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Pharm- Exam 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

List the barrier techniques

A
  1. Condoms
  2. Diaphragms
  3. Cervical Caps
  4. Sponges
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2
Q

Define Spermicides

A

Contain Nonxynol-8:

  • Chemical surfactants that destroy sperm cells walls
  • Act as barriers that prevent sperm from entering cervical os
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3
Q

What type of lubricant in condoms is preferred? Why?

A

Water soluble lubricants: KY Jelly, Astroglide

Mineral-oil based, lotions, lubricants can decrease barreri strength of latex

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4
Q

How long prior to and after sex do you need to insert/keep in diaphragms, cervical caps and sponges?

A

6 hrs prior

6 hrs after

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5
Q

What is the maximum time a diaphragm can be left in place?

A

24 hrs

>24 hrs increases potential for toxic shock syndrome

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6
Q

What must you use if you have subsequent sex when using a diaphragm

A

Condom for additional protection

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7
Q

What is the maximum time a cervical cap can be left in place?

A

48 hrs

>48 hrs increases potential for toxic shock syndrome

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8
Q

What is a benefit of using a cervical cap?

A

Can be left in place for multiple x of sex without needing to add more spermicide

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9
Q

What is the maximum time a cervical cap can be left in place?

A

24-30 hrs

>24-30 hrs increases potential for toxic shock syndrome

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10
Q

What must you have in order for ovulation to occur?

A

LH surge

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11
Q

What hormone is responsible for the follicular phase/early phase of the cycle?

A

Estrogen

STABILIZES the endometrium

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12
Q

What hormone is responsible for the proliferative phase/late phase of the cycle?

A

Progesterone

MAINTAINS THE endometrium for implantation

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13
Q

What precursor is required to make testosterone?

A

Cholesterol

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14
Q

What does the presence of Aromatase allows the conversion of?

A

Different forms of estrogen:

  1. Estradiol
  2. Estriol
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15
Q

Which type of estrogen is predominant?

A

Estradiol

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16
Q

What type of estrogen do we monitor for in pregnancy?

A

Estriol

Produced in large amounts by the placenta

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17
Q

What do we Aromatase Inhibitors in the treatment of?

A

Estrogen Dependent CA’s

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18
Q

Progestin MOA

A

Blocks the LH surge, therefor inhibiting ovulation

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19
Q

Combined Hormonal Contraceptives MOA

A

work BEFORE fertilization to prevent contraception

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20
Q

Estrogen MOA

A

Suppress FSH release from pituitary

May contribute to blocking LH surge and preventing ovulation

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21
Q

List the Estrogen available

A
  1. Ethinyl Estradiol (EE)
  2. Mestranol
  3. Estradiol Valerate
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22
Q

What estrogen would be a good option if you wanted lower levels of hormones?

A

Ethinyl Estradiol (EE): Pro drug that gets activated by the liver, loses 50% of potency

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23
Q

What hormone do we choose the products based off?

A

Progestins=MAJOR contraceptive PREVENTING ovulation

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24
Q

List the 3 types of Progestins

A
  1. Estrogenic
  2. Antiestrogenic
  3. Androgenic Activity
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25
What two variables is androgenic activity based on?
1. Presence of sex hormone binding globulin (SHBG-TBG) | 2. Androgen: Progesterone activity ratio
26
SHBG-TBG and Testosterone relationship
Decreased SHBG-TBG= Increased Free Testosterone levels= Increased Androgenic S/E's
27
List a 1st generation Progestin
Norethindrone
28
Norethindrone ADE
Breakthrough bleeding @ lower doses
29
List 2nd generation Progestin
Levonorgestrel
30
Levonorgestrel activity
Increase Androgenic Activity
31
Levonorgestrel ADE's
Worse for: 1. Hirsutism 2. Acne 3. Lipids
32
List 3rd generation Progestin
Desogestrel
33
Desogestrel activity
Decreased androgenic activity
34
Who should you consider using Desogestrel in?
Libido issues
35
List 4th generation Progestin
Drospirenone
36
Drospirenone activity
Anti-Androgenic
37
Who should you consider using Drospirenone in?
Treatment of Acne
38
Progestin administration directions
1. Take @ same time every day 2. 3 hr window 3. if you miss 3 hr window, use backup method contraception
39
Progestin CI
1. Gastric Bypass surgery 2. Ischemic heart dz 3. Rifampin therapy
40
What do you need to know about minipills?
May NOT block ovulation 40% of women continue to ovulate normally Risk of ectopic pregnancy
41
Progestin indications
Post-partum
42
At what age should you NOT prescribe CHC to women?
>35= RED!
43
What is the MC type of Estrogen?
Ethinyl Estradiol
44
What is the MC ADE of CHC?
Excessive or deficient amounts of estrogen and progestin
45
What is the OC dose in women with NO coexisting medical conditions?
EE=35 mcg | Norethindrone=0.5 mg
46
Who do we prescribe only 20-25 mcg of EE to?
1. Adolescents 2. Underweight: <50 kg, <110 lbs 3. >35 y.o. 4. Perimenopausal
47
What do we prescribe women with oily skin, acne or hirsutism with?
Low androgenic OC's: Yaz
48
Who would benefit from extended-cycle OC regimens? Why?
1. Dysmenorrhea 2. Severe premenstrual syndrome 3. Menstrual Migraines *Reduces or eliminates # of cycles/yr
49
How long should you wait before making a change to OC's d/t SE's?
2-3 months Extended-cycle regimens=6 months Sx's usually improve by the 3rd cycle
50
How long should women who are breastfeeding avoid CHC's for?
With RF's for VTE=42 days | Without RF's=30 days
51
What is the time period for the highest risk of thrombosis following pregnancy? What do you use to avoid this?
Frist 21 days postpartum | Use Progestin only
52
If you want to reduce the risk of thrombosis and reduce nausea, breast tenderness or vascular HA's...what should you prescribe?
Product with lower dose estrogen
53
If you want to minimize spotting or breakthrough bleeding, what should you prescribe?
Pill with higher dosage of estrogen OR | progestin w/ greater potency
54
If you want to minimize androgenic effects and avoid dyslipidemia, what should you prescribe?
3rd generation progestin | low-dose norethidnrone
55
What is a possible benefit of Mirena IUD (levonorgestrel)?
1. Shrink Fibroids | 2. Reduce Endometriosis
56
What is an ADE of ParaGard IUD (Copper)?
May cause more menstrual bleeding
57
ParaGard IUD (Copper) CI
1. SLE | 2. Wilson's disease
58
Mirena IUD (levonorgestrel) and ParaGard IUD ADE's
1. Menstrual irregularities: Amenorrhea 2. Expulsion 3. PID 4. Insertion-related complications (cramping, pain)
59
Nexplanon CI
1. Cirrhosis | 2. Ischemia heart dz
60
Depo-Provera (DMPA) ADE's
1. Weight gain: even after stopping 2. Irregular menses: even after stopping 3. Decreased BMD: Reverse after stopping, limit use to 2 yrs. 4. Acne and hirsutism 5. Depression: Depression screening
61
What do you need to educate your patient about with the use of Depo-Provera (DMPA)?
May take up to 12 months to return to fertility
62
Depo-Provera (DMPA) Indications
1. Sickle cell 2. Older smokers 3. Seizures
63
Depo-Provera (DMPA) CI
CURRENT breast CA
64
Transdermal Patch CI
1. Higher risk for VTE 2. Skin conditions 3. Obesity (less effective)
65
What can the Vaginal Ring (NuvaRing) help decrease the frequency of?
BV
66
How long of overlap do you need when switching from pill to pill and pill to ring?
No change
67
How long of overlap do you need when switching from pill to patch?
1 day
68
How long of overlap do you need when switching from pill to implant?
4 days
69
How long of overlap do you need when switching from pill to copper IUD
up to 5 days
70
How long of overlap do you need when switching from pill to shot and hormone IUD?
7 days/1 week
71
What is the MOA of Progestin-only Emergency Contraceptive?
Inhibits or Delays Ovulation | No effect on implantation or disruption of fertilized egg after implantation has occurred
72
How many days after an Emergency Contraceptive should non hormonal contraceptives be used for?
7 days
73
What is Ulipristal (Ella)?
Selective Progesterone Receptor Modulator w/ mixed progesterone agonist and antagonist properties
74
How many hours after unprotected sex is Ulipristal (Ella) effective for?
120 hrs=5 days | *Prescription only

Pharm- Exam 2 (5 decks)

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