Contraceptives Flashcards
Methods of birth control?
- Abstience
-Male/female sterilization
-natural family planning
-spermicides
BARRIRERS:
1. Diaphragm or cervical cap
2. condom
3. female condom
4. sponge
HORMONAL CONTRACEPTIVES:
1. COC
2. Transdermal
3. Vaginal ring
4. PROGESTIN-ONLY - progestin-only pill
- progestin only injectable
-implanted rod
IUD/IUS:
-copper IUD - progestin-containing IUD/IUS
Most effective form of contraception?
female/male sterilization
least effective form of contraceptives?
Spermicides, sponge, fertility awareness based methods
FDA indications for COC?
- prevents pregnancy
- acne
- pre mensural dysphoric disorder
off label COC uses?
- Hirsutism
- cycle control
- headaches
- pre mensural syndrome
- Iron deficiency anemia
- relief of mensural cramps
Pharmacologic actions of estrogen in contraceptives?
1) Feed back to pituitary= inhibits FSH and ovulation
2) increases aldosterone C%
3) Increases sex-hormone-binding globulin
Pharmacologic actions of progestins in contraceptives
i. Feeds back to pituitary and helps inhibit ovulation.
ii. Causes endometrial atrophy (thinning of uterus lining).
iii. Thickens cervical mucus (inhibits sperm from traveling).
Category 4 contraindications for combined hormonal contraceptives
- Bp greater than 160/100
- CVD risk
- smoker
- < 21 days postpartum for women with no risk factors for DVT
- 42 days for women with risk of DVT
COC contraindications?
- Vascular disease
- stroke
migraine
ischemic heart disease - surgery with prolonged immobilization
- Liver tumor
- complicated diabetes
- DVT
-Breast cancer - systemic lupus erythematous
- complicated solid organ
Breakthrough bleeding in COC?
Consider new product after trying the product for 3 months, assess adherence.
ii. Select new birth control according to when bleeding occurs.
iii. If early in the cycle, there is probably not enough estrogen; select a regimen
with higher estrogen activity.
iv. If late in the cycle, there is probably not enough progestin; select a regimen with
higher progestin activity.
v. In general, if breakthrough bleeding occurs, it is best to select a regimen with
higher estrogen and progestin activities.
Nausea-induced COC?
- related to estrogen
- take pill at night with food
- try the product for 3months= nausea may subside
Acne caused by COC?
- Acne is related to progestin component
- select product with lower androgenic property & higher estrogen activity
Serious complications of COC?
ACHES: A:BDOMINAL PAIN C: CHEST PAIN H: HEADACHE E: EYE PROBLEM S:SEVERE LEG PAIN
Types of Hormonal Contraceptives
- Monophasic
- Biphasic
-Triphasic: Traditional
(Progestin changes & estrogen stays the same)
-Quadri phasic:
Same amount of hormone in pill every day except in placebo
pills
monophasic
Amount of hormone may change halfway through cycle.
Biphasic
Amount of hormone changes every week.
Triphasic
types of triphasic?
(a) Traditional: Progestin usually changes and estrogen stays the same.
(b) Estrophasic: Estrogen changesv
Estrogen changes and progestin changes; four varying
amounts throughout monthly pack
Quadriphasic
COC regimens?
i. High-dose estrogen: Higher than 35 mcg (up to 50 mcg)
ii. Low-dose estrogen: Less than 35 mcg (generally 20–35 mcg)
iii. Very low-dose estrogen: Less than 10 mcg
COC starting methods?
i. Same-day start: Start taking an active pill the first day of menses.
ii.Sunday start: Start taking an active pill the first Sunday after menses begins
iii. Quick start: Start taking an active pill at the physician’s office or first day of
prescription, regardless of menstrual cycle day.
what should you do when switching from one brand to the other?
When changing pills from brand to brand, start the new pack of pills after
finishing the placebo pills from the old pack.
COC counselling points?
1) Proper use: take 1 tablet once daily at the same time everyday
2) adverse effect: usually decreases after 3 months: (stay on a brand for at least 3 months if adverse
effects are not excessively inconvenient).
DEF: Missed doses in COC?
Missed COC pill means more than 24 hours
between doses.