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OTC II > Contraception and STIs > Flashcards

Contraception and STIs Flashcards

1
Q

How is Contraceptive Failure measured?

A

% of women who experience an unintended
pregnancy within one year of us

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2
Q

What are the two failure rates used to measure contraceptive failure?

A

Perfect use rate
Typical use rate

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3
Q

What are the most efficient contraceptives?

A

Prescribed: Birth control shot (4%), Birth control pills, patch and ring (7%)

Practiced by OB/GYN: Hormonal IUD (0.1%), Birth control implant (0.1%)
percentage in perfect use
Worst: Contraceptive sponge

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4
Q

What are the reproductive consequences associated with STIs?

A

-Pelvic Inflammatory Disease (PID)
-chronic pelvic pain
-ectopic pregnancy (pregnancy outside of uterus - not viable)
-malignancies, and infertility

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5
Q

Which STIs are Noncureable/Vaccine-preventable?

A

-Genital warts (HBV)
-Hepatitis B

Noncurable + No vaccine: HIV, Herpes simples (HSV)

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6
Q

What is the best contraceptive method (also to prevent STIs)?

A

-Latex condom
-2nd: Polyurethane condom

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7
Q

Which contraceptive method (also to prevent STIs) is not recommended?

A

Natural membrane condom -> not recommended bc to porous: can prevent the passage of bacteria and parasites but NOT passage of viruses

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8
Q

Which male condom should only be used for pregnancy prevention and not for preventing STIs?

A

Natural membrane condoms
because they are porous

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9
Q

What should be avoided when using condoms?

A

DO NOT use oil-based lubricants with
latex condoms – breakdown within
60 seconds

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10
Q

How is the female condom different from the male condom?

A

-2 rings covering labia cervix
-less prone to breaking, more prone to slippage
-tissue irritation, NOISY
-may be inserted 8 hours before intercourse
Do NOT use male and
female condoms together

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11
Q

How do Spermicides work?

A

-Nonoxynol-9
-Nonionic surfactant that damages the cell membrane of the sperm, immobilizing and killing it

Formulations: Gel, Foam
Suppository and Film (need time 10-15 min to activate)

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12
Q

Why are spermicide-treated condoms not recommended?

A

-Because there is NO benefit over regular condoms

-increases the risk of infections due to microlesions in the vaginal wall

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13
Q

What are the benefits of a Contraceptive Sponge?

A

-3in1 method: soaking (sponge), barrier, spermicide
-may be inserted 24 h prior to intercourse BUT must be kept inside for 6h after intercourse

-Complaints: vaginal dryness, fragmentation on removal

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14
Q

Fertility Awareness Methods

A

-using the likelihood of getting pregnant to plan pregnancy/prevent pregnancy

-most common: symptothermal method
-requires daily physical monitoring: basal body temperature and cervical mucus secretion (change throughout the cycle)

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15
Q

Downside of Fertility Awareness Methods

A

-Not as effective as the barrier options
-requires abstinence and NO STI protection

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16
Q

NEW OTC oral contraceptive

A

-Orgestrel 0.075 mg (Opill)

-Once-daily oral tablet to prevent pregnancy

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17
Q

MOA of Orgestrel

A

-Progestin-only pill aka POP or mini-pill

-MOA: Progestin thickens cervical mucus and may prevent ovulation

-Efficacy: In 8 clinical trials, prevented 98 out of
100 pregnancies per year (probably perfect use)

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18
Q

What are the Contraindications with Orgestrel?

A

-Pregnant
-Using another hormonal contraception method
-Current or history of breast cancer (Progestin can cause recurrence)
-Yellow No.5 (tartrazine) allergy -> Cross-allergy with Aspirin!!

19
Q

When to refer the patient?

A
  • Undiagnosed vaginal bleeding between periods
  • Liver disease
  • Other cancer history
20
Q

Direction for Orgestrel

A

-Start on any day of the cycle
-One tablet daily at the same time each day (can’t be late for more than 3 hours) - there are some contraceptives with hormone-free days - here: NO GAPS!

21
Q

Adverse effects Orgestrel

A

-Changes in periods are likely (timing, flow, spotting)

-Hormonal AEs: headache, dizziness, nausea, cramps, bloating, abdominal pain, increased appetite

22
Q

Counseling points

A

-Only works in women capable of getting pregnant (no transwomen, no women in menopause, women who have undergone hysterectomy)

-NOT intended as Emergency contraception

23
Q

When should a backup method (condom) be used

A

48h after:
-starting a new pack
-missing the dose or late for 3 hours
-vomiting or severe diarrhea within 4 hours

24
Q

Signs of Risks for Pregnancy

A

-Period is late after missing a single tablet
-Period is missed for 2 months

-Contact MD in case of new onset of period or heavy period

25
Q

What is the API for Emergency contraceptives?

A

-Levonorgestrel 1.5 mg (Plan B One-Step, Aftera, New Day, etc.) is the only OTC option

-prevents fertilization and implantation

-does NOT terminate an existing pregnancy and it doesn’t work as a contraceptive
-> This is a much higher dose of a hormone

-40-50$

26
Q

-MOA of Levonorgestrel

A

-High-dose progestin that suppresses ovulation; may prevent fertilization and implantation

-Efficacy within 120 hours of unprotected intercourse (95% in 24h - decreases with time)

27
Q

ADE of Levonorgestrel

A

-nausea and vomiting (due to high dose of hormones)
-Less common- headaches, breast tenderness,
dizziness

28
Q

Counseling points

A

-Emergency contraception is not 100% effective
-May be less effective with BMI of 26 or more

-does NOT protect from STIs and does not replace contraceptive
-if the menstrual period has not occurred within 21
days after use, take a pregnancy test

29
Q

Menstrual Cycle

A

Day 1-5: shedding of the uterus -> Bleeding
Day 6-14: estrogen rises -> uterus lining; FSH rises -> follicle development
Day 10-14: one of the follicles forms a mature egg

Day 14: LH causes release of the egg (ovulation)
Day 15-28: the egg leaves the ovary and travels to the uterus - progesterone helps with uterus lining

No pregnancy: progesterone and estrogen drops -> uterus shedding -> Bleeding

30
Q

Function of Hormones during Menses

A

Corpus Luteum: produces progesteron and estrogen

estrogen: helps with the uterus lining
progesterone: helps with implantation (also prevents contraction that causes menses)

FSH: Development of Follicles (eggs) - activated by low LH and low Estrogen at the start of menses

LH: Triggers ovulation

31
Q

What is the time window for pregnancy?

A

-2 days before and 24 hours after ovulation (4-6 days)
-Why before?: the sperm can survive in the uterus

32
Q

What happens in case of a pregnancy?

A

-The progesterone and estrogen stays high and causes the uterus to stay thick
-the implementation of the egg into the uterus causes the production of hCG

33
Q

What does the pregnancy test detect?

A

hCG in the urine
-can only detect pregnancy after implementation
-so could be a few days after ovulation
-Accuracy: 90-95% perfect use
50-75%: typical use

34
Q

What may affect the results of pregnancy tests?

A

-cancers of the uterus: damaged cells causes a change in hormone levels

-medication: IVF

35
Q

What can cause a False positive pregnancy test?

A

-Miscarriage or given birth in the last 8 weeks due to hCG in the body
-Medication (Pergonal, Profasi) used in IVF
-Unreliable results: menopausal, ovarian cysts, ectopic pregnancies

36
Q

What can cause a False negative pregnancy test?

A

-testing too early
-inadequate level of hCG in the urine (diluted urine)
-if the period is missed and the test is negative -> repeat after one week
-the earlier the test, the higher the risk for FN

37
Q

Why should patients be referred after 2 negative pregnancy tests and still missing periods?

A

-Possibility of ectopic pregnancy -> cause harm to the mother

38
Q

Definition of Infertility

A

35+: having intercourse without contraceptives for 1 year

<35: having intercourse without contraception for 6 months

Primary infertility: never had a pregnancy before
Secondary infertility: had a pregnancy before

39
Q

What are the difficulties in predicting ovulation with body temperature?

A

-slim change (0.5°C)
-measure once a day (morning)
-can be affected by: infection, emotions, movement
-don’t do anything before taking the temperature: coffee, food, smoking, talking

40
Q

Ovulation tests require morning urine
True or False

A

False, but it is recommended

41
Q

What are the difficulties of ovulation tests?

A

-Not helpful after discontinuing BC, because it takes about 3 mo reach normal hormone levels

-False +: menopause, PCOS (polycystic ovary syndrome), pregnancy, breastfeeding, ovulation meds

42
Q

Male Infertiity test:

A

-measures: motility, morphology, volume
-<20 million cells/mL = infertility
-82.4-98% accurate

43
Q

Best way to get the recommended daily dosage of vitamins and minerals

A

-Multivitamins
-For folic acid 600 mcg is recommended (400 mcg supplement 1 month prior to pregnancy)

44
Q

What are the important vaccines for pregnant women?

A

-Flu (inactivated) → in flu season: September-October
-Tdap: as early as possible
-don’t give live vaccines
-COVID: if the mother is not vaccinated: get it as soon as possible, if they are she can get boosted, AVOID Johnson&Johnson

OTC II (17 decks)

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