Contraceptives Flashcards
What are the three Estrogens used for oral contraceptives?
Ethinyl estradiol
Mestranol
Estradiol valerate
What is the MOA of Estrogens?
Influence gene transcription
Cycle control
Stabilize the endometrium
Minimizes irregular shedding
What effect(s) does estrogen have on the reproductive system?
Female Sexual Maturation
Endometrial Growth
Breast Tissue Stimulation
What effect(s) does estrogen have on the hematologic system?
Increased tendency for clotting
What effect(s) does estrogen have on the skin/mucosa?
Increased pigmentation
Increased skin collagen content/thickness
Maintenance of skin moisture
What effect(s) does estrogen have on the metabolic state of the body?
Increases HDL
Decreases LDL
Increases Triglycerides
Decreases bone re-absorption
What are some indications for estrogen use?
There are FIVE
- Contraception
- Menopausal hormone replacement therapy
- Endometriosis
- Dysfunctional Uterine Bleeding
- Prevention of osteoporosis
Estrogen is used to treat the _________ symptoms menopause
Vasomotor
T/F: Estrogen is used to treat osteoporosis
False
It is used to prevent it
What are contraindication for estrogen use?
There are FOUR
- Clotting Disorders
- Un-diagnosed abnormal genital bleeding (already went through menopause and bled again)
- Breast CA
- Pregnancy
What first generation progesterones are used as OCPs?
- Steroids (with similar activity to progesterone)
- Megestrol Acetate
- Medroxyprogesterone acetate
What second generation progesterones are used as OCPs?
- Norethindrone
2. Ethynodial
What third generation progesterones are used as OCPs?
- Norgestrel
- Levonorgestrel
- Desogestrel
- Norgestimate
- Dienogest
What is the nonsteriodal progesterone are used as OCPs?
Drospirenone
What is a Drospirenone derived from?
Spironolactone
What are the indications for Progesterone use?
- Secondary Amenorrhea (PMS)
- HRT
- Cervical Ripening (helps deliver babies)
- Infertility
T/F: Progesterones are metabolized by 3A4
True
What is the MOA of progesterones?
Directly modify RNA synthesis and influences gene transcription
What effects do progesterones have on the reproductive system?
- Determines onset of menstruation
- Changes endocervical gland secretion from watery to viscous
- Maintains pregnancy
How does the progesterone effect of changing endocervical secretion from watery to viscous prevent pregnancy?
Prevent sperm entry into the uterus
What effects does progesterone have on the metabolic system?
- Increases insulin secretion and resistance peripherally
- Increases Lipase activity
- May increase fat deposits
- Increased LDL
- Decreases HDL
What are indications for progesterone use?
- Contraception
- Post-menopausual HRT
- Dysfunctional Uterine Bleeding
- Pregnancy Maintenance
Should progesterone be used in a patient with a clotting disorder?
No
It is contraindicated as it increases the risk for clotting
Other than clotting disorders, what are 4 additional contraindications of progesterone use?
- Severe Migraines
- Unexplained vaginal bleeding
- Breast CA
- Active Liver Disease
What are the ADRs associated with Estrogen use?
- Nausea
- Headache
- Breast Tenderness
What are the ADRs associated with Progesterone use?
- Acne
- Hirsutism
- Increased LDL
- DVT
- Vaginal Bleeding
- Bone loss (specifically with DMPA)
T/F: Estrogen inhibits FSH release
True
_______ oral contraception involves taking 21 days of estrogen-progestin pills followed by 7 days of placebo pills
Monophasic
________ oral contraception involves taking varying concentrations of estrogen at different times during the cycle
Multiphasic
______ _____ oral contraception involves taking 84 active pills and 7 placebo pills.
Extended cycle
Estrogen doses vary from __ mcg to __ mcg
10 mcg to 50 mcg
What are the contraindications for OCP use?
Theres a lot
- History of Stroke/Clot
- Valvular Disease
- Diabetes (with vascular involvement)
- Migraine with Aura
- Uncontrolled HTN
- Breast CA
- Liver Disease
- Pregnancy
Should OCP be used in patient older than 35 who is smoking more than half a pack a day?
No
A patient is 5 weeks post-partum and currently breast-feeding, are OCP safe to start?
No
Contraindicated < 6 weeks post-partum
What ADRs are associated with OCP use?
- Breakthrough Bleeding
- Headache
- Breast Tenderness
- DVT (Clotting)
- Nausea
- Acne
- Hirsutism
Nausea, Breast Tenderness, Cyclic Weight Gain, and Menorrhagia are all symptoms of what?
Excess Estrogen
Vasomotor symptoms, nervousness, and decreased libido are all symptoms of what?
Estrogen Deficiency
Increased appetite, bloating, constipation, acne, hirsutism, and oily skin are all symptoms of what?
Excess Progesterone
Late cycle breakthrough bleeding and menorrhagia are both symptoms of what?
Progesterone Deficiency
What drugs interact with OCPs?
- Rifampin
- Phenobarb, Phenytoin
- Tetracycline
- Penicillin
Does missing a dose of your OCP increase of decrease efficacy?
Decrease
T/F: If you forget to take your OCP on time however it is less than 24 hours it should NOT be taken
False
it can still be taken
When is an OCP dose considered to be missed?
Greater than 24 hrs since dose should have been taken
What estrogen and third generation progesterone compose the Ortho Evra Patch?
Ethinyl Estradiol
Norelgestromin
T/F: The clot risk with the ORtho Evra Patch is half that when compared to OCPs
False
Twice the risk
What first generation progesterone is used in Depo-Provera (DMPA)?
Medroxyprogesterone acetate
DMPA prevents ovulation for __ months
3
What is the most common ADR of DMPA?
Irregular Menstrual bleeding
What reversible ADR is with DMPA use?
Decreased Bone Mass Density
This will reverse when the drug is stopped
What estrogen and second generation progesterone are recommend for contraception in women with NO medical conditions?
Ethinyl Estradiol
Norethindrone
How long should you wear the Ortho Evra Patch?
3 weeks (then replace with new patch)
Is the Ortho Evra Patch more or less effective in patient with a BMI > 25
Less Effective
There is a greater than 2x risk of unintended pregnancy
Etonogestrel and Ethinyl Estradiol are compound used in this IUD contraceptive device
Nuvaring
The Nuvaring should be left inplace for 3 weeks before being removed, when should a new one be place?
1 week after removal
What ADRs are seen with the Nuvaring?
Vaginal irritation, infection, secretions
Norethindrone is a ______ only pill
Progesterone
T/F: Norethindrone is safe in breast feeding and is often used post-partum
True
Implanted contraceptive devices such as the Nexplanon use ________
Etonogestrel
What is the major ADR of a Nexplanon (Etonogestrel)?
What additional ADRs can be seen?
Irregular Bleeding
Headache Vaginitis Weight Gain Acne Breasr Pain
What are “back up” contraception methods?
- Abstinence
- Condom
- Spermicide
- Diaphragm
- Cervical Cap
- Sponges
Emergency contraception should be used within __ days of unprotected sex
5 days
This emergency contraception method uses Ethinyl Estradiol and Levonorgestrel
Yuzpe Method
What ADRs are seen with the Yuzpe Method
Nausea
Vomiting
How does Ulipristal Acetate (Ella) work?
Inhibits or delays ovulation
What ADRs are seen with Ulipristal Acetate (Ella)?
Headache Nausea Abdominal Pain Dysmenorrhea Fatigue Dizziness Acne
T/F: Ulipristal Acetate (Ella) can be purchased OTC
False
What progesterone is used in Plan B?
Levonorgestrel
What is the primary MOA of Plan B?
Secondary?
Primary: Inhibits or delays ovulation
Secondary: Prevents Fertilization
T/F: Plan B is effective if implantation has occurred
False
What ADRs are seen with Plan B?
Irregular Menses Nausea Abdominal Pain Fatigue Headache Dizziness Breast tenderness
T/F: Plan B is available OTC
True
What test should be obtained prior to administering or prescribing emergency contraception
Pregnancy Test
What is also known as the “Abortion Pill”?
Mifepristone (Korlym)
T/F: Mifepristone (Korlym) is metabolized by P450
True
What is a concerning condition to look for following an abortion using Mifepristone (Korlym)?
Sepsis
What is in place in NC that allows providers to refuse prescribing medication to induce or preforming abortions?
Conscience Clause
