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OB/Gyn > Contraception Pharm > Flashcards

Contraception Pharm Flashcards

1
Q

How do we prevent pregnancy (3 mechanisms)?

A
  1. Inhibition of sperm from reaching a mature ovum.
  2. Prevent fertilized ovum from implanting in the endometrium.
  3. Mechanisms that create an unfavorable uterine environment.
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2
Q

What are some barrier methods to preventing pregnancy? Advantage of?

A
  1. Barrier b/t sperm and ovum – Condoms (male and female), Diaphragms, Cervical caps.
    * Condoms are used for STI protection as well.
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3
Q

What is the problem with barrier methods?

A

It depends on proper use before or at time of intercourse; there is a higher failure rate than oral contraceptives.

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4
Q

Highly effective and safe forms of reversible contraception?

A

IUD – Intrauterine Device.

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5
Q

What does OCP stand for?

A

Oral Contraceptive Pills.

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6
Q

What are the 2 types of OCPs?

A
  1. Combination – estrogen and progestin.
  2. Progestin only.

**Highly effective and safe, when used properly.

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7
Q

What are some NON-Contraceptive benefits of OCPs?

A
  1. More predictable cycles w/less pain and blood loss.
  2. Improved ACNE (Yaz, Ortho-Tri-Cyclen, LoEstrin, FE 24).
  3. Decreased incidence of:
    - Endometrial and Ovarian CA.
    - Benign Breast Dz.
    - Pelvic infections.
    - Ectopic pregnancies.
    - Iron Def. Anemia.
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8
Q

Traditional OCPs are based on?

A

The 28 day menstrual cycle w/21 hormonal active pills and 7 inactive (placebo) pills in which bleeding occurs this week.

*Original pills were monophasic; newer pills are now biphasic or triphasic.

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9
Q

What does monophasic, biphasic and triphasic OCPs mean?

A
  1. Monophasic – deliver the same amount of estrogen and progestin each day.
  2. Biphasic – delivers a lower dose of estrogen/progestin the first half of the pill cycle and a higher dose during the second half of the pill cycle.
  3. Triphasic – have 3 different doses of estrogen/progestin that change every 7 days.
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10
Q

What is the MOA of Estrogen hormonal contraceptives?

A

Suppress the production of FSH to prevent the selection and emergence of a dominant follicle.

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11
Q

What are the two types of synthetic estrogens?

A
  1. Ethinyl Estradiol (EE).

2. Mestranol.

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12
Q

Which estrogen is only found in a couple of OCPS and converted to EE (Ethinyl Estradiol) in the liver?

A

Mestranol.

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13
Q

Adverse effects of estrogen OCPs?

A

Breast tenderness, breakthrough bleeding, thromboembolism and increases complications of women w/CV risk factors/disease – most worrisome.

Nauseas, HA, Melasma, Na/water retention, hypertriglyceridemia.

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14
Q

Adverse effects of progestin OCPs?

A

Increased appetite/weight gain, oily skin/acne, hirsutism, incr. LDL/decr. HDL.

Breast tenderness, HA, Fatigue, mood changes, gallbladder dysfunction.

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15
Q

Most common combination contraceptive best for PMS/PMDD, acne, hirsutism or PCOS?

A

Drospirenone/EE (Yasmin, Yaz).

*EE = Ethinyl Estradiol.

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16
Q

Medications that may be affected by OCPs?

A

Anticoagulants, Insulin, Hypoglycemics, TCAs, BZDs, Corticosteroids.

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17
Q

Effectiveness of these drugs due to OCP drug interaction?

A
  1. Abx, esp Rifampin, Griseofulvin.
  2. Anticonvulsants – topiramate, phenytoin, carbamazepine.
  3. St. Johns Wart.
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18
Q

What drugs (1) increase OCP hormone levels?

A

Protease inhibitors – ‘navir’ drugs that inhibit the action of HIV-1 protease.

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19
Q

Choosing an OCP?

A
  1. Know a few common brands of varying amounts and types of hormones.
  2. Estrogen:
    - -low dose recommended: 20-35 mcg EE.
    - -20 mcg may be beneficial in pt’s sensitive to estrogen AE w/women >40 y/o.
  3. Progestin – all fine, drospirenone has special characteristics.
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20
Q

Patient education when starting OCPs?

A
  1. Start during first 5 days of next cycle – most start first SUNDAY of next period.
  2. Use backup method for one week after starting.
  3. TAKE AT SAME TIME QDAY!
  4. Don’t forget to restart a new pack after the 7-day placebo or pill-free interval.
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21
Q

What to do if you miss one pill?

A

Take is ASAP after remembering and the next pill at the regular time.

22
Q

What to do if you miss two pills?

A

Take 2 pills the day you remember, 2 pills the next day, and then back to one Qday pill.

23
Q

What should be used if more than 2 pills missed?

A

Backup birth control – condoms, etc.

24
Q

What may happen with missed pills?

A

Breakthrough bleeding.

25
Q

What are the MC AEs with OCP use?

A

Nausea, Breast tenderness, bloating, mood changes.

26
Q

What is common during the first few months of OCP use?

A

Breakthrough bleeding or spotting, which usually resolve w/out any treatment w/in 2-3 months of use.

27
Q

What is the most important pt. education for your patient taking OCPs?

A

DO NOT smoke!

28
Q

What symptoms are necessary for immediate evaluation while taking OCPs?

A

Abd. pain, chest pain, severe HAs, severe leg pain/swelling.

*Could be Sx of MI, blood clot, stroke, liver and gallbladder disease.

29
Q

When should you recommend a patient follow up after starting OCPs?

A

After 2-3 cycles to discuss any concerns and to check BP.

30
Q

Further on choosing a contraceptive method?

A
  1. Effectiveness.
  2. Safety.
  3. Availability.
  4. Acceptability.
  5. Consider counsel on HIV/STI transmission risk.
31
Q

Why is family planning important?

A
  1. Approx. 6 million pregnancies per year and almost half are unintended.
  2. Social, Financial and health repercussions.
32
Q

What are some medical conditions that make pregnancy unsafe?

A

Breast CA, complicated valvular heart disease, DM w/vascular Dz, Endometrial/Ovarian CA, Malignant Liver hepatoma/Carcinoma, Sickle cell disease, SLE, Thrombogenic mutations, Epilepsy, Severe HTN, IHD, Bariatric surgery, transplant surgery (last 2 yrs), HIV/AIDS, cardiomyopathy, severe cirrhosis, TB.

33
Q

Which is the most effective contraception method?

A

The onse use most consistently and correctly; the one the patient will use!

34
Q

MOA of Progestin?

A

Thickens cervical mucus and thins endometrial lining inhibiting implantation.

**Possibly prevents ovulation; maybe 40% of time.

35
Q

What is the most important aspect when taking a Progestin only OCP?

A

Timing is extremely important and must be taken at the same time each day.

36
Q

Who is the Depo Provera injection contraindicated in?

A

Pt’s w/CAD and liver disease.

37
Q

AE of Depo Provera?

A

Weight gain, irregular bleeding, HA, acne.

38
Q

Which progestin OCPs are considered more androgenic and less thrombophilic?

A

1st and 2nd generation OCPs.

39
Q

Which are 1st and 2nd generation OCPs?

A

1st – Norethindrone, Ethynodiol.

2nd – Levonorgestrel, Norgestrel.

40
Q

Which progestin OCPs are considered less androgenic and more thrombophillic?

A

3rd and 4th generation OCPs.

41
Q

Which are 3rd and 4th generation OCPs?

A

3rd – Desogestrel, Norgestimate, Etonogestrel, Norelgestromin.

4th – Drospirenone.

42
Q

What is thrombophilia?

A

Thrombophilia (sometimes called hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels).

43
Q

What are the non-contraceptive benefits of Combination OCPs?

A

Reduction in acne, hirsutism, PMS/PMDD Sx, improved anemia and Sx of Benign breast disease.

44
Q

Contraindications for Combination OCPs?

A

Migraines w/Aura, HTN, Smokers >35 y/o, Hx of DVT/Clotting, MI/CVD, Breast/GYN CA, SLE.

45
Q

Cautions with Combo OCPs?

A

Uncontrolled HTN, Seizure med, certain Abx, HIV meds, Hx of bariatric surgery.

46
Q

What is a concern for the Nuvaring?

A

The pt is at an increased risk of yeast infections and BV.

47
Q

What contraception is considered Non-Hormonal?

A

Copper IUD, condoms, diaphragms, sponge, spermicide.

48
Q

What is a benefit with condoms?

A

STI protection!

49
Q

Steps to make in order to Rx an OCP?

A
  1. Rule out pregnancy – HCG urine test/UPT.
  2. Make sure the OCP is safe for your pt.
    - -gather a good medical and social history.
    - -discuss pt preferences.
50
Q

Which form of contraception is the only one that requires a pelvic exam before initiating?

A

An IUD.

51
Q

What criteria can be used to reasonably be certain that a woman is not pregnant after having no Sx or signs of pregnancy?

A
  1. <7 days after the start of menses.
  2. No sexual intercourse since last normal menses.
  3. Has correctly and consistently been using reliable method of contraception already.
  4. <7 days after spontaneous or induced abortion.
  5. w/in 4 weeks postpartum.
  6. Fully or nearly fully breastfeeding, amenorrhoeic and <6 months postpartum.
52
Q

Why is emergency contraception used?

A
  1. Indicated after an unexpected or inadequately protected act of sexual intercourse (condom breaks, missed dose of OCP).
  2. Failure to use any form of contraception.

**NOT to be used as primary method of contraception.

OB/Gyn (14 decks)

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