contraceptives

Question 1

methods to prevent ovulation

Answer 1

suppress LH and FSH release

prevent fluctuations in estrogen levels

Question 2

method to impair implantation

Answer 2

maintain elevated progesterone by providing elevated progestin

Question 3

combined OCP

Answer 3

estrogen + progestin

only 2 estrogens = ethinyl estradiol or mestranol

Question 4

norethindrone

Answer 4

progestin

Question 5

norgestrel

Answer 5

progestin

Question 6

levonorgestrel

Answer 6

progestin

Question 7

desogestrel

Answer 7

progestin

Question 8

norgestimate

Answer 8

progestin

Question 9

drospirenone

Answer 9

progestin

Question 10

highest androgenic progestin

Answer 10

levonorgestrel

norgestrel

Question 11

lowest androgenic progestin

Answer 11

norethindrone

3rd gen progestins with even less = desogestrel and norgestimate

Question 12

antiandrogenic progestin

Answer 12

drospirenone

Question 13

AE with low dose combined OCP

Answer 13

higher risk of failure with missed dose

nausea, bloating, breakthrough bleeding that improves by 3rd cycle

breakthrough bleeding - bigger problem with lower dose regimens

HA, migraines - should stop if get migraine

insulin resistance - progestin can cause insulin resistance

hirsutism = common with androgen progestins

melasma = estrogen stimulates melanocytes

dyslipidemia

CV risk = more common in women who smoke and >35

Question 14

combined OCP MOA

Answer 14

prevent ovulation = suppress LH and FSH release

progestin = thicken cervical mucus - prevent sperm penetration - impair implantation

Question 15

how does estrogen inc risk of CV risk

Answer 15

estrogen increases production of factor 7, 10, and fibrinogen = inc risk of thromboembolic events

Question 16

OCP interactions

Answer 16

rifampin - P450 inducer = increases metabolism of estrogen

carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate, vigabatrin, St. John’s wort

Abx = ethinyl estradiol conjugated in liver and hydrolyzed by intestinal bacteria - some broad spec abx may affect this

Question 17

absolute contraindications of OCP

Answer 17

pregnancy
thrombophlebitis
CVA/CAD
breast CA
undx vaginal bleeding
estrogen dependent CA
liver benign/malignant tumors
uncontrolled HTN
DM with vascular dz
active hepatitis
surgery/prolonged immobilization
migraine with aura

Question 18

relative contraindications of OCP

Answer 18

migraine without aura
HTN
renal dz
DM
gallbladder dz
cholestasis
sickle cell
lactation

Question 19

progestin only pills benefit

Answer 19

no risk of thromboembolic events

decreased dysmenorrhea, dcreased blood loss and PMS

Question 20

progestin only MOA

Answer 20

only block ovulation in 60-80% of cycles

mainly works to thicken mucus and impair implantation

Question 21

progestin injection

Answer 21

contains depot medroxyprogesterone acetate

high enough levels of progestin to prevent ovulation and impair plantation

given every 3 months IM

Question 22

depo AE

Answer 22

menstrual irregularities
weight gain
irreversible bone mineral density loss = black box warning

Question 23

progestin implant

Answer 23

major AE = irregular menstrual bleeding

Question 24

IUS

Answer 24

levonorgestrel

work for 5 years

Question 25

emergency postcoital contraception

2 step

Answer 25

2 tablets of levonorgestrel
first tablet taken with 72 hours
second tablet - 12 hours later

PREVENTION OF IMPLANTATION ONLY - (thats why only progestin)

AE: n/v

Question 26

one step plan B

Answer 26

one tablet of levonorgestrel taken within 72 hours

Question 27

Ella

Answer 27

ulipristal acetate
selective progesterone receptor modulator

inhibit/delays ovulation = can be taken within 5 days

available only by prescription

Question 28

non-hormonal emergency postcoital

Answer 28

copper IUD

can be inserted within 5 days of intercourse