Contraceptives

Question 1

Oral hormonal contraceptives

Answer 1

Monophasics, Biphasic, Triphasic -> combined oral contraceptives (estrogen and progesterone)
Norethindrone and norgestrel -> progestin only pills

Question 2

Non oral hormonal

Answer 2

The patch
The ring
Progestin injection
Progestin Implant
Intrauterine systems

Question 3

Emergency post coital contraception hormonal

Answer 3

One or two tablets of levonorgestrel*** taken before 72 hrs and followed 12 hours later -> nausea and vomiting; no prescription needed if over 17yrs
Ulipristal acetate is a selective progesterone receptor modulator-> inhibits or delays ovulation
Other high dose norgestrel or levonorgestrel formulations can be used

Question 4

Emergency post coital contraception non hormonal

Answer 4

Copper IUD inserted within five days of intercourse

Question 5

Estrogens

Answer 5

ethinyl estradiol or mestranol (a prodrug of ethinyul estriol)

Question 6

Non hormonal contraceptive methods

Answer 6

Barriers (least effective) -> condoms, diaphragm, cervical caps, spermicides
IUD
Sterilization

Question 7

Progestins

Answer 7

Most have some androgenic activity
Levonorgestrel and norgestrel -> highest
Norethindrone (2nd gen) -> low
Desogestrel and norgestimate (3rd gen) -> lowest
Drospirenone-> anti androgenic

Question 8

Contraceptive use

Answer 8

Prevention of pregnancy
Menstrual cycle regulation
Reduction of premenstrual symptoms and treatment of acne
Inconsistent use may increase failure rate

Question 9

Monophasic combined oral contraceptive description

Answer 9

Fixed dose in each active pill

Question 10

Monophasic combined oral Mechanism

Answer 10

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

Question 11

Biphasic oral mechanism

Answer 11

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

Question 12

Triphasic oral mechanism

Answer 12

Suppress FSH and LH -> prevents ovulation

Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium

Low dose reduces adverse effects, but may be less efficacious if missed dose

Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control

Question 13

Biphasic and Triphasic oral description

Answer 13

Variable proportions of one or both hormones in each pill to mimic the menstraul cycle

Reduces the monthly progestin dose

Question 14

Monophasic, Biphasic, Triphasic oral PK

Answer 14

21 active + 7 placebo (most common)

Extended cycle: 84 active + 7 placebo -> 4 periods a year

Continuous regimens: 21 active + 4-7 very low dose -> NO periods

Question 15

Monophasic, Biphasic, Triphasic oral Adverse

Answer 15

Nausea, bloating, breakthrough bleeding (improve by third cycle)

HA
Migraine and CVA
Depression
Insulin resistance

Hirsutism, oily skin, acne (from progestin)
Melasma (dark skin discoloration)
Amenorrhea
Dyslipidemia

CVD -> increase prouction of PF VII, X and fibrinogen

Question 16

Monophasic, biphasic, triphasic oral contraindications

Answer 16

Thromoboembolic disease
Stroke, CAD
Breast CA, estrogen dependent neoplasm
Hepatic tumors or liver disease
Abnormal uterine bleeding
Heavy smoking over age 35 yrs

Minor: history of migraine disorder, HTN, diabetes, uterine fibroids, breast feeding, smoking at any age

Rifampin and other CYP450 inducers increase metabolism of estrogen

Broad spectrum antibiotics (especially Rifampin) reduce intestinal flora and interrupt enterohepatic circulation of estrogen and decreasing efficacy of OCP’s

Question 17

Norethindrone and Norgestrel class

Answer 17

Progestin only pills

Question 18

Norethindrone and Norgestrel description

Answer 18

Less effective than combined OCP
NO thromboembolism
Decreased dysmenorrhea, menstrual blood loss and PMS symptoms

Question 19

Norethindrone and Norgestrel mechanism

Answer 19

Blocks ovulation in 60-80% of cycles, but highly efficacious -> thickening of cervical mucus and endometrial alterations that impair implantation

Question 20

Norethindrone and Norgestrel Adverse

Answer 20

Not widely used in US
Unscheduled bleeding
Spotting

Question 21

The patch description

Answer 21

Ethinyl estradiol and progestin

Question 22

The ring description

Answer 22

Transvaginal delivery of ethinyl estradiol and progestin

Question 23

Progestin injection description

Answer 23

Depo-Provera
Contains depo medroxyprogesterone acetate (DMPA)
Extremely effective

Question 24

Progestin injection PK

Answer 24

IM injections every three months

Question 25

Progestin adverse

Answer 25

Menstrual irregularities
Weight gain
Significant loss of bone mineral density (black box)

Question 26

Progestin implant description

Answer 26

Contains a progestin
Placed under skin in upper arm
Effective for 3 years
Adverse->irregular menstrual bleeding

Question 27

Intrauterine Systems

Answer 27

Polyethylene body
Levonorgestrel releasing
Effective for five years