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1-NAPLEX (Review Daily) > Contraception & Infertility > Flashcards

Contraception & Infertility Flashcards

1
Q

Fertility Awareness

A

-LH surge causes the release of the oocyte from the ovary
-Oocyte lives for 24 hours
-Ovulation kits predict the best time for intercourse through LH surge
-To conceive, have intercourse when LH is detected and for the following 2 days.

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2
Q

Preconception Health

A

1) Folic Acid Supplementation
-400 mcg/day to help prevent neural tube defect

2) Lifestyle changes
-No alcohol or illicit drugs
-Avoid smoking
-Keep vaccinations up to date
-Avoid toxic chemicals (HD drugs)

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3
Q

Most Effective Contraception Method

A

Reversible:
-Implant
-IUD

Irreversible:
-Male Sterilization (Vasectomy)
-Female Sterilization

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4
Q

Least Effective Contraception Method

A

1) Spermicide (Non-Oxynol-9)
2) Calender Method

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5
Q

Hormonal Contraceptives

A

MOA: Inhibits the production of FSH and LH, which prevents ovulation

1) Progestin-only
2) Estrogen/Progestin Combination

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6
Q

What are the Estrogen and Progestin COC?

A

Most contain Ethinyl Estradiol (EE) and a Progestin (Norethindrone, levonorgestrel, drospirenone)

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7
Q

What is meant by ‘monophasic’?

A

Same dose of estrogen and progestin

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8
Q

Bi-, Tri-, Quadri-Phasic

A

Hormone strengths change to mimic estrogen and progesterone levels during a menstrual cycle

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9
Q

What are other uses for Estrogen and Progestin Combination Oral Contraceptives?

A

1) Dysmenorrhea
2) Premenstrual Syndrome
3) Acne
4) Anemia
5) Polycystic Ovary Syndrome
6) Endometriosis

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10
Q

What is Drospirenone?

A

-Unique progestin
-Found in some COC to reduce adverse effects commonly seen with oral contraceptives,
-It is a mild K-sparing diuretic which decreases bloating, PMS symptoms and weight gain
-Anti-androgenic

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11
Q

Progestin-Only Pills (mini pills)

A

Norethindrone: Errin, Camila, Nora-BE
Drospirenone: Slynd

-28 day packs
-All are active
-Backup contraceptive is needed for 48 hours after starting.

When to use?
1) Breastfeeding (since estrogen decreases milk production)
2) Migraines with aura (estrogen increases risk of stroke)

Adherence is essential!
1) Take at the same time of day, everyday
2) If >= 3 hours have elapsed from the regularly scheduled time, a back-up contraceptive is required for 48 hours

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12
Q

What are the non-oral Hormonal Contraceptives?

A

1) Xulane Patches - estrogen/progestin
-Higher estrogen exposure
-Less effective in women >198lbs

2) Vaginal Rings (Nuvaring, Haloette) - estrogen/progestin
-Lower AUC than pills
-Insert monthly x 3 weeks, remove for 1 week

3) Injectables (Depo-Provera) - Progestin Only
-Medroxyprogesterone acetate (DMPA)
-IM or SQ every 3 months

4) IUD

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13
Q

What are the Monophasic Brand names?

A

1) Junel Fe 1/20
2) Microgestin Fe 1/20
3) Sprintec 28
4) Loestrin 1/20
5) Yasmin 28
6) Crystelle 28

-Provides the same dose of progestin and estrogen throughout the active pill days
-Junel Fe 1/20: 1 mg Norethindrone and 20 mcg EE
-28’s contain 21 days hormonal pill + 7 days inactive pill

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14
Q

Biphasic and Triphasic Formulations

A

1) Trisprintec
2) Nortrel 7/7/7

-3 different weeks (7/7/7)

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15
Q

Quadriphasic Formulations

A

1) Natazia

-Hormone doses change over 26 days

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16
Q

Extended-Cycle Formulation

A

1) Seasonique

-Period occurs every 3 months

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17
Q

Continuous Formulations

A

1) Amethyst

-No inactive pills (taken continuously)
-No periods

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18
Q

Drospirenone Containing Formulation

A

1) Yaz
2) Yasmin 28

-Mild potassium-sparing diuretic to reduce bloating and other effects
-CI: renal or liver disease
-Monitor K and kidney function

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19
Q

Adverse Effects of Hormonal Contraceptives (ESTROGEN)

A

-Nausea
-Breast tenderness
-Bloating
-Weight Gain

A-Abdominal Pain (Mesenteric or Pelvic vein thrombosis)
C-Chest Pain (Heart Attack or PE)
H-Headaches (Stroke)
E-Eye Problem (Vision loss due to blood clot in eyes)
S-Swelling (DVT)

*Lower Estrogen = less side effects but more breakthrough bleeding (spotting)
-Spotting mid-cycle? —> More estrogen is needed

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20
Q

Adverse Effects of Hormonal Contraceptives (PROGESTIN)

A

-Breast tenderness
-Headache
-Fatigue
-Depression

-Drospirenone has a higher risk of clotting and should not be used in women with clotting risk
-Depo-provera causes a loss in Bone Mineral Density. This is especially importent for teens and young women who are still accumulating bone mass.
-If there is a late-cycle breakthrough bleeding —> a higher dose of progestin is needed

21
Q

Boxed Warning for all estrogen-containing products (pills, ring, patch)

A

1) Do not use in women > 35 years old who smoke due to serious CV risk

22
Q

Boxed Warning for Estrogen+Progestin Transdermal Patch

A

Do not use in women with a BMI >= 30 due to increased risk of thromboembolism

23
Q

Boxed Warning for Depo-Provera

A

Loss of bone mineral density with long-term use

24
Q

When to NOT use Estrogen?

A

1) History of DVT/PE, Stroke, CAD, thrombosis of heart valve
2) History of breast, ovarian or liver cancer, liver disease, uncontrolled HTN, severe headaches, Migraine with Aura

25
Q

When is Progestin-Only Pill prefererd?

A

1) Breastfeeding
2) 3-6 weeks Postpartum
3) Contraindicated to Estrogen
4) Migraine with Aura
5) Uncontrolled Hypertension

26
Q

When is Drospirenone-Containing Product preferred?

A

1) Acne
2) Fluid retention/bloating
3) Mood changes or disorder
4) PMDD (Yaz)

27
Q

What are the drugs which decrease hormonal contraceptive efficacy?

A

1) Rifampin (requires a backup method for 6 weeks after discontinuation)
2) Anticonvulsants (phenytoin, carbamazepine, topiramate)
3) St. John’s Wort
4) Tobacco

28
Q

Starting COC

A

-Takes ~7 days of treatment to achieve efficacy (Requires back-up for 7 days)
-Start today, or
-Start Sunday after onset of menstruation

29
Q

Starting progestin-only pills

A

-Takes ~48 hours to achieve efficacy (use backup for 48 hours)
-Start at any time: all come in 28-day packs and all pills are active

30
Q

Late or Missed Pills

A

Combined-Oral Contraceptives
1) 1 late or missed pills (<48 hours since last dose)
-Take ASAP, and take next dose on schedule
-Backup contraception not needed

2) 2 missed pills (>48 hours since last dose)
-Take the most recent missed pill as soon as possible (discard any other missed pills)
-Take next dose on schedule
-Backup contraception need for 7 days

Progestin-Only Pills
1) >3 hours past scheduled time
-Take ASAP and take next dose on schedule
-Backup contraception needed for 48 hours

31
Q

Xulane Contraceptive Patch

A

-Place on clean, dry skin of buttocks, stomach, upper arm, or upper torso
-Apply once weekly for 21 of 28 days
-Start on day 1 (no back-up needed) or Sunday (back-up needed for 7 days)

*There is a higher exposure to estrogen from the patch than from the COC

32
Q

NuvaRing Vaginal Contraceptive Ring

A

-Insert into the vagina once a month
-Keep in place for 3 weeks, then remove for 1 week
-Start on day 1 of menstrual bleeding

33
Q

IUD Devices

A

Hormonal: <—Contains Levonorgestrel
-Mirena (5 years) - also approved for menorragia
-Skyla (3 years)

Copper-T:
-Paragard (10 years) - can also be used for emergency contraception

34
Q

Implant Contraception

A

Nexplanon
-Plastic rod inserted subdermally
-Releases Etonogestrel for 3 years

35
Q

Emergency Contraception

A

1) Paragard IUD - 100% effective if place within 5 days
2) Ella - Ulipristal - less effective if >195 lbs. ASAP: Works better the sooner. Max 5 days
3) PlanB Once-Step - Levonorgestrel - less effective if >165 lbs. ASAP: Works better the sooner. Max 2 days

36
Q

What is Infertility?

A

Inability to get pregnant after >=1 year of unprotected intercourse

37
Q

Medications to promote female ovulation

A

1) Clomiphene (1st line)

2) Gonadotropins (2nd line)

38
Q

Contraception for ACNE/HIRSUTISM

A

1) COC with low androgenic activity (e.g. norgestimate)
2) COC with no androgenic activity (drospirenone)

39
Q

Contraception while BREASTFEEDING

A

1) Progestin Only
2) Non-hormonal

40
Q

Contraception if there is an ESTROGEN CONTRAINDICATION (e.g. clotting risk)

A

1) Progestin Only
2) Non-hormonal

41
Q

Migraine with Aura

A

1) Progestin-Only
2) Non-hormonal

42
Q

Fluid Retention or Bloating

A

1) Drospirenone containing product

43
Q

Heavy Menstrual Bleeding

A

1) Natazia
2) Mirena IUD

44
Q

Hypertension

A

If uncontrolled, some estrogen formulations are contraindicated

1) Progestin only
2) Non hormonal method

45
Q

Mood changes/disorder

A

1) Monophasic COC - Extended cycle
2) Contnuous cycle with drospirenone

46
Q

Nausea with Contracteption

A

-Take at night with food
-Consider decreasing estrogen dose
-Consider switching to Progestin-only

47
Q

Postpartum

A

-Do not use CHC for 3 weeks, or 6 weeks if the patient has additional risk factors for VTE

1) Progestin-only
2) Non-hormonal

48
Q

Premenstrual dysphoric disorder

A

1) Drospirenone containing product

49
Q

Patient wishes to avoid monthly cycle/menses

A

1) Extended (91 day) formulation
2) Continuous formulation

1-NAPLEX (Review Daily) (32 decks)

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