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Women's Health > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

Methods that contain combined estrogen and
progesterone formulations with different
delivery systems are known as:

A

Combined hormonal contraception

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2
Q

What is the mechanism of action of Combined Oral Contraception (COC)?

A

The effects of estrogen and progesterone suppress GnRH which suppresses FSH and LH
1- inhibiting ovulation
2- ovum transport
3- cervical mucus thickness is altered inhibiting sperm transport
4- implantation is inhibited by suppression and alteration of uterine secretion

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3
Q

What are the advantages of using a combined hormonal contraceptive? (15 items)

A

1- high rate of effectiveness
2- Controlled by women
3- easy and convenient
4- rapid return to fertility
5- improves menstrual characteristics
6- reduction in menstrual bleeding
7- protection against ovarian and endometrial cancer
8- lower incidence of ovarian cyst
9- prevention of ectopic pregnancy
10- lower incidence of endometriosis
11- treatment for PCOS
12- protection against loss of bone mineral density
13- lower incidence of benign breast cysts and fibroadenomas
14- reduction in vasomotor symptoms in perimenopausal women
15- association in mild improvement of acne

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4
Q

What are the current Combined Hormonal Contraceptives?

A

1- Combined Oral Contraceptives (COC)
2- Transdermal patch
3- Vaginal ring

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5
Q

The three estrogen compounds currently used in combined hormonal contraceptives are :

A

1- estradiol
2- estradiol valerate
3- menstranol

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6
Q

What are the disadvantages of Combined Hormonal Contraceptives? (8 items)

A 
1- affects all body systems
2- Some forms require daily maintenance
3- some users experience undesirable side effects
4- should not be used when lactating
5- provide no protection against STDs
6- high cost for women
7- prescription needed
8- may interact with other drugs
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7
Q

What are some side effects associated with combined hormonal contraceptives?

A 
1- Effects on Blood Lipids
2- Cardiovascular disease
3- Stroke
4- Carbohydrate metabolism
5- Risk of breast cancer
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8
Q

What are the advantages to using the transdermal contraceptive patch? (5 items)

A

1- hormonal levels remain therapeutic for 9 days after the application of the second patch, suggesting that ovulation inhibition would be maintained even if a scheduled patch change was missed for as long as 2 days
2- weekly regimen
3- easy verification
4- safe for women with latex allergy
5- delivery system avoids “first pass” effects on liver

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9
Q

What are the disadvantages to the transdermal contraceptive patch? (4 items)

A

1- decreased effectiveness of Ortha Evra patch for women weighing over 198lbs
2- must remember to change it weekly
3- skin reactions
4- breast tenderness

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10
Q

The transdermal contraceptive patch label indicates the higher exposure to estrogen however there is no increased risk of (3 items).

A

1- venous thrombosis
2- stroke
3- MI

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11
Q

What are the advantages of the Contraceptive Vaginal Ring? (5 items)

A

1- elimination of the need for daily pill taking
2- delivery system avoids the first pass effect on the liver
3- low incidence of break through bleeding
4- hormone levels remain therapeutic for at least 35 days, suggesting that the ovulation inhibition would be maintained even if a woman forgets to remove the ring up to 2 weeks late
5- safe for women with a latex allergy

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12
Q

What are the disadvantages to the Contraceptive Vaginal Ring? (5 items)

A

1- vaginal ring not recommended for women with uterine prolapse, lack of vaginal muscle tone or chronic constipation
2- women must be comfortable with the insertion and removal
3- Women may experience a foreign body sensation
4- side effects of headache, leukorrhea and vaginitis
5- back up contraception is needed for 7 days if ring is removed for 3 or more hours

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13
Q

What are some are some important education points for the patient when starting a Contraceptive Vaginal Ring? (3 items)

A

1- some women may experience increase in normal vaginal secretions
2- if woman finding it difficult to insert she can use an empty tampon applicator
3- if unpleasant feeling for woman or partner, it may be removed for up to 3 hours, cleansed with cool water and replaced in the vagina

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14
Q

What is the mechanism of action for Progestin-only pills (POPs)? (4 items)

A

1- Inhibits ovulation
2- increases cervical mucus to inhibit sperm penetration
3- causes the endometrium to become thin and atrophic
4- causes tubal changes to alter tubal transport, contractility and histology

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15
Q

Progestin-only pills are a good choice for women who: (6 items)

A

1- breastfeeding
2- need short term birth control that can be stopped at any time
3- cannot take estrogen (those who smoke, older than 35, long standing DM, heart disease, problems with blood clots, high blood pressure)
4- have migraines with aura
5- have heavy, painful menstrual periods
6- have anemia from heavy menstrual bleeding

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16
Q

What are the advantages to Progestin-only pills? (6 items)

A

1- no estrogen related side effects
2- overall safer than combined hormonal contraceptives
3- may be used in patients with prior history of thrombophlebitis
4- minimal effects on carbohydrate metabolism
5- rapid reversal after stopping
6- decreased cramping, lighter bleeding, shorter periods, decreased PMS symptoms, and lessened breast tenderness

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17
Q

What are the disadvantages to Progestin-only pills?

A

1- Must be taken with meticulous accuracy (no more than 27 hours between pills)
2- Slightly less effective than CHCs
3- May cause irregular bleeding with an unpredictable pattern
4- No protection against STDs
5- interaction with other drugs can decrease effectiveness
6- higher incidence of functional ovarian cyst
7- higher incidence of ectopic pregnancy
8- adverse effects on lipids causing an decrease in HDLs and increase in LDLs

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18
Q

Drugs whose effects may enhance in combination with contraceptives include: (6 items)

A 
1- Tricyclic antidepressants
2- benzodiazepines
3- betablockers
4- corticosteroids
5- theophylline
6- troleandomycin
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19
Q

Drugs whose effects may be diminished in combination with contraceptives include: (4 items)

A

1- acetaminophen
2- oral anticoagulants
3- some benzodiazepines
4- oral hypoglycemic agents

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20
Q

Drugs that may diminish the effects of contraceptives include: (5 items)

A 
1- Anticonvulsants
2- barbiturates
3- benzodiazepines
4- St. Johns wart
5- some antibiotics
21
Q

Drugs that will interact with drospirenone- containing contraceptives to increase the risk of hyperkalemia include:

A 
1- ACE-inhibitors
2- Angiotensin II Receptor Antagonist
3- Potassium Sparing Diuretics
4- Heparin
5- Aldosterone Antagonist
6- Daily NSAIDs
22
Q

How long does the progestin implant Nexplanon provides coverage up to?

A

3 years

23
Q

DMPA also known as Depo Provera (depot-medroxyprogesterone acetate) is the injection form of progestin only contraceptive that provides protection up to:

A

12 weeks

24
Q

______ condoms are stronger than ____ condoms and they are thinner

A

Polyurethane

25
Q

_____ condoms are made from animal membranes and may not protect against STDs

A

Lambskin

26
Q

What are the 5 different types of Intrauterine devices and how long is their protection against pregnancy?

A

1- Skyla® (levonorgestrel 13.5 mg) up to 3 years.
2- kyleena (levonorgestrel 19.5mg) up to 5 years
3- Mirena (Levonorgestrel 52 mg) for up to 7
years
4- Liletta (Levonorgestrel 52 mg) for up to 5 years
(cheaper for patients without insurance
5- Paragard up to 12 years

27
Q

What is the mechanism of action for LARCs (long acting removable contraception)? (3 items)

A

1- Suppresses ovulation
2- alters endometrial structure
3- changes cervical mucous to impede sperm penetration

28
Q

What are the advantages to LARCs (8 items)?

A 
1- ease of use
2- no attention from user required until time of removal
3- discreteness
4- no adverse affect on acne
5- relief of dysmenorrhea
6- relief of endometriosis symptoms
7- reduces risk of ectopic pregnancy
8- no estrogen
29
Q

What are the disadvantages to LARCs? (7 items)

A

1- abnormal uterine bleeding
2- 10% discontinued due to unacceptable bleeding patterns
3- rare insertion complications
4- ovarian cyst
5- no protection against STDs
6- Drug interactions
7- possible increased thromboembolic risk

30
Q

What is Nexplanon an example of

A

LARC (long acting removable contraception)

31
Q

What is the mechanism of action of a copper intrauterine device?

A

inhibition of sperm migration and viability

32
Q

What is the mechanism of action of a levonorgestrel intrauterine device? (4 items)

A

1- Thickening cervical mucous
2- suppression of the endometrium by reducing uterine artery blood flow
3- impairing sperm function by changing uterine immune microenvironment
4- may also impair ovulation

33
Q

What are the advantages of IUDs? (7 items)

A 
1- highly effective
2- continuously effective
3- allows for sexual spontaneity
4- cost-effective
5- returns to fertility immediately
6- can be used during lactation
7- protection against ectopic pregnancy
34
Q

What are the disadvantages of IUDs? (7 items)

A

1- insertion only by a trained professional
2- may cause menstrual disturbances
3- pain and nausea during insertion
4- no protection against STIs
5- device can be expelled without user being aware
6- risk of perforation
7- infection of uterus on insertion

35
Q

Progestin only pills are contraindicated in: (4 items)

A

1- history of functional ovarian cyst or ectopic pregnancy
2- inability to take pills consistently
3- hyperlipidemia
4- undiagnosed abnormal vaginal bleeding during the preceding 3 months

36
Q

What are 2 examples of barriers methods for females?

A

Diaphragm and cervical cap

37
Q

______ must be fitted and examined by a practitioner and a ______ _____ doesn’t have to be fitted

A

Diaphragm; cervical cap

38
Q

What are the advantages to diaphragms and cervical caps? (8 items)

A

1- contraception needed on a irregular basis
2- doesn’t require partner involvement
3- considered medically safe
4- little danger or systemic effects
5- easily reversible
6- provides protection against STIs and PID
7- can be used during lactation
8- may provide some protection against cervical neoplasia

39
Q

What are the disadvantages of diaphragms and cervical caps? (8 items)

A

1- may interfere with sexual spontaneity
2- learning insertion and removal techniques may be difficult for some
3- allergies
4- odor or discharge if left in for a few days
5- vaginal trauma
6- increased risk of UTI
7- potential for toxic shock syndrome
8- less effective in parous women

40
Q

What are some disadvantages to female condoms? (7 items)

A 
1- one time use
2- expensive for frequent use
3- can slip out
4- ring dangles out of vagina
5- may make noise during use
6- can break
7- cumbersome insertion
41
Q

What is the mechanism of action for vaginal contraceptive sponge? (4 items)

A

1- barrier effect
2- spermicide
3- action of trapping and absorbing semen before sperm can enter the cervix
4- can be left in for 24 hours

42
Q

What is a specific instruction that needs to be given to a woman who is using a vaginal contraceptive sponge?

A

must be left in for 6 hours after coitus (sexual intercourse)

43
Q

What is an advantage of spermicides?

A

Provides protection for up to one hour after insertion

44
Q

What is a disadvantage to spermicides? (4 items)

A

1- Does not provide protection against STD’s
2-may increase susceptibility of HIV due to vulvovaginal epithelial disruption
3- interferes with spontaneity
4- taste during oral sex

45
Q

What are the directions given to people using suppository and film spermicide?

A

Must be inserted 15 minutes prior to intercourse to allow them to melt

46
Q

Progesterone increases the body temp by ___-___ degrees indicating ovulation

A

0.4-0.8 degrees

47
Q

The cervical fertility awareness method indicates that the peak day when cervical mucous resembles _____, indicates ovulation

A

egg-white consistency or mid-cycle spotting

48
Q

What is the lactation amenorrhea contraceptive method?

A

First six months after pregnancy when menses has not returned and are consist with breast feeding

Women's Health (11 decks)

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