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Pharmacology II > Contraception > Flashcards

Contraception Flashcards

1
Q

List the methods of contraception

A
  1. Periodic Abstinence (rhythm method)
  2. Barrier techniques
  3. Spermicides (contain nonoxynol-9 chemical surfactants)
  4. Spermicides-implanted barrier technique (sponge with spermicide)
  5. Hormonal contraception
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2
Q

Disadvantages of male condoms

A

-Efficacy decreased by oil-based lubricants

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3
Q

Absolute contraindications for female condoms

A
  • Allergy to polyurethane

- History of toxic shock syndrome

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4
Q

What is important to remember about female and male condoms?

A

not meant to be used together

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5
Q

Why are spermicides no longer recommended?

A

No added benefit against pregnancy and may increase the risk of HIV transmission

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6
Q

What is important to remember about Diaphragm with spermicide?

A
  • Insert 6 hours before intercourse
  • Leave in place at least 6 hours after intercourse
  • DON’T leave in for >24 hours= risk of Toxic shock syndrome
  • Subsequent acts of intercourse, condom use recommended for additional protection
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7
Q

Diaphragm with spermicide: Absolute contraindications

A
  • allergy to latex, rubber, or spermacide
  • Recurrent UTI
  • History of TSS
  • Abnormal gynecologic anatomy
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8
Q

Diaphragm with spermicide: Advantages

A
  • Inexpensive
  • Decreased risk of cervical neoplasia
  • Some protection against STDs
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9
Q

Diaphragm with spermicide: Disadvantages

A
  • High user error/failure rate
  • Decreased efficacy with increase intercourse frequency
  • Increased vaginal yeast UTIs
  • Efficacy decreased by oil-based lubricants
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10
Q

What is a unique contraindication for Cervical cap (FemCap)?

A

Abnormal papanicolaou smear (due to increased risk for cervical dysplasia)***

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11
Q

What are 2 disadvantages with the cervical cap?

A
  • decreased efficacy in women who have given birth

- Can’t use during menses

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12
Q

In combined hormonal contraceptives, what hormone provides the most contraceptive effect?

A

Progestins

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13
Q

Name the effects progestins have to prevent pregnancy

A
  1. Thickening of cervical mucus
  2. Slow tubal motility (sperm transport)
  3. Induce endometrial atrophy
  4. Progestins block LH surge inhibiting ovulation**
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14
Q

What effects do estrogens have to prevent conception?

A
  • Stabilize endometrial lining to provide cycle control**

- Suppress FSH release from pituitary, contribute to blocking LH surge

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15
Q

Which form of synthetic estrogen is a prodrug?

A

Mestranol

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16
Q

Why would you consider Mestranol?

A

50% less potent than Ethinyl estradiol
so…

if you want less estrogen this one is good

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17
Q

Which is the most common synthetic estrogen?

A

Ethinyl estradiol (EE)

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18
Q

Name a 1st Generation progestin and downside

A

Ex. Norethindrone

  • well tolerated
  • Lower doses have more breakthrough bleeding
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19
Q

Name a 2nd Generation progestin and pros and cons

A

Ex. Levonorgestrel

  • long half-life (IUD*)
  • More androgenic activity - better for libido, worse for hirsutism/acne/lipids
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20
Q

Name 3rd Generation progestin and indication for use

A

Ex. Desogestrel

-Similar to 2nd gen but less androgenic activity–> so think about this in someone with slight libido benefit needed

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21
Q

Name 4th Generation progestin and benefit

A

Ex. Drospirenone (Yasmin)

  • anti-androgenic properties**
  • Advertised for acne
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22
Q

For progestin only, what is importnat to know about the dosing?

A
  • Must take at the same time every day (3 hr window)

- If window missed, need back up contraception for 48 hours

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23
Q

What is a main risk factor for progestin only birth control?

A

Higher risk of ectopic pregnancy

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24
Q

When might be a good time to use progestin only birth control?

A

right after giving birth, because with giving estrogen you would be concerned for increased risk of thrombotic events

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25
Q

Progestin only contraindications:

A
  • Gastric bypass
  • ischemic heart disease
  • Rifampin
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26
Q

Which type of populations should we be more cautious of for combined oral contraceptives/combined hormonal contraceptives

A
  1. Women older than 35
  2. Smokers*
  3. Hypertension
  4. Dyslipidemia
  5. Diabetes
  6. Migraine headaches
  7. Breast cancer
  8. Thromboembolism
  9. Obesity
  10. Systemic Lupus Erythematosus
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27
Q

What does 1 represent on the CDC contraceptives chart?

A

No restriction

28
Q

What does 2 represent on the CDC contraceptives chart?

A

Advantages generally outweight theoretical or proven risks

29
Q

What does 3 represent on the CDC contraceptives chart?

A

Theoretical or proven risks usually outweight the advantages

30
Q

What does 4 represent on the CDC contraceptives chart?

A

Unacceptable health risk (method not to be used)

31
Q

What are contraindications for CHC?

A
  • Smoker >35 (>15 cigarettes/day)
  • Lupus
  • current breast cancer
  • Severe liver disesase (cirrhosis)/Liver adenoma
  • High risk of DVT/PE
  • Migraine headaches with aura
  • Hypertension
  • Vascular disease
  • Post partum <21 days
32
Q

If a patient has no coexisting medical conditions, what oral contraceptive is recommended?

A

OC containing:

35 mcg or less of EE and less than 0.5mg of norethinodrone (1st gen)

33
Q

How should you alter the OC dose for adolescents, underweight women, women older than 35 and perimenopausal women?

A

-Lower dose of EE

fewer side effects with 20-25mcg of EE

34
Q

If a patient is nonadherent to her OC what should be considered?

A

increasing the estrogen dose

35
Q

Which type of oral contraceptive is preferred at initiation of therapy?

A

Monophasic (not multiphasic)

36
Q

If a patient on oral contraception is having weight gain what can you do?

A

-this typically improves after 2-3 cycles but can change to a lower estrogentic

37
Q

If a patient has breakthrough bleeding what can you do to the oral contraceptive?

A

Change to higher estrogenic

38
Q

Name the 5 symptoms that should make you immediately discontinue a combined hormonal contraceptive (CHC)?

A

ACHES

Abdominal pain
Chest pain
Headache
Eye problems
Severe leg pain
39
Q

How long should someone be on OC before changing/making an adjustment?

A

2-3 months

40
Q

What is the most common adverse effect of oral contraception?

A

irregular bleeding

especially first 6 months of extended-cycle regimens

41
Q

Traditionally, when is it recommended for women to start OC?

A

“sunday start” - first sunday after menstrual cycle begins

42
Q

With starting new oral contraception, how long do you recommend a second method of contraception?

A

at least 7 days after initiation

43
Q

How long should breast feeding women avoid CHCs?

A

42 days (w/ risk factors)

30 days (no risk factors)

44
Q

How long should you avoid giving CHCs to a women you just gave birth?

A

21 days (higher risk of thrombosis)

45
Q

Mirena IUD: Key points

A
  • good for 5 years
  • Reduces bleeding
  • 99% effective
  • Effective 7 days after insertion
46
Q

ParaGard IUD: key points

A
  • copper
  • Good for 10 years
  • Off label: emergency contraception
  • May cause MORE menstrual bleeding**
  • 99% effective, effective immediately
47
Q

What are the contraindications for ParaGard IUD?

A
  • SLE (with thrombocytopenia)

- Wilson’s Disease

48
Q

Nexplanon Implant: key points

A
  • single rod
  • good for 3 years
  • 99% effective
49
Q

Nexplanon IUD: contraindications

A
  • cirrhosis

- ischemic heart disease

50
Q

Depo-Provera (DMPA) indications

A
  • sickle cell
  • older women smokers
  • seizures
51
Q

Depo-Provera (DMOA) contraindications

A

currently with breast cancer

52
Q

Depo-Provera: ADE

A
  • Bone loss (should reverse after stoping shots
  • Weight gain
  • irregular menses (even after stopping)
53
Q

Transdermal patch: OrthoEvra - key points

A
  • don’t wear over breasts
  • one patch a week for 3 weeks
  • one week off
54
Q

Transdermal patch: contraindications

A

Higher risk for VTE

55
Q

How much overlap between pill brands?

A

none

56
Q

How much overlap needed between pill and patch?

A

one day overlap

57
Q

How much overlap between pill and ring?

A

none

58
Q

How much overlap between pill and shot?

A

1 week

59
Q

How much overlap between pill to implant?

A

4 days

60
Q

How much overlap from pill to hormone IUD?

A

1 week

61
Q

How much time can pass between stopping oral pills and starting copper IUD?

A

5 days

62
Q

If pregnancy already exists and you take emergency contraception- will it harm the embryo?

A

No

63
Q

Levonorgestrel containing emergency contraception should be taken within what window after unprotected intercourse?

A

72 hours (3 days)

64
Q

Levorgestrel emergency contraception: primary mechanism of action?

A

inhibiting or delaying ovulation (doesn’t disrupt implantation)

65
Q

What is the window of use for Ulipristal as an emergency contraceptive?

A

5 days after unprotected sex

-Rx only

Pharmacology II (31 decks)

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