contraceptives Flashcards
methods to prevent ovulation
suppress LH and FSH release
prevent fluctuations in estrogen levels
method to impair implantation
maintain elevated progesterone by providing elevated progestin
combined OCP
estrogen + progestin
only 2 estrogens = ethinyl estradiol or mestranol
norethindrone
progestin
norgestrel
progestin
levonorgestrel
progestin
desogestrel
progestin
norgestimate
progestin
drospirenone
progestin
highest androgenic progestin
levonorgestrel
norgestrel
lowest androgenic progestin
norethindrone
3rd gen progestins with even less = desogestrel and norgestimate
antiandrogenic progestin
drospirenone
AE with low dose combined OCP
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
combined OCP MOA
prevent ovulation = suppress LH and FSH release
progestin = thicken cervical mucus - prevent sperm penetration - impair implantation
how does estrogen inc risk of CV risk
estrogen increases production of factor 7, 10, and fibrinogen = inc risk of thromboembolic events
OCP interactions
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
absolute contraindications of OCP
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
relative contraindications of OCP
migraine without aura HTN renal dz DM gallbladder dz cholestasis sickle cell lactation
progestin only pills benefit
no risk of thromboembolic events
decreased dysmenorrhea, dcreased blood loss and PMS
progestin only MOA
only block ovulation in 60-80% of cycles
mainly works to thicken mucus and impair implantation
progestin injection
contains depot medroxyprogesterone acetate
high enough levels of progestin to prevent ovulation and impair plantation
given every 3 months IM
depo AE
menstrual irregularities
weight gain
irreversible bone mineral density loss = black box warning
progestin implant
major AE = irregular menstrual bleeding
IUS
levonorgestrel
work for 5 years
emergency postcoital contraception
2 step
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
one step plan B
one tablet of levonorgestrel taken within 72 hours
Ella
ulipristal acetate
selective progesterone receptor modulator
inhibit/delays ovulation = can be taken within 5 days
available only by prescription
non-hormonal emergency postcoital
copper IUD
can be inserted within 5 days of intercourse
