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NAPLEX Review > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

How long is a normal menstrual cycle and what is considered day 1?

A

23-35 days (28 average)

Day 1 of period = day 1 of cycle

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2
Q

What are the 3 phases of the menstrual cycle? What happens in each stage?

A

Follicular - FSH causes follicle development and estrogen surge; this surge causes increase in LH and FSH; estrogen peaks at end of this phase
Ovulatory - LH surge triggers ovulation 24-36 hours later
Luteal: start of ovulation begins this phase; progesterone is dominant; lasts ~14 days

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3
Q

How long does an oocyte live once released?

A

24 hours

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4
Q

What hormone is released when a fertilized egg attaches to the lining of the uterus?

A

Human chorionic gonadotropin (hCG)

Can be detected in urine or blood

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5
Q

What should women planning to conceive do to protect the future baby?

A

Folic acid supplements (400 mcg/d)
Stop smoking, using drugs, and drinking excessive alcohol
Keep vaccinations current
Avoid hazardous drugs

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6
Q

What contraceptive method has a delay in return to fertility?

A

medroxyprogesterone injection

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7
Q

What contraceptive methods are most, moderately, and least effective?

A

Most: Implant, intrauterine device, sterilization
Moderate: Injectable, pill, patch, ring, diaphragm
Least: Condom, withdrawal, sponge, spermicide, calendar tracking

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8
Q

What type of condoms don’t protect against STDs

A

“Natural” sheepskin

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9
Q

What types of lubricants should be recommended for use with latex or non-latex synthetic condoms?

A

Water or silicone-based

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10
Q

What is the name of spermicide and why should it not be used with anal sex

A

Spermicide nonoxynol-9

Can cause irritation and increase risk of STDs

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11
Q

What is in a combination oral contraceptive (COC)

A

estrogen and progestin

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12
Q

What is CHC?

A

Combined hormonal contraceptives

Combined contraceptive that is not in an oral formulation

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13
Q

What does the FDA recommend is dispensed with oral contraceptives?

A

Patient Package Insert

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14
Q

What indications do COCs have?

A

Dysmenorrhea (menstrual cramps), premenstrual syndrome, acne (in females), anemia (by reducing blood loss), menses regulation in PCOS, endometriosis

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15
Q

Why is drospirenone a unique progestin?

A

Mild potassium-sparing diuretic which decreases bloating, PMS symptoms and weight gain

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16
Q

Progestin only pills (POPs) MOA; what population are they used in?

A

MOA: suppress ovulation
Used in lactating women because estrogen decreases milk production (start 3-6 weeks postpartum) and estrogen increases risk of thrombosis
Safe in women with migraines with aura

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17
Q

Contraceptive patch important notes

A

Higher systemic estrogen exposure; do not use in someone with clotting risk factors
Less effective in women >198 pounds or BMI >30
Do not use in women > 35 who smoke

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18
Q

How often is Depo-Provera given?

A

every 3 months

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19
Q

What oral contraceptive is approved for continuous contraception

A

Amethyst

Others are used off-label

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20
Q

What do the following mean when included in the name of an oral contraceptive:
Lo
Fe
24

A

Lo: 35 mcg or less of estrogen (less estrogen related SE)
Fe: iron supplement included
24: shorter placebo time

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21
Q

What are monophasic formulations of oral contraceptives?

A

Junel, Microgestin, Sprintec, Loestrin, Yasmin, Lo Loestrin

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22
Q

What are biphasic, triphasic formulations of oral contraceptives?

A

Ortho Tri-Cyclen Lo, Tri-Sprintec

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23
Q

What are extended cycle formulations of oral contraceptives?

A

Seasonique, Camrese, Jolessa, Amethia

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24
Q

What are drospirenone containing formulations of oral contraceptives?

A

Yasmin, Yaz

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25
Q

What contraceptives come in the ring formulation?

A

NuvaRing

Annovera

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26
Q

What contraceptives are progestin-only?

A

Errin
Camila
Nora-BE

27
Q

What to do if patient is having breakthrough bleeding

A

If on estrogen: Switch to product with higher estrogen dose
Wait 3 cycles before changing doses
If on pogesterone: increase dose

28
Q

Estrogen-containing products BBW

A

Do not use in women > 35 who smoke due to risk of serious CV events

29
Q

Estrogen + progestin transdermal patch BBW

A

increased risk of DVT/PE compared to COC

30
Q

Depo-provera BBW

A

loss of bone mineral density

31
Q

When should estrogen containing contraceptives be avoided?

A

Hx of DVT/PE, stroke, CAD, breast CA, ovarian CA, liver CA, migraines with aura

32
Q

Severe and rare adverse effects of estrogen

A 
ACHES
A - Abdominal pain that is severe - ruptured liver tumor/cyst, gallbladder, ectopic pregnancy
C - Chest pain - PE, MI
H - Headaches - stroke
E - Eye problems - clot in eye
S - Swelling or sudden leg pain - DVT
33
Q

What contraceptive to use for someone with

Acne

A

COC with low (Sprintec) or no (Yaz) androgen

34
Q

What contraceptive to use for someone who is

breastfeeding

A

POPs or nonhormonal method

35
Q

What contraceptive to use for someone with

estrogen CI

A

POPs or nonhormonal method

36
Q

What contraceptive to use for someone with

Migraine

A

with aura: POPs or nonhormonal methods

no aura: any method

37
Q

What contraceptive to use for someone with

Fluid retention/bloating

A

Drospirenone containing

38
Q

What contraceptive to use for someone with

Heavy menstrual bleeding

A

COC Natazia and IUD Mirena - indicated for this

COCs with 4 placebo pills may minimize bleeding

39
Q

What contraceptive to use for someone with

HTN

A

POPs or nonhormonal

40
Q

What contraceptive to use for someone with

Mood changes or disorder

A

Monophasic COC - extended cycle or continuous with drospirenone

41
Q

What contraceptive to use for someone with

nausea

A

take at night
decrease estrogen dose
switch to POP or nonhormonal method

42
Q

What contraceptive to use for someone who is

overweight

A

any method

do not use DMPA if trying to avoid further weight gain

43
Q

What contraceptive to use for someone who is

postpartum

A

do not use CHCs for 3 weeks or for 6 weeks if patient has additional risk factors for VTE
Can use POPs or nonhormonal method during this time

44
Q

What contraceptive to use for someone with

premenstrual dysphoric disorder (PDD)

A

Yaz or an antidepressant

45
Q

What medications decrease hormonal contraceptive efficacy

A 
Abx (rifampin, rifabutin)
Anticonvulsants (carbamazepine, oxcarbzepine, phenytoin, primidone, topiramate, lamotrigine)
St. John's wort
Smoking 
Ritonavir
Colesevelam
Byetta
46
Q

What heptitis C treatments cannot be used with ethinyl estradiol containing medications and why?

A

Technivie and Viekira Pak

Risk of liver toxicity

47
Q

When do you not have to use backup birth control when starting a COC?

A

If started within 5 days after the start of the period

48
Q

How to start progestin-only pills

A

Start any time

Use backup method for first 48 hours

49
Q

What to do if a patient misses a dose of COC

A

If <48 hours since last dose - take ASAP, no backup needed, take next dose as scheduled
If >48 hours since last dose - take ASAP, backup needed x 7 days, take next dose as scheduled (if in week 3, omit placebo week or use backup until 7 days of active pill have been taken)

50
Q

What to do if a patient is >3 hours late for POP

A

Take pill ASAP and take next dose on schedule, backup contraception x 48 hours

51
Q

Which long-acting reversible contraceptive can be used for birth control and emergency contraception?

A

Copper-T IUD (ParaGard)

52
Q

What are 3 emergency contraception options?

A

ParaGard IUD
Ella
Plan B One-Step

53
Q

When to use each form of EC? How well do they work?

A

ParaGard: 99.9% effective, use within 5 days
Ella: less effective if over 195 pounds, use ASAP up to 5 days
Plan B: least effective, less effective if over 165 pounds, use ASAP up to 3 days

54
Q

What is the active ingredient in Plan B One-Step and Ella?

A

Plan B: levonorgestrel

Ella: Ulipristal acetate

55
Q

MOA and Primary side effect of Plan B One-Step and Ella

A

MOA: delay ovulation
SE: Nausea
If pt vomits within 2 hours, need to repeat dose

56
Q

How long to leave in diaphragm and sponge - can you reuse?

A

at least 6 hours but no longer than 24 hours

Can reuse diaphragm for 2 years, do not reuse sponge

57
Q

Where to apply contraceptive patch

A

Butt, stomach, upper arm, upper torso

Do NOT apply to breast

58
Q

How long to use NuvaRing

A

3 weeks

Can be kept in for 4 weeks to prevent period

59
Q

If NuvaRing is out for ____, use backup contraception ___

A

> 3 hours

until ring has been in for 7 continuous days

60
Q

Clomiphene indication and drug class

A

Indication: first-line treatment in women with irregular or absent menstrual cycle
Class: selective estrogen receptor modulator (SERM)

61
Q

Clomiphene MOA and SE

A

causes LH and FSH to surge resulting in ovulation
SE: hot flashes, blood clots
*can release more than one egg and result in multiple births

62
Q

How do gonadotropin drugs work?

A

act as LH, FSH, or hCG causing ovulation

*can release more than one egg and result in multiple births

63
Q

Gonadotropin indication and route

A

Infertility
Use after clomiphene failure
Used to spur eff release for intrauterine insemination and in vitro fertilization
Route: SQ or IM

64
Q

What medications are gonadotropin drugs?

A

chorionic gonadotropin-recombinant, follicle stimulating hormone-recombinant, human chorionic gonadotropin-recombinant and menotropin

Menopur, Follistim AQ, Gonal-f, Pregnyl, Novarel, nad Ovidrel

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