Contraceptives

Question 1

what are the two types of estrogen that are seen in oral contraceptives and mention their activity

Answer 1

• ethinyl estradiol: pharmacologically active

- mestranol: converted by the liver to ethinyl estradiol

Question 2

what are the progestins in oral contraceptives

Answer 2

LMNNNDD

Levonorgestrel
Medroxyprogesterone
Norethindrone
Norgestimate
Norgestrel
Desogestrel
Drospirenone

Question 3

how do the progestins in OC differ

Answer 3

• based on their androgenic activity
• Levonorgestrel and Norgestrel have the highest androgenic activity
• Desogestrel and Norgestimate have lower androgenic activity
• Drospirenone has anti androgenic effect

Question 4

what is the combined oral contraceptive most commonly used today and what does it contain

Answer 4

“low dose” combined oral contraceptive and it contains 35 microgram of ethinyl estradiol or less

Question 5

what do most formulation of OC have

Answer 5

21 hormonally active pills followed by 7 placebo pills to allow for withdrawal bleeding

Question 6

mechanism of combined oral contraceptive

Answer 6

• prevents ovulation by suppressing LH and FSH release
• progestin thickens cervical mucus so sperm cannot penetrate
• induces changes in endometrium so that implantation is unlikely

Question 7

when can women start taking OC and be immediately protected

Answer 7

• anywhere from Day 1 to 5 of her period –> immediate protection unless cycle is less than 23 days
• if that’s the case then must be taking pill for at least 7 days for protection to begin

Question 8

non contraceptive benefits of OC

Answer 8

• reduction in endometrial cancer risk
• reduction in ovarian cancer risk
• regulation of menses
• prevent ovarian cysts
• relief of benign breast cancer
• reduced risk for symptomatic PID
• improve acne control

Question 9

AE of OC and how it can be avoided

Answer 9

BHAIM

Breakthrough Bleeding (most common)
Hirsutism
Amenorrhea
Insulin Resistance (progestin competes for its receptors)
Melasma (brown gray patches on face)

adjust estrogen/progestin content of OC

Question 10

the AE hirsutism is associated with which contraceptives

Answer 10

those with androgenic properties so main ones – Levonorgestrel and Norgestrel

Question 11

most serious AE of OC though very rare

Answer 11

cardiovascular disorders such as thromboembolism, hypertension etc

Question 12

what drugs taken concomitantly with OC can cause OC failure and why

Answer 12

CYP450 inducer such as RIFAMPIN, Carbamazepine, Oxycarbazepine, Phenytoin, Phenobarbitol, Topiramate, and St. John’s Wort

-the increase the metabolism of estrogen hence failure of the OC

Question 13

how does Rifampin as an antibiotic affect circulating estrogen (other than being a CYP450 inducer)

Answer 13

decreases intestinal bacteria needed to hydrolyze ethinyl estradiol –> its reabsorption as an active drug

Question 14

absolute contraindications of OC

Answer 14

• Pregnancy
• Thromboembolic or Thrombophlebitis disorder
• Breast Cancer
• Undiagnosed abnormal vaginal bleeding
• Stroke or CAD
• Estrogen Dependent Cancer
• Tumor of liver
• Migraine with aura
• DM with vascular disease
• Uncontrolled hypertension
• Older than 35 and smoke heavily
• Surgery requiring prolonged immobility
• Active hepatitis

Question 15

what is given to women who can’t take estrogen containing OC and give example

Answer 15

progestin-only contraceptives called minipills –> norethindrone or norgestrel

Question 16

disadvantage of taking mini pills (name them)

Answer 16

norethindrone or norgestrel

they are less effective and must be taken at same time every day

Question 17

who is most likely to take progestin only OC (name them)

Answer 17

norethindrone or norgestrel

• if increased risk of thromboembolic event
• over 35 and smoke

Question 18

mechanism of progestin only OC (name what they contain)

Answer 18

norethindrone or norgestrel

• thickening of cervical mucus –> sperm cant penetrate
• endometrial alteration –> impair implantatio

Question 19

when can woman take progestin only OC and be immediately protected

Answer 19

Day 1-5 of period unless cycle 23 days or less –> must then take pill for at least two days before protection (compare to estrogen OC where must take 7 days)

Question 20

what does the contraceptive patch and ring contain

Answer 20

ethinyl estradiol and a progestin

Question 21

what is Depo-provera and its main mechanism

Answer 21

progestin only injectable contraceptive that contains depot medroxyprogesterone acetate (DMPA) –> high enough progesterone that it causes negative feedback

Question 22

AE of depo provera

Answer 22

significant loss of bone mineral density

Question 23

what is subdermal progestin implant

Answer 23

implant containing only progestin that is placed just under the skin of upper arm and is effective for 3 years

Question 24

what is intrauterine systems

Answer 24

contraceptive that contains levonorgestrel and lasts for 5 years

Question 25

what can diaphragm and cervical caps lead to if left longer than 24-48 hours

Answer 25

toxic shock syndrome

used together with spermicides to prevent pregnancy

Question 26

what is the name of the spermicide

Answer 26

nonoxynol-9

Question 27

what is Plan B and One choice

Answer 27

used after unprotected sex to prevent pregnancy

-contain levonorgestrel: 1st taken within 72 hours and next 12 hours later

available over the counter for those 17 and older

Question 28

what is Ella

Answer 28

tablet taken within 5 days of unprotected sex to prevent pregnancy

-contains Ulipristal acetate, progesterone antagonist, to inhibit or delay ovulation