Contraception Pharm Flashcards
Mechanism of progesterones
Increases cervical mucus viscosity which inhibits sperm penetration
Decreases motility of ovum
Increases atrophy of endometrium
Secondary mechanisms of 2nd generation progesterones
Decrease HDL
Increase LDL, glucose tolerance, incidence of acne
Secondary mechanisms of 3rd generation progesterones
Less acne than 2nd gen
May increase risk of thrombosis
POPs
Taken everyday within 3 hour window
Not affected by gut flora (antibiotics don’t affect absorption)
High dose progesterone
Currently available in injectable form only
Pt populations that can use POPs
Pts with sickle cell anemia
Nursing mothers
In women who smoke or are over 35
In women with HTN or migraines
Common AEs of POPs
Spotting
Worsening depression in those already depressed
Reduced libido
Mechanism of estrogens
Inhibits follicular development preventing ovulation
Reduce implantation
Potentiates progesterone mechanisms
Increase uterine edema decreasing likelihood of implantation
Form of estrogen in COCPs
Ethinyl estradiol
Contraceptive effectiveness of COCPs
Effective if first pill is started within 5 days of first day of menstruation otherwise does not begin until 7 consecutive days of active pills have been taken
Affect of obesity on COCPs
Decreased effectiveness with BMI >30
COCPs created for average hormone lvls
Most effective contraception is progesterone IUS instead
COCP drug interaction
High doses of vitamin C will increase side effects of estrogen
Benefits of COCPs
Reduced symptoms of endometriosis, PCOD, anemia
Reduced risk of PID, dysmenorrhea, PMS, acne
Depression and COCPs
No evidence of increased depression
COCPs risks
May increase HTN
Mastalgia, amenorrhea, N/V, melasma, gallstones, decreased ability to build muscle mass
Women > 40 y/o are at greater risk of these SEs
Greatest COCPs risk occurs in women with what comorbid risk factors?
Smoking
> 35 yrs
Long continued use of COCPs
What pt has an increased risk for cardiovascular SEs with COCPs?
Smokers, especially smokers over 35 y/o
Lowest dose of estrogen or POPs recommended
Tri-cycling
3 or 4 packs of active monophasic pills in a row
Triphasic
3 doses of hormones in one pack
Monophasic
Single doses - all active pills alike
Multiphasic/estrophasic
Single doses of progestin with varying doses of estrogen until just before break week then estrogen only for few days then placebo
Biphasic
Two different active pills
Four-phase
4 different active pills (both hormones change)
Which pill is FDA approved for PMDD and moderate acne in females age 14 or older?
EE+drospirenone+placebo (Yaz)
Which pill is designed to prevent neural tube defects in fetuses conceived shortly after stopping the COCP?
EE+drospirenone+levomefolate (Beyaz, Safyral)
Which pill has a spearmint flavor?
EE+norethindrone+ferrous fumarate
What should be considered if acne is exacerbated after COCP use?
Change to EE+drospirenone (Yaz)
Which form of BC is best for a pt with seizure disorder using valproic acid, clonazepam, vigabatrin, or lamotrigine?
Progesterone injection
If 3 or more COCPs were missed
Pills from day 1-7 and intercourse occurred during days 1-7 consider emergency contraception
How long is Plan B effective?
Up to 72 hours
When should ulipristal be taken?
WIthin 5 days of unprotected sex
Benefits and risks of transdermal contraceptive patch
Good for non compliant pill users
May have topical reaction to adhesive
Less effective in obese women
When does protection begin after a contraceptive injection?
1 week after first injection
Benefits of contraceptive injection
FDA approved for endometriosis related pain
Good for non complaint contraceptive users
Good in special needs women - physically, mentally disabled, very young girls
Effectiveness not decreased by anti epileptic drugs
Decreased incidence of sickle cell crisis
What is the vaginal insert ring not approved for?
Tricycling
How long do copper IUDs last?
5 year and 10 year options
How long does levonorgestrel IUS (Mirena) last?
5 years
Risks and common AEs of IUD/IUS
Expulsion rate of 4%
AE - lighter menses, amenorrhea or irregular bleeding
What test must be done prior to insertion of IUD/IUS?
STD testing
Sponges
May be inserted up to 24 hours before intercourse
Must be left in place for at least 6 hours after intercourse
Should not be worn for more than 30 hours at a time
Common AE of sponges
Use of multiple sponges in 24 hours increases risk of tissue irritation
When is mifepristone effective?
Two pill regimen and only effective after 2nd pill
Off label use of mifepristone
Cushing syndrome
Off label as glucocorticoid receptor antagonist for 10 years with no noticeable AEs
Clomifene citrate
Improves sperm penetration and survival by changing cervical mucus and uterine mucosa
Induces ovulation about 67% of time, but pregnancy success only about 37%
hMG
Stimulates follicles
Risk of multiple fetus pregnancy
Bromocriptine
Reduce production of prolactin by the pituitary
When can corticosteroids be used to tx infertility?
When dx is related to overproduction of testosterone by female
What medication is DOC when the pt is at risk of pre-eclampsia but not yet dx?
Methyldopa
What is approved for tx menopause but not contraception?
Drospirenone+estradiol (angeliq)
