Contraception

Question 1

How are failure rates listed?

Answer 1

From “best/typical” use

Question 2

Primary MOA of hormonal contraceptives (HC)

Answer 2

Inhibition of ovulation

Question 3

What are the hormonal components of HC

Answer 3

Estrogen (synthetic -> ethinyl estradiol (E2))

Progestins (synthetic -> levonorgestrel)

Question 4

What are some common groupings of oral contraceptive (OC) products?

Answer 4

Monophasic 
Biphasic
Triphasic
Quadriphasic
Progestin only (mini pill)

Question 5

What is a hematologic benefit of HC?

Answer 5

Increased hemoglobin (some OCs contain Fe2+)

Question 6

What is a fetal benefit of HC?

Answer 6

Reduced risk of neural tube defects (some OCs contain folate)

Question 7

What are some perimenopausal benefits of HCs?

Answer 7

Decrease vasomotor sx

Increased bone mineral density

Question 8

Adverse effects of HC

Answer 8

VTE

Question 9

RFs of VTE on HC

Answer 9

Obesity
Smoker
HTN
DM
Surgery
Previous DVT

Question 10

When risk of VTE what kind of HC are you supposed to use?

Answer 10

Progestin only

Question 11

Which HC has the least risk of VTE?

Answer 11

Levonorgestrel

Question 12

What is cancer associated w/ and how were HC altered to deal with that?

Answer 12

Unopposed estrogen

Decreased estrogen

Question 13

What does decreasing estrogen do to efficacy of HC?

Answer 13

Increased risk of failure -> pregnancy

Question 14

What are HC users w/ HTN at greater risk of?

Answer 14

MI or stroke

Question 15

When are HCs not recommended?

Answer 15

Smokers > 35 years
HTN
Migraines

Question 16

What can we do to deal with less serious SEs of HCs

Answer 16

Adjusting E2 or progestin content

Question 17

Which transdermal patch is no longer available?

Answer 17

Evra

Question 18

What do transdermal patches do?

Answer 18

Deliver EE and norelgestromin daily

Question 19

How do you dose the patch?

Answer 19

1 patch weekly for 3 weeks

Then 1 week w/o a patch

Question 20

When are transdermal patches less effective?

Answer 20

In women > 90 kg

Question 21

What is the med content of the vaginal ring?

Answer 21

EE and etonogestrel

Question 22

How do you dose the vaginal ring?

Answer 22

Leave the NuvaRing in place for 3 weeks

Then take out for 1 week

Question 23

Benefits of vaginal ring/NuvaRing

Answer 23

Rapid return to fertility after removal

Less nausea, acne, irritability, and depression

Question 24

What is the injectable HC, how is it delivered, and how is it dosed?

Answer 24

DMPA -> progesterone
IM q 3 months
SC q 3 months

Question 25

What is the benefit of injectable HC?

Answer 25

Improved adherence over OCs

Question 26

What are some issues with the injectable HC?

Answer 26

Decreased bone density (supposed to DC after 2 years of use) | Delayed fertility

Question 27

What are the subtypes of long acting reversible contraception (LARC)?

Answer 27

``` Subdermal implant Intrauterine device (nonhormonal -> copper; hormonal) ```

Question 28

How long can you use the nexplanon subdermal implant?

Answer 28

3 years

Question 29

What does nexplanon contain for x ray visualization?

Answer 29

Barium

Question 30

Is Nexplanon affected by BMI?

Answer 30

Nope

Question 31

Is Nexplanon safe immediately postpartum/abortion?

Answer 31

Yes :D

Question 32

How long can you use a copper IUD?

Answer 32

10 years

Question 33

What is the greatest benefit of copper IUDs?

Answer 33

They are the MOST effective form of emergency contraception | *may be inserted up to 10 days post intercourse*

Question 34

What is the main SE of copper IUDs?

Answer 34

Increased menstrual bleeding

Question 35

How long can you use hormonal IUDs?

Answer 35

3-5 years

Question 36

What is the benefit of hormonal IUDs over copper?

Answer 36

Less menstrual bleeding

Question 37

What are the two types of emergency contraception pills?

Answer 37

Progestin ECPs | Antiprogestin ECPs

Question 38

How is Progestin dispensed, what is an example, and how long after sex do you take it?

Answer 38

OCT -> no age restriction Levonorgestrel (plan b) 72 hours

Question 39

How is antiprogestin dispensed, what is an example, and when do you take it after sex?

Answer 39

Rx only Uliprostal acetate 5 days after sex

Question 40

Which emergency contraceptive is more effective?

Answer 40

Antiprogestin

Question 41

Is it better to wait out the time period after sex or go get the meds sooner?

Answer 41

Get them sooner -> prompt is prudent

Question 42

What is mifepristone RU-486?

Answer 42

An abortifacient

Question 43

How is mifepristone given?

Answer 43

W/ other prostaglandins

Question 44

Give an example of a mifepristone agent

Answer 44

PO misoprostol

Question 45

What is the success rate of mifepristone?

Answer 45

>90% w/ pregnancies < 49 days

Question 46

What is E2 mainly metabolized by?

Answer 46

CYP3A4

Question 47

What do 34A inducers do?

Answer 47

Increase HC metabolism -> increasing risk of pregnancy

Question 48

What are some examples of 34A inducers:

Answer 48

Anticonvulsants Antiretrovirals (HIV) St. John's wort

Question 49

What is the risk of pregnancy w/ IUD?

Answer 49

18%

Question 50

What is a risk of IUDs?

Answer 50

Uterine perforation

Question 51

What is the risk of expulsion of an IUD immediately after placenta delivery?

Answer 51

3-27%

Question 52

What is the risk of expulsion of an IUD 10 min -48 hours after placenta delivery?

Answer 52

11-27%

Question 53

What is the risk of expulsion of an IUD 4-8 weeks post partum?

Answer 53

0-6%