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NAPLEX > Contraception and Fertility > Flashcards

Contraception and Fertility Flashcards

1
Q

Normal menstrual cycle day range

A

23 - 35 days

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2
Q

What is day 1 of the cycle?

A

The start of bleeding, menses

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3
Q

Follicular Phase

A

Each follicle in an ovary contains an oocyte (immature egg)

-FSH spurs follicle development and causes estrogen to surge

-estrogen peaks by the end of the phase

-surge in estrogen cause LH and FSH to increase

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4
Q

Ovulatory Phase

A

LH surge from the end of follicular phase triggers ovulation 24 - 36 hours later

-ovulation is the release of the egg (ova) from the ovary

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5
Q

How long does the oocyte liver once released?

A

24 hours (happens mid-cycle)

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6
Q

Luteal Phase

A

Start of ovulation begins the luteal (last) phase which lasts 14 days

-progesterone is dominant in this phase

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7
Q

When should someone trying to conceive have sex?

A

Once LH surge is detected (meaning end of follicular stage and start of ovulatory phase when oocyte is released) for the following 2 days

-sperm can survive for 3 days

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8
Q

Human chorionic gonadotropin (hCG)

A

released when a fertilized egg attaches to this lining of the uterus (implantation)

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9
Q

Key Preconception Tips

A

-increase folate and vitamin B9 (400mcg dietary folate/day then 600mcg during pregnancy)
-stop smoking and drinking
-keep vaccinations current
-avoid toxic chemicals

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10
Q

What is the only reversible contraceptive method that delays the return of fertility?

A

medroxyprogesterone injection

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11
Q

What is the typical temperature prior to ovulation?

A

96 - 98%

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12
Q

What is the typical temperature during ovulation?

A

97 - 99%

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13
Q

Phexxi

A

vaginal gel that maintains an acidic pH ranging from 3.5 - 4.5 which does not allow sperm to live
-do not use with vaginal rings or in those with recurrent infections

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14
Q

How do hormonal contraceptives work?

A

inhibit the production of FSH and LH which prevents ovulation
-alter cervical mucus which inhibit sperm from penetrating the egg

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15
Q

Health benefits provided by hormonal contraception

A

-decrease in menstrual pain/ irregularity
-endometriosis
-acne
-ectopic pregnancy
-noncancerous breast lumps
-decreased risk of endometrial and ovarian cancer

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16
Q

Combination Oral Contraceptives (COCs)

A

ethinyl estradiol (EE) and progestin

progestin can be in the form of:
-norethindrone
-levonorgestrel (LNG)
-drospirenone

Monophasic: same dose throughout pack

Biphasic, triphasic and quadriphasic also available to mimic levels during menstrual cycle

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17
Q

Unique progestin: Drospirenone

A

-used in some COCs to reduce adverse effects
-mild potassium-sparing diuretic
-decreases bloating, PMS symptoms and weight gain
-less acne

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18
Q

products that have anti-androgenic activity

A

-drospirenone
-norgestimate
-desogestrel
-dienogest

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19
Q

First line treatment of polycystic ovary syndrome (PCOS)

A

COCs

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20
Q

“Lo”

A

indicates 35mg or less of estrogen causing less estrongenic side effects

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21
Q

“Fe”

A

iron supplement is included

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22
Q

“24”

A

indicates a shorter placebo time
-24 active pills, 4 placebo to make a 28 day cycle

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23
Q

Monophasic COC formulation

A

Junel Fe 1/20
Microgestin Fe 1/20
Sprintec 28
Loestrin 1/20
Yasmin 28
-21/7 pack
*contains 1mg norethindrone and 20mch EE

Loestrin 24 Fe, Yaz (24/4 pack)

Lo Loestrin Fe (24/2/2 pack)

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24
Q

triphasic formulation (COC)

A

Tri-Sprintec (7/7/7)

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25
Q

Quadiphasic Formulation (COC)

A

Natazia

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26
Q

Extended Cycle COC Formulations

A

Seasonique

84 days of EE and LNG followed by 7 days of low dose EE

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27
Q

Drospirenone containing formulations

A

Yasmin 28, Yaz
-contraindicated in renal or liver disease
-monitor potassium and kidney function during use

28
Q

Continuous COC formulations

A

Amethyst
-no inactive pills
-28 days of EE and LNG with no placebo

29
Q

patches

A

Xulane
-higher AUC than pills
-contains both EE and progestin

Xulane and Zafemy less effective in those greater than 198 lbs

30
Q

Rings

A

Nuva Ring
-lower AUC than pills
-contains both EE and progestin

Annovera: lasts for 1 year

31
Q

Progestin only pills

A

-Erin
-Camila
-Nora-BE (nor indicates norethindrone)
-incassia
-Slynd (drospirenone -only)

32
Q

First line for endometriosis

A

COCs

33
Q

Products indicated for heavy menstrual bleeding

A

COC Natazia
Mirena IUD

34
Q

Primary uses for POPs (Progestin-Only Pills)

A

-breast feeding women
(EE decreases milk production)
-contraindication to estrogen use
-can be started 3-6 weeks postpartum
(EE this soon after delivery increases risk of thrombosis)
-migraine with aura (EE cannot be used because of stroke risk)
Downside:
-require very good adherence (within 3 hours of scheduled time)

35
Q

Patch considerations

A

-higher systemic estrogen exposure
-not to be used in anyone with high clotting risk

36
Q

High clot risk considerations with estrogen

A

-greater than 35
-smoker
-cerebrovascular disease or previous blood clots
-postpartum
-BMI greater than 30

37
Q

Side effects of estrogen

A

-Nausea
-breast tenderness
-bloating
-weight gain
-increased blood pressure (fluid retention)
-melasma (dark skin patches on the face)

(reduced dose helps, but too low will cause breakthrough bleeding)

38
Q

Progestin side effects

A

breast tenderness, HA, fatigue, depression

39
Q

Drospirenone side effects

A

slightly higher risk of clotting
(avoid in high clot risks)
-increased potassium
(avoid in kidney, liver, or adrenal gland disease since these can also increase potassium levels)

40
Q

Side effect of Depo-provera shot

A

-loss in bone mineral density
-need to supplement vitamin D and calcium

41
Q

Contraindication with the Estrogen + Progestin patch

A

-do not use in women with a BMI greater than 30 because of increased risk of thromboembolism (Xulane and Zafemy)
-decreased efficacy (Twirla)

42
Q

Contraindications to using estrogen

A

-history of DVT/PE/stroke, CAD
-breast, ovarian or liver cancer
-migraines with aura

43
Q

Drug selection of patient with acne or hirsutism

A

COC with a progestin that has low androgenic activity (norgestimate Sprintec 28) or no androgenic activity like drospirenon (Yaz, Yasmin)

44
Q

Drug selection of patient breastfeeding

A

-POP
-nonhormonal method

45
Q

Drug selection for estrogen contraindication (clot risk)

A

-POP
-non hormonal

46
Q

Drug selection for a patient with heavy menstrual bleeding (menorrhagia)

A

-COC Natazia
-Mirena IUD
-COCs with 4 placebos instead of 7

47
Q

Drug selection for those with mood changes or mood disorder

A

-monophasic COC
-extended cycles
-continuous drospirenone preferred

48
Q

Drug selection for premenstrual dysphoric disorder

A

-yaz (just drospirenone)
-SSRI may be needed

49
Q

Spotting/ break through bleed dose adjustment

A

early in cycle: increase estrogen
late in cycle: increase progestin

50
Q

Benefit of injection

A

-less drug interaction since it bypasses first-pass metabolism An

51
Q

Antibiotics that decrease hormonal contraceptive efficacy

A

-rifampin (back up for 6 weeks after ABX is discontinued)
-rifabutin
-rifapentine

52
Q

Anticonvulsants that decrease hormonal contraceptive efficacy

A

-carbamazepine
-oxcarbazepine
-phenytoin
-primidone
-topiramate
-lamotrigine
-barbiturates
-perampanel

53
Q

Miscellaneous drugs that interact with birth control

A

-st. John’s wort
-smoking tobacco
-ritonavir boosted protease inhibitors (Mycophenolate)
-colesevelam
-Byetta

54
Q

Risks with Hepatitis C treatment

A

Mavyret cannot be used with any formulation containing EE due to risk of liver toxicity

55
Q

Infertility is defined as how long of actively trying to become pregnant

A

1 year of unprotected sex

56
Q

Clomiphene

A

-selective estrogen receptor modulator (SERM)
-causes LH and FSH surge to trigger ovulation
-surge in LH causes hot flashes

57
Q

SERMs

A

-act as estrogen agonists in some tissues and antagonists in others
-clotting risks

58
Q

Letrozole

A

-aromatase inhibitor
-impacts ovulation through estrogen negative feedback

59
Q

Gonadotropins

A

-trigger ovulations by acting similar to the endogenous FSH and LH
-used after poor response to clomiphene
-used to spur egg release during in vitro fertilization

60
Q

Leuprolide

A

-gonadotropin releasing hormone agonists
-used to trigger ovulation

61
Q

Clotting risk with progestin

A

-drospirenone has a slightly higher risk of clotting compared to other progestins

62
Q

Weeks of first trimester

A

0 - 12 weeks
organ development, most at risk of teratogens

63
Q

Gravida (G)
Para (P)

A

G = # of times pregnant
P = # of times given birth `

64
Q

Calcium requirements of a pregnant woman

A

1,000 mg/day calcium
15 mcg/day (600 IU) Vitamin D

65
Q
A

NAPLEX (7 decks)

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