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Foundations III-Women's Health > contraception > Flashcards

contraception Flashcards

1
Q

which women are more likely to experience unintended births?

A

black or hispanic, low education or income, unmarried women

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2
Q

consequences in unintended pregnancies

A

delays in prenatal care, maternal depression, increased risk of physical violence during pregnancy, birth defects and low birth wt., baby will have lower educational attainment and behavioral issues

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3
Q

barriers to contraception?

A

unnecessary screening exams/tests, inability to receive contraceptive on same day as visit, difficulty obtaining continued contraceptive supplies, adolescents understanding confidentiality laws

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4
Q

parameters for rx’ing contraceptives

A

routine pregnancy testing NOT necessary

HISTORY!!
<7d after start of normal menses, no sexual intercourse since start of last normal menses, using contraception reliably, w/in 4 wks postpartum, fully/nearly breastfeeding, amenorrheic….???????

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5
Q

if no criteria for contraception met

A

consider EC, Urine preg test/qualitative HCG

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6
Q

only contraception that you cannot use if a pt happened to be pregnant?

A

IUD

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7
Q

contraception and pt communication

A

ask about future fertility, impact on sexual activity, and recognize personal, physical, religious or cultural values

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8
Q

PMHx questions

A

hormonally based CA, obesity, migraine, HTN, venous thromboembolism, seizure disorders, complicated DM, liver/gallbladder dz

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9
Q

FHx questions

A

CA’s and thromboembolic disorders

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10
Q

what are some contraindications to contraceptive use?

A

using hormonally based contraceptives w/breast CA’s, IUD’s w/cervical or endometrial CA’s, CHC w/clotting conditions

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11
Q

MOAs for contraception

A

inhibit ovulation, prevent sperm from reaching egg, inhibit implantation

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12
Q

which forms of contraception are most effective?

A

implants, vasectomy, female sterilization, IUD’s

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13
Q

which forms of contraception are least effective?

A

fertility-awareness based, spermicide, male condoms, female condoms

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14
Q

standard days method of natural family planning may be utilized by women w/menstrual cycles that are how many days long?

A

26-32

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15
Q

on what days of the menstrual cycle must sexual intercourse be avoided w/the SDM?

A

8-19

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16
Q

how does the calendar method work?

A

monitor cycles x6mo’s

1st day of fertile period = length of shortest menstrual cycle minus 18 days

last day of fertile period = length of longest menstrual cycle minus 11 days

avoid sex during fertile period

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17
Q

cervical mucus method?

A

check daily

“peak” day = last day of stretchy, clear mucus

fertile period = 1st signs of mucus and continues until 4 days after peak

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18
Q

basal body temp?

A

check every am before getting out of bed

rise in temp of 0.5-1degF = ovulation

from end of menstrual period until 3 days after temp increase

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19
Q

what types of products must be avoided w/use of latex condoms (d/t decreasing effectiveness)?

A

oil based

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20
Q

which type of male condom is more likely to break of slip?

A

polyurethane compared to latex (2.6-5% more likely)

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21
Q

what is the minimum amount of time a cervical cap, diaphragm, or sponge must be left in place after sexual intercourse?

A

6hrs

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22
Q

when does spermicide (alone) become active and how long does it last?

A

takes 15 mins and lasts 1 hr

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23
Q

spermicide is assoc. w/increased transmission of what condition? why?

A

HIV, create irritation vaginally

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24
Q

there is an increased risk of ___ w/use of female diaphragm?

A

UTI

25
Q

are any of the CHC’s effected by obesity?

A

patch

under 108lbs

26
Q

what are some contraindications using CHC’s?

A

breast CA, heart dz, smoker >15cigs/day, vascular dz, migraine w/aura, seizure disorder

27
Q

what screening or monitoring should be completed w/CHC use?

A

BP at initiation, no routine f/u needed

28
Q

what is the primary MOA for CHC’s?

A

prevents ovulation

29
Q

proper prescribing for CHC?

A

no back up needed if start in first 5 days of bleed, can be initiated at any time, should Rx yearly

30
Q

if miss 1 CHC pill?

A

take pill ASAP and take next pill as usual

take most recent missed pill asap, backup for 7d, consider emergency contraception

31
Q

what is the primary MOA for progestin only contraception?

A

thicken cervical mucus

thin, atrophic endometrium inhibits implantation

ovulation suppression, slows sperm motility

32
Q

how long does it take to achieve maximum efficacy of POP’s? (progestin only pill)

A

2 days or 48hrs

33
Q

when is a POP considered ‘missed’?

A

3hrs

if V or severe D occur w/in 3hrs after taking POP

34
Q

who would be an ideal candidate for POP?

A

someone who can’t take estrogen

35
Q

limitations for progestin only pills?

A 
limited window (3hr delay= missed)
current breast ca, liver dz's, meds that incr hepatic clearance (st. john's wort, anticonvulsants, etc)
36
Q

what is the continuation rate for Depot Provera?

A

56%

37
Q

what are common side effects of depot provera?

A

delayed to returned fertility after stopping, amenorrhea, irregular bleeding, decreased BMD

38
Q

LARC (long acting reversible contraception) options?

A 
copper IUD (Cu-IUD)
levonorgestrel (LNG-IUD)
39
Q

what physical exam must be completed prior to IUD insertion?

A

pelvic exam

40
Q

Contraindications to LNG-IUD use?

A

anatomically abnl uterus

41
Q

what are risks assoc. w/IUD failure? (if pregnant on IUD)

A

ectopic pregnancy

42
Q

what bleeding patterns are expected w/use of a LNG-IUD?

A

amenorrheic after several months

43
Q

proper prescribing for IUD

A

if NOT pregnant, no backup with Cu-IUD, no backup if inserted w/in 7days of insertion for LNG-IUD

44
Q

what is the primary MOA for the LNG-IUD?

A

causes cervical mucus to become thicker, changes in uterotubal fluid also impairs sperm and ovum migration, alteration of endometrium prevents implantation of fertilized ovum

45
Q

what is the primary MOA for copper-IUD?

A

inhibits sperm motility so sperm rarely reach the fallopian tubes, creates inflammatory response in vagina

46
Q

what is an AE of the copper IUD?

A

heavy bleeding

47
Q

what is the MOA of the etonogestrel implant?

A

thickened cervical mucus and inhibit tubal motility, also inhibit follicular maturation and ovulation

48
Q

what is a common side effect of etonogestrel implant?

A

irregular bleeding

49
Q

what is the MOA of EC when taken prior to ovulation?

A

prevent ovulation (block LH surge)

50
Q

what is the effect of EC on an implanted pregnancy?

A

no effect

51
Q

how long after unprotected sexual intercourse is EC effect?

A

72hrs to 5 days

52
Q

which IUD can be used as an EC?

A

copper IUD w/in 1 month

53
Q

how many days do you need backup if you use Post-UPA?

A

14 days or until next menses

54
Q

name some factors assoc. w/a higher risk of regret about sterilization??

A

young age < 30y/o, low parity, sterilization at time of C-section, poverty, minority status, hurried decision, misinformation about permanence or risks

55
Q

if hysteroscopic occlusion is performed for sterilization, what f/u is required?

A

hysterosalpingogram

56
Q

what is the 1st line recommendation for contraception in an adolescent patients?

A

LARC

57
Q

what age should contraception use be discontinued?

A

ACOG–> 50-55y/o or until menopause

>45y/o caution w/comorbidities

58
Q

in women over age 45, which contraceptives have a preferred safety profile?

A

Cu or progestin only

Foundations III-Women's Health (13 decks)

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