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Therapeutics > Ex. 5 L1: Preventative Health/Nonhormonal Contraception (43) > Flashcards

Ex. 5 L1: Preventative Health/Nonhormonal Contraception (43) Flashcards

1
Q

Menstrual cycle

A

Two Phases:
Follicular
-Onset of menses through ovulation
Luteal
-Ovulation through onset of next menses

Drop in estrogen -> LH surge -> release of matured follicle (ovulation)

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2
Q

Preventative health: annual exam

A

Vital signs
Breast exam
Pelvic exam and or screening

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3
Q

Breast exam

A

Average risk women:
-Self exam or clinical breast exam (varying recommendations)
-Mammogram
Recommended to start by age 40-50
Complete every 1-2 years
Continue until age 75 or when life expectancy is less than 10 years

High risk women:
-I.e. BRCA1 or BRCA2 gene mutations and first-degree relatives
Recommended to receive breast MRI and a mammogram annually starting at age 30

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4
Q

Pelvic exam

A

Utility
-Screening tool for STIs, gynecologic cancers, pelvic inflammatory disease, ovarian cysts, polyps or fibroids
Components
-Assessments of external genitalia, internal speculum exam or rectovaginal exam
Recommendation
-Not routine in asymptomatic patients
-Performed when indicated by medical hx or symptoms

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5
Q

Cervical screening (PAP) recommendations:

A

21-29: Pap every 3 years

30-65: Anyone:
-Pap smear every 3 years
-HPV testing every 3 years
-Co-testing (Pap + HPV testing) every 5 years

> 65 years (no prior screenings were normal)
-No screening

Hysterectomy with cervix removal
(no screening)

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6
Q

Additional screening and counseling (PAP)

A

Cancer
-Endometrial, ovarian, colorectal
Substance use
Domestic violence
Hyperlipidemia
HTN
Diabetes
STIs
Thyroid function
Infertility
Osteoporosis
Obseity
Eating disorders
Sexual dysfunction
Depression
Anxiety
Contraception
Immunizations

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7
Q

HPV

A

-Most common STI in the US, containing >150 viruses
-14 million new infections every year
-Genital HPV affects 42.5% of adults aged 18-59
-Commonly causes warts (papilloma)
-Genital warts may lead to an increased risk of multiple cancers

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8
Q

HPV transmission

A
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9
Q

HPV associated cancer cases per year - female

A

Cervix
11,869
11%
Vagina
875
75%
Vulva
4238
69%
Anus
5150
93%
Oropharynx
3557
63%

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10
Q

HPV associated cancer cases per year - male

A

Penis:
1,364
63%
Anus:
2,410
89%
Oropharynx
17,248
72%

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11
Q

HPV prevention

A

Barrier protection (condoms, dental dams)
Mutually monogamous
Male circumcision
HPV screening
HPV vaccination

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12
Q

HPV screening

A

Patients w/a cervix
-Follow recommended cervical screening guidelines
Patients w/a penis
-Routine screening not currently recommended
Patients at higher risk include men who have sex w/men and or HIV+
May benefit from anal PAP smears

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13
Q

HPV Vaccines

A

Cervarix (2vHPV)
Serotypes: 16, 18
Admin - no longer available in the US
Gardasil (4vHPV) - no longer available in the US
Gardasil 9 (9vHPV)
Serotypes:
6,11,16,18,31,33,45,52,58
Admin schedule:
Start <15y/o: 2 dose series
-0,6-12 months
Staer >15y/o: 3 dose series
0,2,and 6 months
Females 9-45
Males 9-45

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14
Q

HPV vaccines ages

A

Ages 19-26:
-Administer 2 or 3 doses series in those who did not start or finish the vaccine series
Ages 27-45:
Vaccination provides less benefit after exposure
Risk vs benefit discussion

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15
Q

HPV vaccine - efficacy

A

Aged 16-26:
F: 98% cervical cancer
100% vulvar cancer
100% vaginal cancer
M: ~75%
Aged 27-45:
~88-95% effective genital warts, vulvar cancer, vaginal cancer, and cervical cancer in Females
Efficacy in men aged 27-45 is inferred based on this data

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16
Q

HPV Vaccine safety

A

Injection site reactions
Dizziness/Fatigue
HA
Syncope (fainting)
Vomiting
Myalgia

17
Q

Role of provider in HPV assessment

A

Educate about HPV related risks
Give strong and clear recommendations
Utilize standing orders
Process or monitoring and follow up
-Protecting your patients from preventable cancers

18
Q

_% of women aged 15-49 are currently using contraception

A

65

19
Q

Ideal contraception

A

100% safe and effective
Easy to use
Independent of timing of intercourse
Affordable
Reversible
HIV/STI protection

20
Q

Reasons for Non-Hormonal Contraception

A

Back-up hormonal method
SE or contradictions to hormones
No need for ongoing contraception
No alteration to body’s natural menstrual cycle

21
Q

Behavioral Methods

A

Coitus Interruptus
Lactation Amenorrhea Method (LAM)
Fertility Awareness Methods (FAM)
Natural Family Planning (NFP)

22
Q

FAM + NFP

A

Basal Body Temp (BBT)
-Predict Ovulation
-Regular cycles
-Initial drop in temp followed by a significant rise indicates ovulation
Billings Ovulation Method
-Cervical Mucus
-Irregular Cycles
Calendar/Rhythm Method
-based on past cycles
Standard Days Method
-26-32 day cycles
Two-Day method
-Cervical secretions

23
Q

FAM + NFP Other methods

A

Sympothermal method
-Uses a minimal of 2 indicators at the same time
-May include other symptoms of ovulation
Electronic Monitoring
-Detect luteinizing hormone (LH) in urine
ClearBlue Fertility Monitor
OvuSense Fertility and Ovulation Monitor
Marquette Method
-Combination of ClearBlue Fertility Monitor and Other NFP methods

24
Q

FAM + NFP App

A

Natural cycles
-First app approved by FDA to be marketed as a contraception method
Based on BBT and cycle data
App will prompt user to use protection on likely fertile days
Typical use failure rate: 7%
Perfect use fail: 1%
Monthly Subscription costs: $14.99
Partnership w/Oura Ring - Allows patient to skip manual temperature checks

25
Q

FAM + NFP Summary

A

Advantages:
-No effect on hormones or menstrual cycle
-No SE
-Inexpensive or free
-Acceptable in many cultures and religions
Disadvantages
-No protection against STI
-Difficulty predicting ovulation in those w/irregular cycles
-Requires consistent and accurate record keeping
-Requires extended periods of abstinence or backup contraception

Effectiveness: 1-34% failure rate

26
Q

Barrier Methods

A

Physically prevents sperm from entering the uterus
Used each time a person has intercourse
Used CORRECTLY each time
Many different options
Fewer SE and less efficacy compared to hormonal Contraception

27
Q

Barrier method types

A

Male condom
Female condom
Vaginal sponge
Diaphragm
Cervical cap
Contraceptive Gel
Spermicide

28
Q

Barrier Methods Summary:

A

Male Condom
Adv:
Low $$
HIV/STI protection
Easy to obtain
Disadv:
User dependent
Slippage/breakage

Female Condom
Adv:
-Insert up to 8 hrs before
-HIV/STI protection
Disadv:
-user dependent

Vaginal Sponge:
Adv:
Protects for 24hrs from insertion
Disadv:
User dependent
No HIV/STI protection

Diaphragm
-Insert 6-8 hrs before
-No systemic SE
Disadv:
-No HIV/STI protection
-Need proper fitting
-UTI/TSS risk

Cervical cap
Protects for up to 28 hrs
No systemic SE
Disadv:
-No HIV/STI protection
-Need proper fitting
UTI/TSS risk

Contraceptive Gel
-Insert immediately before or up to 1 hour
Disadvantage:
-1 dose for each act of interocourse
Vaginal infections
-No HIV/STI protection

Spermicide
-Low $$
-Easy to obtain
Disadvantage:
No HIV/STI protection
Irritation

29
Q

Long Term Method

A

Copper IUD
-Prevents pregnancy up to 10 years
Can also be used for emergency contraception
Inserted and removed by HCP
Extremely effective - typical fail rate 0.8%
Non-hormonal - copper acts as a spermicide and prevents sperm from fertilizing eggs
$$$
No STI prevention
SE
-Heavy/painful bleeding
-Spotting

30
Q

Permanent Methods

A

Surgery Sterilization

31
Q

Effectiveness ranking

A

MOST:
Implant
IUD
Sterilization
Injection
Pill
Patch
Vaginal Ring
Diaphragm
Male Condom
Female Condom
Cervical cap
Sponge
FAM
Spermicide

32
Q
A

Therapeutics (61 decks)

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