HC

Question 1

What are the two types of COC Daily Use Oral Tablets?

Answer 1

Estrogens and Progestins

Question 2

What COC Daily Use Tablets are Estrogens?

Answer 2

Ethinyl estradiol (EE, most commonly used)
Estradiol Valerate
Mestranol

Question 3

What does the ethinyl group in Ethinyl Estradiol (EE) do?

Answer 3

Slows hepatic degradation/metabolism

Question 4

Risks and S/E of Estrogens?

Answer 4

Irregular bleeding, breast tenderness, fluid retention, mood changes, HA and GI distress, acne, hirsutism, wt gain, systemic thromboembolism, HTN, gallbladder dx

Question 5

What Progestin is used as emergency contraception?

Answer 5

Levonorgestrel

Question 6

What do the progestins all have in common?

Answer 6

The piece “gest” in their name

Question 7

Which Progestin is a Spironolactone-analog?

Answer 7

Drospirenone

Question 8

What are the non-oral Progestins?

Answer 8

Norelgestromin (patch)
Etonogestrel (vaginal ring, implantable rod)
Medroxyprogesterone (MPA): IM injection
Levonorgestrel (IUS)
Copper IUD

Question 9

What is Norelgestromin? What’s its duration?

Answer 9

Patch

7 days

Question 10

What is Etonogestrel? What’s its duration?

Answer 10

Vaginal ring or implantable rod
3 weeks (ring)
3 years (rod)

Question 11

What is Medroxyprogesterone (MPA)? What’s its duration?

Answer 11

IM injection

3 months

Question 12

What is Levonorgestrel? What’s its duration?

Answer 12

IUS

3-5 years

Question 13

What is the Copper implant? What’s its duration?

Answer 13

IUD

10 years

Question 14

Does the copper IUD need to be removed in PID?

Answer 14

No

Question 15

How long may emergency contraception be effects after an incident?

Answer 15

5 days

Question 16

What do HCs do?

Answer 16

Suppress the hypothalamic-pit-ovarian axis -> dec GnRH secretions from the hypothalamus -> dec ovarian hormone production

this inh release of immature ovum, inc cervical mucus viscosity to impede sperm transit, produces endometrial changes

Question 17

What are phasic combination COCs?

Answer 17

Hormones taken for 21 days (28-day packs)

Mono: fixed E and P
Bi: fixed E, low P 1st half, high P 2nd half
Tri: inc dose of E (or E + P) 3 times during cycle
Quad: dec E and inc dose of P 4 times during cycle

Question 18

Non-contraceptive effects of estrogen:

Answer 18

Dec: cholesterol, osteoclast activity (reduced bone turnover), anti-thrombin III, bile acid

Inc: TGs, clotting factors and platelet aggregations, Na/water uptake, folate metabolism and excretion

Question 19

Non-contraceptive COC HCs benefits:

Answer 19

Improved menstrual cycle consistency, fixes dysmenorrhea/menorrhagia, prevents ovarian cysts.. acne.. anemia.. hirsutism, reduces CA risk (ovary, endometrial, colon/rectal)

Question 20

Do HCs prevent or reduce the risk of STIs and HIV?

Answer 20

FUCK no

Question 21

Contraindications for COC:

Answer 21

Suspected pregnancy, vascular dx, HD, cardiomyopathy, liver dx, organ xplant rejection or organ failure, prolonged immobilization, uncontrolled HTN, DM, migraines, smoking > 15 cigs/d in pts > 35 yo

Question 22

When shouldn’t you start tx?

Answer 22

Acute/flare of viral hep

Question 23

What medications can you not give HC with?

Answer 23

Drugs that induce CYP3A4

• ATBs
• antivirals
• anti-seizure agents

Question 24

Most affective tx? Least?

Answer 24

Most: implant, IUS, surgery
Least: condoms, withdrawal, fertility awareness method, spermicide

Question 25

What are the starting strategies?

Answer 25

Back-up methods must be used for first week
COC req BP check
IUS req cervical inspection