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NAPLEX - OUR cards > Contraception & Infertility > Flashcards

Contraception & Infertility Flashcards

1
Q

Normal menstrual cycle range

A

23- 35 days (average 28)

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2
Q

Follicular phase

A

1st phase of menstrual cycle

FSH stimulates egg development and increases estrogen

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3
Q

Ovulatory phase

A

brief phase in between follicular and luteal phase

surge of LH, which leads to ovulation 24-26 hrs later

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4
Q

Luteal phase

A

final phase, which includes ovulation and last about 14 days

High amounts of progesterone in this phase

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5
Q

Estrogen and PG levels are high during a woman’s period (t/f)

A

False

estrogen and PG cause thickening of endometrium, when levels are low the lining sloughs off (period)

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6
Q

What hormone does ovulation kits measure?

A

Luteinizing hormone (LH)

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7
Q

What hormone is measured in pregnancy tests?

A

human chorionic gonadotropin (hCG)

best to use first urine in the AM when hCG is highest

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8
Q

Recommended folate supplementation for child-bearing age women

A

400 mcg/day

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9
Q

Primary MOA of combo oral contraceptives

A

inhibit FSH and LH, which prevents ovulation

also alter endometrial lining, alter cervical mucus, interfere with fertilization

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10
Q

Most common estrogen used in oral contraceptives

A

ethinyl estradiol (EE)

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11
Q

Other indications for oral contraceptives

A 
dysmenorrhea
PMS
peri-menopausal symptoms
acne
PCOS
endometriosis (uterine lining outside of the uterus)
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12
Q

Other name for progestin only oral contraceptives and MOA

A

“mini-pill”

suppress ovualation (in some women), thickening cervical mucus, inhibit sperm penetration

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13
Q

In what population is progestin only oral contraceptives preferred

A

pts with contraindications to estrogen
Post-partum (3-6 wks) due to incr clot risk
migraines w/ aura (estrogen can incr stroke risk)

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14
Q

Women on oral contraceptives or patches/rings will have lighter periods (t/f)

A

True

thinner endometrium lining

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15
Q

Extended cycle and continuous cycle contraception

A

extended: active pills taken for 84 days, then 7 days of palcebo/lower dose
continuous: taking only active pills (spotting can occur; usually for the first 3-6 mons)
Amethyst approved for continuous (EE + levonorgestrel)

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16
Q

Names of common combo monophasic oral contraceptives

A 
Gildess Fe
Junel Fe
Mononessa
Microgestin
Orth-Cyclen
yasmin
Yaz, Loestrin 24, Minastrin 24 Fe: contains 24 active pills and 4 placebo
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17
Q

Names of common combo bi-/triphasic oral contraceptives

A

Necon 10/11
Orth Tri-cyclen
Trinesssa

dose changes to try to mimic menstrual cycle

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18
Q

Quadriphasic combo oral contraceptives

A

Natazia

estradiol valerate and dienogest

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19
Q

Extended cycle combo oral contraceptives

A

period every 3 months
Jolessa (84 days active, 7 placebo)
Amethia Lo, Seasonique: 84 days of lower EE, then 7 days of even lower EE

20
Q

Combination patch

A

Xulane
1 patch q week x 3 weeks, then 1 week off

higher exposure to estrogens = higher clotting risk

21
Q

Combo vaginal ring

A

NuvaRing

Insert for 3 weeks, then remove for 1 week

22
Q

Names of progestin only oral contraceptives

A

Camila
Errin
Ortho-micronor

contains norethindrone
no placebo pills

23
Q

Depo-Provera

A

medroxyprogesterone injection

150 mg IM every 3 months

24
Q

Common sides effects of estrogen

A 
nausea
breast tenderness
bloating/weight gain
elevated BP
spotting - wait 3 cycles to see if it goes away; might need higher dose
25
Q

Serious side effects of estrogen

A

thrombosis:
heart attack
stroke
DVT/PE

risk incr with age (avoid > 35 y/o), smokers, diabetes, obesity, HTN

26
Q

Side effects of progestins

A 
breast tenderness
fatigue
changes in mood
HA
spotting 
incr clot risk (drospirenone)
decr BMD (depo-provera)
27
Q

When should combo oral contraceptives not be used:

A

women > 35 y/o who smoke (incr clot risk)
hx of dvt/pe, stroke, CAD, clotting disorders
Hx of breast, ovarian, liver cancer
uncontrolled HTN
severe HAs
migraine w/ aura

28
Q

Signs and symptoms that all woman should be aware of when taking hormonal contraceptives

A 
ACHES
Abdominal pain that is severe (liver tumor, cyst, ectopic pregnancy)
Chest pain (heart attach, PE)
Headaches (sudden and severe)
Eye problems ( blood clot in the eye)
Swelling/ sudden pain in legs (DVT)
29
Q

If spotting occurs during early or mid-cycle, what should be done?

A

incr dose of estrogen

spotting later in cycle: incr progestin dose

30
Q

Preferred agent for pts complaining of bloating

A

products with drospirenone (yaz, yasmin)

works as K-sparing diuretic

31
Q

Preferred agent for pts complaining of acne

A

low androgenic activity
Ortho cyclen
Yaz, Yasmin (no androgenic activity)

32
Q

Antibiotics with evidence of decreased efficacy of hormonal contraceptives

A

Rifampin
rifapentine
rifabutin

use back up for 6 weeks after stopping rifampin

33
Q

Other drugs that decr efficacy of hormonal contraceptives

A

anticonvulsants: barbs, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, lamotrigine
St john’s wort
Protease inhibitors
mycophenolate
Smoking tobacco
take at least 1 hr prior to Byetta injection

34
Q

Why can’t ethiny estradiol be used certain hep C drugs?

A

risk of liver toxicity

Technivie and Viekira Pak

35
Q

How long should back up methods be used when first starting oral contraceptives?

A

7 days of back-up for combo pills
“Quick start”: start day of receiving Rx
Sunday start: start sunday after onset of menstruation

Progestin pills:
back up for 48 hours
start meds at any time

36
Q

What is required to be dispensed with each combo hormonal contraceptive?

A

patient package insert (PPI)

37
Q

General rule for missed pills

A

If more than 1 pill is missed (2+) then back-up is required
If missed 2 pills during week 3 of cycle, omit hormone free week and start new pack right after finishing current pack

1 pill missed: take as soon as you remmeber, 2 pills iin 1 day is OK

38
Q

Main benefits and risks of drospirenone containing hormonal contraceptives

A

benefits: less bloating and weight gain, less acne, less PMS symptoms
risks: incr clot risk

39
Q

Xulane specific info

A

Same side effects and CIs as oral combo contraceptives
Higher exposure of estrogen: avoid in pts with high clot risk
Less effective in women > 198 lbs
application: butt, stomach, upper arm, upper torso
Start on day 1: no back-up
Sunday start: 7 days of back-up

40
Q

NuvaRIng specific info

A

same side effects and CIs as pills
3 weeks in, 1 week out
Used 4 weeks to prevent period (off-label)
Insert ring on day 1 on menstrual bleeding
Can be stored at room temp for up to 4 months

41
Q

Most effective reversible contraceptives

A 
IUDs:
Hormonal: Mirena and Kyleena ( 5 yrs)
Skyla and Liletta ( 3 yrs)
Copper (Paraguard) up to 10 yrs
Implant:
Nexplanon (etonogestrel) up to 3 yrs
42
Q

Most effective form of emergency contrception

A

copper IUD

inserted w/in 5 days

43
Q

Other options for emergency contraception:

A

levonorgestrel (Plan-B) OTC
89 % effective when taken w/in 72 hrs (5 days off-label)
MOA: prevents ovulation, thickens cervical mucus
1.5 mg x 1
causes n/v, vomit w/in 2 hrs of taking: consider taking again
Ulipristal (Ella) - requires Rx
30 mg once
delys ovulation, prevent implantation
use up to 5 days after intercourse
Can only use 1 per cycle
HA, nausea, abd pain

44
Q

Clomiphene notes

A

Clomid
selective estrogen receptor modulator
incr FSH and LH
50-100 mg x 5 days, start 3,4,5 days after period starts
SEs: hot flashes, abdominal bloating, HA, incr chance of multiple births

45
Q

Human chorionic gonadotropini (hCG) meds

A

Ovidrel - SC

Pregnyl, Novarel - IM

46
Q

Gonadotropins meds

A

Follitropin beta - IM, SC

47
Q

Gonadotropin releasing hormone agonist (GnRH)

A

Leuprolide (Lupron)
Goserelin (Zoladex)
Nafarelin (Synarel)

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