Contraceptives and Infertility Flashcards
Which of the following are common uses of combination PO contraceptives?
a. Preventing conception immediately after childbirth
b. Regulating menses in PCOS
c. Preventing contraception during lactation
d. Preventing conception in pts who have a hx of migraine with aura
e. Treatment of painful, heavy menstrual bleeding caused by endometriosis
b, e
-COC are contraindicated for 3-6 weeks after childbirth (d/t increased risk of thromboembolism with estrogen) and in pts who have migraine with aura.
-Estrogen decreases breastmilk supply.
-Progesterone-only pills are used commonly during breastfeeding and are safe to use in pts who have migraine with aura. If no aura, any method can be used if otherwise appropriate.
-The Mirena IUD and Natazia (COC) are indicated for heavy menstrual bleeding (also called menorrhagia).
JG has just received a NuvaRing at the pharmacy. It’s a good choice for her because she sometimes forgets to the take the pill. Counseling points for the NuvaRing should include which of the following recommendations:
a. Insert the ring the Sunday after the 1st day of the menstrual period.
b. The ring can be removed for up to 24 hours during week 1 without risk of pregnancy.
c. The ring can be stored at room temp for up to twelve months.
d. The ring is kept in place for 3 weeks and taken out for 1 week.
e. Place the ring inside the vagina just prior to intercourse.
d
The ring is refrigerated at the pharmacy but can be kept at room temp by the pt for up to 4 months. It should be inserted on the 1st day of menstrual bleeding.
A pregnancy test kit is positive if this hormone is present in the urine:
a. Parathyroid hormone
b. Luteinizing hormone
c. Progesterone
d. Ethinyl estradiol
e. Human chorionic gonadotropin
e
A pt vomited after taking Plan B One-Step and asks the pharmacist if she should take the dose again. The pharmacist should recommend another dose if the pt vomited within what time frame of the dose?
a. 60 min
b. 90 min
c. 2 hours
d. 3 hours
e. 4 hours
c
The following are contraindications to the use of estrogen therapy, in any dose or formulation:
a. Hx of myocardial infarction
b. Hx of DVT
c. Hx of breast cancer
d. Hx of pregnancy
e. Hx of cerebrovascular accident
a, b, c, e
Which of the following is true regarding Yaz and Yasmin?
a. Prevent pregnancy more than some of the older formulations
b. Prevent monthly bleeding
c. Lower potassium
d. Cause less headaches
e. Cause less weight gain
e
-These forms contain drospirenone, and are popular because they have less bloating, weight gain, and other PMS symptoms.
-The lower androgenic activity of drospirenone may help decrease acne.
-Drospirenone has a higher clotting risk than other progestins.
When do pts begin a COC?
a. Can only be started the Sunday after the onset of menstruation (“Sunday start”)
b. Can be started at any time
c. Can’t be started in the 1st 5 days of menses
d. Must be started the Monday after onset of menstruation
e. Can only be started on the Thursday after the period has started
b
The “Sunday Start” is a common strategy, as bleeding will occur during the week rather than on the weekend.
-Other options are to start on the 1st day of menses or using the “quick start” method (start as soon as pills are obtained).
-Unless initiating during the 1st 5 days of menses, a non-hormonal back-up contraception method is required until 7 days of active pills have been taken (condoms with spermicide).
-Always consult package labeling for the product for the manufacturer’s recommendations.
Which of the following BC pill forms is a mini-pill?
a. Sprintec
b. Yaz
c. Errin
d. Yasmin
e. Seasonique
c
The POPs have the same dose of a progestin only, taken daily.
Which of the following contraception forms would have a higher risk of clotting than Loestrin Fe 1/20 formulation?
a. Xulane
b. Yaz or Yasmin
c. 35 mcg ethinyl estradiol/1 mg norethindrone
d. The mini-pill (POP)
e. Condoms and foam
a, b, c
-Clotting risk increases with estrogen dose or exposure (higher AUC with Xulane).
-Drospirenone has a higher clotting risk than other progestins.
A 32 y/o female usually takes her Loestrin 24 Fe at 6am daily. She’s in her 2nd week of this pack and took her dose as usual on Thursday and Friday but left her pack at home when she went out of town for the weekend, missing her Saturday dose. She took her pill on Sunday night when she returned. Which of the following is true?
a. She requires use of a backup contraceptive method until she has taken 2 days of active pills.
b. She requires use of a backup contraceptive method until she has taken 7 days of active pills.
c. She requires use of a backup contraceptive method until she has taken 3 days of active pills.
d. She doesn’t require a backup contraceptive method.
e. She should have started a new pack on Sunday night, skipping the rest of the previous pack (including the inactive pills).
b
If 2 or more doses are missed (or it has been 48+ hours since the last dose), a backup method should be used for 1 week.
Rank the following contraceptive methods in order of increasing efficacy.
a. Abstinence from intercourse
b. Male latex condom
c. Loestrin 24 Fe
d. Nonoxynol-9 gel alone
e. Mirena intrauterine device
d - b - c - e - a
Nonoxynol-9 gel alone is a spermicide. It’s more effective when used with another barrier form.
Pts taking estrogen-containing products should be cautioned to report blurry vision, headaches, or swelling of the lower extremities. This is d/t a risk of:
a. Thromboembolism
b. Hemorrhagic stroke
c. Severe depression
d. Liver cancer
e. Breast cancer
a
If a woman takes levonorgestrel emergency contraception (EC) while pregnant, what is expected to happen?
a. Could cause infertility
b. Will terminate the pregnancy
c. Could cause birth defects
d. Won’t cause birth defects, terminate an established pregnancy, or affect her future fertility
e. She’s not pregnant; EC can cause a false positive pregnancy test
d
The primary mechanism of EC is to delay ovulation.
A woman is using Microgestin 1/20 COC pills. She doesn’t enjoy getting a monthly menstrual cycle and has heard about new pill forms where you get fewer periods. Choose the form that decreases the frequency of bleeding to every 3 months.
a. Yaz
b. Loestrin
c. Nortrel 7/7/7
d. Seasonique
e. Trivora
d
-OCs with “Tri” or “7/7/7” in the name usually indicate triphasic pills.
-Seasonique is an extended-cycle formulation.
A pharmacist is filling an Rx for clomiphene for a women who’s attempting pregnancy. Which of the following statements regarding clomiphene are correct?
a. This med can cause hot flashes, which can make the user feel sweaty and flushed.
b. Unlike OCs, clomiphene doesn’t increase the risk of thrombosis.
c. This med is a selective estrogen receptor modulator.
d. This med is a synthetic form of estradiol.
e. This med can increase the chances of a multiple birth.
a, c, e
