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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
what cancers have a reduced risk with OCP use
- endometrial - ovarian - colorectal
26
contraindications to OCP use
- > 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
27
monophasic OCPs
- same amount of estrogen and progestin in all active pills
28
biphasic OCPs
- same amount of estrogen each day | - level of progestin increases halfway through pack
29
triphasic OCPs
- varying dose of estrogen +/- progestin every 7 days
30
extended cycle OCPs
- placebo every 3 mo | - can continue cycling monthly packs
31
estrogens used in OCPs
- ethinyl estradiol 20, 30, 35, and 50 - low dose < 20-25 - normal- 30-35 - more risk of BTB if < 20
32
which progestins are most androgenic
- norgestrel | - levonorgestrel
33
side effects related to estrogen excess
- breast cystic changes/ tenderness - dysmenorrhea - chloasma- discoloration of skin
34
side effects related to progestin excess
- increased appetite - depression - fatigue - libido decrease - weight gain
35
side effects related to estrogen deficiency
- spotting days 1-9 - continuous bleeding/ spotting - hypomenorrhea - atrophic vaginitis
36
side effects related to progestin deficiency
- BTB days 10-21 - delayed withdrawal bleeding - dysmenorrhea - hypermenorrhea
37
options for starting OCPs
- first get BP and BMI before prescribing - quick start - sunday start - first day start
38
quick start for OCPs
- start same day as rx | - if > 5 d from menses use back up method for 7 d
39
sunday start for OCPs
- start the sunday after period begins - avoids withdrawal bleeding on weekends - use back up method for 7 days
40
first day start for OCPs
- start on 1st day of menses | - no back up required
41
one pill missed and < 24-48 hours
- take late or missed pill ASAP - continue with remaining pills at normal time - no protection needed
42
if two or more consecutive pills missed or > 48 hours
- 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
what progestin is used in progestin only pills
- norethindrone
44
how do progestin only pills work
- thickens cervical mucous - suppress ovulation - thinks endometrium - pack of 28 pills taken continuously
45
advantages to progestin only pills
- rapid acting - back up method only needed for 2 days - commonly used post partum
46
disadvantages to progestin ony pills
- 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
nuvaring
- 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
advantages to nuvaring
- no daily pill | - less BTB
49
disadvantages to nuvaring
- increased vaginal d/c | - failure rate 9%
50
orthoevra
- aka transdermal patch - enthinyl estradiol and etonogestrel - dosed weekly- new patch X3 weeks and one week patch free
51
where is orthoevra applied
- buttocks - abdomen - upper arm - torso
52
disadvantages to orthoevra
- BBW | - may be less effective in obese women
53
what is the return to fertility for orthoevera
- 1-3 months
54
depo-provera
- injectable medroxyprogesterone | - suppresses gonadotropins to inhibit ovulation
55
how often is depo-provera dosed
- every 90 days | - have 2 week grace period
56
disadvantages to depo-provera
- weight gain - return to fertility is delayed 1-18 months - bone loss
57
nexplanon
- single rod placed subdermally in upper arm - lasts 3 years - suppresses ovulation aind induces cervical mucous changes
58
advantages to nexplanon
- highly effective | - progestin only
59
disadvantages to nexplanon
- irregular bleeding patterns | - scarring
60
what is the return to fertility for nexplanon
- within 3 months
61
how do hormonal IUDs work
- prevent implantation - cervical mucus change - endometrial atrophy - inhibit binding of sperm and egg - similar efficacy to sterilization*
62
misconceptions of IUDs
- risk of PID - ectopic pregancy - infertility
63
what is the return to fertility with IUDs
- within 1 month
64
mirena
- IUD | - lasts 5 years
65
kyleena
- IUD | - lasts 5 years
66
lilleta
- IUD | - lasts 4 years
67
skyla
- IUD | - lasts 3 years
68
advantages to IUDs
- lighter shorter menses - no daily dosing - if malpositioned it is still effective - ? protects against endometrial cancer
69
when to insert an IUD
- bimanual exam, cervical inspection - when not pregnant - immediately post partum
70
contraindications to IUD use
- distortion of uterine cavity - active infection - undx uterine bleeding - pregnancy - post partum sepsis
71
tubal ligation
- form of female sterilization - can be done post partum or laparoscopically - options: electrocoagulation, tubal excision, or clips/ rings
72
essure
- form of female sterilization - hysteroscopic tubal occlusion with coils - requires HSG after 3 mo - BBW
73
disadvantages to female sterilization
- permanent, invasive | - if pregnancy does happen it is more likely to be ectopic
74
how is male sterilization done
- vasectomy | - cut vas deferens
75
advantages to vascetomy
- outpatient procedure - safer than female sterilization - highly effective - easily reversible
76
disadvantages to vascetomy
- requires semen analysis 3 mo post | - used back up method
77
emergency contraception options
- copper IUD- most effective - progestin only pills - combined EC pills - ella - mifepristone
78
what is the most commonly used form of emergency contraception
- progestin only pills: levonorgestrel | - single tablet or two tablet regimens
79
how do combined EC pills work for emergency contraception
- ethinyl estradiol plus levonorgestrel - take multiple OCPs - 100 mg ethinyl estradiol - 5 mg of levonorgestrel - must be taken twice 12 hours apart
80
ella
- selective progestrone recptor modulator - anti-progestin activity - used as emergency contraception
81
disadvantages to emergency contraception
- 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
postpartum contraception
- progestin only if breast feeding | - combined OCPs after 5 weeks: increased risk of VTE and estrogen may decrease milk production
83
progesterone only options for postpartum
- progesterone only pills - depo-provera - nexplanon - IUD
84
what is the average BP increase with hormonal contraception
- SBP 8 mmHg | - DBP 6 mmHg

Therapeutics II (8 decks)

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