Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HSHD Block 1 > Contraception and Fertility > Flashcards

Contraception and Fertility Flashcards

1
Q

What are the key hormones in oral contraceptives

A

Estrogen and progestin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do combo estrogen progestin OC work

A

Combinations of estrogen and progestin work by preventing ovulation. They also change the lining of the uterus (womb) to prevent pregnancy from developing and change the mucus at the cervix (opening of the uterus) to prevent sperm from entering.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two types of preparations for estrogen progestin combo OC

A

combinations of estrogens and progestins

continuous progestin therapy without concomitant administration of estrogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can estrogen be given alone for BC?

A

No, estrogen-only contraception is not an option due to “unopposed estrogen” causing uterine hyperplasia and eventually uterine cancer! If estrogen is given chronically for birth control, it will always be accomanied by an progestin. In contrast, progestins can be very effective alone for birth control without causing dangerous side effects/adverse events. However, they have to be given in a way that guarantees a relatively constant serum level of progesterone, or breakthrough ovulation occurs and then pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common synthetic estrogen used in BC

A

Ethinyl estradiol, which has the ethinyl at C-17 to avoid first pass (seen in natural steroid hormones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the two estrogen agonists

A

Ethinyl estradiol

Mestranol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Progestin that is antiandrogenic and also antimineralcorticoid

A

Drospirone, derived from 17-alpha spironolactone

Yaz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hydroxyprogesterone derivatives

A

Hydroxypregesterone

Medroxypregesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

19-Nortestosterones

A

Levonorgestrel

Norethynodrel

Norethindrone/Norethindrone acetate

Ethynodiol

Norgestrel

Norgestimate

Desogestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Four types of oral contraception

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Instructions for progestin only “minipill”

A

Critical to take at the same time, every day to maintain a constant level of progesterone receptor activity! Or will fail and result in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the recommended first-line BC for most women

A

Long-acting subdermal implantable or depot forms of progesterone

These are very effective forms of contraception, with the long-acting implantable subdermal forms being even more effective in preventing pregnancy than surgical sterilization of male or female partners.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the usual level opf estrogen in combo pills

A

Typically, the pill with the least amount of estrogen that is still effective is prescribed, due to increase venous thromboembolism (VTE) concerns.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is mifepristone and what is its mechanism

A

Progesterone receptor antagonist

Mifepristone has luteolytic properties in 80% of women when given in the midluteal period, but the mechanism is unknown. Mifeprestone has a long half-life, large doses may prolong the follicular phase of the cycle and make it difficult to use continuously as a contraceptive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common use of mifepristone

A

To terminate early pregnancy

Doses of 400-600 mg/d for 4 days or 800 mg/d for 2 days successfully terminated pregnancies in 85% of women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Plan B

A

Progestin-only levonorgestrel

17
Q

What is Ulipristal acetate

A

A progestin antagonist, may impact sperm motility. Used as emergency contraception

18
Q

Most effective form of emergency contraception

A

Copper IUD

19
Q

What is ulipristal

A

Selective Progesterone Receptor Modulator - Ulipristal potently antagonizes progesterone receptor. It also binds the androgen and glucocorticoid receptors, but has weak antagonistic activity.

20
Q

What are the 4 IUDs

A

ParaGard is a copper containing IUD, FDA-approved for 10 years of use, but shown to be effective for up to 20. No progestin or estrogens in this preparation.

Mirena provides continual release of levonorgestrel is FDA-approved for 5 years (effective for up to 7). Mirena is approved for those with heavy bleeding. It releases 20 mcg/day of levonogestrol initially and tapers to 10 mcg/day.

Skyla is FDA approved for up to 3 years of use. Skyla is slightly smaller which is advantageous for nulliparous women. The smaller device has less reported pain. This preparation initially releases 14 mcg/day and tapers to 5 mcg/day.

Liletta is similar in size to Mirena. It is FDA approved for up to 3 years. Mirena releases 18.6 mcg/day and decreases to 12.6 mcg/day.

21
Q

What is nexplanon

A

Arm implant, containing the progestin etonogestrel

22
Q

What is Medroxyprogesterone acetate

A

Injectable contraception, injected intramuscularly

23
Q

Side effects of estrogen

A

nausea and breast tenderness and enlargement. OC with lower levels of ethinyl estradiol are associated with higher incidence of bleeding disturbances.

24
Q

What lab tests can be altered with contraceptions

A

Increased Clotting factors

Lipid alterations

Increased Thyroxine-binding globulin (TBG) and total T4

25
Q

Drug interactions of significance for BC

A

anticoagulants, anticonvulsants, antibiotics (rifampin), antiretroviral (Efavirenz)

26
Q

Tips for too little or too much estrogen and progestin

A

If the problem is a menstrual irregularity, your probably have a deficiency in one or other of the components.

If the problem is due to excess estrogen, think “ salt and water retention “

If the problem is excess progestin, think “ anabolic/masculinizing side effects of the 19-nortestosterones “ and choose a later generation progesterone

27
Q

Mild adverse effects of OCPs

A

Nausea, change in serum proteins, withdrawal bleeding, headache

28
Q

Moderate adverse effects of OCPs

A

Breakthrough bleeding, weight gain, increased skin pigmentation, acne, hirsutism, ureteral dialtion, vaginal infections, ammenhorea

29
Q

Significant side effects of OCPs

A

Vascular disorders, GI disorders, depression, cancer

Other, less evidence: alopecia, erythema multiforme, erythema nodosum, and other skin disorders

30
Q

Must ask questions before giving oral contraception

A
  1. >35 and smoker
  2. History of venous thromboembolism (VTE)/strong family history
31
Q

Contraindications for OC

A
32
Q

Organic causes of female infertility

A

Adrenal (lack of androgen precursor)

Pituitary/hypothalamic dysfunction - lose ovarian stimulation

Anatomic - e.g. obstruction of the Fallopian tubes

33
Q

Conditions of infertility amenable to pharmacological treatment

A
34
Q

What is clomiphene and when is it used

A

Clomiphene is a partial agonist of the estrogen receptor and inhibits the actions of stronger estrogens. Blocks estradiol’s negative feedback effect on gonadotropins leading to a surge gonadotropin release and ovulation.

used to normalize/reboot feedback communication when anovulation occurs

HSHD Block 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions