EXAM #1: CONTRACEPTION Flashcards
What is nonoxynol-9?
Spermicide
What are the disadvantages of nonoxynol-9?
1) No protection against STD
2) High failure rate
3) Messy/ irritating
What STDs do condoms NOT protect well against?
HSV and HPV
What should a diaphragm be used with?
Spermicide
Can you get a diaphragm OTC?
NO- this is fitted by an OB/GYN
What are diaphragms associated with (adverse effects)?
Increased risk of UTI
What is periodic abstinence?
“Natural Family Planning”
What is the mechanism by which progesterone prevents conception?
1) Inhibits ovulation
2) Thickens cervical mucous
Estrogen and Progestins inhibit LH/FSH and thus prevent estrogen surge. No estrogen surge → no LH surge → no ovulation.
What is the mechanism by which estrogen aids in preventing conception?
1) Maintains the endometrium
2) Prevents unscheduled bleeding
Estrogen and Progestins inhibit LH/FSH and thus prevent estrogen surge. No estrogen surge → no LH surge → no ovulation.
Generally, what is the difference between the various generations of oral contraceptives?
Androgen effect DECREASES with INCREASING generation
What exactly is the estrogen component of the estrogen in oral contraceptives?
Ethinyl estradiol or mestranol
What are the adverse effects of the estrogen component in oral contraceptives?
1) Nausea
2) Breast tenderness
3) Fluid retention
*Also can induce melasma
What are the adverse effects of the progestin component in oral contraceptives?
1) Weight gain
2) Acne
3) Mood changes
In terms of blood clots, what do you need to remember about oral contraceptives?
History of inherited clotting disorder puts the patient at an increased risk of DVT/PE
What patient’s are at a risk of CVA with oral contraceptives?
Patient that has migraines WITH aura
Is there a higher risk of DVT/PE with oral contraceptives or actually being pregnant?
Pregnant
Are oral contraceptives a risk factor for cervical dysplasia?
No
Are oral contraceptives a risk or protective factor in endometrial and ovarian cancer?
Protective
What are the absolute contraindications to oral contraceptives?
1) History of vascular disease
2) Systemic disease that may affect the vascular system
- SLE
- DM
- Retinopathy
3) Cigarette smoking and older than 35
4) Uncontrolled HTN
5) ER+ neoplasm
6) CVA, MI or known CAD
7) Pregnant female
8) Active liver disease
9) Migraines with aura
What drugs will decrease the efficacy of OCP?
1) Barbiturates
2) Sulfonamides
3) Cyclophosphamide
4) Rifampin
What are the non-contraceptive uses for OCP?
1) Reduced blood loss during menstruation
2) Decreased dysmenorrhea
3) Decreased risk of ectopic pregnancy
What is the general MOA of emergency contraception?
Disruption of ovulation
What drugs are in emergency contraception?
1) High dose estrogen
2) High dose progesterone
What is Plan B?
High dose progesterone
What is the common name for Depo-medroxyprogesterone acetate?
DEPO-provera
What is a drawback to DEPO-provera?
Can take a year to regain fertility
What can DEPO-provera exacerbate?
Depression
How long can a progestin implant be left in?
3 years
What is the mechanism of the progestin implant?
Daily release of progestin that inhibits ovulation/thickens cervical mucous
What are the advantages to progestin implants?
1) Decreased iron deficiency anemia
2) Decreased PID
3) Decreased endometrial cancer
4) Decreased ovulation pain
5) Reduced sx. of endometriosis
6) Reduced primary dysmenorrhea
What are the benefits of IUDs?
1) Lack of associated metabolic effects
2) Very high level of efficacy
3) Single time “motivation”
What is the mechanism of action of IUDs?
Local sterile inflammatory reaction
What are the adverse effects of IUDs?
1) Uterine bleeding
2) Uterine perforation
If a woman gets pregnant with an IUD in, what should she do? What should you do?
- She should take the IUD out
- You need to ensure no ectopic pregnancy
What are the contraindications to IUDs?
1) Pregnancy
2) Acute PID
3) Post-partum endometritis
4) Known or suspect cervical malignancy
5) Genital bleeding of unknown etiology
6) Untreated acute cervicitis
7) She already has 1x IUD
What is the most cost effective method of contraception?
IUD
