Hormonal Contraception Flashcards by Kirsten Neal

What two types of hormonal contraception are there?

Combined- Estrogen/Progestin

Progrestin Only

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MOA of combination contraceptives:

*Suppression of mid-cycle gonadotropin (FSH, LH) secretion, thereby inhibiting ovulation
Development of endometrial atrophy=unreceptive to implantation
Production of viscous mucous to impede sperm transport
Possible effect on secretion and peristalsis within the fallopian tube interfering with ovum and sperm transport

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What does the 7 day off period common with contraceptive cause?

Removal of estrogen/progestin causes sloughing of the endometrium and menses

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Why is menstruation lighter with hormonal contraceptive?

Progestin throughout the cycle inhibits proliferative growth of the menses

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The 3 types of combination oral contraceptives include:

Monophasic, biphasic, and triphasic

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What is monophasic combination oral contraceptives?

Fixed amount of estrogen and progestin throughout cycle

Some people may have less AE

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What is biphasic combination oral contraceptives?

Progestin/estrogen rate is lower in 1st half of the cycle, then increases estrogen (some contain not progestin during 2nd half of cycle)

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What is triphasic combination oral contraceptives?

Estrogen/progestin ratio varies throughout the cycle

Can mimic natural cycle

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Most common form of estrogen used in combination oral contraceptions:

Ethinyl estradiol

mestranol is also used, prodrug of ethinyl estradiol

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Standard estrogen dose vs low dose=

Standard= 30-35mcg
Low dose= 20mcg
(Mestranol 50mcg=ethinyl estradiol 35mcg)

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What AE may low dose oral contraceptives causes?

Breakthrough bleeding

Decreased efficacy in obese patients (high Vd)

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Why is estrogen always used in combination with progestin?

Unopposed estrogen promotes endometrial growth and may lead to endometrial cancer

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The goal of dosing progestin in combined oral contraceptives is to limit:

Androgen activity unnecessary for contraception

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Which adverse effects does androgen activity cause?

Acne and hirsutism

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An antiandrogenic progestin is_____ and what are its SE good/bad?

Drospirenone (derived from spironolactone)
Antimineralcorticoid properties so can causes hyperkalemia
May causes less water retention, breast tenderness, and acne

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Examples of mild combination oral contraceptive effects include:

Nausea, breast tenderness, breakthrough bleeding, edema, headache

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Examples of moderate combination oral contraceptive effects include:

Breakthrough bleeding, weight gain, increased skin pigmentation, acne, hirsutism, amenorrhea

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Examples of severe combination oral contraceptive effects include:

Vascular d/o, GI d/o(gallstones, infection), depression, cancer

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What patient s/s may require a decreased estrogen dose?

Breast tenderness
Weight gain
Nausea
HA

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What patient s/s may require a increased estrogen dose?

Breakthrough bleeding
Amenorrhea
Acne (also decrease androgen potency)

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What patient s/s may warrant switching to a less potent progestin?

Breast tenderness 
Weight gain
Depression
Moodiness, irritability 
HA

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What patient s/s may warrant switching to a more potent progestin

Breakthrough bleeding

Severe menstrual cramps

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Potential benefits of combination contraceptives include:

Dec. ovarian cancer
Dec. endometrial cancer
Dec. benign breast cancer 
Dec. PID (pelvic inflamm. disease)
Dec. Iron deficiency anemia 
Dec. ectopic pregnancy 
Dec. dysmenorrhea
Dec. menorrhagia
Contraception

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Potential harms of combination oral contraceptives include:

DVT/PE
Relative CI in women >35 who smoke d/t increased risk of thrombotic CV events
Increased risk of breast cancer- more likely to worse cancer than be the cause of cancer

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Which drugs can cause induction of metabolism of combination oral contraceptive and what does that mean?

``` Reduction of contraceptive effectiveness- use another method Rifampin Phenytoin Primidone Carbamazine Phenobarbital Griseofulvin ```

Which drugs can be potentiated by combination OC's?

``` May need less of these meds Diazepam(Valium) Chlordiazepoxide (Librium) Theophylline Tricycle antidepressants Corticosteroids/cortisone ```

How do cyclic, extended-cycle, and continuous administration of OCs differ?

Cyclic: monthly withdrawal bleeding Extended cycle: withdrawal bleeding once every 4months or so Continuous: no withdrawal bleeding

What are the commonly used estrogen and progestins used in combination OC's?

Ethinyl Estradiol | Levonorgestrel, norgestrel, norethindrone, norgestimate, desogestrel, ethyndiol, drospirone

Which are two commonly used progestin only contraceptives?

Norethindrone and Norgestrel

Progestin only pills are slightly _____ effective than combination OC's.

less

What is one common AE of progestin only pills?

breakthrough bleeding

Who may the use of progestin-only pills be recommended for?

``` Breastfeeding mothers (estrogen decreases milk supply) Patients who should avoid estrogen: PMH of SLE, sickle cell, CV, VTE, migraines) ```

Ortho Evra (norelgestromin/EE):

Transdermal patch | Combination therapy

How is Ortho Evra administered?

Each patch lasts 7 days (3patches/cycle) | 1 week off for withdrawal bleed or continuous administration

What type of absorption does Ortho Evra have?

Excellent absorption: highly lipophillic

What type of hormone release does Ortho Evra have?

Continuous sustained release, avoids peaks/troughs | Delivers 20mcg EE and 150mcg norelgestromin each day (low dose)

AE of the transdermal patch:

skin irritation

MOA of the Nuva Ring:

``` Combined therapy (etonogestrel/EE) Hormone release into vagina and absorbed through the vaginal epithelium Continuous sustained release of hormones (avoidance of peaks/troughs) ```

Dosing for the Nuva Ring:

15mcg EE and 120mcg etonogestrel/day (low dose)

How is the Nuva Ring administered?

Inserted into the vagina and left in place for 3wks 1wk of withdrawal bleeding One size, can be placed anywhere in the vagina

What type of contraceptive is the Depo Provera shot?

Progestin only (medroxyprogesterone)

How is Depo Provera administered?

IM or SubQ

Advantages of Depo Provera:

No daily adherence necessary, shot lasts 3 months, hight efficacy

AE of Depo Provera:

Increased bleeding

The Implanon is what type of contraceptive?

Progestin only (etonogestrel)

How long does Implanon provide contraception for?

3years Slow release of 60mcg of etonogestrel/day Immediately reversible

AE of the Implanon implant:

Irregular bleeding

What type of contraception is the Mirena?

Progestin releasing IUD (levonorgestrel) | Releases 14-20mcg of levonorgestrel/day

How does the Mirena work?

Local endometrial effect Inhibits sperm transport and fertilization of the ova Possible prevention of implantation

How long can the Mirena prevent pregnancy for?

5years

Warning associated with the Mirena include:

ectopic pregnancy, intrauterine pregnancy, sepsis, amenorrhea or irregular bleeding

Plan B is generally two high doses or one high dose of:

Levonorgestrol

How does Plan B work?

Interferes with ovulation, fertilization, transport of egg, and implantation

When is Plan B most effective but up to hour many hours after intercourse can it be used?

72hrs (75-80% effective) | up to 120hrs

Once ______ has occurred Plan B is ineffective.

implantation

AE of Plan B:

N/V

What are other emergency contraceptive options, other than Plan B, that are available with Rx?

``` High dose levonorgestrel/EE Copper IUD(can insert up to 5 days after intercourse) ```

Patients who have acne should be recommended what formula of OC?

High Estrogen | Lower androgen potency

Patients with breakthrough bleeding should be recommended what formula of OC?

Higher Estrogen Higher Progestin Lower Androgen

Patients with absent/light menstrual flow should be recommended what formula of OC?

High Estrogen | Lower Progestin

Patients with depression should be recommended what formula of OC?

Lower Progestin

Patients with moodiness or irritability should be recommended what formula of OC?

Lower Progestin

Patients with headaches should be recommended what formula of OC?

Lower Estrogen | Lower Progestin

Patients with breast soreness should be recommended what formula of OC?

Lower Estrogen | Lower Progestin

Patients with weight gain should be recommended what formula of OC?

Lower Estrogen | Lower Progestin

Patients with severe menstrual cramps should be recommended what formula of OC?

Higher Progestin

Patients who have endometriosis or need endometriosis prevention should be recommended what formula?

Lower Estrogen High Progestin Higher Androgen

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Hormonal Contraception Flashcards

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