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A-GNP Exam Prep > Contraception > Flashcards

Contraception Flashcards

1
Q

Phases of ovarian cycle + day ranges

A

Follicular (0-13)

Luteal (14-28)

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2
Q

Phases of uterine cycle + typical day range

A

Menses (0-6)
Proliferative (7-13)
Secretory (14-28)

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3
Q

Cycles of the menstrual cycle

A

Ovarian cycle

Uterine cycle

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4
Q

Steroid hormones of the ovarian cycle

A

Estrogen
Inhibin
Activin
Progesterone

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5
Q

Gonadotropins of the ovarian cycle

A 
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
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6
Q

Inhibin function in ovarian cycle

A

FSH suppression

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7
Q

Activin function in ovarian cycle

A

Enhances ovarian follicle FSH binding

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8
Q

Estrogen function in ovarian cycle

A

Ovarian follicle maturation; gonadotropin regulation

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9
Q

Progesterone function in ovarian cycle

A

Converts endometrium to secretory phase for implantation

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10
Q

Precipitant of normal menstrual bleeding

A

Progesterone-withdrawal

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11
Q

Inhibits uterine smooth muscle contractions (i.e. prevents preterm labor)

A

Progesterone

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12
Q

Inhibits preterm lactation

A

Progesterone

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13
Q

Fertile period (typical)

A

days 12-17

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14
Q

Endometrial thickening period (typical)

A

days 7-13

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15
Q

Endometrial slough period (typical)

A

days 0-6

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16
Q

Endometrial implantation and mucus thickening period (typical)

A

days 14-28

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17
Q

Ethinyl estradiol (EE)

A

Synthetic estrogen

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18
Q

Ethinyl group in ethinyl estradiol (EE)

A

Orally active

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19
Q

Estradiol valerate (EV)

A

Naturally occurring estrogen

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20
Q

Progestin

A

Synthetic progesterone

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21
Q

Progestin types

A

Levonogestrel
Drospirenone
Norethindrone

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22
Q

Progestin contraceptive mechanism

A 
Thickens cervical mucus 
Inhibit ovulation 
Thin endometrium
HPO axis interruption
Inhibits sperm capacitación
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23
Q

Progestin secondary effects

A

Reduced/eliminated menses, BP elevation, mood swings, depression, weight gain, increased appetite, fatigue, tender breasts, acne, hirsutism, nausea

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24
Q

Most prescribed progestin

A

Levonogestrel

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25
Combined hormonal contraceptive (CHC) formats
Pill Ring Patch
26
CHC hormones
Estrogen | Progestin
27
CHC duration
Short-acting
28
Minipill
Progestin-only pill (POP)
29
Number of active/inactive pills in conventional COC packs
21 active / 7 inactive (28) | 24 active / 4 inactive (28)
30
Bleeding period on convetional COC
Inactive pills
31
Number of active/inactive pills in extended cycle COC packs
84 active / 7 inactive (91)
32
Bleeding period on extended cycle COC
Inactive pills
33
Amethyst continuous COC pill hormones
Levonogestrel | Ethinyl estradiol
34
Number of active/inactive pills in continuous COC packs
365 active / 0 inactive
35
Continuous COC trade name
Amethyst
36
Bleeding period on continuous COC
Amenorrhea
37
Monophasic COC
Estrogen and progestin levels remain constant across follicular and luteal phases
38
Multiphasic COC
Estrogen and progestin levels vary by phase
39
First-year failure rate COC
3%
40
First-year failure rate COC < 22 years
4.7%
41
Gonadotropin(s) suppressed by estrogen
``` Follicle stimulating hormone (FSH) Luteinizing hormone (LH) ```
42
Number of annual menstrual bleeds on extended cycle COC packs
4x/year
43
Excessive estrogenic effects
``` Dysmenorrhea Nausea Chloasma CVA DVT VTE PE Telangectasias ```
44
Benefits of combined contraception
``` Decreased cramping, pain Oligo or amenorrhea Improved acne Ovarian, endometrial cancer prevention Reduced risk of ectopic pregnancy, ovarian cysts, endometriosis ```
45
Contraceptive ring trade name
NuvaRing
46
NuvaRing hormones
EE + etonogestrel
47
NuvaRing change interval
21 days/3 weeks, leave out for 1 week, replace
48
NuvaRing falls out
>3 hours use backup contraception
49
CHC hormone responsible for most FSH suppression
Estrogen >> progestin
50
COC contraindications
Progestin contraindications + ≥35 years, ≥15 cigarettes/day HTN ≥160/100 (≥140/90, relative) Thromboembolic d/o w/o anticoag
51
CHC hormone responsible for most FSH suppression
Estrogen >> progestin
52
CHC hormone responsible for most FSH suppression
Estrogen >> progestin
53
CHC hormone responsible for most FSH suppression
Estrogen >> progestin
54
Contraception patch trade name
Xulane
55
Xulane hormones
EE + norelgestromin
56
Xulane failure rate
< 1 - 2%
57
Xulane regimen
3 weeks on 1 week off (set change day)
58
Xulane change interval
Once weekly
59
Xulane contraindication
Same as COC BMI ≥30 Certain HCV regimens
60
Xulane detachment
>24 hours back up method x 7 days
61
Xulane placement
Not on the breasts
62
Depo-Provera (DMPA) hormones
progestin only
63
DMPA failure rate
< 1%
64
DMPA time to return to fertility
1 year
65
DMPA regimen interval
3 months
66
DMPA PID, endometrial, cervical CA risk
Reduced risk
67
DMPA long term risk
Bone density, lower HDL
68
DMPA contraindications
Allergy Abnormal uterine bleeding, undiagnosed Pregnancy
69
DMPA grace period
2 weeks
70
DMPA back up method
1st 2 weeks after injection unless admin by DOC 5
71
Contraceptive implant trade name
Nexplanon
72
Nexplanon failure rate
0.01%
73
Nexplanon hormone
Progestin
74
Nexplanon regimen interval
3 years
75
Nexplanon advantages
``` LARC No EE side effects Few systemic SE Scant/absent menses Less anemia Lower r/o endometrial CA ```
76
Hormone IUD trade name
Mirena (most common)
77
Non-hormone IUD trade name
ParaGard
78
ParaGard MOA
Copper ions sterile inflammatory reaction toxic to sperm ova and impairs implantation
79
Mirena MOA
LNg has progestin effects
80
Mirena regimen interval
5 years
81
ParaGard regimen interval
10-12 years
82
LNg/Cu IUD contraindications
``` Active pelvic infection (impedes resolution) Severe structural abnormality Pregnancy* Cu allergy Wilson's disease Abnormal uterine bleeding, undiagnosed ```
83
ParaGard noncontraceptive benefits
Continued menstrual cycle (b/c nonhormonal) Reduced r/f cervical CA Possible reduced r/f endometrial CA
84
Mirena (etc) noncontraceptive benefits
Reduced menorrhagia, anemia, dysmenorrhea Reduced endometriosis pain, hyperplasia Reduced r/f PID, cervical/ovarian/endometrial CA
85
ParaGard bleeding effects
Heavier, crampier bleeding first 6 months
86
Mirena (etc) bleeding effects
Irregular, longer, or reduced bleeding first 6 months, increasing amenorrhea over years of use
87
IUD danger signs
Abdominal pain, dyspareunia, fever, chills
88
Diaphragm fit
Refit +/- 20 lbs or use universal diaphragm
89
Diaphragm adjunct
spermicide should be used
90
Diaphragm failure rate
18% (with spermicide!!)
91
Diaphragm STD protection
physical barrier and spermicide provide protection
92
Diaphragm contraindication
Occupied vaginal canal (tampon)
93
Diaphragm proper use
Leave in 6 hours postcoitus
94
Diaphragm continued use
Do not remove, instill more spermicide into vagina
95
Vaginal sponge trade name
Today Sponge
96
Today Sponge MOA
Physical barrier and spermicide
97
Today Sponge pregnancy rate nulliparous
12%
98
Today Sponge pregnancy rate multiparous
24%
99
Today Sponge risk factor
Breaks apart, TSS (rare)
100
Today Sponge proper insertion
Premoisten w/2 tbsp H2O to activate spermicide, insert to fully cover cervix
101
Today Sponge interval/timeframe
Max 30 hours, 24 hours in advance, 6 hours postcoitus
102
Today Sponge lifespan
Single use!
103
Penile condom failure rate
12%/year
104
Inserted condom failure rate
21%/year
105
Emergency contraception (EC) hormone
LNg
106
Hormonal EC trade name
Plan B, One Step, etc
107
Hormonal EC timeframe
Earlier the better, 72 hours optimal, 120 hours (5 days) max
108
Ella EC active ingredient
Ulipristal acetate
109
Hormonal EC benefit
OTC
110
Ella EC timeframe
Equal efficacy within 120 hours / 5 days
111
IUD EC
ParaGard / Cu IUD
112
ParaGard EC timeframe
120 hours / 5 days
113
LNg EC effectiveness
≥89% within 72 hours
114
ParaGard / Cu IUD EC effectiveness
≥99%
115
Hormonal EC side effects
N/V/f/HA/dizziness/diarrhea/breast tenderness/edema/irregular menses
116
Vasectomy failure rate
1:400
117
Tubal ligation failure rate
1:600
118
Family planning failure rate
20%/year
119
Calendar method step 1
Record serial cycles x 6 months longest/shortest cycles | Mark day 1 of period then count days between day 1 of ea period
120
Calendar method NOT appropriate
All cycles <27 days
121
Calendar method step 2
Determine fertile period subtract 18 from shortest cycle (earliest day of fertility) and 11 from longest cycle (latest day of fertility)
122
Calendar method Ex.: if shortest cycle = 26 days
26 - 18 = 8, if day 1 was on the 4th, then mark 11th as first fertile day
123
Calendar method Ex.: if longest cycle = 30 days
30 - 11 = 19, if day 1 was on the 4th, then mark 22nd as last fertile day
124
Calendar method principle
Abstain during calculated fertile period
125
Basal body temp method step 1
Record BBT before getting out of bed daily x 3-4 months
126
Basal body temp method step 2
Identify BBT drop, identify BBT rise
127
Basal body temp method principle
Abstain 2-3 days prior to expected BBT drop and 3 days following BBT rise
128
Basal body temp ____ ovulation
drops 12-24 hours before
129
Basal body temp rises ____ ovulation
after (d/t progesterone)
130
Billings test method
Cervical mucus test
131
Billings test method step 1
Record changes in mucus 3-4 months noticing change in quality
132
Billings test mucus quality
from scant and thick to thin with increasing Spinnbarkeit
133
Billings test method (Spinnbarkeit defined)
stringy ellastic cervical mucus indicating fertility
134
Billings test method step 2
Abstain from mucus change to 4 days after (mucus will return to thick, scant state)
135
TwoDay method
Variation of Billings test, check mucus ≥BID, presence of mucus yesterday + today = fertile; dry/no mucus = less fertile
136
Symptothermal method
Basal body temp method + Billings test method
137
Lactation method
Postpartum, rely on breastfeeding to delay ovulation for up to 6 months
138
Family planning method limitations
No STI/HIV protection High failure rate, requires accuracy No sex for ~25% of month

A-GNP Exam Prep (2 decks)

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