Contraceptive Technique Flashcards
Emergency Contraception:
- Levonorgestrel
- -aka
- -dosing
- -effective within how many hours after intercourse?
- -SE
- -CI
- -MOA
LEVONORGESTREL:
Aka: plan B
Dosing:
-levonorgestrel 0.75mg two pills taken 12hrs apart
-Plan B One Step or Next Choice One Dose is single levonorgestrel 150mg pill
Effective up to 120hrs after the event but best to take as soon as possible.
SE:
- N/V
- irregular bleeding the month after tx
- less common: dizziness, fatigue, HA, breast tenderness
CI: NONE! : )
MOA:
- progestin only
- only works before ovulation has occurred, it does not interrupt a pregnancy and has no known adverse SE on pregnancy or fetus.
- delays ovulation.
Emergency Contraception: Copper IUD
- MOA
- CI
MOA:
- interfering with fertilization or tubal transport
- preventing implantation by altering endometrial receptivity. (inhospitable environment)
CI: if pregnant
What are the categories of contraception?
Hormonal
IUD
Barrier
Permanent
Oral Contraceptives:
- MOA
- whats the difference between the older and newer progestins?
MOA:
- estrogen:
- -suppression of GnRH and inhibits the midcycle surge of LH preventing ovulation. suppresses FSH secretion thereby preventing ovarian folliculogenesis.
- -stabilizes endometrium to minimize breakthrough bleeding.
- progestins:
- -suppress LH secretion and prevent ovulation
- -thickens mucus to prevent sperm migration
- -creates an atrophic endometrium unfavorable to implantation
- -impairs normal tubal motility/peristalsis
Progestins:
-older are more androgenic. (levonorgestrel)
-newer are less androgenic. (Drospirenone/Yasmin/Yaz)
Off label of oral contraceptive pills?
Endometriosis
Acne/hirsutism
Tx of heavy, painful, irregular periods
reduce ovarian cysts
PCOS
PMS/PMDD
Decreases risk of ovarian** and colon CA
Descreass menstrual migraine
What are the oral contraceptive preparation types?
Monophasic
Multiphasic (diff levels of hormones throughout cycle)
Extended cycle
Progestin only pill (POP)
When is the proper time to begin a new oral birth control method?
Quick start: start the day of Rx regardless of the day of cycle once pregnancy is ruled out
Sunday start: start 1st sunday after period begins
Start 1st day of menses
- quick start or sunday start must use back up method for 7 days after starting the pill.
- progesterone pill should be started in first 5 days of menses.
Important education to provide to the patient about oral birth control.
take the med same time everyday.
If miss 1 pill take as soon as realized and continue to take remainder of pills regularily.
If miss 2 pills in a row, “double up” for 2 days.
*must use back up method for rest of cycle
High risk time for conception if next pill cycle not started on time
Notify with increasingly severe or frequent HA, SOB, chest pain or swelling of an extremity
Menses are shorter, lighter, and less cramping.
progestin only pill should be taken in 3hr window
Ortho-Evra
- route of administration & directions
- what hormones are being delievered?
Route of admin: transdermal patch; changed every 7 days for 3wks and then 1wk off for menses.
Hormones:
-estradiol and progestin
NuvaRing
- route of administration & directions
- what hormones are being delivered?
Route: intravaginal; in for 3wks and taken out 1wk for menses.
Hormones: estradiol and progestin
What are the absolute CI for estrogen contraception?
Hx of thromboembolic event, stroke, or thrombogenic mutation (factor V leiden)
Known CVD, cardiomyopathy, BP 160/100 or greater, complicated valvular heart dz
SLE with postive antiphopholipid abys
Women 35 or older who smoke
Migraines with Aura
Women 35 or older with migraines
Hx of cholestatic jaundice with pill use
hepatic carcinoma or benign adenoma, any active liver dz or severe cirrhosis
breast cancer (current)
first 21 days post partum
undiagnosed abnormal uterine bleeding.
Careful consideration before use of estrogen
HTN
Anticonvulsant therapy
Migraines without aura
DM
Hx of bariatric surgery w/ malabsortive procedure like Roux en Y
Psychotic depression
Ulcerative colitis
Obese (greater 35YO)
What is the efficacy of hormonal pills, patch, and ring?
SE of hormonal contraception (E-P)
Theoretical/correct use: less than 1%
Typical use: 9%
SE:
- nausea/bloating
- breast tenderness
- spotting/break though bleeding (*MC SE)
- amenorrhea
- fatigue
- HA
- depression/moodiness
- decreased libido
Risks w/ E-P therapy
CVD: thrombotic not atherosclerotic
HTN: may cause mild elevation
Stroke: ischemic
Mild insulin resistance (progestin)
serum triglycerides and HDL increases; LDL decreases (estrogen)
decrease HDL andd increased LDL (progestin)
Venous thromboembolic dz
cholithiasis
What is a major hormonal contraceptive-drug interaction?
drugs that increase liver microsomal enzyme activity accerlerates OCs metabolism and may decrease efficacy
*Rifampicin (Rifampin) is the only proven antimicrobial shown to decrease efficacy of OCs.
PROGESTIN ONLY:
Depo Medroxyprogesterone acetate
-aka
Progestin Implant:
- aka
- how long does this last?
Progestin IDU:
- aka
- how long does this last?
- SE
Depo: DMPA or Depoprovera
Implant: Nexplanon; previously implanon
-lasts 3 years
Progestin IUD: mirena, skyla -Mirena approved 5yrs -Skyla approved 3yrs SE: -irregular bleeding* -breast tenderness, mood changes, acne
Advantages of Progestin only methods? Disadvantages?
- can use for estrogen CI
- fewer CI and fewer drug interactions
- long acting
- scanty or no menses
- decreased menstrual cramps
- decreased risk of endometiral cancer or PID
- decrease in endometriosis pain
Disadvantages:
- early on irregular bleeding and spotting
- most become amenorrheic
- possible weight gain (Depo)
- possible moodiness/aggravation of depression
- bone density decrease (BBW to limit to 2 years if possible)
DMPA or Depo
- how soon after delivery can you use this?
- how long until periods return?
- SE
- what are some clinical advantages of this?
Safe to use immediately post delivery
18mo after last injection
SE:
- weight gain
- dizziness
- HA
- Nervousness
- libido decreased
- menstrual irregularities
Clinical advantages:
- decreases painful crises of sickle cell anemia
- has intrinsic anticonvulsant effects.
IUD:
-MOA
MOA: foreign body reaction creates sterile inflamm changes toxic to sperm and ova and inhibits ovulation
*primary effect is prevention of ovulation.
What is the non-hormonal IUC?
- MOA
- how long does this last?
- SE
Paragard
MOA:
-releases Copper continuously into the uterine cavity; this interferes with sperm transport and prevents fertilization of ova.
Lasts 10yrs
SE:
-heavy menses, dysmenorrhea
Who are the ideal candidates for IUC?
not planning a pregnancy for at least 1 year
want to use a reversible form of contraception
want or need to avoid estrogen
want “minimal user effort”
Clues of possible expulsion of IUD?
unusual vaginal discharge
cramping or pain
intermesntrual or postcoital spotting
dyspareunia
absence or lengthening of IUD string
presence of IUD at the cervical os or in the vagina.
When are women with IUD most at risk of PID?
IUD CI?
within the first few weeks following insertion.
CI:
- severe uterine distortion
- acute pelvic infection
- known or suspected pregnancy
- wilsons dz or copper allergy
- unexplained abnormal uterine bleeding
- current breast cancer (Mirena, skyla) (can use paragaurd)
Diaphragm
- what is this?
- how long to leave in vagina after intercourse?
- who are not good candidates?
What: dome-shaped cup made of latex or silicone that gets partially filled with spermicidal cream/jelly that is inserted deep into the vagina to cover the cervix.
Must leave in got 6-8hrs after intercourse.
Bad candidates:
- latex/silicone allergy
- organ prolapse
- frequent UTI
- HIV infection
- difficulty with insertion
- adolescents
- CI if hx of toxic shock syndrome
Cervical Cap
- what is this?
- how long must this remain in vagina after intercouse?
- SE
what: reusable, deep rubber cup that fits over the cervix, must be used with spermicide
Must remain in place for 6-8hrs after intercourse
SE:
- UTIs
- Vaginal infections
- toxic shock syndrome
Contraceptive Sponge:
- what is this?
- how long must this remain in vagina after intercourse?
- risks
What: sponge that contains nonoxynol-9, must be moistened with tap water before insertion.
must remain in the vagina for 6hrs
Risk of TSS
Spermicides with condoms are almost as effective as OCP, T/F?
what is coitus interruptus also known as?
TRUE!!!!!!!!
Withdrawal
Lactation:
- can this be used as birth control?
- delays ovulation, T/F?
Birth control only when woman is less than 6mo postpartum, breastfeeding EXCLUSIVELY, and she is amenorrheic
Breast feeding delays ovulation.
What are the fertility awareness methods?
ovulation method: predicting fertile time based upon recent history of cycle length. (if cycles are 26-32 days; days 8-19 are most fertile)
Sympatothermal: body temperature and cervical mucus as well as other sx of ovulation
Cervical mucus: increases in amount and is thin and slippery in several days before ovulation.
BBT alone: basal body temperature increases 0..5-1 degree F at time of ovulation but 2-3days before ovulation is most fertile time.
