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Naplex Drug Card > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

Condom type to protect against STD

A

Latex or Synthetic

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2
Q

Use with condoms would increase irritations and risk of STD/HIV

A

Nonoxynol-9 spermicide

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3
Q

What lubricant type should be avoided with latex or non-latex synthetic condoms

A

Oil-based lubricant

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4
Q

What lubricant type is recommended latex and non-latex synthetic condoms

A

Silicone or Water based lubricants

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5
Q

What is contained in foams, films, creams, suppositories, sponges and jellies

A

Nonoxynol-9 spermicide

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6
Q

Prescription only spermicide that decreases vaginal pH (3.5-4.5)

A

Phexxi
(Vaginal gel)

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7
Q

Phexxi contraindications

A

Vaginal rings

History of UTI

Urinary tract abnormalities

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8
Q

Hormonal contraceptives MOA

A

Inhibits FSH and LH to prevent ovulation

Alter cervical mucus to prevent sperm penetration to egg

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9
Q

Types of hormonal contraceptives

A

Progentin only (pill, injection, implant, IUD)

Estrogen/Progestin combination (pill, patch, ring)

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10
Q

What is required by FDA to be dispensed with oral contraceptives

A

Patient Package Insert

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11
Q

Most common estrogen formulation in hormonal combination contraceptives

A

Ethinyl estadiol

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12
Q

Most common progestin formulation in combination hormonal contraceptives

A

Norethindrone, Levonorgestrel, Drospirenone

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13
Q

Types of combinations hormonal contraceptives

A

Monophasic
Biphasic
Triphasic
Quadriphasic

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14
Q

Progestin with mild potassium sparing diuretic and anti androgenic activity

Associated with less bloating, PMS sx, weight gain and acne

A

Drospirenone

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15
Q

Progestin with low androgenic activity

A

Norgestimate
Desogestrel
Dienogest

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16
Q

Other indications for COC

A

Dysmenorrhea
PMS sx
Acne
Anemia
Menstural associated migraine
Peri-menopausal sx (hot flash, night sweat)

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17
Q

First line to regulate menses in PCOS

A

COC

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18
Q

First line to regulate dysmenorrhea and heavy bleeding in endometriosis

A

COC

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19
Q

FDA approved for endometrial pain

A

Elagolix (Orilissa)

(COC)

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20
Q

COC and Levonorgestrel IUD approved for heavy menstural bleeding

A

Natazia (COC)

Mirena (Levonorgestrel IUD)

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21
Q

Approved for heavy bleeding associated with uterine fibroid but not a contraceptive

A

Oriahnn (estradiol, norethindrone, elagolix)

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22
Q

Nonhormonal oral formulation of TXA for menorrhagia

A

Lysteda
(COC)

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23
Q

aka mini pill

A

Progestin Only Pill (POP)

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24
Q

MOA of action POP

A

Suppresses ovulation
Thickens cervical mucus
Thins endometrium

28 days active pills

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25
Q

Indication of use for POP

A

Breastfeeding (estrogen reduces milk production)
Migraine prophylaxis
Migraines with aura (estrogen increases the of stroke)
Any contraindication to estrogen

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26
Q

How soon can POP be initiated post-partum

A

3-6 weeks

(Estrogen increases risk of thrombosis post-partum)

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27
Q

What is the timing of administration for POP

A

Take within 3hrs of scheduled time

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28
Q

How is the patch (CHC) different from COC

A

Higher systemic estrogen content

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29
Q

Avoid with COC patch

A

Increased clotting risk
> 35 y.o and smokes

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30
Q

When is patch less effective

A

Wt > 193 lbs (Xulane)

BMI > 30 (Twirla)

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31
Q

How often are vaginal rings (CHC) inserted

A

Once monthly

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32
Q

Injectable contraceptive

A

Depo-Provera
Depo-SQ Provera 104

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33
Q

Depo-Provera dosing

A

IM 150mg or SC 104mg every 3 months

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34
Q

What is an important counseling point for depot shots for women who wants quick return of fertility following discontinuation

A

Most females will remain amenorrheic for 12 months (prolonged return of fertility)

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35
Q

How are most COC or CHC dosed

A

28 days supply

3 wks of active drug and 1 wk of inactive drug (placebo, iron, folate)

Bleeding will occur during the hormone free week (aka week 4)

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36
Q

Extended cycle COC

A

84 days of active drug and 7 days of inactive drug or low dose estrogen

Bleeding occurs every 3 months rather than monthly

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37
Q

Clinical pearl of continuous use of COC without placebo

A

Continous use can suppress menses altogether

Difficult to predict if pregnancy has occured

Risk of breakthrough bleeding or spotting usually resolves after 3-6 months

Less anemia and menstrual migraines

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38
Q

Continous COC without placebo week

A

Amethyst

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39
Q

Monophasic COC common brand names

(21/7 days)

A

Junel Fe 1/20
Microgeatin Fe 1/20
Loestrin 1/20
Yasmin 28
Sprintec 28

40
Q

Monophasic COC common brand names

(24/4 days)

A

Loestrin 24 Fe
Yaz

41
Q

Monophasic COC common brand names

(24/2/2 days)

A

Lo loestrin Fe

42
Q

Biphasic or Triphasic COC common brand names

A

Ortho Tricyclen Lo
Tri-Sprintec

43
Q

Quadriphasic COC common brand names

44
Q

Extended cycle COC common brand names

A

Seasonique

45
Q

Drospirenone containing COC

A

Yasmin 28
Yaz
Loryna
Ocella
Zarah

46
Q

Important lab for drospirenone containing COC

A

Potassium (3.5-5)
Scr

Contraindicated in renal and hepatic and adrenal impairment

Avoid in women with clotting risk

47
Q

CHC vaginal ring brand name

A

Nuvaring

Annovera (reusable for upto 1 year)

48
Q

POP brand name contains norethindrone alone

A

Errin

Camilla

Nora-BE

Incassia

49
Q

POP brand name contains Drospirenone alone

50
Q

Estrogen ADR

A

Breast tenderness and fullness

Increases BP

Risk of VTE/PE (caution if HTN, Diabetic, Smoker, Overweight, Bed ridden)

Weight gain

Melasma

51
Q

Progestin ADR

A

Breast tenderness

Headache

Depression

52
Q

Progestin reduces bone mineral density

Requires supplementation with calcium and vitamin D

A

Drospirenone

53
Q

When is breakthrough bleeding resolve

A

2-3 months

54
Q

Breakthrough bleeding will usually occur due to

A

Fast drop in estrogen level from missing a pill. Can be used to assess adherence

55
Q

Patients with spotting and estrogens dosed at < 30mcg

A

Increase estrogen dose

56
Q

Patients with spotting and estrogens dosed at >= 30mcg

A

Try different progestin

57
Q

Warning and estrogen contraindication

A

Avoid if >35 and smoker (risk of CVD)

Avoid with the following conditions:
CAD
Hx of thrombosis
Hypercoagulopathy
Hx of breast, ovarian or liver cancer
Liver disease
Uncontrolled HTN
Severe headache
Migraine with Aura
Diabetes + Vascular diease
Unexplained uterine bleeding

58
Q

Use Depot shot for patient with weight gain

59
Q

Drugs that decrease contraceptive efficacy

A

Antibiotics (Rifampin and co)

AED

St Johns Wort

Smoking

Protease inhibitors

Bosentan (Trecleer)

Mycophenolate (Cellcept, Myfortic)

Seperate from colesevelam by 4 hrs

Take 1 hr before byetta injection

60
Q

Increased risk of hepatotoxicity in Hep C with EE containing contraceptive and

A

If administered with:

Mavyret

Virkira Pak

61
Q

Contraceptive efficacy is achieved when

A

7 days if initiation

62
Q

Types of COC starts

A

Start today aka quick start

Sunday start

63
Q

Quick start COC counseling

A

Requires backup for 7 days after starting

64
Q

Time to COC efficacy

65
Q

Time to POP efficacy

66
Q

Sunday start COC counseling

A

Start on the sunday after menses onset

Requires 7 days of backup

67
Q

COC started on days 1-5 of menses

A

Does not require back up

68
Q

POP can be started at anytime. Counseling

A

Use backup in the first 48h

69
Q

IUD containing progestin LEVONORGESTREL and time to replacement

A

Mirena- 7 years

Liletta- 6 years

Kyleena- 5 years

Skyla- 3 years

70
Q

IUD used as EC and regularly birth control

A

Copper IUD last 10 years

Associated with heavier bleeding and cramping

71
Q

Etonorgestrol containing implant

A

Nexplanon last 3 yrs

72
Q

Emergency contraception types

A

Copper IUD (Paragard)

Ullipristal acetate (Ella)

Levonorgestrel (Plan-B, Take Action, Aftera, My Way, React)

73
Q

Timing of EC use

A

Copper IUD inserted within 5 days and last 10yrs

Ullipristal ASAP within 5 days (Rx)

Levonorgestrel ASAP within 3 days (OTC)

74
Q

Should be taken immediately after any unprotected sex

A

Ullipristal

Levonorgestrel

75
Q

EC least efficient at wt > 193 lbs or BMI > 30

A

Ullipristal

76
Q

EC least efficient at wt > 165 lbs or BMI > 25

A

Levonorgestrel

77
Q

Dose of levonorgestrel in EC

A

1.5mg single dose

78
Q

Levonorgestrel common ADR

79
Q

Patient throws up within 2hrs of plan B

A

Repeat dose

80
Q

Why are many hesitant to use Ulipristal

A

Related to abortion pill mifepristone

81
Q

Dose of EC Ullipristal

A

30mg. Required Rx

82
Q

Ullipristal ADR

A

Headache
Nausea
Abdominal pain

83
Q

How long should diaphragm be left in after intercourse

A

6 hrs but no more than 24hrs

84
Q

When should spermicide on diaphragms be reapplied

A

Repeat intercourse

Diaphragm placed 2hrs before sex

85
Q

How long can diaphragm be used

86
Q

Should be placed right before intercourse

A

Foam
Creams
Suppositories
Jellies
Sponge

87
Q

Left in place 6hrs after intercourse and for more than 24h

88
Q

Patch is loose or falls off for > 24hrs within the three weeks active period or more than 7 days has passed since week 4

A

Use back up for 7 days

89
Q

Ring left in place for 4weeks

A

Make sure not pregnant

Insert new ring

Use back up for 7 days

90
Q

Inserts ring day 1 of menses

A

No backup required

91
Q

Inserts ring day 2-5 of menses

A

Backup required for 7 days

92
Q

Week 1 and 2 and ring falls out > 3hrs

A

Wash and reinsert

Use backup for 7 days

93
Q

Week 3 ring falls out

A

Discard

Insert new ring

Backup for 7 days

94
Q

Ring should be refrigerated prior to dispensing

95
Q

EC and no period for 3 weeks

A

Pregnancy has occured

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