Contraceptives, Menstration, Hormones, Lactation

Question 1

what are some of the benefits of COMBINATION oral contraceptives

Answer 1

reduce risk of endometrial and ovarian cancer

• prevents ovarian cysts
• relieves PMS, benign breast disease, endometriosis
• acne control

Question 2

What is the efficacy of PERFECT use of oral contraceptives?

Answer 2

98%

80% with typical use

Question 3

What type of contraceptive should a 40 year old smoker with hypertension and hx migraines use?

Answer 3

Progestin only

Question 4

When is estrogen CONTRAINDICATED in contraceptive use?

Answer 4

smoker >35 years old
HTN
migraine headaches w/ aura
-venous thromboembolism
-gallbladder disease
-hepatic tumors

Question 5

in what kind of tumors is oral contraceptives contraindicated?

Answer 5

hepatic

Question 6

Patient presents wanting to begin oral contraceptives, she is 42 years old and has a history of DVT. What kind of OC do you consider?

Answer 6

Progestin-only!

estrogen contraindicated

Question 7

common adverse effects of oral contraceptives?

Answer 7

headache
n/v
nostalgia
weight gain
breakthrough bleeding/spotting

Question 8

what 2 options do you have regarding management of AEs w/ oral contraceptives?

Answer 8

• adjust the amount of estrogen/progestin

- use lower dose combo

Question 9

are progestin-only pills more effective than combo or estrogen pills?

Answer 9

NO - less effective

Question 10

When using Progestin-only pills, missing a dose can yield a higher risk for contraceptive failure. What is the time frame for missing a dose?

Answer 10

3 hours = missed dose

Question 11

why would you prescribe a woman with hx thromboembolism progestin-only?

Answer 11

lower risk of thromboembolism

Question 12

which type of oral contraceptive is ok for breastfeeding?

Answer 12

progestin-only; start 6 weeks postpartum

Question 13

estrogen is metabolized by which CYP system?

Answer 13

CYP450-3A4

Question 14

Drospirenone (COC) has a spironolactone analog; how does this affect the body?

Answer 14

can affect sodium and water imbalance in body

Question 15

Which type of patient would you prescribe Drospirenone to?

Answer 15

a patient who produces too much androgen, because it is an antiandrogenic drug.

CAUTION if low K

Question 16

What is the advantage of a NON-oral hormonal contraceptive?

Answer 16

does not need to be taken every day and are just as effective

Question 17

What is the transdermal type of non-oral hormonal contraceptive? How long does it last?

Answer 17

Ortho-Evra (estrogen + progestin)

replace patch every week

Question 18

What is the transvaginal type of non-oral contraceptive? How long does it last?

Answer 18

NuvaRing (estrogen + estronogestrel)

lasts 3 weeks, out for 1 week, repeat.

Question 19

What is the non-oral hormonal contraceptive? How long does it last?

Answer 19

Depo-Provera (progestin only)

every 3 months

Question 20

The black box warning for this reads: causes loss of bone mineral density, reversible with D/C - not recommended for long term use

Answer 20

Depo-Provera (progestin only)

Question 21

What is the delayed return to fertility time frame for Depo-Provera?

Answer 21

10-12 months

Question 22

What type of contraceptive includes: Mirena, Skyla, ParaGard?

Answer 22

Intrauterine IUDs

Question 23

What is the MOA for intrauterine IUDs?

Answer 23

causes inflammatory response that interferes with implantation, and/or interferes with sperm transport and fertilization

Question 24

What are the names of the implantable contraceptive devices?

Answer 24

Implanon & Nexplanon

-inserted under skin of upper arm

Question 25

What are the contraindications for IUDs?

Answer 25

abnormal/distorted uterine cavity PID postpartum endometritis uterine malignancy

Question 26

If a patient has Wilson disease, what type of IUD do they get?

Answer 26

COPPER only, (paragard)

Question 27

What is emergency contraception used for?

Answer 27

to prevent pregnancy after known intercourse

Question 28

What is the name of emergency contraceptions (2)?

Answer 28

Levonorgestrel | Ulipristal Acetate

Question 29

What drug's MOA inludes inhibition of ovulation/fertilization by thickening the cervical mucosa (altering the endometrium to inhibit implantation)

Answer 29

Levonorgestrel

Question 30

Which emergency contraceptive is a progesterone receptor agonist/antagonist, preventing it from binding, delaying follicular rupture

Answer 30

Ulipristal acetate (ella)

Question 31

what is the treatment of choice for dysmenorrhea?

Answer 31

NSAIDs - decreases uterine contractions and reduces menstrual blood flow

Question 32

True or false: DO NOT use estrogen alone if intact uterus

Answer 32

True - always add a progestin

Question 33

Patient presents with amenorrhea and menopause symptoms. She does NOT have a uterus. Which patch is ok?

Answer 33

ethinyl estradiol patch (estrogen only)

Question 34

MOA of medroxyprogesterone

Answer 34

derivative of progesterone; transforms proliferative into secretory endometrium, INDUCING WITHDRAWAL BLEEDING IN SECONDARY AMENORRHEA

Question 35

A menopausal patient presents with amenorrhea, and has a history of hyperprolactinemia. What is the best hormone treatment, which can restore ovulation in 90% of people?

Answer 35

Bromocriptine

Question 36

This treatment is a dopamine 2 receptor agonist, inhibiting prolactin secretions

Answer 36

Bromocriptine

Question 37

AE Bromocriptine?

Answer 37

hypotension, constipation, nausea, anorexia, Raynauds

Question 38

Which hormonal replacement's MOA is inhibition of plasminogen activation

Answer 38

Tranexamic acid

Question 39

Which hormone replacement therapy is often used in patients with PCOS-related amenorrhea and anovulatory bleeding?

Answer 39

Clomiphene

Question 40

What are 1st line for prevention of osteoporosis?

Answer 40

bisphosphates (add Ca and Vit D)

Question 41

what is the treatment of choice for dysmenorrhea?

Answer 41

NSAIDs (release of prostaglandins cause uterine contractions and pain)

Question 42

What do you NEVER use alone in treatment for menopause if the patient has an intact uterus?

Answer 42

ESTROGEN

Question 43

What is the MOA of medroxyprogesterone

Answer 43

induces withdrawal bleeding in secondary amenorrhea (derivative of progesterone)

Question 44

For those who cannot take hormonal therapy, what are some other options?

Answer 44

Antidepressants Clonidine Gabapentin Phytoestrogens

Question 45

What type of birth control to use with a person who is 37, smoker, hypertension, and suffers from migraines?

Answer 45

Progestin-only

Question 46

Long term use of COC have an association with benign tumors of what origin?

Answer 46

hepatic

Question 47

which Contraceptive has antiandrogenic AND antimineralocorticoid activity; including a spironolactone analog

Answer 47

Drospirenone (Yasmin, yaz)

Question 48

Yaz or Yasmin is commonly chosen if patient is producing too much ______, but CAUTION for low _____

Answer 48

androgen; K

Question 49

The transdermal (patch) type of OC is

Answer 49

ortho-evra (estrogen + progestin)

Question 50

weight over ____ kg increase failure rates of ortho-evra

Answer 50

90

Question 51

which has more estrogen exposure; ortho-evra patch or COC?

Answer 51

ortho-evra (35 mg)

Question 52

how long can the NuvaRing stay in the vagina?

Answer 52

3 weeks (followed by 7 days period)

Question 53

what's the maximum amount of time that the nuvaring can be OUTSIDE the vagina to still work? (some people remove it during sex)

Answer 53

3 hours

Question 54

what is the injectable (IM/SubQ) form of contraception?

Answer 54

Depo Provera (progestin-only)

Question 55

how often does the depo provera need to be administered?

Answer 55

every 3 months

Question 56

what is an advantage of Depo Provera?

Answer 56

it's estrogen-free; great choice when estrogen is contraindicated

Question 57

The Depo shot has a black box warning that reads:

Answer 57

loss of bone mineral density, NOT RECOMMENDED FOR LONG TERM USE

Question 58

What is the component of IUDs?

Answer 58

Levornorgestrel - progestin only (or copper if Paragard)

Question 59

MOA of intrauterine devices (IUD)

Answer 59

causes inflammatory response that interferes with implantation, and with sperm transport/fertilization (copper paragard prevents implantation)

Question 60

how is implanon and nexplanon administered?

Answer 60

under the skin of inner upper arm

Question 61

MOA implanon?

Answer 61

increases viscosity of cervical mucous, altering endometrium and inhibiting ovulation

Question 62

What is the major contraindication to ParaGard

Answer 62

Wilson disease

Question 63

what are some common adverse effects of nexplanon/implanon?

Answer 63

abdominal cramping uterine bleeding expulsion of device (less common: ectopic pregnancy, embedded device, uterine perforation)

Question 64

T or F: emergency contraception is more effective the earlier it's used after unprotected sex

Answer 64

True

Question 65

How does Levonorgestrel prevent pregnancy as an emergency contraceptive?

Answer 65

alters the tubal transport, thickens cervical mucus (alteration of endometrium = inhibits implantation)

Question 66

What are the 2 types of emergency contraception?

Answer 66

Levonorgestrel | Ulipristal acetate

Question 67

what is the MOA of ulipristal acetate?

Answer 67

progesterone receptor antagonist (delays follicular rupture if taken before ovulation)

Question 68

True or False: ALL teratogens are completely contraindicated during pregnancy

Answer 68

FALSE - sometimes the benefits outweigh the risks

Question 69

What problems can benzodiazepines, lamotrigine, topiramate case?

Answer 69

oral cleft

Question 70

Paroxetine is considered a teratogen because it can cause _____

Answer 70

cardiac septal anomalies

Question 71

Pseudoephedrine is a teratogen as it can cause _____

Answer 71

gastroschisis

Question 72

absolute risk VS relative risk

Answer 72

absolute risk = actual risk of person getting the malformation relative risk = risk compared to control & general population

Question 73

how to avoid neural tube defect during pregnancy?

Answer 73

take 0.4-0.8 mg folic acid daily starting 1 month before pregnancy through first 2-3 months

Question 74

Drugs are least likely to transfer into breast milk if they have these characteristics

Answer 74

``` High protein point high molecular weight short 1/2 life no active metabolites well tolerated by kids ```

Question 75

1st line for treating n/v in pregnancy

Answer 75

pyridoxine + doxylamine

Question 76

how to treat pain in pregnancy

Answer 76

Acetaminophen (APAP)

Question 77

How to treat UTI in pregnancy?

Answer 77

cephalexin, cefpodoxime, amoxicillin clav

Question 78

when discontinuing hormone therapy, over what period of time do you taper?

Answer 78

3-6 months (reduces risk of symptom return)