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Clinical part B > Hormonal Contraception > Flashcards

Hormonal Contraception Flashcards

1
Q

define menarche

A

first menstraul cycle

around 12 years

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2
Q

define menses

A

sloughing of endometrial cells - period

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3
Q

define menopause

A

cessation of menstraul cycle
one year with no period
around 50

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4
Q

goals of therapy

A

prevent fertilization in order to prevent pregnancy
tailor method to individual needs
avoid/minimize adverse effects
ensure adherance by providing clear oral and written instructions

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5
Q

4 mechanisms of action

A
  1. estrogen and progesteron provide negative feedback
  2. creates endometrium that is unreceptive to implantation
  3. production of viscous cervical mucus
  4. effect secretion adn peristalisis in fallopian tubes
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6
Q

doses of ethinyl estradiol

A

low - 10mcg
high - 50mcg
most women dont need over 35mcg

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7
Q

diff types of progestins

A

1st gen - bind to estrogen, progesterone, androgen
2nd gen - more potent and better tolerated
3rd gen - fewer androgenic effects
newer - antiandrogens

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8
Q

two different categories of progestins

A

androgenic activity

progestagenic activity

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9
Q

difference between the different phasics

A

monophasic - fixed amount of estrogen and progestin
biphasic - 2 phases of progestin
triphasic - 3 phases of progestin

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10
Q

how do the extended cycles work

A

24/26 days only 4 days hormone free

84 day 7 days hormone free (seaonale) or will little estrogen (seasonique)

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11
Q

what is suggested dose for starting a coc

A

20mcg ethinyl estrodiol and older progestin (levonorgestrel or norethindrone)

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12
Q

which is preferred for doing continuous use with no hormone free period and why

A

monophasic because biphasic will get that drop in progesterone level and may get spotting

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13
Q

why cant the hormone free interval be more than 7 days

A

dominant follicle will form and ovulation will occur

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14
Q

what is recommended for starting coc

A

back up contraception for first 7 days unless its on the first day of your period
to avoid weekend periods start the first sunday after period starts

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15
Q

cautions with COCs

A

people at increased risk of VTE
migraines with an aura higher risk of stroke
hypertension that is uncontrolled or greater then 160/100
smoke more than 15 cigs a day and over 35
21 days post partum, 30 days if breast feeding
current or previous breast cancer
diabetes for 20 yrs
uncontrolled dyslipidemia- may increase LDL and decrease HDL
obesity decreases serum levels
systemic lupus erythmatosus - high risks associated wiht pregnancy so use contraception

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16
Q

benefits of combined oral hormonal contraception

A

relief from menstrual issues such as cramps, ovulatory pain, blood loss
menstrual regularity
decreased acne and hair growth due to antiadrogenic effects
reduced risk of ovarian and endometrial cancer
bone density benefits

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17
Q

risks of coc’s

A

heart attack and stroke due to high doses of estrogen

thromboembolism, but less risk than in pregnancy

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18
Q

who are at high risk of DVT/PE and what should they do

A 
over than 35 adn smoker
history of clots
obesity 
prolonged immobilization 
family history 
use other contraceptive methods
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19
Q

what are some earyl danger signs (ACHES)

A

abdominal pain severe (thrombosis, pancreatitis, gallbladder disease)
chest pain, shortness of breath (pulmonary embolus, MI)
headache (stroke, hypertension)
eye problems (stroke, hypertension, vascular insufficiency)
severes leg pain (DVT)

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20
Q

symptoms of too much estrogen

A 
nausea
bloating
breast tenderness
melasma
irritable 
headache
weight gain
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21
Q

signs of too little estrogen

A 
early spotting
vasomotor symptoms 
headache
depression 
nervous
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22
Q

signs of too much progestin

A 
breast tenderness
headache
fatigue
cahnges in mood
increased appetite
weightgain 
decreased libido
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23
Q

signs of too little progestin

A

late break through bleeding
dysmenorrhea
heavy flow

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24
Q

signs of too much androgen

A 
increased appetite and weight
oily skin and scalp 
acne 
hirsutism 
increased libido 
rash 
increased LDL
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25
Q

what do you do if pt experiences break through bleeding

A

may occur in first month of use but keep using

after 3-6 months doesnt resolve may need to change to increase estrogen or progestin

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26
Q

what to do if pt experiences breast tenderness

A

if continues after 3 months see doctor

may need less estrogen

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27
Q

should you gain weight on the pill

A

may have increased appetite in first month but overall not associated with weight gain

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28
Q

what to do if pt experiences nasuea

A

should resolve in 3 months
take at bedtime or with food
may consider less estrogen

29
Q

what to do if pt experiences headaches

A

if related to treatment avoid oco

30
Q

what to do if pt experiences acne

A

may worsen initially but general should improve long term

if not change to less androgenic progesterone

31
Q

drug interactions with coc

A 
carbamazepine
oxcarbazepine
phenytoin
primidone
phenobarb
topiramate
rifampin 
griseofulvin 
ritonavir 
stjohns wort
antibiotics?
32
Q

how is ethinyl estradol metabolized

A

CYP3A4

33
Q

what is contained in the transdermal contraceptive patch evra

A

norelgestromin 150mcg

ethinyl estradiol 20 mcg

34
Q

how do you use the transdermal patch

A

apply one patch weely for 3 weeks with 1 week patch free

start first day of menses

35
Q

some of the side effects of transdermal not seen in coc

A

more spotting and breast tenderness in the first 2 cycles

local skin reaction

36
Q

what is contained in the vaginal contraceptie ring - nuvaring

A

120mcg etonorgestrel

15mcg ethinyl estradol - less estrogen so less SE

37
Q

how do you use nuva ring

A

insert for 3 weeks then remove for 1 week

start day one of mensus no back up method needed

38
Q

disadvantages of the nuva ring

A

requires self insertion and removal
more vaginal symptoms of irritation, discharge, vaginitis
concurrent use of tampons not recommended bc absorb some of the progesterone

39
Q

who should you use the progestin only pill in

A

during lactation

contraindication to estrogen

40
Q

what does the minipill contain

A

35mcg norethindrone

41
Q

how do you take the minipill

A

no pill free interval

have to take tablet within 3 hours everyday

42
Q

MAO of the minipill

A

increases cervical mucus viscosity and endometrial atrophy
decreases sperm motility
ovulation still occurs

43
Q

adverse effects of minipill

A

irregular bleeding

hormonal side effects

44
Q

what to do if pill is taken more than 3 hours past

A

take the pill ASAP and continue taking pack
back up must be used for 48 hrs
emergency contraception should be considered if unprotected intercourse occurred in the past 5 days

45
Q

how often do you get the medroxyprogesterone acetate injection

A

every3 months

46
Q

MAO of progestin injection

A

inhibits secretion of gonadotropins
inhibits ovulation
increases cervical mucus viscosity and endometrial atrophy
resembles menopause bc no GnRH release

47
Q

who should use the progestin injection

A

women who desire 3 month contraception
contraindications to estrogen (over 35 smokers, migraine sufferers, breastfeeding, endometriosis, sickle cell disease, taking anticonvulsants, high risk of stroke)

48
Q

contraindications for the progestin injection

A 
pregnancy 
unexplained vaginal bleeding 
current breast cancer 
severe liver disorder - caution 
between 16-18 bc thats when peak bone mass is being laid fown
49
Q

benefits of progestin injectable

A

no period
decreased risk of endometrial cancer
decreased symptoms of endometriosis?

50
Q

adverse effects of progestininjectable

A

menstraul cycle disturbance
hormonal
weight gain
decrease mood
decreased bone mineral density (increased with greater duration of use)
delayed return of fertility (9-12 months)

51
Q

who cant use an ius

A 
current pregnancy 
pelvic inflammatory disease
STI
undiagnosed abnormal vaginal bleeding 
uterine abnormalities
52
Q

what are some of the risks associated with ius

A

uterine perforation with insertion or expulsion

53
Q

MAO copper IUD

A

creates a hostile environment for sperm through an immune response
reduces formation of mature eggs

54
Q

side effects of copper iud

A

increase in menstrual bleeding and cramping

55
Q

maximum time a copper iud is inserted

A

30 months

dont need back up contraception as soon as its inserted

56
Q

MAO of levonorgestal ius

A

creates a hostile environment for sperm trhoguh an immune response
reduces formation of mature eggs
endometrial suppression and thickening of cervical mucus

57
Q

side effects of levonorgestrel ius

A

breast tenderness
headache
acne
maybe irregular periods and amenorrhea

58
Q

benefit of levonorgestrel ius

A

reduced menstrual bleeding and cramping

59
Q

does back up contraception have to be used with levonorgestrel ius

A

use back up for 7 days if it hasnt been inserted within 7 days of onset of menses

60
Q

duration and strength of mirena ius

A 
levonorgestrel 52mcg (20mcg/day of progestin)
5 years
61
Q

strength and duration of jaydess

A

levonorgestrel 13.5mg

3 years

62
Q

who is jaydess marketted for

A

adolescent and nulliparous (havent given birth) women

63
Q

strength and duration of kyleena

A

levonorgestrel 10.5mg

5 years

64
Q

which progestins have the most progestagenic activity

A

desogestrel
levonorgestrel
norgestrel

65
Q

what does yasmin contain as a progestin

A

drospirenone

66
Q

activity of yasmin and what it is good for

A

progestagenic
antiadrongenic
antimineralcorticoid
polycystci ovary syndrome, acne, premenstrual dysphoric disorder

67
Q

adverse effects of yasmin

A

increase potassium

68
Q

what does diane contain and what is it actually used for

A

cyptoterine which is an antiandrogenic so used as a temporary treatment of severe acne

Clinical part B (15 decks)

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