Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Summer FDTN Exam 3 > contraception > Flashcards

contraception Flashcards

1
Q

Groups with the largest increase in unintended pregnancies are

A

Low education
Low income
Cohabiting women (not married)
(black women also more likely to have unintended births)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Barriers to contraception are

A

unnecessary screening exams and tests
Inability to receive contraceptive on same day as visit
Difficulty obtaining continued contraceptive supplies
teens: understanding confidentiality laws

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Routine pregnancy screening is NOT necessary if

A

<7 days after start of normal menses
no sexual intercourse since start of last normal menses
Correct and compliant use of contraception
<7 days after spontaneous or induced abortion
w/in 4 weeks postpartum
fully or near fully breastfeeding, amenorrheic, and <6 months postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If you dont meet reasonable certainty, when can you start contraception regardless (except IUD)

A

If benefits>risks;
start contraception and have patient get a pregnancy test in 2-4 weeks
(not IUD bc they have a higher risk of complications- spontaneous, preterm, septic aboriton)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Key medical history before starting contraceptives are

A

PMHx: hormonal cancer, obesity, liver dz, gallbladder dz, migraines w/ aura, HTN, VTE, Sz, DM
Med use
SHx: smoking, sexual (high risk for STI)
FHx: cancer, DVT/VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The 3 MOA of contraceptives take

A
  1. Inhibit ovulation
  2. Prevent sperm from reaching egg
  3. Inhibit implantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the types of contraception

A 
Natural family planning 
Barrier/ Spermicidal 
Combined Hormonal Contraception 
Progestin only contraception 
Long Acting Reversible Contraception 
Emergency Contraception 
Sterilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rate types of contraception by effectiveness

A

Worst: NFP, spermicide
Eh: condoms, withdrawal
Better: Depo, pill, patch, ring, diaphragm
Best: Implant, sterilization, IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the standard days method

A

For women w/ cycles 26-32 days long, NO SEX days 8-19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the calendar method

A

Monitor cycles for 6 months, then abstain form sex when fertile
Fertility starts: length of shortest cycle-18 days
Fertility ends: length of longest cycle-11 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the cervical mucus/2 day method

A

check cervical mucus daily
“Peak” day is last day of stretchy, clear mucus
Fertility starts with first signs of clear mucus-4 days after peak day
If no mucus for 2 days, you can have sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the basal body temp method

A

Check basal temp when you wake up every morning before getting out of bed
Rise in temp of 0.5-1.0 degree= ovulation occurred
don’t have sex from end of period-3 days after temp increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the symptothermal method

A

combo of cervical mucus assessment and basal body temp
also monitor for signs of ovulation (cramping, spotting, tender breasts); fertility is from first sign of ovulation-3 days after temp rise of 4 days after peak mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of male condoms

A

Latex
Polyurethane: more likely to slip and break
Natural (lamb cecum): lower level of STI protection
*Avoid petroleum or oil based vaginal products with latex condoms!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do female barrier methods work

A

mechanical barrier to sperm entering cervical canal

Spermicide attacks flagella and body= reduced motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long does spermicide require to activate

A

15 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is in the transdermal patch

A

150 Norelgestromin/ 20 ethinyl estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is in the vaginal ring

A

120 etonorgestrel/ 15 ethinyl estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When can you start CHC

A

any time!
No backup needed if you start in the first 5 days of a bleed
**Prescribe 1 year supply at initiation and follow up!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you need to monitor prior to initiating CHC

A

Blood Pressure

No routine follow up needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do CHC work

A

Suppress ovulation**
thicken cervical mucus
thin endometrium= hard for implantation
slow tubal motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Limitations to using CHC include

A 
current breast cancer 
severe HTN or vascular disease 
complicated DM (or DM >20 years) 
heart disease 
migraine with aura 
seizure disorder 
liver/gallbladder disease 
smoke 15+ cigarettes per day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens if you miss 1 CHC pill

A

Take it ASAP and take the next pill as usual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens if you miss 2 CHC pills

A

Take the most recently missed one ASAP
Continue as usual the next day (you will have an extra pill in your pack)
Use backup for 7 days or EC if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What if you miss 2 pills from the last hormonal week

A

dont take the placebo week pills, start a new pack the next day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When can you start POPs

A

any time!
No backup needed if you start in the first 5 days of bleed
Prescribe 1 year supply at a time
NO monitoring necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do POP work

A

Thicken cervical mucus
thin endometrium
Suppress ovulation 50% of the time
slow sperm motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

ADE of POP include

A

Increased spotting/bleeding

intermittent amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Limitations to taking POPs include

A

Current breast cancer, liver disease, meds that increase hepatic clearance (anti-convulsant, rifampin, St johns wort)

30
Q

What is a missed pill with POP

A

If you wait >3 hours of normal time

if you vomit or have severe diarrhea w/in 3 hours after taking a POP

31
Q

What do you do if you miss a POP pill

A

take another pill, use backup for 2 days

consider EC

32
Q

How do you prescribe Depo-Provera (progestin injectable)

A

can start any time
no backup needed if you start w/in 7 days of bleed
Repeat injections every 13 weeks

33
Q

Limitations to using Depo-provera

A 
current breast cancer 
severe HTN 
heart disease 
vascular disease 
migraine w aura
liver disease 
changes in bleeding patterns 
weight gain (5.4 lb in first year) 
decreased bone mineral density
34
Q

What are LARCs

A 
Copper IUD (10 years!) 
Levonorgestrel IUD
35
Q

What are the types of LNG-IUD

A

Mirena: 5 years
Kyleena: 5 years
Liletta: 4 years
Skyla: 3 years

36
Q

What is in Nexplanon

A

single 68mg etonorgestrel rod

37
Q

IUD are preferred for

A

adolescents

parous or nulliparous

38
Q

When can you place an IUD

A

anytime if reasonably certain not pregnant
Cu-IUD, no back up needed after insertion
LNG-IUD no back up if inserted in first 7 days of bleed

39
Q

What must you monitor with IUDs

A

bimanual exam and cervical inspection
STD screening at time of insertion
no routine follow up!

40
Q

Limitations to IUD are

A

cervical cancer
purulent cervicitis
current gonorrhea or chlamydia, or high likelihood to exposure
increased risk of spontaneous abortion and preterm delivery if you become pregnant on an IUD

41
Q

What is the MOA of LNG-IUD

A

thicken cervical mucus
slow tubal motility
alter endometrium= no implantation
5-15% anovulatory effect

42
Q

If IUD fails, you have a higher chance of

A

Ectopic pregnancy

43
Q

What is the MOA of Cu-IUD

A

coper ions inhibit sperm motility so sperm rarely reach fallopian tube= no fertilization
inflammatory reaction of endometrium phagocytizes sperm

44
Q

ADE of Cu-IUD is

A

increased menstrual blood loss and dysmenorrhea

45
Q

What is the MOA of nexplanon (etonorgestrel implant)

A

thicken cervical mucus
inhibit ovulation
atrophic endometrium

46
Q

How do you insert nexplanon

A

at any time if reasonably certain not pregnant

no backup needed if in first 5 days of bleed

47
Q

Limitations of nexplanon include

A

current breast cancer
liver disease
unpredictable, irregular menstrual bleeding

48
Q

What is the MOS of emergency contraception

A

if taken before ovulation: disrupt normal follicular development, block LH surge, inhibit ovulation
-Cu-IUD has different method, provides EC for 5 days after unprotected sex

49
Q

What happens if you take emergency contraception after ovulation

A

they are not abortifacient and do not disturb implanted pregnancy
little effect on ovarian hormone production at this time

50
Q

What are the available EC pills

A

Ulipristal acetate single dose
Levonorgestrel 1.5 single dose or split dose (q12 hr)
Combined estrogen/progestin in 2 doses (not as effective, lots of ADE)

51
Q

ADE of EC are

A 
nausea 
vomiting (if you vomit w/in 3 hrs of taking EC, take another dose and consider taking Meclizine before your second try)
52
Q

How do you prescribe EC

A

Cu-IUD: insert w/in 5 days

ECP: ASAP, w/in 5 days

53
Q

Do you need contraception after taking Ulipristal acetate

A

Use backup for 14 days, or until next menses
you can start another form of contraception at any time
*If no withdrawal bleed in 3 weeks of taking UPA, take a pregnancy test

54
Q

Do you need contraception after taking the LNG or combined ECP

A

Use backup for 7 days
can start any contraceptive immediately
If no withdrawal bleed in 3 weeks, take a pregnancy test

55
Q

What are sterilization techniques for women

A

Hysteroscopic: tubal occlusion (wire)- need to confirm after
Laparoscopic (abd): tubal ligation
(irreversible)

56
Q

What are risk factors for regretting sterilization

A 
<30 y/o 
low parity 
sterilization at time of c-section 
change in marital status 
poverty 
minority status 
misinformed of risks 
hurried decision
57
Q

Do you need additional contraception after vasectomy

A

yes, until 2 consecutive sperm samples show no motile sperm!
1% of men request reversal, low regret

58
Q

What contraceptive methods have the highest rate of continuation at 1 year in 15-24 year olds

A

LARC**

Cu-Iud, OCP, Ring, Depo, Patch

59
Q

Can teens use Depo

A

Yes! discuss ADE with them before administering, but it should not prevent you from using this method

60
Q

Preferred contraception for teens is

A

IUD!!!

ACOG says these are first line!

61
Q

If obese, do not use

A 
Ortho evra patch 
Depo provera shot 
\+/- OCP (VTE risk)
\+/-LNG-IUD (weight gain) 
(but these are not contraindications)
62
Q

Obese adolescents are noted to have

A

earlier coital debut

higher rates of unprotected sex

63
Q

Hormonal contraception decreases the risk of

A

endometrial hyperplasia and cancer! wahoo!

64
Q

ACOG recommends use of contraceptives until

A

menopause, or age 50-55

65
Q

These methods are preferred for >45 y/o

A

POP
Implants
LNG-IUD
Cu-IUD

66
Q

If >45, do not use

A

COC
Depo
(bc they have risks related to chronic conditions that come with age)

67
Q

How long do you need to use backup when starting contraceptives

A

Cu-IUD: none
POP: x 2 days
All others: x 7 days

68
Q

In postpartum women, when can you start contraceptives

A 
CHC: breastfeeding, 4 wks// not BF, 3 wks// VTE RF, 4-6 wks
POP: anytime 
Depo: anytime 
Cu-IUD: anytime (as long as no sepsis) 
LNG-IUD: anytime (as long as no sepsis) 
Nexplanon: anytime
69
Q

When should you start contraceptives post-abortion

A 
CHC: anytime w/in 7 days 
POP: anytime, w/in 7 days 
Depo: anytime 
IUD: anytime, w/in 7 days (no septic abortion) 
Nexplanon: anytime, w/in 7 days
70
Q

At contraception follow ups, you should

A

assess satisfaction
concerns about method use
changes in health status or meds
consider assessing weight changes

Summer FDTN Exam 3 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions