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Pharm II Exam 2 > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

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.

A

progesterone
FSH
LH

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2
Q

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

A

Ethinyl estradiol (EE) 10-50 micrograms

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3
Q

list 5 AEs of EE.

A

VTE
MI stroke
HTN
Migraine

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4
Q

What provides majority of contraceptive effect in COCs?

A

Progestin

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5
Q

name 3 AEs for progestin.

A

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

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6
Q

What is the primary MOA for COCs?

A

Suppression of ovulation

Thickens cervical mucus

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7
Q

Describe the difference between mono and multiphasic COC.

A

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

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8
Q

What are the extended cycle COCs?

A

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

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9
Q

Name 4 pros to COCs.

A
  1. Better cycle control
  2. light menses
  3. less AEs - cramping, acne
  4. Decreased days of bleeding
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10
Q

What is the major disadvantage to COCs?

A

greater risk of adverse effects 2/2 estrogen component

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11
Q

Name 7 contraindications to COC.

A
  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
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12
Q

Progestin does/does not contain inactive pills.

A

Does not contain inactive pills

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13
Q

What are the 2 indications for progestin only pills?

A
  1. CI to COC

2. Lactating women

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14
Q

Name 3 pros to progestin only pills?

A
  1. May increase libido
  2. Decrease risk of VTE
  3. Excellent for patients with light menses
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15
Q

Name 4 cons to progestin only pills.

A
  1. Must take everyday at same time
  2. Weight gain
  3. More break thru bleeding
  4. Small inc risk of ectopic pregnancy
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16
Q

Symptoms of serious AEs of OCPs?

A 
Abdomen pain
Chest pain
HA
eye problems
severe leg pain
17
Q

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

A

MORE - bypass first pass metabolism

18
Q

Name the 2 pros of transdermal OCs.

A
  1. Improved compliance

2. Quick therapeutic levels.

19
Q

Name the 4 cons to transdermal OCs?

A
  1. Can’t use in women weighing >198#
  2. Increased risk of clot
  3. Patch displacement
20
Q

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

A

Combined estrogen and progestin

21
Q

3 Pros for vaginal rings (Nuvaring)?

A
  1. Increased compliance
  2. Low incidence of break thru bleeding
    3, Precise placement not necessary
22
Q

Cons for vaginal rings.

A
  1. Discomfort during sex
  2. Unwitnessed expulsion
  3. Adverse reactions
23
Q

How does Depo Provera work?

A

Progestin only

inhibits ovulation for more than 3 months

24
Q

5 Pros for Depo?

A
  1. Increase compliance
  2. No estrogen
  3. Reduction in sickle cell pain
  4. Fewer seizures
  5. Treatment of endometriosis pain
25
Q

4 Cons for Depo?

A
  1. takes longer to reverse
  2. irregular cycles
  3. weight gain
  4. decreased bone marrow density
26
Q

What chemicals do the subdermal implants (implanon) release?

A

progestin only

27
Q

What are the pros for implants?

A
  1. Fertility returns quickly
  2. Increased compliance
  3. doesn’t affect bone marrow density
28
Q

What are the cons for implanon?

A
  1. irregular bleeding
  2. CI for pregnancy, liver disease, clots, breast cancer
  3. Decreased efficacy in women >130% body weight
29
Q

Name the 2 intrauterine devices .

A

Paraguard - copper - stays in place for 10 years

Progestin only - Mirena (5 yrs) and Skyla (3 yrs)

30
Q

What are the 5 pros of intrauterine devices?

A
  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
31
Q

What are the 3 cons to intrauterine devices?

A
  1. Increased risk of infection
  2. break thru bleeding
  3. CI to fibroids, uterine abnormalities, current PID
32
Q

Emergency contraception that is OTC?

A

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

33
Q

What is the Rx emergency contraception?

A

Ulipristal (Ella) - used for up to 120 hrs

34
Q

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

A

T

Pharm II Exam 2 (8 decks)

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