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443-SRH and MSK > Contraception L3-4 LARCs > Flashcards

Contraception L3-4 LARCs Flashcards

1
Q

3 actions of LNG-IUS

A

thins lining, inhibits sperm movement, thickens cervical mucus

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2
Q

T or F: IUDs prevent ovulation

A

F

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3
Q

list 4 uses of LNG-IUS

A

contraception
treatment of heavy or abnormal uterine bleed
dysmenorrhea
provide endometrial protection from estrogens (from those who can not tolerate progesterone)- not an approved indication

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4
Q

which is larger? the mirena or kyleena

A

mirena

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5
Q

the mirena initially releases ___/day, which reduces to ___ /d by 5yrs

A

20 to 10

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6
Q

the Kyleena initially releases ___/day of levonorgestrel, which reduces to ___ by 2 mths, then ___ by 5 yrs

A

17-15-7

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7
Q

T or F: majority of pts with LNG-IUS experience reduced vaginal bleeding, with amenorrhea common

A

T

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8
Q

list 3 AEs of LNG-IUS

A

irregular bleeding- spotting common in first 3-6mths
pain with placement in abdomen/ pelvis
systemic LNG levels may result in mood eff, breast tenderness, headache
malposition
expulsion

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9
Q

with the LNG-IUS, when is irregular bleeding most likely to happen?

A

first 3-6mths

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10
Q

how does the copper IUD prevent fertilization

A

copper ions inhibit sperm movement and ability to fertilize ovum

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11
Q

duration of Cu-IUD

A

5-10yrs

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12
Q

which is cheaper, Cu-IUD or LNG-IUS

A

Cu-IUD

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13
Q

Cu-IUD AEs

A

irregular bleeding/ BTB
dysmenorrhea/pelvic pain/ cramps

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14
Q

which has more BTB and dysmenorrhea/ pelvic pain/ cramps
1. LNG-IUS
2. Cu-IUD

A

Cu-IUD

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15
Q

how long does it take for hormonal IUDs to start working?

A

7d, unless inserted within 7 days of start of period (check with yuksul)

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16
Q

advantages of Cu-IUD over hormonal

A

cheaper, no hormonal SEs, may be alt for choosing nonhormonal option

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17
Q

IUD contraindications include

A

pregnancy
current PID
current/hx breast cancer (PR +)-LNG-IUD only
liver disease- LNG-IUD
undiagnosed abnormal uterine bleeding
pueperal sepsis
cervical or endometrial cancer
postpartum =>48hrs to <4wks

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18
Q

how long after delivery can you get an IUD inserted

A

must be either <48hrs since delivery or >4wks

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19
Q

T or F: misoprostil administration prior to insertion is usually necessary

A

F- do not always need to soften cervix for IUD penetration

20
Q

can you keep an IUC in when being treated for STI

A

yes

21
Q

4 main risks with IUD

A

expulsion, uterine perf, PID, vasovagal/fainting with insertion

22
Q

rank the following based on most common to least when using IUC
PID, uterine perf, expulsion, fainting

A

expulsion > perforation > PID >fainting

23
Q

expulsion of IUD is most common in

A

the first year

24
Q

risk factors for uterine perf with IUD

A

inexperienced inserter, postpartum or breastfeding women

25
Q

RF for PID

A

risk in first mth of insertion
higher if BV, cervicitis, contamination with instrument

26
Q

risks factors for fainting with IUD insertion

A

previous vasovagal rxn
cervical stenosis

27
Q

what chemical does the subdermal progestin implant contain

A

etonogestrel 68mg

28
Q

duration of subdermal implant

A

3yrs

29
Q

where is the progestin implant placed

A

under skin of upper arm

30
Q

the progestin implant releases ___mcg etonogestrel daily for the first mth, then decreases down to ___mcg daily at the end of 3 yrs of use

A

60mcg
30mcg

31
Q

AEs of contraceptive implant

A

irregular bleeding, BT, spotting
progestin related AEs

32
Q

most common AE of implant

A

irregular bleeding

33
Q

interactions with implant include

A

CYP3A4 inducers

34
Q

how to switch from CHC oral/ patch/ ring to LNG-IUS or implant

A

continue CHC for 7 dyas after insertion for LNG-IUS or implant

35
Q

how to switch from depot to LNG-IUS or implant

A

insert LNG-IUS or implant no later than 13wks after last inj (around wk 12-13)

36
Q

T or F: hormonal contraceptives can be safely used in those with seizure disorders

A

T

37
Q

if an individual is on an anticonvulsant that induces enzymes for hormonal contraceptives, options include

A

use IUDs
use CHC with min 30-35mcg EE and progestins with longer half lives

38
Q

list 3 progestins with a longer half life

A

levonorgestrel, desogestrel, drospirenone

39
Q

T or F: migraines with neuro/ aura are a CI for POP, IUDs, implant

A

F- can have all of those, can’t have CHC

40
Q

how to regimen CHC if migraine without aura

A

identify if migraines are due to fluctuations in hormones = use continuous CHC or estrogen in HFI

41
Q

the transdermal patch is not recommended for __kg

A

> 90kg

42
Q

what is a concern for CHC in obesity? what can be used instead

A

VTE
use IUDs (including LNG-IUS) instead

43
Q

T or F: breastfeeding delays return of ovulation

A

T

44
Q

what OC should be considered if <6wks postpartum and breastfeeding?

A

avoid CHC
try POP

45
Q

what OC to use if 6wks-6mths postpartum and breastfeeding

A

POP over CHC

46
Q

what OC to use postpartum if not breastfeeding

A

if <3wks postpartum and not breastfeeding = avoid CHCs due to hypercoagulable state (if risk for VTE = wait 6wks)

POP good for any stage of repro cycle

443-SRH and MSK (24 decks)

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