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PHARM II TEST 2 > Contraceptive Meds Part 1 > Flashcards

Contraceptive Meds Part 1 Flashcards

1
Q

Diaphragm remains in place for 6-8 hrs, remove within?

A

24 hrs

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2
Q

Cervical cap remains in place for 6-8 hours, remove within?

A

48 hrs

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3
Q

Nonsurgical block of Fallopian tubes forming scar tissue?

Surgical one?

A

Tubal implant

Tubal ligation

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4
Q

In vasectomy, two vas deferents are surgically cut

A

…

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5
Q

Vaginal ring, delivers estrogen and progestin analogs for 3 weeks, remove when?

A

4th week and new ring 7 days later

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6
Q

Implant is a low dose of progestin, protects for up to?

A

3 years

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7
Q

Patch applied new one once a week for 3 weeks, patch 4th week or no?

A

No

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8
Q

Injectable BC is every 3 months IM or SubQ, need diet rich in calcium and vitamin D, what’s injected?

A

Medroxyprogesterone

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9
Q

Estrogen hormones include Estradiol, Estrone, and Estriol used for?

A

Grow uterine lining, breast development, regulate pregnancy, regulate metabolic processes (clots/cancers), suppress LH and FSH

Available forms: Ethinyl estradiol, Estradiol valerate, Mestranol

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10
Q

Combined oral contraceptives (COCs) work by?

A

Suppressing release of LH and FSH, prevent ovulation, thin endometrium , thicken cervical mucus

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11
Q

COCs are used to prevent fertilization or abort implantation of the ovum into uterus (not abortion), other effects?

A

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)

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12
Q

Off label uses for other med conditions of COCs?

A

Cycle control, amenorrhea, dysfunction uterine bleeding, hypermenorrhea, IDA, EMERGENCY CONTRACEPTION (72HRS), other androgen effects

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13
Q

COCs come in several different types: monophonic, biphasic, triphasic, etc explain each…

A

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

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14
Q

Quadriphasic, Extended cycle, continuous?

A

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

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15
Q

Monophasic are best for?

A

Mentrual issues/pain, benign breast disease, avoid mood changes, for those w/ SEs related to progestin

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16
Q

Biphasic best for?

A

Acne

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17
Q

Triphasic best for?

A

Progestin-associated SEs…increased appetite, acne, weight gain or in women w/CV disease or metabolic abnormalities

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18
Q

Quadriphasic best for?

A

Reduce the SEs of oral contraceptives

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19
Q

Tri and Quad are not used as much because?

A

Confusing, missed doses

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20
Q

Common pill packs:

A

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

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21
Q

Concerns for taking extended/continuous regimen products

A

Never know if you’re pregnant, possibly hurts endometrium, no studies on long-term SEs

22
Q

Estrogen and venous thromboembolism (VTE) is related to what?

A

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)
23
Q

COC dosing initiation: quick start, Sunday start, first/same day start?

A

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

24
Q

Are there placebo pills in progestin only contraception 28-day packs?

A

No, and they must be taken within the same 3 hr window each day to be effective

25
Q

What’s the ideal patient population for progestin contraception?

A

Breastfeeding
Non-breastfeeding post-partum
Migraines
Those at CV risk

26
Q

Progesterone only contraception comes in the 3 start methods, they are?

A

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

27
Q 
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?

A

Progestin only

28
Q

What are the advantages and disadvantages of progestin only contraception?

A

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

29
Q

There are 4 generations of progestin OCPs, what is each characterized by?

A

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

30
Q

This generation of progestin pills has high risk of unscheduled bleeding and spotting, less androgenic than the 2nd gen?

A

1st gen

31
Q

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

A

2nd gen

32
Q

This gen of progestin is similar activity to 2nd, but with slightly higher risk of thrombosis…some benefits with acne

A

3rd gen

33
Q

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

A

4th gen

34
Q

Analog of spironolactone that decreases bloating effect of ethinyl estradiol, low androgenic, DIs with K+ sparing drugs

A

Drospirenone (4th gen)

Yasmin
Yah
Safyral
Beyaz

All combo meds with estrogen

35
Q

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

A

Transdermal patch (ortho-evra)

36
Q

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

A

Vaginal ring (Nuvaring)

Of note: not shown to increase VTE risk or have reduced efficacy in fat girls

37
Q

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

A

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

38
Q

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?

A

Copper allergy, too big/small uterus (6/9cm), uterine/cervical cancer, STDs, pregnancy, must be inserted by HCP

39
Q

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?

A

Mireya: stays in uterus for up to 5 yrs, use for contraception and MENORRHAGIA*

Skyla: stays in uterus for 3 yrs, just for contraception

40
Q

IUDs really can’t be used in those with what?

A

History of PID, ectopic pregnancy

Also maybe wait until had at least 1 kid

41
Q

Disadvantages of the two IUD types?

A

Copper: possible heavier menstrual bleeding/cramping

Progestin IUD: possible irregular bleeding/spotting first 3 months after insertion

42
Q

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?

A

Bleeding irregularities, site reaction, inflammation, hematoma, pain/redness at site…can have difficulty removing the rod, it can break, or fibrosis around it

43
Q

What are the main common AEs and most serious ones in hormonal contraception?

A

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

44
Q

How do you manage breakthrough bleeding?

A

Increase estrogen/progestin

BTB early in cycle: use higher estrogen regimen

BTB late in cycle: use higher progestin regimen

45
Q

How do you manage the N/V (estrogen) and acne/hirsutism from androgenic properties of progestin?

A

N/V: take at night before bed or with meal

Acne/Hirsutism: select produce w/lower androgenic activity or lower progestin component

46
Q

What’s the MoA for emergency contraceptives?

A

Inhibits ovulation, prevents fertilization, increases thickness of cervical mucus, prevents implantation (not abortion)..not to be used as a routine method

47
Q

The two emergency contraceptives are?

A

Plan B (levonorgestrel) OTC: Take ASAP, within 72hrs

Ella (Ulipristal acetate) Rx only: 120hrs, possible more effective than plan B

48
Q

What’s the time to return to fertility after stopping COCs, injectable, implant?

A

COC: 1-3 months

Injectable DMPA: 10 months on average (up to 18)

Implant: 1 month

49
Q

After pregnancy what can they use if breastfeeding or not?

A

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

50
Q

In terms of DIs, what drug classes decrease the levels of oral contraceptives?

A

Anticonvulsants, anti-invectives, maybe Abx, and supplements like St. John’s warts and garlic

51
Q

What drug concentrations are decreased/increased BY oral contraceptives?

A

Decreased: anticonvulsants, lorazepam, oxazepam, temazepam, opioids

Increased: alprazolam, clonazepam, diazepam, midazolam…corticosteroids, TCAs

52
Q

Only Abx that was proven to decrease estrogen (not progestin)

A

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)

PHARM II TEST 2 (7 decks)

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