Contraceptives

Question 1

Estrogens acts synergistically with _________ and suppresses ______ release from pituitary , thereby maintaining the stability of the endometrium and preventing the _____ surge that is responsible for ovulation.

Answer 1

progesterone
FSH
LH

Question 2

What hormone is is almost all combined oral contraceptives (COC)?

Answer 2

Ethinyl estradiol (EE) 10-50 micrograms

Question 3

list 5 AEs of EE.

Answer 3

VTE
MI stroke
HTN
Migraine

Question 4

What provides majority of contraceptive effect in COCs?

Answer 4

Progestin

Question 5

name 3 AEs for progestin.

Answer 5

Androgenic adverse effects
VTE (4th generation)
worsening lipid panel

Question 6

What is the primary MOA for COCs?

Answer 6

Suppression of ovulation

Thickens cervical mucus

Question 7

Describe the difference between mono and multiphasic COC.

Answer 7

Monphasic: 21-24 day same estrogen/progestin dose, followed by placebo pills
Multiphasic: variable amounts of E/P following by 7 days of placebo pills

Question 8

What are the extended cycle COCs?

Answer 8

21-84 days of hormone containing pills, then 7-day placebo

Question 9

Name 4 pros to COCs.

Answer 9

1. Better cycle control
2. light menses
3. less AEs - cramping, acne
4. Decreased days of bleeding

Question 10

What is the major disadvantage to COCs?

Answer 10

greater risk of adverse effects 2/2 estrogen component

Question 11

Name 7 contraindications to COC.

Answer 11

1. Migraines with aura (w/o in >35)
2. Age >35 and heavy smoker
3. Anything that predisposes to DVTs
4. Breast cancer
5. Heart failure or uncontrolled HTN
6. Liver disease
7. Post-patrum

Question 12

Progestin does/does not contain inactive pills.

Answer 12

Does not contain inactive pills

Question 13

What are the 2 indications for progestin only pills?

Answer 13

1. CI to COC

2. Lactating women

Question 14

Name 3 pros to progestin only pills?

Answer 14

1. May increase libido
2. Decrease risk of VTE
3. Excellent for patients with light menses

Question 15

Name 4 cons to progestin only pills.

Answer 15

1. Must take everyday at same time
2. Weight gain
3. More break thru bleeding
4. Small inc risk of ectopic pregnancy

Question 16

Symptoms of serious AEs of OCPs?

Answer 16

Abdomen pain
Chest pain
HA
eye problems
severe leg pain

Question 17

Patients using a transdermal contraceptive are exposed to more/less estrogen than typical OC.

Answer 17

MORE - bypass first pass metabolism

Question 18

Name the 2 pros of transdermal OCs.

Answer 18

1. Improved compliance

2. Quick therapeutic levels.

Question 19

Name the 4 cons to transdermal OCs?

Answer 19

1. Can’t use in women weighing >198#
2. Increased risk of clot
3. Patch displacement

Question 20

How do the patches and vaginal rings work (what is in them)?

Answer 20

Combined estrogen and progestin

Question 21

3 Pros for vaginal rings (Nuvaring)?

Answer 21

1. Increased compliance
2. Low incidence of break thru bleeding
   3, Precise placement not necessary

Question 22

Cons for vaginal rings.

Answer 22

1. Discomfort during sex
2. Unwitnessed expulsion
3. Adverse reactions

Question 23

How does Depo Provera work?

Answer 23

Progestin only

inhibits ovulation for more than 3 months

Question 24

5 Pros for Depo?

Answer 24

1. Increase compliance
2. No estrogen
3. Reduction in sickle cell pain
4. Fewer seizures
5. Treatment of endometriosis pain

Question 25

4 Cons for Depo?

Answer 25

1. takes longer to reverse 2. irregular cycles 3. weight gain 4. decreased bone marrow density

Question 26

What chemicals do the subdermal implants (implanon) release?

Answer 26

progestin only

Question 27

What are the pros for implants?

Answer 27

1. Fertility returns quickly 2. Increased compliance 3. doesn't affect bone marrow density

Question 28

What are the cons for implanon?

Answer 28

1. irregular bleeding 2. CI for pregnancy, liver disease, clots, breast cancer 3. Decreased efficacy in women >130% body weight

Question 29

Name the 2 intrauterine devices .

Answer 29

Paraguard - copper - stays in place for 10 years | Progestin only - Mirena (5 yrs) and Skyla (3 yrs)

Question 30

What are the 5 pros of intrauterine devices?

Answer 30

1. increased compliance 2. Less adverse effects from minimal systemic absorption 3. Immediate fertility return 4. Tx of heavy menstrual bleeding (Mirena) 5. No estrogen

Question 31

What are the 3 cons to intrauterine devices?

Answer 31

1. Increased risk of infection 2. break thru bleeding 3. CI to fibroids, uterine abnormalities, current PID

Question 32

Emergency contraception that is OTC?

Answer 32

Levonorgestrel (Plan B One-Step) - must be taken within 72 hours of unprotected sex - can be taken up to 120 hours (5 days)

Question 33

What is the Rx emergency contraception?

Answer 33

Ulipristal (Ella) - used for up to 120 hrs

Question 34

T/F. use back up contraception when on Abx for duration of Abx course + 7 days after course.

Answer 34

T