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Family Health Practicum 833P > Contraception > Flashcards

Contraception Flashcards

1
Q

What happens in the follicular stage?

A

FSH stimulates several follicles to develop. The dominant follicle synthesizes enough estradiol to create negative feedback and decrease FSH levels

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2
Q

What happens in the ovulatory phase?

A

Estradiol levels peak and exert positive feedback to induce an LH surge, which facilitates the release of the mature ovum. Estrogen promotes proliferation of the endometrium and development of progesterone receptors in the endometrium.

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3
Q

What happens in the luteal phase?

A

Progesterone prevents new follicle development as well as differentiation of the endometrium. If no pregnancy occurs, the corpus luteum degenerates, leading to menstrual bleeding.

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4
Q

What hormone makes people feel better during menstruation?

A

estrogen- increases energy and feel good feeling

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5
Q

What hormone makes people feel bloated, low, and slow?

A

Progesterone

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6
Q

What percentage of pregnancies are unintended in the United States?

A

nearly half (45%)

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7
Q

What percentage of unintended pregnancies were paid for my medicaid?

A

2/3

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8
Q

What are the challenges for family planning?

A

few easy effective methods, low patient compliance and lack of knowledge, societal conflict about FP, clinical challenge, little time, tight budgets, risk taking behaviors

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9
Q

What do you need before prescribing contraception?

A

Medical history and blood pressure

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10
Q

What is not required prior to prescribing contraception?

A

pap smear, pelvic/breast exam, STI testing, hgb

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11
Q

Estrogen has positive effects on ?

A

bone mass, increases serum triglycerides, and improves HDL and LDL ratios

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12
Q

Estrogen stimulates which pathways

A

coagulation and fibrinolytic pathways

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13
Q

Progesterone increases ___ ____ and _____ ____

A

body temperature and insulin levels

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14
Q

Progesterone may depress the ?

A

Central nervous system

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15
Q

Estrogen is contraindicated with which types of migraines

A

migraines with aura

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16
Q

Progestins are primarily responsible for?

A

contraceptive effect

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17
Q

Progestins exhibit a ______ effect in the ______ _____ ____ axis

A

negative

hypothalamic-pituitary-ovarian axis

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18
Q

Progestins cause ____ of the endometrium, which ?

A

atrophy

prevents implantation

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19
Q

The ____ component improves efficacy by ______ ____ release

A

estrogen

suppressing FSH

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20
Q

Estrogen provides _____ ____

A

cycle control

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21
Q

What are the three goals of contraceptive treatment?

A

safety, tolerance, effectiveness

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22
Q

If a patient has a history of ____, do not use estrogen

A

clotting

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23
Q

Progesterone decreases the ____ _____ and may take a ____ to come back

A

endometrial lining; a year

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24
Q

Non-contraceptive benefits of OC

A

decreased dysmenorrhea, irregularities, and blood loss
fewer ovarian cysts
lower incidence of benign breast conditions
reduced hospitalizations for gonorrheal PID
endometriosis suppression

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25
Q

Contraception significantly reduces the chance of what cancer?

A

endometrial and ovarian

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26
Q

What is contraindicated in a family history of breast cancer?

A

estrogen

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27
Q

venous thrombo-embolism risk increases how much with OC use?

A

3-5 times

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28
Q

Adverse drug reactions with OC

A

cholestatic jaundice, benign hepatic neoplasms, myocardial infarction, stroke, neurological migraines

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29
Q

Estrogen contraindications

A

migraine with aura, uncontrolled hypertension, postpartum <3 weeks, history of DVT, SMOKING (over 35 and smoking >15 cigarettes/day)

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30
Q

Traditional dosing of OC

A

21 days active drug + 7 days inactive drug

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31
Q

Extended cycle dosing for OC

A

84 days of active drug then 7 days off

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32
Q

Withdrawal bleed

A

Once every 3 months

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33
Q

monophasic dosing

A

same dose of estrogen and progestin for full cycle

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34
Q

biphasic dosing

A

vary the dose of progestin, with an increase in the amount of progestin in the latter half of the active pills (these are rarely used today)

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35
Q

triphasic dosing

A

vary the dose of estrogen, progestin, or both (more popular today)

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36
Q

Is there a benefit to doing triphasic dosing? Why?

A

no benefit to triphasic dosing and you cannot do continuous dosing with this dosing as you are more likely to have break through bleeding

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37
Q

If a patient comes to the office for OC and has a negative hcg, when can they start the pill?

A

same day-but use a backup method for 2 weeks

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38
Q

If you are on OCP, can you still have withdrawal bleeding?

A

yes-at the end of the pack as there are still hormone adjustments

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39
Q

OC cycle is better controlled with which dosing?

A

30-35EE rather than 20mcg

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40
Q

Extended cycle dosing decreases what?

A

the days of bloating and menstrual cramping

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41
Q

Which OC would you choose for acne control?

A

Yazmin

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42
Q

If a patient suffers from depression or mood swings around the menstrual cycle, avoid what?

A

progesterone

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43
Q

According to a new study, women have a ___ ____ in pregnancy if on abx.

A

7 fold increase

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44
Q

Emergency contraception dosing

A

Progestin Only 0.75mg (plan B): must be taken within 72 hours of unprotected sex. pills stat of 1 pill 12 hours apart

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45
Q

If taken appropriately, how effective is plan B?

A

95% within 24 hours, 89% within 72 hours

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46
Q

What age do you have to be to buy OTC plan B?

A

over age 17

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47
Q

Plan B is less effective if BMI is >?

A

26 (165 lbs)- due to lower serum levels; patient may need to double the dose: also offer IUC and oral ulipristal

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48
Q

Does plan B disrupt or harm an implanted pregnancy?

A

No

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49
Q

Plan B MOA

A

inhibits ovulation, thickens cervical mucus, inhibits tubal transport of egg or sperm, may interfere with fertilization or early cell division

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50
Q

Ulipristal acetate (ELLA) is what kind of contraception

A

emergency contraception-decreases risk of unintended pregnancy by 90%

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51
Q

ulipristal acetate is effective for how many days after unprotected intercourse?

A

5 days

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52
Q

Ulipristal acetate loses efficacy at what BMI?

A

35

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53
Q

what is ulipristal?

A

mixed progestin agonist/antagonist

54
Q

Is ulipristal acetate OTC?

A

No-prescription only; cost is 40-68$

55
Q

side effect of ulipristal acetate?

A

dizziness, typically resolves in 1 day; also headache, nausea, tiredness, cramping, and abdominal pain

56
Q

dose of ulipristal?

A

30mg orally in 1 dose

57
Q

MOA of ulipristal?

A

delays ovulation. not an abortifacient; also has a direct effect on inhibiting follicular rupture making it more effective closer to obulation

58
Q

when is ulipristal preferred?

A

for overweight and/or obese patients

59
Q

What is the first line contraceptive in teens?

A

IUD

60
Q

Can IUD’s be used as emergency contraception?

A

Yes-for up to 7 days after unprotected intercourse

61
Q

Is an IUD an abortifacient?

A

no-it is not disrupting an already established pregnancy

62
Q

Nuvaring contains what ingredients?

A

progesterone, etonogestrel, and estrogen ethinylestradiol

63
Q

how long can each ring be used for?

A

one cycle, which consists of a 3 week period of continuous ring use followed by a ring free period of one week

64
Q

how much hormone does each ring release

A

15 ug of ethinyl estradiol and 120 ug etonogestrel per day over the 3 week periods

65
Q

What is annovera

A

combo estrogen progesterone ring that can be used for one year, taken out, and washed every cycle

66
Q

patch is the highest dose of ?

A

estrogen/progesterone

67
Q

what group of people does the patch not work well in?

A

obese patients as it is absorbed differently in adipose tissue

68
Q

Does the ring/patch or pill have better adherance?

A

Theoretically the ring/patch as it is not daily

69
Q

how often does the patch need to be changed?

A

every 9 days

70
Q

progesterone only medications have been thought to affect ____ _____

A

bone density; but patient regain this when they go off of their medication, bone loss is not permanent;

71
Q

While on progesterone only medications, encourage what supplements?

A

vitamin D (800 u) and calcium (1200mg)

72
Q

which contraceptive methods are considered highly effective?

A

male and female sterilization, implants, hormone shot, intrauterine devices: they are not user dependent

73
Q

IUD’s release how much levonorgestrel?

A

between 14 and 20mcg daily

74
Q

how long can an IUD be left in place?

A

3-5 years

75
Q

what is the benefit of an IUD systemically?

A

the small level of circulating hormone has low risk of systemic side effects

76
Q

What does the IUD do?

A

thickening of cervical mucus, endometrial atrophy, and inhibits sperm motility and function

77
Q

IUD has minimal effect on?

A

ovulation suppression

78
Q

how long does it take for normal endometrium function to return after discontinuation of IUD

A

1-3 months

79
Q

What IUD’s are the smallest?

A

Skyla and Kyleena, smaller in length and width compared to Mirena and Liletta. They have a smaller diameter insertion tube and Skyla has a silver ring at the top for visualization on ultrasound. The smaller size may make it easier to insert in nulliparous women

80
Q

How long does implanon provide protection?

A

3 years

81
Q

What is implanon made of?

A

one rod that contains 68mg of etonogestrel, an active metabolite of desogestrel.

82
Q

Who can insert implanon?

A

Trained providers, it is easier now because it is only one rod to insert rather than several

83
Q

What is depo-provera?

A

a long acting injectable, progestin only contraception.

84
Q

How many miligrams in each injection and how long does it last for?

A

150mg IM for 12-13 weeks

85
Q

how does depo provera work?

A

thickens cervical mucus and atrophies the endometrium.

86
Q

Are their other injections rather than IM?

A

yes, subcutaneous 104mg injection offers a lower overall hormone dose with no change in efficacy, even in patients with a higher BMI

87
Q

How early or late can they get their injection?

A

They should get it every 12 weeks, although a week early or late is acceptable

88
Q

Will DMPA change a women’s bleeding pattern?

A

yes-causing an increased number of days of spotting or amenorrhea

89
Q

what is the primary reason women d/c DMPA?

A

increased spotting or amenorrhea

90
Q

What is another negative side effect of DMPA?

A

weight gain

91
Q

How long does it take to restore normal fertility cycles after DMPA?

A

9-10 months

92
Q

What should you counsel patients on before prescribing depo provera

A

to increase dietary calcium intake and weight bearing exercise along with smoking cessation to mitigate BMD changes

93
Q

Two brand names of POPs (progestin only pills)

A

micronor and no-QD

94
Q

What is special about POPs?

A

They contain no estrogen

95
Q

What populations are contraindicated for receiving estrogen?

A

migraine with aura, uncontrolled hypertension, postpartum <3 weeks, history of DVT, SMOKING (over 35 and smoking >15 cigarettes/day) and breastfeeding

96
Q

Dosing specifications for POPs?

A

must take the dose at the exact same time every day as the medication takes 2-4 hours to work and only last for 22 hours

97
Q

what is the primary contraceptive method of POPs?

A

thickening of the cervical mucosa and prevention of sperm penetration

98
Q

Even if the POP is taken a few hours late, you must use _____ _____ for ___ ____

A

backup contraception: 48 hours

99
Q

traditional COC dosing

A

21 days active pill, 7 days inactive pills

100
Q

extended menstrual cycling

A

84 days of active pill and 7 days off; produces withdrawal bleeding every 3 months

101
Q

What is different about seasonique?

A

considered monophasic but contain 10mcg of EE in the last week of one cycle of dosing

102
Q

Lybrel dosing

A

continuous cycle without any hormone free weeks for 1 years.

103
Q

Can other monophasic COC’s be dosed continuously?

A

yes-just take the active pill continuously without the inactive pill

104
Q

What is the newest dosing regimen for monophasic COC’s?

A

24 active and 4 inactive pills per cycle

105
Q

First day start

A

the first pill is taken on the first day of the menstrual cycle. No backup method is needed when using this initiation method because ovulation will be suppressed with the first cycle

106
Q

Sunday start

A

the first pill is taken on the Sunday following the start of menses; a backup method is recommended for the first 7 days

107
Q

Quick start

A

The first pill is taken on the day of the office visit; a backup method is recommended for the first 7 days. This method can be used if the clinician is reasonably sure that the patient is not pregnant

108
Q

3 most common reasons for missed pills

A

being away from home, forgetting, or not having the pill available

109
Q

If you miss one active pill

A

take pill as soon as you remember, taking two pills in 1 day if missed pill was the day prior (use backup contraceptive for 7 days)

110
Q

missed two to four active pills

A

take two pills for 2-3 days (use back up contraception for 7 days)

111
Q

Missed 5 or more active pills

A

start a new pack on the next start day (ex.Sunday for sunday starters) Use backup contraception until 7 days of active pills are taken

112
Q

How much hormone does the ring release?

A

15 mcg of EE and 120mcg of etonogestrel daily

113
Q

Dosing for vaginal ring

A

ring is placed in the vagina for 3 weeks and then removed for 1 week.

114
Q

what is the benefit of the ring

A

does not need to be placed by a provider, releases a steady, low dose of hormone which offers better cycle control in the form of decreased breakthrough bleeding when compared to COCs, and offers convenient once-monthly self-administration

115
Q

how much hormone is released by the ring

A

approximately 50% compared to COC and 30% of levels used with the patch

116
Q

Extended cycling with the ring caused what?

A

increased serum triglycerides and HDL levels

117
Q

research is being done on what types of rings?

A

dual purpose of contraception and protection from STI’s

118
Q

dosing or ortho evra topical patch?

A

20mcg of EE and 150mg of norelgestromin, which is the primary active metabolite or norgestimate

119
Q

does norelgestromin undergo liver metabolism?

A

yes, however, it results in the metabolite levonorgestrel which is highly bound to sex hormone binding globulin, limiting it biological impact

120
Q

How often is the patch applied

A

once a week for 3 weeks and then 1 week off

121
Q

when should the first patch be applied

A

on the first day of menses; if it is started on any other day, a backup method should be used for 7 days

122
Q

where should the patch be applied

A

abdomen, upper torso, outer arm, or buttocks and rotated with each patch change. It should be placed on skin that is clean and dry

123
Q

Side effects of patch

A

similar to those of COC, and skin irritation

124
Q

Decreased patch efficacy in patients with?

A

increased BMI

125
Q

bleeding is a common side effect of POP and COC, does it usually resolve?

A

yes, within the first 3-6 months

126
Q

why do some women experience break through bleeding after extended use?

A

decidualization and fragility of the endometrium, which is a progestational effect-stopping the dosing regimen is unnecessary

127
Q

how can you improve bleeding?

A

determine when the bleeding is occurring during the cycle and change pill formation

128
Q

side effects from systemic absorption of levonorgestrel

A

breast tenderness, mood changes, and acne

129
Q

commin side effects of COC, the ring, and patches

A

nausea, weight gain, mood swings, breast tenderness, and headaches

130
Q

if patient are experiencing a lot of side effects, the provider should encourage?

A

the patient to try a different pill formulation to manage side effects rather than discontinuing the method altogether

131
Q

what typically resolves the side effects

A

continued use of the same method

132
Q

what are the three major influences on the continuation of contraception

A

the number and severity of side effects, concerns over medical risks (cancer, blood clots), and nonmedical factors such as not understanding directions and complicated packaging

Family Health Practicum 833P (3 decks)

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