Contraceptives II Flashcards
Contraception Options
Postcoital Transdermal Intravaginal Injectable Implantable Oral
Injectable example
Depro-Provera and Depo-SubQ Provera
Progestin only
Depo-Provera Info
Inject IM or SQ every 3 months
Good for pt who can’t use estrogen
Can cause amenorrhea
Depo-Provera special property
Fertility doesn’t return for 10-12 months after discontinuation
Intrauterine contraceptives
Mirena
ParaGard
Implantable devices
Implanon
Nexplanon
Progesterone implantables
Mirena
Implanon
Nexplanon
Abnormal implantable?
ParaGard; releases copper
Implantable Contraceptive Info
Long Acting Reversible Contraceptives
Up to 5-10 years
Progestin does what?
Prevents ovulation and thickens cervical mucus
Copper does what?
Interfere with sperm transport and prevent implantation
Good candidate for intrauterine devices
At least one child
Monogamous relationship
No PID
No etopic pregnancy
Intrauterine devices AE
Ab cramping
Bleeding
Expulsion
Transdermal Contraception Drug
Ortho Evra
Transdermal Info
Apply new patch once weekly for 3 weeks
Obesity issue
Intravaginal Contraception drug
Nuvaring
Intravaginal info
Insert and remove 3 weeks later
If the ring dislodges for more than 3 hours use back up for 7 days and a new ring
Emergency contraception that is progestin only drugs?
Plan B
Levonorgestrel
Ella (RX only)
YuzpE Method
200 micrograms of EE + 1 mg of levonorgestrel OR 2 mg of norgestrel
Divided into 2 doses
Ovral Emergency Contraception
2 tablets STAT, repeat in 12 hours
Levora, Lo/Ovral, Levlen, Nordette, Seasonale Emergency Contraception
4 tablets STAT, repeat in 12 hours
Trivora, Tri-Levlen, Triphasil Emergency Contraception
Yellow pills only
4 tablets STAT repeat in 12 hours
Alesse, Levlite Emergency Contraception
5 tablets STAT, repeat in 12 hours
What has a higher failure rate?
YuzpE is worse than Levo
Counseling Tips for Emergency Contraception
N/V Headache Vomit within 1 hr = repeat dose Late period = pregnancy Take more does not increase efficacy
Women >35 + OC
CV disease, cancer risk reduce, bone mineral density benefits
Should use <50 mcg EE if nonsmoker
Smokers + OC
> 15 cigs/day = NO
OCs >50 mcg = MI
Progestin only
HTN + COCs
Increased angiotensinogen levels
Cause Na/H20 retention
More prevalent with higher dose, prolonged use, age >35
Progestin only + HTN
Does not increase BP
Caution with drospirenone
Estrogen + HTN
Increase BP 6-8
Return to normal in 3-6 months
Increase risk stroke and MI
Dyslipidemia + COC
E: remove LDL and increase HDL, increase TGs
Levonorgestrel: decreases HDL
Could increase CV risk
Diabetes + OC is okay IF
Nonsmoker
<35 you
No vascular disease
Diabetes + progestins
Alter carb metabolism
Alter insulin, glucose, and glucagon release
Newer and low dose: little to no affect (except levonorgestrel)
Migraines and OCs?
Progestin only, IUD or barrier method
Migraine + aura
NO COCs
Higher risk of stroke
Breast Cancer + OC??
Small increased risk
No association with low-dose
WHO says do NOT use
History of Thromboembolism
DMPA and levonorgestrel IUD (first line)
Contraindicated in a history of thromboembolism
Estrogens
Increased clotting factures
Greatest risk with transdermal contraception
SLE + antiphospholipid antibodies, you would use?
Progestin only
SLE without antibodies
COCs do not increase flare risk
Sickle Cell
DMPA (1st line) Avoid CHCs (platelet activaiton, RBC deformity)
