Gyn- contraception

Question 1

Ella vs LVNG dose and MOA

Answer 1

Ella- ulipristal acetate, selective progesterone receptor modulator, 30mg, up to 5 days , inhibits follicular rupture
Levonorgestrel- 1.5 mg, plan B, up to 3 days, delays follicular development
Both inhibit or delay ovulation
No adverse effect to existing pregnancy
Paragard> Mirena> ella > plan B LVNG
Fu patient. No period in 3 weeks. Check hcg.
Almost everyone candidate for oral emergency contraception.
Meds that decease effectiveness of OCPs can decrease effects (rifampin, phenytoin, etc)

Question 2

Mifepristone MOA

Answer 2

Decidu necrosis, cervical softening, increased uterine contractility, PG sensitivity, antagonist

Question 3

Misoprostol MOA

Answer 3

Prostaglandin E1 analogue causes cervical softening and uterine contractions

Question 4

What teratogenic effect with miso

Answer 4

Limb defects, mobius stndrome (facial paralysis )

Question 5

LVNG IUD Mirena and Liletta

Answer 5

52 mg levonorgestrel
Mirena 20 mcg/day
Liletta 18.6 mcg/day
8 years
thickens cerical mucus, endometrial changes, ovulatory inhibition

Question 6

LVNG Kyleena

Answer 6

Total of 19.5 mg of LVNG
releases total of 17.5 mcg/day
Good for 4 years

Question 7

LVNG Skyla

Answer 7

13.5 mg of LVNG
releases 14 mcg/day
3 years

Question 8

expulsion rate for immediate PP IUD placement

Answer 8

10-27%

Question 9

contraceptive implant dose and MOA

Answer 9

68 mg of etonogestrel surrounded by ethylene vinyl acetate cpolymer skin. controlled release over 3 years. 4 cm in length and 2 mm in diameter. suppression of ovulation. thickening cervical mucus

Question 10

typical and perfect use preg rates of Copper, LVNG 20, implant and OCPs for unintended preg in the first year of use

Answer 10

copper: 0.8 (perfect use 0.6)
LVNG 20: 0.2 for both
implant: 0.05% for both
OCPs 9% for typical use, 0.3% for perfect use

Question 11

risks of continuing pregnancy w/ IUD in place
Should it be removed?

Answer 11

risks: increased risk for SAB, septic abortion, chorio, and PTD. risks reduced by not eliminated with removal. if you can see the strings or IUD is in cervical canal and can be easily removed, do it.

Question 12

how are CHCs, POPs and progestin released by the implant metabolized

Answer 12

hepatic cytochrom p450 system

Question 13

drugs that may have decreased efficacy with CHCs, POCs, implant

Answer 13

anti retrovirals (efavirenz)
anti epileptic drugs (phenytoin, carbamazepine, phenobarbital, lamotrigine) - potent enzyme inducers. May need higher dose of AED
Antibiotics (rifampin, rifabutin)
Usually DMPA is only systemic one that is okay because it has such high levels. IUDs work lcoally

Question 14

among those with diabetes, who can you not use hormonal contraception with

Answer 14

diabetes more than 20 years or evidence of microvascular disease (retinopathy, nephropathy, or neuropathy)

Question 15

CREST 5 year failure rates
1) tubal ligation
2) PP tubal ligation
3) Copper IUD
4) Progesterone IUD
5) Etonogestrel implant

Answer 15

1) 13/1000
2) 6/1000
3) 14/1000
4) 5-11/1000
5) 5/1000

Question 16

copper IUD

Answer 16

copper, blocks sperm transport, implantation and fertilization