Contraception And Infertility

Question 0

Adverse effects to estrogen

Answer 0

Nausea, breast tenderness, bloating, weight gain, elevated blood pressure, thrombogenic disorders including heart attack, stroke, DVT/PE

Question 1

Teratogens

Answer 1

Alcohol, Ace inhibitors, angiotensin receptor blockers, benzodiazepines, carbamazepine, isotretinoin, leflunomide, lithium, methimazole, NSAIDs, paroxetine, phenytoin, phenobarbital, quinolones, propylthiouracil, tetracyclines, topiramate, valproic acid, misoprostol, methotrexate, statins, dutasteride, finasteride, warfarin, thalidomide

Question 2

Safety concern with progestin drospirinone

Answer 2

Examples: Yaz, Jazmin, Ocella, Syeda, Zarah, Beyaz, and Safyral (also Ortho Evra patch)

Linked to a higher risk of blood clots and are best avoided in at risk women

Has a slight potassium sparing effect and should be used with caution in patients taking Ace inhibitors, angiotensin receptor blockers, heparin, canagliflozin, potassium sparing diuretics, aldosterone antagonist and potassium supplements

Question 3

Do not use any form of estrogen with these conditions

Answer 3

History of blood clot, history of stroke, heart valve disease, severe hypertension, diabetes that causes blood vessel problems, poorly controlled diabetes, severe headache, prolonged bed rest, breast cancer, liver cancer I’m her uterine cancer, abnormal bleeding from the uterus, jaundice during pregnancy, known possible pregnancy, if greater than 35 years old and smoking greater than 15 cigarettes a day

Question 4

Adverse effects associated with progestin

Answer 4

Breast tenderness, headache, fatigue or changes in mood

Question 5

Drug interactions that cause decreased efficacy of hormonal contraceptives

Answer 5

1. Antibiotics(rifampin, rifapentine, rifabutin)
2. Anticonvulsants (barbiturates, Carbamazepine, oxcarbazepine, phenytoin, topiramate and Felbamate
3. St. John’s wort
4. Several protease inhibitors and nine nucleoside reverse transcriptase inhibitors
5. Bosentan (Tracleer) and mycophenolate (cellcept)
6. Smoking

Question 6

Oral fertility agent

Clomiphene (clomid, serophene): SERM

Answer 6

Moa: increases ovulation.

Contraindications: liver disease, pregnancy, uncontrolled entering or thyroid disorders.

Side effects include hot flashes, ovarian enlargement, abdominal bloating, blurred vision, headache, fluid retention and can increase chance of multiple births, thrombosis risk

Question 7

Injectable fertility treatments

Answer 7

examples: human chorionic gonadotropin (noVarel, pregnyl), gonadotropins (follistim), urofollitropin (bravella), follitropin alpha (gonal-F), menotropins (menopur, repronex), gonadotropin releasing hormone agonist (Lupron, zoladex, synarel)

Side effects: injection site pain, CNS, ovarian hyperstimulation and enlargement

Notes: SC abdomen is preferred and IM upper outer quadrant of the butt is preferred