Hormonal Contraception

Question 1

2 types of contraception

Answer 1

estrogen + progestins

just progestins

Question 2

Define mono-, bi-, and triphasic contraception

Answer 2

constant dose

changed once during cycle

changed twice during cycle - most similar to bodily function

Question 3

MOA:

Answer 3

feed-back inhibition of pituitary release of FSH and LH

Changes cervical mucus, motility and secretion of tubes to discourage conception and implantation

Question 4

What are effects of chronic contraception use?

Answer 4

depress ovarian function

decrease ovary size

2% of women stay amenorrheic for several years after cessation of therapy

Cervial hypertrophy and polyps

Question 5

Which type of agent can cause glandular atrophy?

Answer 5

19- nor progestins

Question 6

Which type of agent can cause breast enlargement and suppression of lactation?

Answer 6

estrogen containing agents

Question 7

What CNS uses does contra. have?

Answer 7

premenstrual tension, post-partum depression, and climacteric depression (menopause based)

Question 8

Which clotting factors are affected by contra. use?

Answer 8

7, 8, 9, 10 are increased

3 is decreased

Question 9

Contraceptive failure may occur due to:

Answer 9

missing doses

use of phenytoin (dilantin- inc. CYP450 enzyme metabolism)

antibiotics- interfere with enterohepatic recycling

Question 10

Why should you always use the smallest effective dose of contra?

Answer 10

undesirable side effects are limited

Question 11

Mild AE’s?

Answer 11

N, HA, mastalgia, edema, breakthrough bleeding

Question 12

Moderate AE’s and treatment

Answer 12

Breakthrough bleeding- switch to bi/triphasic form

Weight gain- less progestins and dieting

Acne- more estrogen and less androgen like progestins

hirsuitism- non-androgenic progestins preferred

• Amenorrhea- several years after for some women +galactorrhea
• Prolactin levels must be monitored b/c hyperprolactinemia

Question 13

Severe AE

Answer 13

Thromboembolism
MI- much higher in heavy smokers >40
stroke risk
GI
Depression
Cancer

Question 14

What are some severe GI side effects of Contra?

Answer 14

cholistatic jaundice, cholecystits, cholangitis, hepatic adenomas, and ischemic bowel disease.

Question 15

Contra is CI’ed in:

Answer 15

thromboplebitis
thromboembolic phenomena
cardiovascular and cerebrovascular disorders
vaginal bleeding (unknown reason)
estrogen dependant cancers
adolescents with epiphyseal closure still incomplete

Question 16

Caution in patients with:

Answer 16

liver diease, asthma, eczema, migraine, diabetes, hypertension, optic neuritis, and convulsive disorders

Edema- bad for heart failure patients