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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
Q

Progestin only OC

A

Norgestrel - Ovrette

Norethindrone - Ortho Micronor, Nor QD

26
Q

Name 3 biphasic OC

A

Mircette (Desogestrel)

Jenest (Norethindrone)

Necon, Nevola, Ortho-Novum (Norethindrone)

27
Q

Name 3 triphasic OC

A

Ortho Tri Cyclin (EE 30) - Noregestimate
Ortho Tri Cyclin Lo (EE 25) - Norgestimate

Tri Levlin - Levonorgestrel

Cyclessa (Desogestrel)

28
Q

Contraindications for OC

A

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
Q

Drugs that reduces efficacy of OC

A

Rifampin (TB antibiotic)

Phenobarb, carbamazepine, phenytoin (Seizure meds)

30
Q

Estrogen (excess) ADRs

A

Headache

Breast tenderness

DVT, clot

Nausea

Dysmenorrhea, menorrhagia, uterine fibroid growth

31
Q

Progestin (excess) ADRs

A

Acne
Hirsutism

Increased appetite
weight gain
bloating 
constipation
fatigue
depression

(androgenic)

32
Q

Decreased estrogen effects

A

Vasomotor symptoms,

decreased libido

nervousness

Amenorrhea

early cycle BTB

33
Q

Decreased progestin effects

A

Dysmenorrhea, menorrhagia

Late cycle BTB

34
Q

OC efficacy w typical use

A

91%

35
Q

What to tell patient if one OC is late (<24 hr) or missed 24 - <48) hours

A
  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
Q

What to tell patient if 2 or more OC pills missed (> 48 hrs since a pill has been taken)

A
  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
Q

Ortho Evra Patch

A

Norelgestromin + EE

New patch every 3 weeks, no patch week 4

38
Q

Ortho Evra Patch problems

A

(Norelgestromin + EE)

Less effective in patients > 90kg

Higher estrogen exposure, higher clot risk

39
Q

Under which circumstances might a patient not be protected from pregnancy w the patch

A
  1. Forgets to change patch at beginning of new cycle

2. No patch for > 2 days

40
Q

Nuvaring + Side effects

A

Etonogestrel + EE

In place 3 weeks

Vaginal irritation, infections, secretions

41
Q

POP pills

A

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
Q

Depo Provera, use

A

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
Q

Depo Provera ADRs

A

Irregular bleeding

Breast tenderness

Bone Loss - need calcium and VD3

44
Q

Implants, use

A

Implanon (Etonogestrel) 3 years

  1. 9% effective if implanted correctly
    • may be less effective for obese women*

Reversible
Doesn’t affect bones

45
Q

Implants ADRs

A

Irregular bleeding

Headache, vaginitis, weight gain, acne, breast tenderness

46
Q

5 methods for emergency contraception

A

** Must be used within 5 days of unprotected sex **

Yuzpe Method

Levonorgestrel (Plan B)

Ulipristal (Ella)

Mifepristone

Cu - IUD

47
Q

Yuzpe method

A

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
Q

Ulipristal acetate (Ella)

A

Inhibits / delays ovulation

Take one tablet within 120hrs of intercourse

Rx only - more effective than levonorgestrel

ADRs
nausea, vomiting, headache, acne, dysmenorrhea

49
Q

Levonorgestrel (Plan B)

A

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
Q

Mifepristone

A

“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
Q

What to watch for after administering Mifepristone

A

Watch for sepsis

N/V/D, weakness, abdo pain
fever
cbc

PHARM II, QUIZ 1 (2 decks)

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