Contraceptive Meds Part 1 Flashcards
Diaphragm remains in place for 6-8 hrs, remove within?
24 hrs
Cervical cap remains in place for 6-8 hours, remove within?
48 hrs
Nonsurgical block of Fallopian tubes forming scar tissue?
Surgical one?
Tubal implant
Tubal ligation
In vasectomy, two vas deferents are surgically cut
…
Vaginal ring, delivers estrogen and progestin analogs for 3 weeks, remove when?
4th week and new ring 7 days later
Implant is a low dose of progestin, protects for up to?
3 years
Patch applied new one once a week for 3 weeks, patch 4th week or no?
No
Injectable BC is every 3 months IM or SubQ, need diet rich in calcium and vitamin D, what’s injected?
Medroxyprogesterone
Estrogen hormones include Estradiol, Estrone, and Estriol used for?
Grow uterine lining, breast development, regulate pregnancy, regulate metabolic processes (clots/cancers), suppress LH and FSH
Available forms: Ethinyl estradiol, Estradiol valerate, Mestranol
Combined oral contraceptives (COCs) work by?
Suppressing release of LH and FSH, prevent ovulation, thin endometrium , thicken cervical mucus
COCs are used to prevent fertilization or abort implantation of the ovum into uterus (not abortion), other effects?
Regulate hormones, relieves menstrual cramps, relieves peri-menopausal symptoms, reduce heavy Montreal bleeding/irregular bleeding, reduced risk of ovarian, endometrial, possibly colon cancers (progesterone)
FDA: prevent pregnancy, acne, prementrual dysphoric disorder, reduce heavy periods (Natazia was the first BC pill proven to do this)
Off label uses for other med conditions of COCs?
Cycle control, amenorrhea, dysfunction uterine bleeding, hypermenorrhea, IDA, EMERGENCY CONTRACEPTION (72HRS), other androgen effects
COCs come in several different types: monophonic, biphasic, triphasic, etc explain each…
Mono: constant dose or estrogen and progestin daily, avoids mod changes (no placebo week)
Bi: Two combos of estrogen/progestin (so there’s a dose change 1 time throughout the 28 day cycle)
Tri: Hormone dose changes every 7 days during first three weeks, usually a gradual increase in estrogen
Quadriphasic, Extended cycle, continuous?
Quad: hormone levels change 4 times per cycle (to reduce SEs of COCs)
Extended: use for 84 days, then 7 days placebo, most monophasic but some new are different
Continuous: monophasic OCP does not have placebo days at all
Monophasic are best for?
Mentrual issues/pain, benign breast disease, avoid mood changes, for those w/ SEs related to progestin
Biphasic best for?
Acne
Triphasic best for?
Progestin-associated SEs…increased appetite, acne, weight gain or in women w/CV disease or metabolic abnormalities
Quadriphasic best for?
Reduce the SEs of oral contraceptives
Tri and Quad are not used as much because?
Confusing, missed doses
Common pill packs:
21 day pill pack = take for 21 days, then nothing for a week (M Q1 month)
28 day pill pack: 1 every day, last 7 are placebo (M Q1 month)
91 day pill pack: 1 every day for 91 days, last 7 are placebo, start new on day 92 (menstruation Q3 months)
Continuous: no menstruation, should switch to placebo for 7 days once per year
Concerns for taking extended/continuous regimen products
Never know if you’re pregnant, possibly hurts endometrium, no studies on long-term SEs
Estrogen and venous thromboembolism (VTE) is related to what?
Estrogen dose, more taken = higher risk
Start with 20mcg EE with progestin (i.e. levonorgestrel, norethindrone)
VLDE = <30mcg usually 10-25 LDE = <30-50mcg usually 30-35 HDE = >/= 50mcg (not used)
COC dosing initiation: quick start, Sunday start, first/same day start?
Quick start: start at time other than post-menses (need alternate method of contraception for 7 days)
Sunday start: most popular method, first tablet on first Sunday after the beginning of menstruation (need alternate method for 7 days
First/same days start: first tablet on first day of menses = backup contraception is not needed
Are there placebo pills in progestin only contraception 28-day packs?
No, and they must be taken within the same 3 hr window each day to be effective
What’s the ideal patient population for progestin contraception?
Breastfeeding
Non-breastfeeding post-partum
Migraines
Those at CV risk
Progesterone only contraception comes in the 3 start methods, they are?
Quick start: any day of her cycle, need backup method for 48 hrs
First/same day start: start on first day of period, no backup needed
Breast-feeding: can take immediately if not breastfeeding, wait until 3-weeks if partially breastfeeding, 6 weeks if solely breastfeeding
Missed dose (more than 3 hrs difference or total miss) = use backup, no hormone free days with these
Spotting/irregular bleeding Loss of libido Increase or decrease in acne/oily skin Bone density loss Possibly hair loss Increase or decrease in facial and body hair Slight weight gain
These are AEs of what type of OCP?
Progestin only
What are the advantages and disadvantages of progestin only contraception?
Adv: avoids the estrogen SEs, preferred in lactating women, retail its returns rapidly after discontinuation
Disadvantages: AEs from before, must be taken regularly and not in those not breastfeeding (often), short window for missed pills
There are 4 generations of progestin OCPs, what is each characterized by?
1st: the start
2nd: more potent, most androgenic
3rd: similar potency to 2nd, fewer androgenic/metabolic effects
4th: least potent, has anti-mineralcorticoid and antiandrogen effects
This generation of progestin pills has high risk of unscheduled bleeding and spotting, less androgenic than the 2nd gen?
1st gen
This gen of progestin is more potent w/longer half-life than 1st, most androgenic, improved libido but can have some hirsutism, acne, and dyslipidemia
2nd gen
This gen of progestin is similar activity to 2nd, but with slightly higher risk of thrombosis…some benefits with acne
3rd gen
This gen of progestin is least potent, is like anti-mineralcorticoid/anti-androgen effects of spironolactone…but some concerns of increased risk of venous thromboembolism
4th gen
Analog of spironolactone that decreases bloating effect of ethinyl estradiol, low androgenic, DIs with K+ sparing drugs
Drospirenone (4th gen)
Yasmin
Yah
Safyral
Beyaz
All combo meds with estrogen
These method of contraception is less effective in heavier women so shouldn’t be used in them, and has more estrogen exposure than tablet, but risk of contact dermatitis and thromboembolism
Bypasses first pass in the body
Transdermal patch (ortho-evra)
This contraception has a similar efficacy to OCP, placed into vagina and removed week 4, if dose missed beyond 3 hrs then backup is needed
Vaginal ring (Nuvaring)
Of note: not shown to increase VTE risk or have reduced efficacy in fat girls
This contraceptive, also for endometriosis, is injected every 11-13 weeks, but use cautions in women 35 yrs and older who might want to get pregnant in the future
Depo-Medroxyprogesterone Acetate
Low fail rate, but AEs: weight gain, can delay return to fertility up to 18 months, decreased bone mineral density (decline in estrogen production, take calcium)…not recommended for use longer than 2 years unless unwilling/unable to use other methods
The copper IUD uses copper ions to inhibit sperm motility and across all enzyme activation and can remain in body for up to 12 year as, but what are the CIs?
Copper allergy, too big/small uterus (6/9cm), uterine/cervical cancer, STDs, pregnancy, must be inserted by HCP
Progestin IUD is CI in those with acute/history PID, increased susceptibility to infections (multiple partners), endometriosis or abortion in past 3 months, pregnancy…what are the two products?
Mireya: stays in uterus for up to 5 yrs, use for contraception and MENORRHAGIA*
Skyla: stays in uterus for 3 yrs, just for contraception
IUDs really can’t be used in those with what?
History of PID, ectopic pregnancy
Also maybe wait until had at least 1 kid
Disadvantages of the two IUD types?
Copper: possible heavier menstrual bleeding/cramping
Progestin IUD: possible irregular bleeding/spotting first 3 months after insertion
Implantable hormonal contraceptives are 3rd gen equivalents, effective for up to 3 years, may be less effective in fat girls (not tested), what are the AEs?
Bleeding irregularities, site reaction, inflammation, hematoma, pain/redness at site…can have difficulty removing the rod, it can break, or fibrosis around it
What are the main common AEs and most serious ones in hormonal contraception?
Common: breast pain/tender, headache/dizzy/light-headed, gain weight, swollen feet/legs, irregular menses, N/V
Serious: CV so thromboembolic events like DVT, PE, stroke, IHD, CP, MI…HTN
In DM it can induce glucose intolerance
How do you manage breakthrough bleeding?
Increase estrogen/progestin
BTB early in cycle: use higher estrogen regimen
BTB late in cycle: use higher progestin regimen
How do you manage the N/V (estrogen) and acne/hirsutism from androgenic properties of progestin?
N/V: take at night before bed or with meal
Acne/Hirsutism: select produce w/lower androgenic activity or lower progestin component
What’s the MoA for emergency contraceptives?
Inhibits ovulation, prevents fertilization, increases thickness of cervical mucus, prevents implantation (not abortion)..not to be used as a routine method
The two emergency contraceptives are?
Plan B (levonorgestrel) OTC: Take ASAP, within 72hrs
Ella (Ulipristal acetate) Rx only: 120hrs, possible more effective than plan B
What’s the time to return to fertility after stopping COCs, injectable, implant?
COC: 1-3 months
Injectable DMPA: 10 months on average (up to 18)
Implant: 1 month
After pregnancy what can they use if breastfeeding or not?
Breastfeeding? Progestin only or DMPA at 6wks postpartum
Not breastfeeding in women w/no CV risk: progestin only or DMPA immediacy postpartum, but avoid estrogen for 21 days (VTEs)
Not breastfeeding in women w/CV risk: avoid estrogen contraceptives for 42 days post-delivery
In terms of DIs, what drug classes decrease the levels of oral contraceptives?
Anticonvulsants, anti-invectives, maybe Abx, and supplements like St. John’s warts and garlic
What drug concentrations are decreased/increased BY oral contraceptives?
Decreased: anticonvulsants, lorazepam, oxazepam, temazepam, opioids
Increased: alprazolam, clonazepam, diazepam, midazolam…corticosteroids, TCAs
Only Abx that was proven to decrease estrogen (not progestin)
Rifampin…backup is NOT needed if other Abx are taken (still a concern, but not proven to be an issue…this all has to do with those that are CYP inducers being the issue)
