstrual cycle?

A 
Anxiety, depression
Wt gain, bloating, constipation 
Swollen eyes, ankles 
Breast fullness, tenderness 
HA
Nausea 
Acne 
Spotting, discharge
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14
Q

In combined hormonal contraceptives (CHCs), what provides the majority of the contraceptive effect?

A

Progestin

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15
Q

What is the MOA of progestins?

A

Thicken mucus
Slow motility & delay sperm transport
Induce endometrial atrophy
Block LH surge –> inhibits ovulation

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16
Q

What is the MOA of estrogens?

A

Suppress FSH release –> prevents ovulation
Stabilize endometrial lining & control cycle
Thicken mucus

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17
Q

What are the 3 synthetic estrogens?

A

Ethinyl estradiol (EE)
Mestranol (liver converts to EE)
Estradiol valerate

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18
Q

Progestins differ w/ respect to….

A

inherent estrogenic, antiestrogenic, & androgenic effects

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19
Q

What 2 variables are androgenic effects dependent upon?

A

presence of sex hormone binding globulin

androgen:progesterone activity ratio

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20
Q

What happens if SHBG decreases?

A

Free testosterone increases

Androgenic side effects become more prominent

21
Q

Describe 1st gen progestins. Give an example of one.

A

Well tolerated, but lower doses have breakthrough bleeding

Norethindrone

22
Q

Describe 2nd gen progestins. Give an example of one.

A

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

Levonorgestrel

23
Q

Describe 3rd gen progestins. Give an example of one.

A

Same progestational activity w/ decreased androgenic activity

Desogestrel

24
Q

Describe 4th gen progestins. Give an example of one.

A

Anti-androgenic

Drospirenone

25
Q

What are special considerations of oral contraceptives?

A 
Women > 35
Smoking 
HTN 
HLD
DM
Migraines 
Breast CA
Thromboembolism
Obesity 
SLE
26
Q

What are the risks associated with Minipills (progestin only)?

A

40% of women continue to ovulate

Increased risk of ectopic pregnancy

27
Q

What are contraindications of progestin only?

A

Gastric bypass
Ischemic heart disease
Rifampin

28
Q

What are ADEs of CHCs?

A 
N/V
Breast tenderness
Wt gain
Acne, oily skin
Depression, fatigue 
Breakthrough bleeding/spotting
Site reaction 
Vaginal irritation
29
Q

What s/s warrant discontinuation of CHCs?

A

“ACHES”

  • Abd pain
  • Chest pain, SOB
  • HAs
  • Eye problems
  • Severe leg pain
30
Q

Women breastfeeding w/ RFs of VTE should avoid CHCs for how long? What about those w/out RFs?

A

42 days postpartum

If no RFs –> avoid CHCs for 30 days postpartum

31
Q

What type of contraception should be offered if trying to minimize androgen effects or avoid HLD?

A

3rd gen progestin, low dose

32
Q

What is 1st line for contraception in adolescents?

A

LARC

  • Nexplanon
  • Mirena, Kyleena, Skyla
  • Copper ParaGard
33
Q

What are contraindications to IUDs?

A 
Unexplained vaginal bleeding
STDs
PID 
Hx of breast CA or endometrial CA
Post abortion
Pregnancy 
Pelvic TB 
Anatomic abnormalities
34
Q

Describe the mirena

A

Lasts 5 years
Reduces bleeding
Shrinks fibroids, reduces endometriosis
Effective 7 days after insertion

35
Q

Describe the ParaGard

A

Lasts 10 years
Can be used for emergency conception
May cause more menstrual bleeding

36
Q

What are contraindications of ParaGard?

A

Wilsons disease

SLE

37
Q

Describe Nexplanon

A

Lasts 3 years

Irregular bleeding

38
Q

What are contraindications for Nexplanon?

A

Cirrhosis

Ischemic heart disease

39
Q

What are ADEs of levonorgestrel & copper IUDs?

A

Menstrual irregularities
Expulsion
Insertion complications
PID

40
Q

What are ADEs of progestin only implants?

A

Menstrual irregularities

Insertion site reactions

41
Q

Describe ADEs of Depo Provera (DMPA)

A 
Wt gain
Irregular menses 
Bone loss 
Acne, hirsutism 
Depression
42
Q

Who is the Depo Provera shot good for?

A

Sickle cell anemia
Older smokers
Seizures

43
Q

What is a contraindication of Depo Provera?

A

Breast CA

44
Q

What are considerations of Depo Provera?

A 
Cirrhosis
DM w/ microvascular disease
CVD
Uncontrolled HTN 
SLE
Unexplained vaginal bleeding
Women close to menopause (risk of osteoporosis)
45
Q

What are contraindications for the transdermal patch (OrthoEvra)

A

Higher risk of VTE
Skin conditions
Obesity

46
Q

If switching pill to patch, what should be the overlap?

A

1 day

47
Q

If switching pill to shot or pill to hormone IUD, what should be the overlap?

A

1 wk

48
Q

If switching pill to implant, what should be the overlap?

A

4 days

49
Q

If switching pill to copper IUD, how long do you have to wait?

A

5 days after stopping pill

1. Pharm II (11 decks)

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