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Gen Med: Ob/gyn > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

What are the methods available for contraception?

A
  1. Abstinence
  2. Post coital douche
  3. Lactational amenorrhea
  4. Male condom
  5. Female condom
  6. Periodic abstinence
  7. Coitus interruptus
  8. Spermicides
  9. Vaginal diaphragm
  10. Cervical cap
  11. Vaginal ring
  12. Intrauterine devices
  13. Contraceptive patch
  14. OCP’s
  15. Implantable devices
  16. Long acting injectable contraception
  17. Sterilization
  18. Emergency contraception
  19. Elective termination of pregnancy
    A. Medical
    B. Surgical
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2
Q

Define abstinence

A

Absolutely NO intercourse; NO ejaculate in vagina

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3
Q

What is coitus interruptus?

A
  1. Problem: pre-ejaculate present prior to ejaculation & may contain sperm
  2. Issues w/ male self control & female awareness
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4
Q

What is the premise of post-coital douche? What products are used?

A
  1. Hopes of flushing semen out
  2. Sperm enter cervical canal w/in 5-10 seconds of ejaculation & douching speeds process
    A. Vinegar, water, milk or feminine hygiene products introduced into vagina after intercourse
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5
Q

What is the pathophys of lactational amenorrhea?

A
  1. Exclusive breast feeding → ↓ LH, FSH & GnRH
    A. Suppresses prolactin →anovulation & amenorrhea
    B. Can have menses but most likely anovulatory
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6
Q

How can lactational amenorrhea be an effective contraceptive method?

A
  1. MUST breastfeed w/ EVERY feeding!
    A. Not 100% effective
    B. Should wait to have intercourse until 6wk PP check (usually don’t)
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7
Q

What are the different barrier methods?

A
  1. Male condom
  2. Female condom
  3. Vaginal diaphragm
  4. Cervical cap
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8
Q

What are the types of male condoms?

A
  1. Sheath covering penis during coitus, prevents semen deposition in vagina
    A. Latex, polyurethane, lambskin
    B. Failure rate in misuse
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9
Q

What types of male condoms are the best at preventing STDs?

A

Latex & polyurethane better/stronger at preventing STDs (NOTHING is 100%)

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10
Q

What can be added to the use of male condoms to raise the efficacy?

A

For greater effectiveness add spermicide or use condom w/ spermicidal lubricant

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11
Q

What are the general characteristics of the female condom?

A
  1. Unpopular
  2. 21% failure rate
  3. Costly $10-$25
  4. Bulky, hard to use, polyurethane
  5. Some protection against STDs
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12
Q

How is the female condom used?

A

Thin polyurethane material w/2 flexible rings at each end; barrier end of ring fits in vaginal cul-de-sac & 2nd ring sits outside vagina near introitus

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13
Q

What are the negative about a cervical cap?

A
  1. Can be dislodged
  2. Unpopular
  3. Requires change w/weight changes or postpartum
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14
Q

How is the cervical cap held in place? What is used in conjunction with the cervical cap?

A
  1. Fits directly over cervix & held in place by suction

2. Used with spermicidal jelly

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15
Q

How long does a cervical cap remain in place?

A

Remain in place 24-48 hrs post-coital; foul discharge can result

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16
Q

What is a vaginal diaphragm?

A
  1. Circular ring w/ polyurethane barrier fits in vaginal cul-de-sac & covers cervix
  2. Custom fit during pelvic exam
    A. 50-105 mm sizes
    B. Re-measure w/weight change (10 lb) or postpartum
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17
Q

What must be used in conjunction with a vaginal diaphragm?

A
  1. MUST be used w/ spermicidal jelly or cream
  2. MUST add more spermicide w/ every intercourse
  3. Can get vaginal irritation from spermicide
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18
Q

What is the timeline for use of a vaginal diaphragm?

A
  1. Insert up to 6 hrs prior to intercourse & must remain in place (w/ each intercourse) for 6 hrs
  2. If having intercourse a second time, do not remove the diaphragm, insert additional spermicidal jelly
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19
Q

When is a diaphragm contraindicated?

A

Contraindicated w/ pelvic relaxation or sharply anteverted or retroverted uterus

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20
Q

What are the women at an increased risk for when using a vaginal diaphragm?

A

↑ risk of UTI from urethral pressure & ↑ yeast infections (FB)

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21
Q

What is periodic abstinence? What are the different ways of determining where you are in the your cycle?

A
  1. AKA rhythm method, natural family planning (NPF)
    A. Calendar
    B. Basal Body Temp (BBT)
    C. Calendar & BBT
    D. Cervical mucous
    E. Symptothermal method: cervical mucous & BBT
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22
Q

When is intercourse avoided in periodic abstinence?

A
  1. Avoid intercourse during fertile period

A. Ovum in tube 1-5 days (2-3) after ovulation

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23
Q

What is the failure rate of periodic abstinence?

A

High failure rate (≥ 35%)

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24
Q

What is necessary in order to use the calender method?

A
  1. Requires regular tracking for 3-6 months to develop a pattern
  2. Must have regular menses & track pattern
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25
Q

What is a typical menstrual cycle pattern?

A

Approx 28 day cycle; luteal phase is 14 days prior to beginning of menses & ovulation is few days prior to that (day 11-13)

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26
Q

When is intercourse avoided when using the calender method?

A
  1. intercourse avoided day 10-day 18/19/20

2. Intercourse prior to day 10, NO intercourse day 10-day 20, then intercourse anytime after that

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27
Q

What is the phys of basal body temperature as a contraceptive method?

A

Slight ↓ in temp day of ovulation, then abrupt ↑ (0.5°-1° F) & remains at spike plateau for remainder of cycle

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28
Q

When must the basal body temperature be obtained?

A
  1. Must take oral, vaginal or anal temperature QD before any activity at all!!!
    A. Track daily from day 1 (menses)
    B. Record daily & keep calendar
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29
Q

What is the phys of cervical mucous testing as a contraceptive method?

A
  1. Cervical mucous affected by cyclical hormones & changes constantly throughout cycle
  2. Several days prior to ovulation, mucous becomes clear & thin (egg white), any other time opaque & thicker
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30
Q

What can impair the use of cervical mucous testing?

A

Difficult to evaluate if vaginitis occurs

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31
Q

What are the combination natural family planning methods?

A
  1. Calendar & BBT
    A. Slightly more accurate than calendar alone
  2. Symptothermal method
    A. Cervical mucous testing & BBT
    B. Must track for a few months to know cyclical changes
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32
Q

What hormones are in Nuvaring?

A
  1. Estrogen (ethinyl) & a progestin (etonogestrel) impregnated in a silastin ring; inserted by patient
  2. Equivalent to a low-dose OCP
33
Q

What is the timeline of use for Nuvaring?

A
  1. Remains in place for 3 wks, then removed for 1 wk
  2. Inserted 1st day of menses or Sunday after onset
  3. Store in refrigerator until use
34
Q

What must be provided by the HCP before nuvaring can be prescribed?

A

Need full H & P on any patient considering hormonal contraception
(Nuvaring, implants, Depo, OCP, IUD, etc)

35
Q

What are the contraindications of Nuvaring?

A
  1. Smoker > 35 yr
  2. DVT Hx
  3. Hypercoagulable condition
  4. Uncontrolled HTN
  5. DM w/ organ damage
  6. Severe migraine w/ neuro sx’s
  7. Breast cancer
  8. Pregnancy/nursing
  9. Allergy to ingredients
36
Q

What is the most effective form of contraception?

A
  1. Oral Contraceptive pills

2. Most effective form of birth control if used correctly (99.6%)

37
Q

What hormones are included in OCPs?

A

Synthetic estrogen & progestin in various combos

38
Q

What is the phys of OCPs?

A
  1. Suppresses FSH, LH → suppresses ovulation

2. Progestin inhibits LH release & thickens cervical mucous, inhibiting sperm motility

39
Q

What are the potential se of OCPs?

A
  1. Break Through Bleeding most common
  2. Weight gain
  3. Bloating
  4. Minor H/A
  5. Combo OCP ↓ lactation
  6. Thromboembolic Dz
  7. DVT, MI, CVA, PE, (smokers & hyperlipidemia)
40
Q

What is the general timeline of OCPs?

A

Begin on 1st day of menses or Sunday following menses start

41
Q

What are the different OCP combinations regimens?

A

1, 21 active pills only or 21 active & 7 placebos
2. 42 active pills & 7 placebos
3, 84 active pill & 7 placebos (4 menses/yr)
4. 126 active pills & 7 placebos (3 menses/yr)
5. Different strength each week x 3 then 7 placebos (PMS)
6. 10 pill same strength followed by 11 pills diff strength

42
Q

What are the characteristics of a progestin only pill?

A
  1. Progestin only pill (POP):
    50% effective as combo
  2. Lactating women
  3. Continuous dose daily-no placebos
43
Q

What are the advantages of OCPs?

A
  1. Treats dysmenorrhea
  2. Treats menorrhagia
    A. ↓ anemia
  3. Treats acne
  4. ↓ occurrence of ovarian cysts
  5. Helps endometriosis
  6. Improves PMS
  7. Helps perimenopausal symptoms
  8. Suppresses PCOS issues
  9. ↓ risk of ovarian CA if taken > 10 yr
44
Q

What are the intrauterine devices? How long can they stay in place?

A 
1. Copper 
A. Flexible plastic, wrapped in copper
B. Paragard- 10 yr
2. Progestin impregnated 
A. Levonorgestrel in flexible silastin 
B. Mirena- 5 yr
C. Skyla-3 years
45
Q

What is the physiology of Paragard IUD?

A
  1. Releases small amount of copper each day
    A. Acts as spermicide
    B. Hostile environment→ NO embryo implantation
    C. Copper interferes w/ovum development & ↑ phagocytosis
    D. Can have heavier, longer, more painful menses
46
Q

What is the physiology of Mirena/Skyla IUD?

A
  1. 20mcg levonorgestrel released in tiny amounts daily
    A. Alters utero-tubal fluid → thicker
    B. Thickens cervical mucous
    C. Slows/inhibits sperm motility
    D. Hostile uterine environment → NO implantation
    E. Can cause anovulation
    F. Light menses or amenorrhea
47
Q

What are the potential se for Mirena/Skyla IUD?

A
  1. ↑ chance of Break Through Bleeding
  2. Weight gain
  3. Acne
  4. Oily skin
  5. Mood changes, depression
  6. H/A
48
Q

What are the advantages of IUDs?

A
  1. No daily regimen
  2. No planning
  3. Continuous contraception
  4. Low failure rate
  5. Cost
    A. Mirena $400-$500 ( ≈ $7.50/mo)
    B. Skyla $650-$780 (≈ $20/mo)
    C. Paragard $200-$300 (
49
Q

What are the disadvantages of IUDs?

A
  1. Initial cost
  2. Risk of PID
    A. Mostly w/in 1st few months
    B. ↓ risk w/duration of use & monogamous couples
  3. Risk of ectopic pregnancy
  4. Risk of uterine perforation
  5. Expulsion
50
Q

What are the contraindications of IUDs?

A
  1. Allergy to any ingredients
  2. Hx of or active PID
  3. Pregnancy
  4. Unexplained vaginal bleeding
  5. GYN malignancy
  6. Nulliparous **
    A. Can be used, but harder to place, and need to check hCG before prescribed
    B. Some providers do not give to a nulliparous woman
51
Q

What should you educate the pt on regarding the insertion of IUD?

A
  1. May have discomfort
    A. Ibuprofen 800mg 2 hours prior to procedure
  2. Easier in multiparous
  3. May have cramping or bleeding directly after insertion
    A. Ibuprofen- will also reduce flow
52
Q

How often should the IUD be inserted?

A

HCP recheck strings in 1 month; pt check monthly after that

53
Q

How is an IUD removed?

A
  1. Pull on strings & remove; should remove easily
    A. If not → sono to see IUD placement
    B. If no string, sono necessary
54
Q

What is ortho-evra patch?

A

Transdermal adhesive patch containing ethiny estradiol & norelgestimin (norgestimate)

55
Q

What is the timeline for ortho-evra patch?

A

One new patch weekly x 3 weeks & 4th week is patch free

56
Q

What are the application sites for ortho-evra patches?

A

Application sites: buttocks, lower abdomen, upper outer arm, upper torso except breasts

57
Q

What complications may occur from the ortho-evra patch?

A
  1. Allergy to ingredients or adhesive
  2. Detachment issues
    A. Emergency patch
58
Q

What is an example of long acting injectable contraception?

A

DepoProvera 150mg IM q 12 weeks (DepoMedroxyprogesterone)

59
Q

How does a long acting injectable contraception suppress ovulation?

A
  1. Suppresses gonadotropin RH
  2. Thickens cervical mucous
  3. Thins lining of endometrium
60
Q

What is the timeline for a long acting injectable contraception?

A
  1. 150mg IM q 12 weeks

2. Grace period of 1 week from LMP

61
Q

What are the benefits of DepoProvera?

A
  1. Amenorrhea usually after 6-9 months
  2. Improves endometritis issues
  3. ↓ risk of endometrial cancer
  4. ↓ risk of arterial & venous clots
62
Q

What are the risks of Depo-Provera?

A
  1. Heavy or continuous bleeding w/ start of Depo
    A. Usually ↓ w/ continued injections
    B. May become amenorrheic
    C. Bleeding can be sporadic, unpredictable
  2. Risk of osteoporosis
    A. Get DEXA on long time users
    B. Encourage Vit D daily
  3. Weight gain
  4. Return of fertility may take up to 2 years
63
Q

What are the general characteristics of implantable subdermal contraception?

A
  1. Slow release etonogestrel in silastin
  2. Minor office surgical procedure
  3. Reliable protection
64
Q

What are examples of subdermal contraception?

A 
1. Implanon
A. 1 capsule-3 years
2. Nexplanon
A. 1 capsule- 3 years 
B. Same as Implanon  + barium sulfate - can be detected by X-ray
65
Q

What are the se of implantable subdermal contraception?

A
  1. Irregular prolonged bleeding
    A. Improves over time; if greater than 4 mo, consider adding one pack OCPs or estrogen supplement to ↓ bleeding; bleeding not dangerous -> annoying; reassure
  2. Weight gain
  3. Acne
  4. Oily skin
  5. Hirsutism
  6. Emotional issues
  7. Vaginal dryness
  8. Insertion site:
    A. Burning, itching, bruising, infection, expulsion
66
Q

What are the contraindications for implantable subdermal contraception?

A
  1. Hx or current breast or uterine cancer
  2. Unexplained vaginal bleeding
  3. Allergy to etonogestrel
  4. Breast feeding????
  5. Liver disease
  6. Severe migraines, heart Dz or Hx of stroke
67
Q

Define emergency contraception?

A

Prevents unintended pregnancy after unprotected intercourse or contraceptive failure

68
Q

What are examples of emergency contraception?

A
  1. Plan B, Next Choice, My Way, Take Action-levonorgestrel -$20 (gen)-$50 OTC
    A. (Must be ≥ 15 yr to purchase)
  2. Ella-misoprostil- Rx only
  3. $80 million/yr industry
  4. Can use any OCP in specific combination
69
Q

How can OCPs be used as emergency contraception?

A
  1. Plan B (OTC): 1 levonorgestrel pill PO (
70
Q

What is the MOA of emergency contraception?

A
  1. Prevents or delays ovulation
  2. Interferes w/ fertilization of ovum
  3. Alters uterine environment
71
Q

What does the pt need to be counseled about regarding emergency contraception?

A

Counsel pt will bleed, maybe heavily w/in 2 wks

72
Q

How is Ella (Rx) used as an emergency contraceptive?

A

1 PO (

73
Q

What are the methods for female sterilization?

A
  1. Tubal ligation

2. Essure

74
Q

What is essure?

A
  1. Minor office procedure-coils placed at proximal end of fallopian tube & acts as FB
  2. Must have salpingogram after 3 months to ensure blocked
75
Q

What are the methods for male sterilization?

A
  1. Vasectomy
    A. Minor office procedure-prevents sperm from reaching urethral orifice
    B. Semen analysis must be done 6+ weeks before stopping current BC
76
Q

What is the surgical procedure for a vasectomy?

A
  1. Under local anesthesia, scrotal skin pierced & vas deferens located
  2. Vas deferens removed from scrotal sac & divided
  3. Each end ligated w/ surgical clip
  4. Vas placed back into scrotum & closes sponateously
77
Q

What is a medical termination of pregnancy? What meds are used?

A
  1. Meds given to terminate pregnancy up to 9 wk gestation
    A. Mifepristone/RU486 and misoprostil: combo induces contractions & expulsion of fetus
    B. Methotrexate
78
Q

What is a surgical termination of pregnancy?

A
  1. Suction D&C up to 12 wk gestation
  2. Saline 16-24 wk gestation
  3. Dilation & Evacuation (D&C + vacuum aspiration)
    A. 13-24 wk gestation
79
Q

What is included in contraceptive counseling?

A
  1. Give all contraceptive options w/ explanation of each
  2. Discuss when & how to start BC
  3. Discuss SE/risks/advantages to method
  4. Discuss problems they may encounter
  5. Advise to call if any problems/issues; if emergent, go to ER
  6. If patient cannot insert vaginal ring/diaphragm, offer assistance or use alternative method
  7. Give written info to follow verbal info given

Gen Med: Ob/gyn (13 decks)

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