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ENRP Exam 1 > Contraception and Sterilization > Flashcards

Contraception and Sterilization Flashcards

1
Q

Which general class of contraceptives provide the most effective reversible contraception?

A

Hormonal contraceptives

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2
Q

What is the implantable hormonal contraceptive called?

A

Etonogestrel rod implant (Nexplanon)

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3
Q

What hormones are contained in the combo oral contraceptives; describe how each hormone contributes to its function?

A
  • Progesterone = major player –> suppresses LH and therefore ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium
  • Estrogen: mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
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4
Q

How does the progestin-only oral contraceptive (mini-pill) work; chance of ovulation; and who is it mainly used in?

A
  • MOA is primarily making cervical mucous thick and impermeable
  • Ovulation continues in about 40% of users
  • Mainly used in breastfeeding women and women who have contraindication to estrogen
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5
Q

When using a progestin-only OC (mini-pill) when must the patient take the pill and what if they mistime a dose?

A
  • Because of low dose, they MUST be taken at same time everyday starting on first day of menses
  • If pt is >3 hours late taking pill should use backup method for 48 hours
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6
Q

What are 4 benefits to using hormonal oral contraceptives?

A
  • Menstrual cycle regularity
  • Improve dysmenorrhea (painful periods)
  • ↓ risk of iron deficiency anemia (shorter and less heavy cycles)
  • Lower incidence of endometrial and ovarian cancer, benign breast and ovarian disease (cysts)
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7
Q

What are some of the side effects associated with oral contraceptives?

A
  • Breakthrough bleding: 10-30% experience during first 3 months of use (make sure to counsel it will improve!)
  • Amenorrhea
  • Mild AE’s: bloating, weight gain (perceived), breast tenderness, nausea, fatigue, and HA
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8
Q

What is a contraindication for using hormonal oral contraceptives?

A

Migraine WITH aura

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9
Q

What are 5 serious AE’s associated with hormonal oral contraceptives?

A
  • Venous thrombosis
  • Pulmonary embolism
  • Cholestasis and GB disease
  • Stroke and MI
  • Hepatic tumors
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10
Q

What is the name of the hormonal contraceptive transdermal patch; how often is it applied?

A
  • OrthoEvra
  • Apply one patch weekly for 3 weeks
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11
Q

Caution should be used when using the transdermal OC, orthoevra, in whom?

A

Women >198 lbs.

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12
Q

There is a greater risk of what AE associated with the transdermal patch, Orthoevra?

A

Greater risk of thrombosis

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13
Q

What are the benefits of the hormonal contraceptive ring, NuvaRing?

A
  • Combo of progesterone and estrogen
  • Associated w/ greater compliance due to once a month use
  • Can be removed for up to 3 hours without affecting efficacy
  • Better tolerated since not going thru GI tract and less breakthrough bleeding
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14
Q

Who can’t use combination contraceptives?

A
  • Women over 35 who smoke cigs
  • Women w/ personal hx of thromboembolic event
  • Women w/ hx of CAD, cerebral vascular disease, CHF or migraine w/ aura, uncontrolled HTN
  • Women w/ moderate to severe liver disease or liver tumors
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15
Q

Caution should be used in women with which underlying conditions when considering combination contraceptives?

A
  • Diabetes
  • Chronic HTN
  • SLE
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16
Q

What is the name of the injectable hormonal contraceptive?

A

Depo medroxyprogesterone acetate (DepoProvera)

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17
Q

How long does injectable, DepoProvera, maintain contraceptive level of progestin; when is it preferred to be given?

A
  • Maintains contraceptive level of progestin for about 14 weeks
  • IM injection every 11-13 wks, preferred to be given within first 5 days of menses and if not, use a back up method for 2 weeks
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18
Q

What is the MOA of the injectable contraceptive, DepoProvera?

A
  • Thickens cervical mucous
  • Decidualization of the endometrium
  • Blocks the LH surge and ovulation
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19
Q

What is the efficacy of the injectable contraceptive, DepoProvera?

A

Roughly equivalent to sterilization and is not altered by weight

20
Q

Which AE associated with DepoProvera caused the FDA to issue a black box warning; what is this warning?

A
  • Alterations of bone metabolism assoc. w/ ↓ estrogen levels
  • Particular concern in adolescents
  • Reversible after discontinuation
  • BLACK BOX = if used for more than 2 years should consider alternative method
21
Q

Side effects associated w/ injectable, DepoProvera?

A
  • Alterationsinbone metabolism
  • Irregular bleeding –> ↓ with use, but 25% will discontinue within one year
  • Weight gain
  • Exacerbation of depression
22
Q

What is a strategy for improving the bleeding profile in someone suffering from irregular bleeding while on DepoProvera?

A

Short term use of estrogen add back (usually wait till after receiving 2nd dose)

23
Q

What are some of the underlying conditions where the contraceptive DepoProvera can still be used?

A
  • Women w/ seizure disorders
  • Sickl cell anemia
  • Anemia secondary to menorrhagia
  • Endometriosis
  • ↓ risk of endometrial hyperplasia
24
Q

List 4 indications for choosing the contraceptive DepoProvera?

A
  • Desire for effective contraception
  • Need a method w/ better compliance
  • Breastfeeding
  • Can be used when estrogen is contraindicated
25
List 5 contraindications for the use of the contraceptive DepoProvera?
- Known or suspected **pregnancy** - **Unevaluated vaginal bleeding** - Known or suspected **malignancy** of the **breast** - **Active thrombophlebitis** or **current/past hx** of **thromboembolic events** or **cerebral vascular disease** - **Liver dysfunction/disease**
26
How long is the long acting reversible contraceptive (LARCS), Nexplanon good for?
Used for **3 years**
27
What is the MOA of the long acting reversible contraceptive (LARCS), Nexplanon?
- Thickens cervical mucous - Inhibits ovulation
28
List 6 side effects associated with the long acting reversible contraceptive (LARCS), Nexplanon?
- Irregularly irregular vaginal bleeding - **HA** - Vaginitis - **Weight increase** (mild) - Acne - **Breast pain**
29
What are the contraindications for use of the long acting reversible contraceptive (LARCS), Nexplanon?
- **Known** or **suspected pregnancy** - Current **(yes**) or past hx of thrombosis or thromboembolic disorders (**consideration**) - **Liver tumors** or **active liver disease** (**poorly metabolized**) - Undiagnosd abnormal uterine bleeding - **Known** or **suspected breast cancer** (only **absolute**)
30
What are the names of the 5 hormone containing IUD's?
**-** Copper T (**Paragard**) - **Levonorgestrel releasing** = Mirena and Skyla + Liletta and Kyleena
31
What are some of the risks associated with IUDS?
- ↑ risk of **infection** within first **20 days** post-insertion - ↑ risk of **ectopic pregnancy** if pregnancy would occur - Risk of **uterine perforation** at time of insertion requiring **laparoscopy** for removal - Risk of **malposition** and necessitating **hysterscopy** for removal
32
List 6 contraindications to using IUDS; which are specific to levonorgestrel containing and which to Copper T?
- **Breast cancer** - **levonorgestrel** containing **only** - Recent **puerperal sepsis** - Recent **septic abortion** - **Active cervical infection** - **Wilson disease** - **Copper T only** - **Uterine malformations** (uterine septums/fibroids/enlarged \>10cm)
33
Which IUDS are used for 5 years and which are used for 3 years?
- **Mirena/Kyleena** are used for **5 years** - **Liletta/Skyla** used for **3 years**
34
List 4 benefits to using the levonorgestrel containing IUDS.
- ↓ in **menstrual blood loss** (up to **50%**) - **Less dysmenorrhea** (painful periods) - **Protection** of **endometrial lining** from **unopposed estrogen** - **Convenient** and **long term**
35
How long is the Copper T IUD, Paragard, used for and what is it's MOA?
- Used for **10 years** - **Copper** interferes w/ **sperm transport** or **fertilization** and **prevention** of **implantation**
36
Women who use diaphragms as a method of contraception are more likely to get what?
UTI's
37
What are the contraindications to using emergency contraception?
**NO** medical contraindication to use
38
Which hormone is found in Plan B and how quickly must use take it?
- **Progestin** only (levonorgestrel) **2 pills** taken **12 hrs apart** - Must be used within **120 hrs** after unprotected intercourse
39
How long after unprotected sex can you take the emergency contraceptive, Ella; what is it's MOA?
- Indicated for **up to 5 days** after unprotected sex - **Postpones follicular rupture** / **inhibit** or **delay ovulation**
40
How long after vasectomy does it take for complete azoospermia?
Takes about **10 weeks**
41
What are the benefits and risks to using electrocautery for female sterilization?
- **Fast!** - ↑ risk of **thermal injury** to surrounding tissue - **Poor reversibility** - **Greater** risk of **ectopic pregnancy**
42
What are the differences between hulka anf filshie clips used for female sterilization?
- **Hulka** = MOST **reversible** method, but **greatest failure rate \>1%** - **Filshie** = lower rate of **failure** because of larger diameter
43
Female sterilization is done using which methods?
- **Laparoscopy** - **Mini-laparotomy** - **Hysteroscopy** - At time of **C-section**
44
Why is the use of salpingectomy as a means of female sterilizaton increasing in use?
Due to recent literature regarding **decrease** in **ovarian cancer** risk
45
What is the most common method of female sterilization throughout the world and how is it done?
- **Mini-laparotomy** - Use **small infra-umbilical** incisions in postpartum period or suprapubic incisions as an interval procedure

ENRP Exam 1 (30 decks)

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