Contraceptives Flashcards
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.
progesterone
FSH
LH
What hormone is is almost all combined oral contraceptives (COC)?
Ethinyl estradiol (EE) 10-50 micrograms
list 5 AEs of EE.
VTE
MI stroke
HTN
Migraine
What provides majority of contraceptive effect in COCs?
Progestin
name 3 AEs for progestin.
Androgenic adverse effects
VTE (4th generation)
worsening lipid panel
What is the primary MOA for COCs?
Suppression of ovulation
Thickens cervical mucus
Describe the difference between mono and multiphasic COC.
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
What are the extended cycle COCs?
21-84 days of hormone containing pills, then 7-day placebo
Name 4 pros to COCs.
- Better cycle control
- light menses
- less AEs - cramping, acne
- Decreased days of bleeding
What is the major disadvantage to COCs?
greater risk of adverse effects 2/2 estrogen component
Name 7 contraindications to COC.
- Migraines with aura (w/o in >35)
- Age >35 and heavy smoker
- Anything that predisposes to DVTs
- Breast cancer
- Heart failure or uncontrolled HTN
- Liver disease
- Post-patrum
Progestin does/does not contain inactive pills.
Does not contain inactive pills
What are the 2 indications for progestin only pills?
- CI to COC
2. Lactating women
Name 3 pros to progestin only pills?
- May increase libido
- Decrease risk of VTE
- Excellent for patients with light menses
Name 4 cons to progestin only pills.
- Must take everyday at same time
- Weight gain
- More break thru bleeding
- Small inc risk of ectopic pregnancy
Symptoms of serious AEs of OCPs?
Abdomen pain Chest pain HA eye problems severe leg pain
Patients using a transdermal contraceptive are exposed to more/less estrogen than typical OC.
MORE - bypass first pass metabolism
Name the 2 pros of transdermal OCs.
- Improved compliance
2. Quick therapeutic levels.
Name the 4 cons to transdermal OCs?
- Can’t use in women weighing >198#
- Increased risk of clot
- Patch displacement
How do the patches and vaginal rings work (what is in them)?
Combined estrogen and progestin
3 Pros for vaginal rings (Nuvaring)?
- Increased compliance
- Low incidence of break thru bleeding
3, Precise placement not necessary
Cons for vaginal rings.
- Discomfort during sex
- Unwitnessed expulsion
- Adverse reactions
How does Depo Provera work?
Progestin only
inhibits ovulation for more than 3 months
5 Pros for Depo?
- Increase compliance
- No estrogen
- Reduction in sickle cell pain
- Fewer seizures
- Treatment of endometriosis pain
4 Cons for Depo?
- takes longer to reverse
- irregular cycles
- weight gain
- decreased bone marrow density
What chemicals do the subdermal implants (implanon) release?
progestin only
What are the pros for implants?
- Fertility returns quickly
- Increased compliance
- doesn’t affect bone marrow density
What are the cons for implanon?
- irregular bleeding
- CI for pregnancy, liver disease, clots, breast cancer
- Decreased efficacy in women >130% body weight
Name the 2 intrauterine devices .
Paraguard - copper - stays in place for 10 years
Progestin only - Mirena (5 yrs) and Skyla (3 yrs)
What are the 5 pros of intrauterine devices?
- increased compliance
- Less adverse effects from minimal systemic absorption
- Immediate fertility return
- Tx of heavy menstrual bleeding (Mirena)
- No estrogen
What are the 3 cons to intrauterine devices?
- Increased risk of infection
- break thru bleeding
- CI to fibroids, uterine abnormalities, current PID
Emergency contraception that is OTC?
Levonorgestrel (Plan B One-Step) - must be taken within 72 hours of unprotected sex - can be taken up to 120 hours (5 days)
What is the Rx emergency contraception?
Ulipristal (Ella) - used for up to 120 hrs
T/F. use back up contraception when on Abx for duration of Abx course + 7 days after course.
T
