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Karboski's Pharmacology - UT AEMSN > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the 2 proven MoA of conception for birth control?

A
  • Suppression of ovulation

- Thickening of cervical mucous

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2
Q

What are other possible MoA of conception for Birth control pills NOT proven?

A
  • slowing tubal motility
  • endometrial atrophy
  • local endometrial edema
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3
Q

What are the 4 general contraception mechanisms?

A

1) prevent sperm from entering
2) prevent ovum from entering area of fertilization
3) prevent implantation
4) fertility awareness

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4
Q

1) What is the only estrogen used in all hormonal contraceptives?
2) What is it’s pro-drug?
3) Where is it converted from pro-drug to drug?

A

1) ethinyl estradiol
2) mestranol
3) liver

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5
Q

How do the different forms COCs (mono-, bi-, tri-) differ from one another?

A
  • estrogen : progestin
  • which progestin is used
  • how many phases
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6
Q

What does the estrogen component of COCs do?

A
  • provides regulation of the menstrual cycle
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7
Q

What is the primary reason for failure in COCs?

A
  • missed pills

- stop taking pills and not starting another form of BC

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8
Q

What are the advantages to COCs?

A
  • rapid reversibility –> return of ovul after 2 wks
  • decreased dysmenorrhea
  • reduced PMS Sx
  • reduction of PMDD
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9
Q

What are the symptoms that you MUST have at least one of for PMDD diagnosis?

A
  • marked depressed mood
  • anxiety or tension
  • swing in emotion
  • pronounced anger or irritability
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10
Q

What are the general health benefits for COCs?

A

1) ↓ endometrial cancer risk
- 1 yr = 40% ↓, 10 yr = 80%
- protection continues 20 yrs after Rx d/c
2) ↓ ovarian cancer risk
3) ↓ benign breast dz risk (controversial)
4) improvement in acne (r/t ↓ in testosterone)
5) plugs them into the healthcare system

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11
Q

What are the disadvantages to COCs?

A
  • daily admin
  • prescription required in most states
  • no STI protection
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12
Q

Which part of the birth control pill is mainly for contraceptive action

A

progestin

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13
Q

What factors put women at risk for MI?

A
  • older, higher doses of estrogen
  • other MI risks
  • smoking
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14
Q

What are the FDA Complications listed for COC

A 
RISK of VTE ie. HTN, DM, hx of VTE etc. 
Cancers ie abnormal vaginal bleeding
Liver disease ... jaundice, hepatic ademona
allergy to
pregnancy...
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15
Q

What factors put women at risk for stroke?

A
  • smoking >10 cig/day
  • Age > 35
  • Uncontrolled HTN
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16
Q

COC Quick start method

A 
start day of visit
other contraception x 7 days
menses delayed till placebo
*OFF LABEL but WHO Recommends
improved compliance
NO known effect of COC on Pregnancy
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17
Q

What factors put women at risk for VTE?

A
  • older, higher dose estrogen pills
  • obesity (BMI > 30)
  • Hx of VTE, immobilization
  • Age
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18
Q

COC Sunday Start

A
  • 1st pill on 1st Sunday after period
    **If period on Mon/Tues use backup for 7 days
    Limitation will run out of pills on a Sat. limits access to pharmacy..
    Benefit period free weekend.
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19
Q

Broad spectrum antibiotic cause for decrease (Not Proven)

A

theoretical reduction in systemic levels due to change in gut bacteria that strip conjugation from estradiol allowing re-absorption

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20
Q

actual effect of antibiotics on COC

A

some affect liver metabolism reducing amount of conjugated form available

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21
Q

For smokers, don’t uses COCs if:

A
  • > 35 and >15 cig/day

- > 40 and any regular smoking

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22
Q

How to start COCs in smokers?

A
  • Start with 20 mcg EE
  • Use backup for 2-3 mo d/t enzyme inducer effect and already low dose
  • ↑ EE if breakthrough bleeding occurs
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23
Q

When to start COC in postpartum women?

A

Delay until 3-4 weeks postpartum d/t hypercoagulability and thrombo. risk

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24
Q

How to manage COC in breastfeeding women?

A
  • inform that COC may affect QUALITY of milk and ↓ nutrition content
  • Do not use if breastfeeding is ONLY source of nutrition
  • Ok to use if using both bottle/breast
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25
Q

missed pills Simplified approach Overkill method if unprotected sex in last 5 days

A

use EC at once
take 2 COC the next day then continue as directed
use a condom for 7 days

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26
Q

missed pills Simplified method no unprotected sex X 5D

A

2 COC then continue use

Condoms x 7D

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27
Q

Side effects of COC

A

spotting or bleeding before completing, after withdrawal, mid cycle.
Headaches evaluate for HTN
Weight change. Insufficient data
usually go away after 3rd cycle

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28
Q

Yasmin

A
  • Drosperinone +EE

- Drosperinone has antimineralcorticoid activity = K sparing diuretic

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29
Q

Yas

A

like Yasmin but 4 placebo = shorter periods

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30
Q

Missing 1-2 active pills (>30 mcg EE)

A
  • take 1 active pill ASAP and take 1 pill for day

* *consider EC if missed in 1st week and unprotected sex

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31
Q

Missing 3+ pills during week 1-2 (>30 mcg EE)

A
  • take 1 active pill ASAP and take 1 pill for day

- use back-up until 7 active pills taken in a row

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32
Q

Missing 3+ pills during week 3

A
  • finish active pills and throw away placebo

- start new pack next day without using placebo

33
Q

COC S/E - Unsched Vag Bleeding (UVB) Key Points

A
  • By 3rd pack UVB should cease for most women

- Avoid switching to new BC before 3 month period

34
Q

COC S/E - UVB Mgmt Issues

A
  • ↑ [progestin] i.e. switch to TP COC if spot/bleeding occurs before completing active pills
  • ↑ [EE] and ↓ [progestin] if cont spotting/bleeding after withdrawal bleeding
35
Q

COC S/E - Headache concerns

A
  • Eval for HTN if new onset, worsening, and other S/Sx of TIA/CVA
  • *HA d/t S/E usually gone by 3rd cycle and switching COCs won’t help**
36
Q

What ↑ risk of hyperK on Yas?

A
  • chronic NSAID
  • concurrent spironolactone use
  • ACEi/ARBs
  • K suppl/salt sub
37
Q

1) How Seasonique and LoSeasonique different from Seasonale?
2) What are the benefits
3) What is effect of extended cycle COCs on cancer risk?

A

1) Both have no placebo, Seasonale has 84 active + 7 placebo
2) shorter and lighter periods
3) showed no ↑ in cancer risk or no ↑ presence of pre-cancerous cells

38
Q

1) What Rx causes atrophic endometrium?
2) What was its proposed benefit?
3) How was it hypothesized to cause this?
4) What actually happened?

A

1) Lybrel (1st approv for cont use)
2) No periods
3) Thought to reduce bleeding and CA risk b/c nothing to slough off, shown safe and effective
4) After 6 mos, approx half of women still had irreg spotting/bleeding**

39
Q

1) What is NuvaRing

2) How is it used?

A

1) Soft flexible ring w/ 120 mcg prog and 15 mcg EE
- Similar [EE] d/t no first pass effect
2) Use like monophasic COC, just don’t put it in your mouth (21 days in, 7 days out)

40
Q

Advantages of NuvaRing?

A
  • easy to use
  • slow and steady hormone release
  • rapid effect, rapid reverse
41
Q

Disadvantages of NuvaRing?

A
  • Same VTE risk as COCs
  • Ring expulsion spits out like ping pong ball.
  • Foreign body sensation
42
Q

How is ring expulsion managed with NuvaRing?

A

< 3 hrs = rinse, reinsert
> 3 hrs in week 1-2 = reinsert, back-up 7 days, EC if unprotected sex
> 3 hrs in week 3 = discard, new ring right away, back-up for 7 days

Don’t take out during sex, keep it in for target practice turns into a Cock ring…

43
Q

How to start NuvaRing?

A

1) Insert 1st day (0)of period –> no contra back-up
2) Insert 1-5 days of period –> back up for 7 days
3) Insert on day of MD visit –> back up for 7 days

44
Q

How is Annovera different from NuvaRing?

A

Annovera can be reused 13 times like a condom. whereas a new NuvaRing needed each cycle

45
Q

How are transdermal patches used?

A
  • A new patch placed each week
  • *Make sure old patch is removed** shouldn’t look like a checkerboard on back.
  • Can be placed on abd, butt, upper torso (no boobs), upper-outer arm (where skin is more uniform)
46
Q

Advantages and disadvantages of patches?

A

Adv:
- weekly application and rapidly reversible
Disadv:
- ↑↑ risk of MI/CVA/VTE d/t higher [systemic]
- skin rxn
- breast sx: engorgement(< why is that a disadvantage?)/painful that’s more common vs COC

47
Q

How to start patches?

A
  • 1st day of period –> no back-up req’d

- 1st Sunday after period –> back-up for 7 days

48
Q

How to manage lost/loose patches?

A
  • < 24 hr = re-adhere w/ pressure (no adhesives)
  • *if no seal –> replace**
  • > 24 hr / unknown = new patch cycle, back-up x7 days, and offer EC if unprotected
  • *Change days are different**
  • if site rxn occurs –> rotate sites, not on same site
49
Q

How is POPs different from COC?

A
  • NO VTE risk
  • Progestin only at a lower dose (norethindrone)
  • No placebos
  • Less variability in spotting, breakthrough
50
Q

Why do POP typically fail?

A
  • Pills must be taken at the same time d/t lower progestin doses having shorter DoA
51
Q

POP MoA

A
  • Inhibited ovulation in variable portion of cycle
  • Cervical mucus thickening
  • *Reduced ovum transport**
  • *Altered endometrium**
52
Q

PO injection disadvantage (Depot)

A 
slow recovery 50% @ 10 mo 90% @20 mo.
RTClinic x3 Mo.
Decrease in Bone Mineral Density.  
- WHO says reversible
- FDA says may be not reversible and use
- FDA says use > 2 yrs only if other methods inadeq
53
Q

COC First Day Start

1) procedure
2) key points

A

1) 1st pill on 1st day of next period (ensures woman not preg)
2) No need for back-up method but ↑ chance of not starting correctly

54
Q

Nexplanon advantage

A

no user maintenance
works for 3 years
0.05% effective
reversible in 6 weeks

55
Q

Nexplanon disadvantages

A

impropper insertion bruising/pain
Clinician dependant
effective during first 5 days of bleed else Backup x7D

56
Q

1) 4 situations where POP can be started immed w/ no back-up req’d
2) When to use back-up when starting POPs?
3) For how long?

A

1) Starting during 1st five days of period
- Btw 6 wks - 6 mos postpartum if fully breastfeeding and amenorrheic
- W/in first 21 d postpartum if not breastfeeding
- Day after stopping another hormonal method

2) When any other situation occurs that does not require back
3) 2 days

57
Q

IUD advantages

A

effective, long lasting, cost effective

58
Q

IUD Disadvantages

A 
spotting
cramping, 
spontaneous expulsion 2-10% x1 yr
perforation a insertion
string problems (missing may be perforation/expulsion)
gets stuck in teeth
59
Q

Condom types and key points

A

1) latex - stronger, less break and slip
2) synthetic - more breaks and slips vs latex
3) no std manufact, more porous –> ↑ risk of STI and preg

60
Q

Spermicide formulations and timing

A

1) Gels, creams, and foams
- immediate use, used alone if thrill seeker
2) Suppositories/Tablets/Inserts
- “hold on a minute” x15
3) Film
- “hold on a minute”x15 and at the back near cervix

61
Q

Spermicide disadvantages

A
  • “hold on a minute”
  • Pre-cuddling takes > 1-3 hours –> degredation
  • Genitalia irritation
  • Messy (and this is bad?)
    makes your breath smell funny
62
Q

important distinction for Novelty condoms

A

not FDA tested cannot claim to prevent pregnancy or STD

63
Q

1) Progestin Only EC MoA

2) Indication and Key Point

A

1) Prevent ovulation and impair sperm transportation
2) Approved up to 72 hours after unprotected sex
* *Taking sooner = ↑ efficacy**

64
Q

1) Progestin Only EC MoA

2) Indication and Key Point

A

1) Prevent ovulation and impair sperm transportation
2) Approved up to 72 hours after unprotected sex
* *Taking sooner = ↑ efficacy**

65
Q

COC EC ADR’s

A

N/V headache, irregular bleeding breast engorgement

66
Q

Ulipristal (Ella) 2 key points

A

1) 30 mg dose has same effectiveness for entire 120 hours

2) May be more effective vs POPs in BMI > 26

67
Q

Copper-T IUD 2 key points

A

1) Inserted up to 5 days after unprotected sex

2) Most effective EC (~99%)

68
Q

When is Copper-T IUD not recommended?

A
  • Pelvic inflamm Dz
  • Active gonorrhea
  • Active chlamydia
69
Q

What is Seasonale, Seasonique, LoSeasonique?

A
  • COCs approved for extended cycles
70
Q

What is Lybrel?

A
  • First COC approved for continuous use
71
Q

What is Xulane?

A
  • Transdermal EE + progestin patch
72
Q

What is the progestin-only injection?

A

depot medroxyprogesterone acetate

73
Q

What are Implanon and Nexplanon?

A

Intradermal progestin-only impregnated implant

74
Q

What are Mirena/Skyla/Liletta/Kyleena?

A

Levonorgestrel impregnated IUD

75
Q

What is ParaGard?

A

Non-drug, copper-based IUD

76
Q

What are Plan B One-Step, Next Choice One Dose, My Way, Take Action?

A

Progestin-only emergency contraceptives with single 1.5 mg levonorgestrel dose

77
Q

What is Ella?

A

30 mg progesterone receptor modulator with mixed agonist/antagonist emergency contraceptive that has a uniform 120 hour efficacy

78
Q

What is Copper-T IUD?

A

Copper-based emergency contraceptive IUD

Karboski's Pharmacology - UT AEMSN (11 decks)

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