contraceptives Flashcards
MOA of both estogen and progestin
prevention of ovulation
How does estrogen change the endometrium?
stabilizes the lining → prevents irregular shedding and provides cycle control
How does progestin change the environment of the uterus?
increases viscocity of cervical mucus → inhibits sperm penetration
Three methods of Combined Hormonal Contraceptive
oral pil, transdermal patch, vaginal ring
what is the most common form of estrogen in COC, transdermal patch and the vaginal ring?
ethinyl estradiol
Pro of drospirenone and dienogest
bind primarily to progesterone receptors and have potential anti-adrenergic effects
Cons of earlier forms of progestin
bind to androgen receptors → side effects
Side effect seen if there is not enough estrogen in COC
early cycle spotting
side effects with too much estrogen
nausea and bloating, breast tenderness, headache, increased BP
Side effects with too little progestin
late cycle spotting
Side effcts of too much progestin
fatigue, breast tenderness, headache, mood changes
Side effects of too much androgen
acne, weight gain, hirsutism, increased LDL and decreased HDL
Which COC is FDA approved in treating acne?
4th generation progestin → drospirenone and dienogest
This COC has the same amount of estrogen and progestin in all the active tablets
monophasic
This COC has varying amounts of estrogen and progestin in the active tablets in attempt to minimize cumulative hormone doses and better mimic hormone levels throughout the menstrual cycle
multiphasic → biphasic, triphasic, quadriphasic
what are some things that COC products differ on?
type of estrogen, amount of estrogen, type of progestin, amount of progestin, androgenic activity, monophasic vs multiphasic, duration of cycle, number of active tablets, ethinyl estradiol in inactive tablets, iron or folate in inactive tablets
What do you consider when choosing an initial COC agent?
monophasic, product with < 35 mcg of EE and <0.5 mg norethindrone
What are the components of transdermal patch?
ethinyl estradiol and norelgestromin
How often does the patient have to reappy transdermal patch (ortho evra, xulane)?
every week and then a week off
Who is the transdermal patch not first line in?
women over 90kg
Black box warning for transdermal patch in comparision to COC?
increased risk of VTE → more exposure to estrogen than the pill
ADE for nuvargin (vaginal ring)
foreign body sensation, device expulsion, vaginal symptoms
what are the components of nuvaring?
ethinyl estradiol and etonogestrel
what are the components of annovera (other vaginal ring)?
ethinyl estradiol and segesterone
How does annovera differ from nuvaring?
provides contraception for a year → left in place for 21 days, removed for 1 week, SAME ring is reinserted
Who would benefit from annovera?
patient with little access to pharmacy
MOA of high dose progestin only contraceptive products → not the pills
prevents ovulation
MOA of all progestin containing products
increases viscocity of cervical mucus → inhibits sperm penetration
Four types of progestin only contraceptive
oral pills, injections, implants, IUD
In Progestin Only Mini Pills, what is the active compound and how should they be taken?
norethindrone
condinuously → no week off and AT THE SAME TIME EACH DAY (within 3 hr time)
Why do some women on POP sometime have unpredictable and irregular bleeding?
mayn women continue to ovulate normally
How often do you have to administer injectable depo provera (either IM or subQ)?
evey 3 months (13wks)
Do women ovulate with depo provera?
no → progestin dose is sufficient to inhibt
Most common ADE of depo provera
menstrual irregularities, weight gain, bone density loss
Injectable progestin can’t be used over 2 years due to this black box warning
bone density loss
What is the median time to conception from the first omitted dose of injectable progestin?
10 months
How long is etonogestrel implant effective?
3 years
ADE for etonogestrel implant?
not for women >130% IBW, menstrual irregularities, still susceptible to DDI (potent CYP450 inducers)
What are the differences between IUD?
amount of progestin released on daily basis and size
MOA of IUD
thickens cervical mucus, suppresses endometrium, inhibit sperm survival and migration
Do women ovulate with IUD?
yes
Is there a risk of infertility with IUD?
no
MOA of copper IUD
creates inflammatory reaction within the endometrium that interferes with sperm and fertilization; may prevent implantation (emergency contraception)
How long is the copper IUD effective?
10 years
what is a side effect seen with copper IUD?
increased menstrual blood flow
What should you check prior to prescribing combined hormonal contraceptive?
BP
What do you check prior to prescribing progestin only method?
none
what should you do prior to prescribing a IUD?
bimanual examination and cervical inspection
Which two contraceptive methods are the most effective?
inplants and IUD
What cardiovascular/cerebrovascular indications would you avoid a CHC in?
BP >160/>100, vascular disease, > 35 and smoke >15 cigs/day, ischemic heart disease, history of cerebrovascular accident, migraines with aura
What are the thrombolic risks that would make you avoid prescribing CHC in?
DVT/PE risk or history, major surgery resulting in prolonged immobilization, thrombogenic mutations, SLE, valvular heart disease
how does estrogen put patients at increased thromotic risk?
increases the hepatic production of factor VII, X and fibrinogen
Can women with breast cancer take a hormone contraceptive?
no → avoid all but IUD
How long should women wait postpartum before starting CHC?
21 days
what are some contraindications for an IUD?
pregnancy, cervical or endometrial cancer, PID, STD, TB, anatomical abnormalities
Which contraceptives should you be cautious with in heavier women?
impalnt, injectable (cause weight gain), transdermal patch, vaginal ring (annovera) all COC
you can start contraceptive method if it has been _____ days after menses onset and if they used back up method or abstain for ___ days
> 5-7 days
7 days
What adverse effects would you stop a contraceptive?
A - abdominal pain C - Chest pain H - headaches E - eye problems S - severe leg pain/stroke symptoms
what instructions should you give a patient with misses 2 or more dosese of COC (>48 hrs since first missed pill)?
take 2 pills that day and use back up for 7 days
If a patient has gone >48 hours without their patch or ring what should you do?
apply/insert a new one ASAP and used back up for 7 days
How long should you wait to refer a patient to a MD if they have amenorrhea after discontinuing contraceptive?
6 months
How do emergency contraceptive work?
interfere with ovulation or implantation of fertilizaed egg in endometrial lining
Preferred emergency contraceptive method in obese patients
copper IUD
MOA of levonogestrel (plan B)
inhibits or delays ovulation
This emergency contraceptive is available by prescription only and is selective progesterone receptor modulator thus delaying ovulation
ulipristal
