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PHARM II, QUIZ 1 > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

How does estrogen increase tendency for clotting?

A

It increases circulating levels of vitamin K dependent clotting factors

2, 7, 9, 10

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2
Q

How does estrogen affect bone metabolism?

A

Decreases bone resorption via antagonism of parathyroid hormone (PTH) and IL-6

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3
Q

How does estrogen affect cholesterol?

A

Increases HDL, triglycerides

Decreases LDL

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4
Q

Indications for prescribing estrogen?

A

Contraception (only in combination w progesterone)

HRT - decreases vasomotor symptoms

Osteoporosis prevention

Endometriosis treatment

Dysfunctional uterine bleeding*

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5
Q

Contraindications for prescribing estrogen?

A

Pregnancy

Undiagnosed genital bleeding

Hx breast cancer

Hx MI, stroke, DVT, PE

LIVER DYSFUNCTION

Protein C or S deficiency etc

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6
Q

A few ways in which progesterone is different from estrogen

A

More bioavailable in oral form

Highly protein bound

Metabolized by 3A4 (ketoconazole)

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7
Q

Indications for Progesterone

A

Secondary amenorrhea

PMS

Infertility

DUB, HRT

Mastodynia

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8
Q

Which generation of progesterones has less androgenic effects. Gives a few examples.

A

Third Generation:

Levo-norgestrel
Desogestrel
Norgestimate

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9
Q

Which progestin is nonsteroidal

A

Drospirenone

derived from spironolactone

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10
Q

first generation progestins (2)

A

Depo-provera (bone loss!)

Megace

not used in OC

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11
Q

2nd gen progestins (2)

A

Norethindrone (Aygestin) (NorETHIN is SECOND)

Ethynodiol

Used in OC

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12
Q

Progestin MOA

A

Directly modifies RNA synthesis

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13
Q

Reproductive effects of progestin

A

Decline initiates menstruation

Changes CM from watery to visous (less fertile)

Maintains pregnancy

Increased BBT w pre-ovulatory surge

Mild sedative

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14
Q

Metabolic effects of progestin

A

Increased insulin secretion and resistance

Increased lipase activity

Increased LDL, decreased HDL

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15
Q

Progestin contraindications

A

Risk or Hx of DVT, PE

Severe migraine

Breast cancer

Liver disease

Unexplained vaginal bleeding

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16
Q

Progestin ADRs

A

Androgenic activity

DVT

Vaginal Bleeding

Bone Loss (Depo provera)

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17
Q

How does progestin work as a contraceptive?

A

Inhibits LH surge, so no ovum is released

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18
Q

high dose OC

A

Ovcon 50 (Norethindrone)

Ogestrel 5/50 (Norgestrel)

Zovia 1/50 (Ethynodial diacetate)

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19
Q

Low dose Levonogestrel OC

A

Levien, Levora

EE 30 mcg

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20
Q

Low dose Norethindrone OC

A

Necon 1/35
Nevola 1/35
Notrel 1/35

Necon 0.5/35
Nevola 0.5/35
Notrel 0.5/35

Ovcon 35

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21
Q

Low dose Ethynodial Diacetate OC

A

Zovia 1/35

22
Q

Low dose Drospirenone OC

A

Yasmin (30)

23
Q

Low dose Norethindrone acetate OC

A

Loestrin / Microgestin 1.5 / 30

24
Q

ULTRA low dose OC

A

Norethindrone acetate, Loestrin/Microgestin 1/20

Levonogestrel 0.1mg Alesse, Avian, Levlite

25
Progestin only OC
Norgestrel - Ovrette Norethindrone - Ortho Micronor, Nor QD
26
Name 3 biphasic OC
Mircette (Desogestrel) Jenest (Norethindrone) Necon, Nevola, Ortho-Novum (Norethindrone)
27
Name 3 triphasic OC
Ortho Tri Cyclin (EE 30) - Noregestimate Ortho Tri Cyclin Lo (EE 25) - Norgestimate Tri Levlin - Levonorgestrel Cyclessa (Desogestrel)
28
Contraindications for OC
Hx thromboembolic . thrombogenic events (clot, stroke, DVT, PE, valvular) Diabetes w vascular involvement Uncontrolled HTN Migraine w aura Hx breast cancer Liver disease Pregnant / breastfeeding <6 weeks postpartum ** Age >35 smoker **
29
Drugs that reduces efficacy of OC
Rifampin (TB antibiotic) Phenobarb, carbamazepine, phenytoin (Seizure meds)
30
Estrogen (excess) ADRs
Headache Breast tenderness DVT, clot Nausea Dysmenorrhea, menorrhagia, uterine fibroid growth
31
Progestin (excess) ADRs
Acne Hirsutism ``` Increased appetite weight gain bloating constipation fatigue depression ``` (androgenic)
32
Decreased estrogen effects
Vasomotor symptoms, decreased libido nervousness Amenorrhea **early cycle BTB**
33
Decreased progestin effects
Dysmenorrhea, menorrhagia ***Late cycle BTB***
34
OC efficacy w typical use
91%
35
What to tell patient if one OC is late (<24 hr) or missed 24 - <48) hours
1. Take late or missed pill ASAP 2. Continue remaining pills at usual time - even if taking 2 pills in one day 3. *No additional contraceptive method needed*
36
What to tell patient if 2 or more OC pills missed (> 48 hrs since a pill has been taken)
1. Take most recent missed pill ASAP 2. Discard other missed pills 3. Continue remaining pills at usual time 4. ** Use backup contraception or avoid intercourse until pill has been taken for 7 days** If pills were missed in last 15-21 days (last hormonal) of 28 day cycle: 1. Omit hormone free pills 2. Start new pack 3. Use backup contraception ** Consider emergency contraception, esp if hormonal pills were missed in first week **
37
Ortho Evra Patch
Norelgestromin + EE New patch every 3 weeks, no patch week 4
38
Ortho Evra Patch problems
(Norelgestromin + EE) Less effective in patients > 90kg Higher estrogen exposure, higher clot risk
39
Under which circumstances might a patient not be protected from pregnancy w the patch
1. Forgets to change patch at beginning of new cycle | 2. No patch for > 2 days
40
Nuvaring + Side effects
Etonogestrel + EE In place 3 weeks Vaginal irritation, infections, secretions
41
POP pills
Norethindrone Camila, Errin, Heather, Jolivette, Micronor, Nor QD, Nora BE **Used postpartum, breastfeeding ok** **Can start any time in cycle* use backup if started > 5 days in cycle**
42
Depo Provera, use
94% efficacy Given within 5 days of cycle start Long acting, prevents ovulation for 3 months Can use 30 days after delivering in breastfeeding women
43
Depo Provera ADRs
Irregular bleeding Breast tenderness **Bone Loss** - need calcium and VD3
44
Implants, use
Implanon (Etonogestrel) 3 years 99. 9% effective if implanted correctly * may be less effective for obese women* Reversible Doesn't affect bones
45
Implants ADRs
Irregular bleeding Headache, vaginitis, weight gain, acne, breast tenderness
46
5 methods for emergency contraception
** Must be used within 5 days of unprotected sex ** Yuzpe Method Levonorgestrel (Plan B) Ulipristal (Ella) Mifepristone Cu - IUD
47
Yuzpe method
decreases pregnancy rate 2/100 100mg EE + 0.5 levonorgestrel First dose within 72 hrs intercourse Second dose 12 hrs after first dose ADRs Nausea Vomitting
48
Ulipristal acetate (Ella)
Inhibits / delays ovulation Take one tablet within 120hrs of intercourse Rx only - more effective than levonorgestrel ADRs nausea, vomiting, headache, acne, dysmenorrhea
49
Levonorgestrel (Plan B)
Inhibits / delays ovulation Prevents fertilization - by impairing semen transport and corpus luteum function Not effective if woman already pregnant. 1st dose 72 hours after intercourse 2nd dose 12 hours after 1st dose *May work as long as 120 hours after intercourse* ADRs **Higher incidence of ectopic pregnancy** ``` Nausea Abdo pain Fatigue Headache Dysmenorrhea ```
50
Mifepristone
"RU-486" - abortion pill Progesterone and cortisol receptor antagonist Ends early pregnancy, up to 70 days after first day of last menstrual period 97% effective 1st dose given at office Misoprostol given 2 days later, at home - to empty uterus
51
What to watch for after administering Mifepristone
Watch for sepsis N/V/D, weakness, abdo pain fever cbc

PHARM II, QUIZ 1 (2 decks)

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