Contraception Flashcards
What is the estrogen component of OCs
ethinyl estradiol
T/F: Estrogenic portions of OCs only work on estrogen receptors while progestins have the exact same effect as progesterone
False: Estrogenic portions only work on estrogen receptors while progestins work on progestational, androgenic and estrogenic activity BUT are not equivalent to progesterone
What dictates androgenic activity of hormonal contraceptives
Sex hormone binding globulin (SHBG)
What is a specific progestin MOA, what are other MOAs
slows ovum transport, inhibit ovulation by suppressing LH surge, inhibit implantation by increasing uterine secretions, , thickend cervical mucus, atrophic endometrium
What is a specific estrogenic MOA, what are other MOAs
Accelerats ovum transport to fallopian tubes, inhibits ovulations by suppressing release of FSH and LH, increase uterine secretions inhibiting implantion, induction of leutolysis
T/F: Estrogen allows for a more regulated period with more controlled bleeding
True
What are disadvantages of estrogen/progestin contraceptives
daily administration, hypertension, risk for stroke or MI, thromboembolic risk, metabolic risk
What is an advantage of multiphasic OCs
Decrease breakthrough bleeding
How long does it take to return to ovulation when using combined oral contraceptives, patches, nuva ring
Around 3 months
T/F: If a patient has side effects they should not change their therapy until 3 months have passed
True
What side effects will happen throughout therapy
Headache, fatigue/anxiety, decreased libido. Acne
What are side effects of excess estrogen
Nausea, edema/bloating, headaches during active pills, breast tenderness/increased breast size
What are side effects of excess progestin
Moodiness, headaches between pill packs, vaginal candidiasis
What are side effects of excess androgens
Increased appetite, noncyclic weight gain, acne
What are side effects of estrogen deficiency
hot flashes/vasomotor symptoms, early and midcycle spotting and breakthrough bleeding, decreased libido
What are side effects of progestin deficiency
weight loss, heavy menstrusal flow, late breakthrough bleeding with spotting, delayed onset of menses
What are severe warning signs that say a patient should stop their contrception and see a physician immediately (Hint: Severe ACHES)
A- Abdominal pain C- Chest pain H- Headaches E- Eye problems S- Severe leg pain
What happens if a patient misses 1 OC in time in thier cycle
Take missed OC immediately and next regularly scheduled time
What happens if a patient misses 2 OC in the first 2 weeks in their cycle, third week
Take 2 OC daily for next 2 days then resuming taking OCs on regular schedule/ if Sunday start Take 1 OC daily until Sunday then dispose of current pack once at placebo pills to begin new pack OR Dispose of current current OCs and begin new OC
What happens if a patient misses 3 OCs at any time
if Sunday start Take 1 OC daily until Sunday then dispose of current pack once at placebo pills to begin new pack OR Dispose of current current OCs and begin new OC
T/F: If a patient misses 2 or 3 doses of OCs they should use back-up even if they start a new pack when they menses
False: If a patient misses 2 or 3 doses of OCs they use back up UNLESS they start a new pack when they menses
What is pack stacking, what does it do, what is the most important recommendation
Take all active pills and then throw out placebo of pack1 to start active pills of pack 2, extend the cycle, break 3-4 month intervals for menses
T/F: Progestin only pills have 28 acitve pills with no placebo
True
What is the strict guidelines for taking progestin only pills
Must be taken every day at the same time within a 3 hour window AND backup contraception must be used for 48 hour window if is taken more than 3 hours late
What are advantages of taking progestin only pills
Patients with contraindications to estrogen, patients older than 35, breastfeeding
When does ovulation occur for progestin only pills
after one month
For the xulane patch what are the instructions
Apply once a week for 3 weeks each month with no patch on the fourth weeks for menses
What are key counseling points for the xulane patch
Rotate patch site, safe with bathing and swimming, do not apply topical products around patch site, higher estrogen exposure with lower estrogen pea k
When should xulane patches be avoided
Greater than 90 kg
What are disadvantages of xulane patch
Skin irritation, patch detachement, one strength
What should be done if xulane falls off within 24 hours, greater than 24 hours
Reapply to same place or replace with new patch, start new patch and use backup for one week
How should the nuva ring be used, what happens when n the patient would like to have intercourse
Insert one ring every 3 weeks then remove the fourth week for menses, may be removed up to 3 hours for intercourse
What medication is injected every 3 months and usually has no menses, how long does it take to return to ovulation
Depo-provera, 9 months
What is the disadvantages of Depo
Heavy breakthrough bleeding when started, weight gain, bone loss with use greater than two years
What are the eonogestrel implants and how long do they last, what is the biggest side effect
Nexplanon and Implanon, every 3 years, infrequent bleeding
Which product has an MOA of preventing implantation and impairing sperm motility, how long is it, how effective, biggest side effect
Copper IUD, 10 years, over 99%, heavy menses
T/F: Emergency Contraception will NOT prevent implanation
True
When are combined hormonal contraceptions use highly contraindicated
Breastfeeding (21 days postpartum), Severe liver cirrohosis, History of DVTs, Diabetes (over 20 years or with neuropathy), gallbladder disease, headaches WITH aura
When are IUDs use highly contraindicated
Distroted uterine cavity, Cervical cancer, endometrial cancer, persistently elevated beta-hCG levels or malignant disease
When is an IUD the only recommened option for birth control
Current breast cancer
