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Therapeutics II > contraceptives > Flashcards

contraceptives Flashcards

1
Q

what are the period abstinence methods used for contraception

A
  • abstinence
  • coitus interruptus
  • fertility awareness based methods
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2
Q

what are fertility awareness based methods of contraception?

A
  • standard days methods- avoid sex while ovulating
  • cervical mucous method- avoid when mucus present
  • basal body temp method- BBT increases with ovulation
  • symptothermal method- BBT + cervical mucuous
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3
Q

what are different mechanical barriers

A
  • male condom
  • female condom
  • diaphragm
  • cervical cap
  • sponge
  • spermicide
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4
Q

what mechanical barrier is most effective against STI

A
  • male condoms
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5
Q

what is a diaphragm

A
  • shallow cup shaped like saucer
  • made of silicone
  • covers cervix to present fertilization
  • must be used with spermicide
  • lasts 2 years, can be put in prior to intercourse
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6
Q

cons to diaphragm use

A
  • must be measured
  • requires skill to place
  • no STI protection
  • must be refitted after pregnancy
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7
Q

what is a cervical cap

A
  • cap that covers the cervix
  • put in before intercourse, reusable
  • requires spermicide
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8
Q

cons to cervical cap use

A
  • must have pelvic exam and measurement
  • must be refitted after pregnancy
  • no STI protection
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9
Q

wat is a sponge?

A
  • foam disk placed against cervix
  • contains spermicide
  • can be inserted 24 hours prior to sex
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10
Q

cons to sponge use

A
  • can cause irritation
  • cant use in sulfa allergy
  • no STI protection
  • one time use
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11
Q

spermicides

A
  • stop sperm from moving
  • come as cream, foam, gel or suppositories
  • used with other barrier methods
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12
Q

copper IUD

A
  • non-hormonal
  • enhances cytotoxic inflammatory response in endometrium
  • impairs sperm migration, viability, acrosomal rxn, and implantion
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13
Q

benefits of copper IUDs

A
  • may be used as emergency contraception within 5 days
  • non-hormonal
  • last 10 years
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14
Q

disadvantages of copper IUDs

A
  • heavy menses

- dysmenorrhea

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15
Q

what is the return to fertility after d/c copper IUD

A
  • immediate
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16
Q

what are the hormonal contraception options

A
  • lactation amenorrhea method
  • OCPS
  • progestin only pills
  • vaginal rings
  • transdermal patches
  • subdermal implant
  • IUD
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17
Q

how does lactation amenorrhea method work

A
  • inhibits follicular maturation and prevention of ovulation
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18
Q

lactation amenorrhea only induces anovulation in the following circumstances:

A
  • < 6 mo postpartum
  • exclusively breast feeding
  • amenorrhea
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19
Q

how do OCPs work

A
  • suppress LH and FSH
  • no dev of dominant follicle
  • no LH surge
  • end result= no ovulation*
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20
Q

role of progestins in OCPs

A
  • alter cervical mucus: thickens, inhibits sperm entry

- promotes endometrial decidualization and eventual atrophy

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21
Q

role of estrogens in OCPs

A
  • stabilize endometrium to prevent BTB

- increase intracellular progesterone receptors and potentiates action of progestin

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22
Q

side effects of OCPs

A
  • VTI, HTN, MI, stroke: dose and pt specific
  • breast tenderness, nausea, bloating
  • BTB
  • amenorrhea
  • drug interactions
  • mood disorders- either improve or worsen
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23
Q

when is return to fertility with OCPs

A
  • varies
  • can be immediate
  • can be up to 3 months
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24
Q

non-contraceptive benefits of OCPs

A
  • menstrual cycle regularity
  • less dysmenorrhea
  • inducible amenorrhea for lifestyle
  • reduced PMS, PMDD
  • improved BMD
  • reduced ovarian cysts
  • reduced risk ectopic pregnancy
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25
Q

what cancers have a reduced risk with OCP use

A
  • endometrial
  • ovarian
  • colorectal
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26
Q

contraindications to OCP use

A
  • > 35 years and smoking
  • multiple RF for CVD
  • HTN > 160/100
  • VTE
  • known thrombogenic mutations
  • known ischemic heart disease
  • hx of stroke
  • migraine with aura
  • current breast cancer
  • impaired liver function
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27
Q

monophasic OCPs

A
  • same amount of estrogen and progestin in all active pills
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28
Q

biphasic OCPs

A
  • same amount of estrogen each day

- level of progestin increases halfway through pack

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29
Q

triphasic OCPs

A
  • varying dose of estrogen +/- progestin every 7 days
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30
Q

extended cycle OCPs

A
  • placebo every 3 mo

- can continue cycling monthly packs

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31
Q

estrogens used in OCPs

A
  • ethinyl estradiol 20, 30, 35, and 50
  • low dose < 20-25
  • normal- 30-35
  • more risk of BTB if < 20
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32
Q

which progestins are most androgenic

A
  • norgestrel

- levonorgestrel

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33
Q

side effects related to estrogen excess

A
  • breast cystic changes/ tenderness
  • dysmenorrhea
  • chloasma- discoloration of skin
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34
Q

side effects related to progestin excess

A
  • increased appetite
  • depression
  • fatigue
  • libido decrease
  • weight gain
35
Q

side effects related to estrogen deficiency

A
  • spotting days 1-9
  • continuous bleeding/ spotting
  • hypomenorrhea
  • atrophic vaginitis
36
Q

side effects related to progestin deficiency

A
  • BTB days 10-21
  • delayed withdrawal bleeding
  • dysmenorrhea
  • hypermenorrhea
37
Q

options for starting OCPs

A
  • first get BP and BMI before prescribing
  • quick start
  • sunday start
  • first day start
38
Q

quick start for OCPs

A
  • start same day as rx

- if > 5 d from menses use back up method for 7 d

39
Q

sunday start for OCPs

A
  • start the sunday after period begins
  • avoids withdrawal bleeding on weekends
  • use back up method for 7 days
40
Q

first day start for OCPs

A
  • start on 1st day of menses

- no back up required

41
Q

one pill missed and < 24-48 hours

A
  • take late or missed pill ASAP
  • continue with remaining pills at normal time
  • no protection needed
42
Q

if two or more consecutive pills missed or > 48 hours

A
  • take most recent missed pill ASAP
  • continue with normal pills at usual time
  • use back up contraceptive until pills have been taken for 7 consecutive days
43
Q

what progestin is used in progestin only pills

A
  • norethindrone
44
Q

how do progestin only pills work

A
  • thickens cervical mucous
  • suppress ovulation
  • thinks endometrium
  • pack of 28 pills taken continuously
45
Q

advantages to progestin only pills

A
  • rapid acting
  • back up method only needed for 2 days
  • commonly used post partum
46
Q

disadvantages to progestin ony pills

A
  • higher failure rate than OCPs
  • MUST be taken at same time each day- short half life
  • irregular bleeding patterns
  • not as effective at suppressing follicular cysts
47
Q

nuvaring

A
  • aka vaginal ring
  • dosed monthly
  • left in place for 3 weeks, 1 ring free week a month
  • start whenever
  • if started not on first day of period may need back up
48
Q

advantages to nuvaring

A
  • no daily pill

- less BTB

49
Q

disadvantages to nuvaring

A
  • increased vaginal d/c

- failure rate 9%

50
Q

orthoevra

A
  • aka transdermal patch
  • enthinyl estradiol and etonogestrel
  • dosed weekly- new patch X3 weeks and one week patch free
51
Q

where is orthoevra applied

A
  • buttocks
  • abdomen
  • upper arm
  • torso
52
Q

disadvantages to orthoevra

A
  • BBW

- may be less effective in obese women

53
Q

what is the return to fertility for orthoevera

A
  • 1-3 months
54
Q

depo-provera

A
  • injectable medroxyprogesterone

- suppresses gonadotropins to inhibit ovulation

55
Q

how often is depo-provera dosed

A
  • every 90 days

- have 2 week grace period

56
Q

disadvantages to depo-provera

A
  • weight gain
  • return to fertility is delayed 1-18 months
  • bone loss
57
Q

nexplanon

A
  • single rod placed subdermally in upper arm
  • lasts 3 years
  • suppresses ovulation aind induces cervical mucous changes
58
Q

advantages to nexplanon

A
  • highly effective

- progestin only

59
Q

disadvantages to nexplanon

A
  • irregular bleeding patterns

- scarring

60
Q

what is the return to fertility for nexplanon

A
  • within 3 months
61
Q

how do hormonal IUDs work

A
  • prevent implantation
  • cervical mucus change
  • endometrial atrophy
  • inhibit binding of sperm and egg
  • similar efficacy to sterilization*
62
Q

misconceptions of IUDs

A
  • risk of PID
  • ectopic pregancy
  • infertility
63
Q

what is the return to fertility with IUDs

A
  • within 1 month
64
Q

mirena

A
  • IUD

- lasts 5 years

65
Q

kyleena

A
  • IUD

- lasts 5 years

66
Q

lilleta

A
  • IUD

- lasts 4 years

67
Q

skyla

A
  • IUD

- lasts 3 years

68
Q

advantages to IUDs

A
  • lighter shorter menses
  • no daily dosing
  • if malpositioned it is still effective
  • ? protects against endometrial cancer
69
Q

when to insert an IUD

A
  • bimanual exam, cervical inspection
  • when not pregnant
  • immediately post partum
70
Q

contraindications to IUD use

A
  • distortion of uterine cavity
  • active infection
  • undx uterine bleeding
  • pregnancy
  • post partum sepsis
71
Q

tubal ligation

A
  • form of female sterilization
  • can be done post partum or laparoscopically
  • options: electrocoagulation, tubal excision, or clips/ rings
72
Q

essure

A
  • form of female sterilization
  • hysteroscopic tubal occlusion with coils
  • requires HSG after 3 mo
  • BBW
73
Q

disadvantages to female sterilization

A
  • permanent, invasive

- if pregnancy does happen it is more likely to be ectopic

74
Q

how is male sterilization done

A
  • vasectomy

- cut vas deferens

75
Q

advantages to vascetomy

A
  • outpatient procedure
  • safer than female sterilization
  • highly effective
  • easily reversible
76
Q

disadvantages to vascetomy

A
  • requires semen analysis 3 mo post

- used back up method

77
Q

emergency contraception options

A
  • copper IUD- most effective
  • progestin only pills
  • combined EC pills
  • ella
  • mifepristone
78
Q

what is the most commonly used form of emergency contraception

A
  • progestin only pills: levonorgestrel

- single tablet or two tablet regimens

79
Q

how do combined EC pills work for emergency contraception

A
  • ethinyl estradiol plus levonorgestrel
  • take multiple OCPs
  • 100 mg ethinyl estradiol
  • 5 mg of levonorgestrel
  • must be taken twice 12 hours apart
80
Q

ella

A
  • selective progestrone recptor modulator
  • anti-progestin activity
  • used as emergency contraception
81
Q

disadvantages to emergency contraception

A
  • must be taken ASAP
  • may be less effective in obese
  • N/V, irregular bleeding for up to 1 mo
  • if vomit give antiemetic and repeat
82
Q

postpartum contraception

A
  • progestin only if breast feeding

- combined OCPs after 5 weeks: increased risk of VTE and estrogen may decrease milk production

83
Q

progesterone only options for postpartum

A
  • progesterone only pills
  • depo-provera
  • nexplanon
  • IUD
84
Q

what is the average BP increase with hormonal contraception

A
  • SBP 8 mmHg

- DBP 6 mmHg

Therapeutics II (8 decks)

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