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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)

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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

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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

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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)

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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

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6
Q

The 3 MOA of contraceptives take

A
  1. Inhibit ovulation
  2. Prevent sperm from reaching egg
  3. Inhibit implantation
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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
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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

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9
Q

What is the standard days method

A

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

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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

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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

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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

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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

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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!

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15
Q

How do female barrier methods work

A

mechanical barrier to sperm entering cervical canal

Spermicide attacks flagella and body= reduced motility

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16
Q

How long does spermicide require to activate

A

15 minutes

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17
Q

What is in the transdermal patch

A

150 Norelgestromin/ 20 ethinyl estradiol

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18
Q

What is in the vaginal ring

A

120 etonorgestrel/ 15 ethinyl estradiol

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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!

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20
Q

What do you need to monitor prior to initiating CHC

A

Blood Pressure

No routine follow up needed

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21
Q

How do CHC work

A

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

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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
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23
Q

What happens if you miss 1 CHC pill

A

Take it ASAP and take the next pill as usual

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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

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25
What if you miss 2 pills from the last hormonal week
dont take the placebo week pills, start a new pack the next day
26
When can you start POPs
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*
27
How do POP work
Thicken cervical mucus thin endometrium Suppress ovulation 50% of the time slow sperm motility
28
ADE of POP include
Increased spotting/bleeding | intermittent amenorrhea
29
Limitations to taking POPs include
Current breast cancer, liver disease, meds that increase hepatic clearance (anti-convulsant, rifampin, St johns wort)
30
What is a missed pill with POP
If you wait >3 hours of normal time | if you vomit or have severe diarrhea w/in 3 hours after taking a POP
31
What do you do if you miss a POP pill
take another pill, use backup for 2 days | consider EC
32
How do you prescribe Depo-Provera (progestin injectable)
can start any time no backup needed if you start w/in 7 days of bleed Repeat injections every 13 weeks
33
Limitations to using Depo-provera
``` 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
What are LARCs
``` Copper IUD (10 years!) Levonorgestrel IUD ```
35
What are the types of LNG-IUD
Mirena: 5 years Kyleena: 5 years Liletta: 4 years Skyla: 3 years
36
What is in Nexplanon
single 68mg etonorgestrel rod
37
IUD are preferred for
adolescents | parous or nulliparous
38
When can you place an IUD
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
What must you monitor with IUDs
bimanual exam and cervical inspection STD screening at time of insertion no routine follow up!
40
Limitations to IUD are
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
What is the MOA of LNG-IUD
thicken cervical mucus slow tubal motility alter endometrium= no implantation 5-15% anovulatory effect
42
If IUD fails, you have a higher chance of
Ectopic pregnancy
43
What is the MOA of Cu-IUD
coper ions inhibit sperm motility so sperm rarely reach fallopian tube= no fertilization inflammatory reaction of endometrium phagocytizes sperm
44
ADE of Cu-IUD is
increased menstrual blood loss and dysmenorrhea
45
What is the MOA of nexplanon (etonorgestrel implant)
thicken cervical mucus inhibit ovulation atrophic endometrium
46
How do you insert nexplanon
at any time if reasonably certain not pregnant | no backup needed if in first 5 days of bleed
47
Limitations of nexplanon include
current breast cancer liver disease unpredictable, irregular menstrual bleeding
48
What is the MOS of emergency contraception
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
What happens if you take emergency contraception after ovulation
they are not abortifacient and do not disturb implanted pregnancy little effect on ovarian hormone production at this time
50
What are the available EC pills
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
ADE of EC are
``` nausea vomiting (if you vomit w/in 3 hrs of taking EC, take another dose and consider taking Meclizine before your second try) ```
52
How do you prescribe EC
Cu-IUD: insert w/in 5 days | ECP: ASAP, w/in 5 days
53
Do you need contraception after taking Ulipristal acetate
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
Do you need contraception after taking the LNG or combined ECP
Use backup for 7 days can start any contraceptive immediately *If no withdrawal bleed in 3 weeks, take a pregnancy test*
55
What are sterilization techniques for women
Hysteroscopic: tubal occlusion (wire)- need to confirm after Laparoscopic (abd): tubal ligation (irreversible)
56
What are risk factors for regretting sterilization
``` <30 y/o low parity sterilization at time of c-section change in marital status poverty minority status misinformed of risks hurried decision ```
57
Do you need additional contraception after vasectomy
yes, until 2 consecutive sperm samples show no motile sperm! 1% of men request reversal, low regret
58
What contraceptive methods have the highest rate of continuation at 1 year in 15-24 year olds
LARC** | Cu-Iud, OCP, Ring, Depo, Patch
59
Can teens use Depo
Yes! discuss ADE with them before administering, but it should not prevent you from using this method
60
Preferred contraception for teens is
IUD!!! | ACOG says these are first line!
61
If obese, do not use
``` Ortho evra patch Depo provera shot +/- OCP (VTE risk) +/-LNG-IUD (weight gain) (but these are not contraindications) ```
62
Obese adolescents are noted to have
earlier coital debut | higher rates of unprotected sex
63
Hormonal contraception decreases the risk of
endometrial hyperplasia and cancer! wahoo!
64
ACOG recommends use of contraceptives until
menopause, or age 50-55
65
These methods are preferred for >45 y/o
POP Implants LNG-IUD Cu-IUD
66
If >45, do not use
COC Depo (bc they have risks related to chronic conditions that come with age)
67
How long do you need to use backup when starting contraceptives
Cu-IUD: none POP: x 2 days All others: x 7 days
68
In postpartum women, when can you start contraceptives
``` 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
When should you start contraceptives post-abortion
``` 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
At contraception follow ups, you should
assess satisfaction concerns about method use changes in health status or meds consider assessing weight changes

Summer FDTN Exam 3 (25 decks)

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