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443-SRH and MSK > Contraception L1-2 general and OC > Flashcards

Contraception L1-2 general and OC Flashcards

1
Q

LARC include

A

implants, IUDs, injections

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2
Q

what is the PEARL index?

A

comparison of expected rate and typical use

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3
Q

most effective reversible contraceptives

A

implant, IUD

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4
Q

____ stimulates FSH and LH which stimulates ___ and ___ respectively

A

GnRH
E and P

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5
Q

efficacy rate of contraception is compared using the

A

pearl index

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6
Q

estrogen MOA in CHC

A

prevents follicular development and ovulation

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7
Q

progestins MOA in CHC

A

inhibits ovulation, thickens cervical mucus, slows tubal motility

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8
Q

estetrol is a synthetic version of estrogen produced by

A

human fetal liver

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9
Q

estranes include

A

norethindrone, ethynodiol

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10
Q

gonanes include

A

levonogestrel, norgestrel, desogestrel, norgestimate, etonogrestrel, norelgestromin

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11
Q

first generation estranes include

A

norethindrone, ethynodiol

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12
Q

second generation gonanes include

A

levonorgestrel, norgestrel

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13
Q

third generation gonanes include

A

desgrestrel, norgestimate, norelgestromin, etonorgestrel

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14
Q

4th generation is

A

drosperinone

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15
Q

second gen gonanes characteristics

A

higher progesterone selectivity and androgenic activity, with lower estrogen activity

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16
Q

third gen gonanes characteristics

A

higher progesterone selectivity, lower androgenic activity compared to second gen

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17
Q

4th gen spironolactone characteristics

A

antiandrogenic and antimineralocorticoid

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18
Q

cyproterone is used for

A

acne

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19
Q

list some noncontraceptive benefits of CHC

A

improved cycle control (less dysmenorrhea, PMS< blood loss)
inhibits ovulation (lowers incidence of ectopic pregnancy, ovarian cysts), improves acne, lowers risk of ovarian and endometrial cancer
lowers risk of CRC
sx control in perimenopause
positive effect on bone mineral density

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20
Q

medical risks of CHC

A

VTE, MI/stroke

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21
Q

why is there a VTE risk with CHC

A

estrogens have a dose dependent procoagulation effect

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22
Q

VTE risk on CHC is greater in

A

first year, inherited thrombophilia, older age, smoking, obesity, recent surgery
third gen progestins
drospirenone
cyproterone`

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23
Q

CHC may exacerbate

A

BP, glucose control, increase in TG, symptomatic gallbladder disease, migraine headaches

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24
Q

contraindications for drospirenone

A

renal or liver failure, adrenal disease, drugs that increase k+

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25
Q

CHC most common AE

A

BTB

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26
Q

estrogen related AEs

A

nausea, breast tenderness, fluid retention/ edema, headaches/ migraines, chloasma, poor contact lens fit

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27
Q

progestin related AEs

A

mood, breast tenderness, fluid retention, increased appetite, headache/ migraine

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28
Q

why might there be lowered androgen side effects for CHCs

A

oral estrogens increase sex hormone binding globulin = decreases free testosterone levels = decreased acne and libido

29
Q

E deficiency sx

A

early or midpoint spotting
BTB
hypomenorrhea
mood
menopausal sx

30
Q

P deficiency sx

A

late BTB/ spotting, heavy period, delayed menses

31
Q

EE and P are both metabolized by

A

CYP3A4

32
Q

which undergoes enterohepatic recycling, which may be affected by antibiotics?
1. E
2. P

A

estrogen

33
Q

drug interactions with CHCs

A

anticonvulsants
antiHIV meds
rifampin
st johns wort

34
Q

EE induces _____ metabolism by 50%

A

lamotrigine

35
Q

CHC contraindications include (list 3)

A

CV risk: =>15 cigs/d and >35yrs old, CV disease, HPTN (>140/90), hx stroke, migraines with aura, DM with microvascular complications
VTE risk
breast cancer
liver disease
birth in last 3 weeks
breast feeding <6wks postpartum
rheumatic disease like lupus
active cancers/ chemo
abnormal uterine bleed

36
Q

what is the cut off BP for CHC

A

140/90

37
Q

EE dose for teens starting should be around

A

30-35mcg

38
Q

EE dose for =>35yrs starting CHC should be

A

<20mcg

39
Q

types of CHC phases

A

monophasic
multiphasic (bi or triphasic): fixed E, changing P

40
Q

why might a 21/7 regimen not be preferred

A

FSH lvls may come back up, resulting in follicular development and ovulation = not as forgiving as 24/4 or no extended cycle (3mths/7d)

41
Q

when might an extended cycle regimen be preferred

A

painful periods, endometriosis, headaches/ migraines, PMS, perimenopausal sx, anyone that doesn’t want periods

42
Q

the patch __ OC VTE risk

A

patch is higher

43
Q

the patch may be less effective in those ____

A

> 90kg

44
Q

how long can a vaginal ring be removed for

A

3hrs, if more = BU f7d

45
Q

vaginal contraceptive rings should not be used with

A

diaphragm or oil based vaginal products

46
Q

vaginal ring CIs

A

vaginal stenosis and uterovaginal prolapse

47
Q

how does estetrol work

A

binds to nucleus estrogen receptor a and b and inhibits membrane ER

48
Q

advantages of estetrol

A

less effect on markers of homeostasis, lower risk of VTE, weaker estrogen eff on mammary glands compared to estradiol, not metabolized by CYP

49
Q

what kinds of start regimens require 7d BU

A

quick start
sunday start

50
Q

what should you do if you miss 2 pills in the first week

A

take 1 as soon as you remember
use BU f7d

51
Q

what should you do if you miss 2 pills in the last week

A

take 1 as soon as you remember, BU not required (=>3)
start new pack without HFI

52
Q

when do you need BU F7D with the patch

A

if ≥24hrs late on first week/ patch fell off or ≥72hrs 2nd/3rd wk (+no HFI)

53
Q

how to manage BTB

A

change to different CHC
- if on 10 or 20mcg EE = increase dose
- or change to different progestin
- ibuprofen 800mg TID F7D
- estrogen 1mg daily F7D

54
Q

what to do if BTB is still continuous after increasing dose or changing to different progestin

A

stop pill for 3-4 days then resume (don’t need BU)

55
Q

when to consider progestin only contraceptives

A

pts that need to avoid estrogen
postpartum and breastfeeding

56
Q

progestin only contraceptives CI in

A

current/ hx breast cancer, liver disease, inducers

57
Q

norethindrone main effect

A

cervical mucus changes

58
Q

counselling point for norethindrone

A

must be taken at the same time every day- may not be effective if delayed >3hrs

59
Q

drospirenone main effect

A

inhibits ovulation and thickens cervical mucus

60
Q

T or F: norethindrone inhibits ovulation as its main contraceptive mechanism

A

F- thickens mucus
ovulation only inhibited in 60%

61
Q

if norethindrone is started any time other than first day of period, BU must be used for

A

2d

62
Q

if drospirenone is started any time other than first day of period, BU must be used for

A

7d

63
Q

what is a contraceptive option for those that want to avoid E or are on anticonvulsants

A

DMPA

64
Q

DMPA MOA

A

inhibits ovulation, thickens cervial mucus, induces endometrial atrophy

65
Q

DMPA injection regimen

A

q3mths
start in first 5 days of menstrual cycle
BU F7D if not started within 5d

66
Q

how long is the delay in return to fertility after DMPA

A

9mths

67
Q

SEs of DMPA

A

menstrual cycle disturbances
weight gain
reduction in bone mineral density

68
Q

what is considered a late injection for DMPA? what should you do

A

=>14wks
BU F7D

443-SRH and MSK (24 decks)

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