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Repro 2-Unit 1 Pharm > Hormonal Contraceptives (Segars) > Flashcards

Hormonal Contraceptives (Segars) Flashcards

1
Q

list some pharmacologic effects of HCs:

A
  • suppress function of H-P-O axis; decrease secretion of GnRH
  • diminish ovarian hormone production
  • inhibit maturation/release of dominant ovule
  • modify mid-cycle surges of LH and FSH
  • increase viscosity of cervical mucus to impede sperm transit
  • produce endometrial changes unfavorable for ovum implantation
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2
Q

name the COC estrogens:

A
  • Ethinyl estradiol (EE) - most common
  • Estradiol valerate-synthetic prodrug of 17-beta estradiol
  • Mestranol-metabolized to ethinyl estradiol
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3
Q

Ethynodiol and Norethindrone are what type of drugs?

A

-Progestin COCs –> 19-Nortestosterone-analog –> Estranes

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4
Q

Desogestrel, Dienogest, Levonorgestrel, Norgestrel, Norgestimate are what types of drugs?

A

-Progestin COCs –> 19-nortestosterone-analog –> Gonanes

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5
Q

Drospirenone is what type of drug?

A

Progestin COC –> Spironolactone analog

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6
Q

which progestins have the most pronounced progestinic activity?

A

Desogestrel and Levonorgestrel

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7
Q

which progestins have low progestinic as well as low estrogenic activity?

A

Ethynodiol and Norethindrone

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8
Q

how many days are hormones take in a 28 day pack?

A

21

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9
Q

what is the duration of usage of Norelgestromin?

A

7 day duration

It is a metabolite of Norgestimate (Gonane) available in a patch with Ethinyl estradiol

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10
Q

what non-oral progestin can be used for a pt who only needed Progestin who doesnt want to have to remember to take their meds (orally)?

A

Etonogestrel (progestin-only implantable rod)

lasts 3 yrs

also have NuvaRing which has Ethinyl Estradiol

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11
Q

what sort of non-contraceptive effects of estrogens occur with: cholesterol, osteoclastic activity, anti-thrombin III, and bile acid levels?

A

they decrease

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12
Q

what effects do estrogens have on: TG’s & HDL-C, clotting factors, platelet aggregation, RAAS (Na/fluid retention), THBG, CHBG, SHGB, Fe/TIBC & prolactin, and folate metabolism/excretion?

A

they increase

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13
Q

serious adverse effects of HCs?

A
  • systemic thromboembolism (MI/stroke/DVT/PE/intestinal ischemia)
  • HTN
  • GB disease
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14
Q

which categories of medical eligibility criteria for contraceptive use are the ones we should know?

A

3-a condition for which the theoretical or proven risks usually outweigh the advantages of using the method

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15
Q

List some MEC-4 contraindications for COC use (Laundry list):

A
  • Known/suspected pregnancy or <21 d postpartum
  • Vascular-related diseases
  • complications to valvular heart disease
  • peripartum cardiomyopathy
  • rheumatic hear disease, esp if + for anti-phopsholipid Ab
  • Hepatic adenoma or malignant hepatoma
  • severe decompensated cirrhosis
  • acute/chronic solid organ transplant rejection or organ failure
  • major surgery w/prolong immobilization
  • uncontrolled/severe HTN (>160/>100 mmHg)
  • Diabetes > 20 yrs w/nephropathy/retinopathy/neuropathy/other vascular disease
  • migraines with aura
  • acute/flare viral hepatitis (initiation of tx only)
  • smoking >15 cigs/day in pts >35 yrs old

If absolute contraindications=No prescription

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16
Q

List some MEC-4 contraindications for IUD (laundry list)

A
  • known/suspected pregnancy
  • postpartum sepsis
  • immediate post-sepsis abortion
  • distorted uterine cavity

These below are contrandicated for initiation of tx ONLY:

  • unexplained vag bleeding
  • cervical cancer
  • current PID
  • pelvic TB
  • current purulent cervicitis
  • current STI
  • confirmed gestational trophoblastic disease with persistently elevated B-hCG levels
  • malignant gestational trophoblastic disease w/evidence/suspicion of intrauterine disease
17
Q

List some U.S. selected practice recommendations of contraceptive use (laundry list)

A
  • timing of starting therapy
  • need for back-up contraception
  • examinations/tests required to initiate tx
  • follow-up evals
  • late or missed doses (COCs)
  • access to therapy continuation (1 YR REFILLS)
  • management of bleeding irregularities
  • management of PID in IUD/IUS users
18
Q

how can you be reasonably certain that a woman is not pregnant?

A
  • <7 days after start of normal menses
  • has not had sex since start of last normal menses
  • has been correctly and consistently using reliable method of contraception
  • <7 days after spontaneous or induced abortion
  • w/in 4 weeks postpartum
  • fully or nearly fully breastfeeding, amenorrheic, and <6 months postpartum
19
Q

most effective, and reversible methods of HCs?

A

implant

IUD

20
Q

most effective, permanent sterilization methods of HCs?

A

female-abdombinal, laparoscopic, hysteroscopic

male-vasectomy

21
Q

intermediate effectiveness, and reversible methods of HCs?

A 
injectable
pill
patch
ring
diaphragm
22
Q

least effective and revesible methods of HCs?

A

male/female condom
pull out
sponge
spermicide

23
Q

which method of HC needs ongoing evaluation for BP?

A

CHCs

24
Q

what is recommended if one hormonal pill is late (<24 hrs since pill should have been taken) OR if 1 hormonal pill has been missed (24 to <48 hrs since pill should have been taken?)

A
  • take the late or missed pill ASAP
  • continue taking remaining pills at usual time
  • no add’l contraceptive protection needed
  • emergency contraception is not usually needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle
25
Q

what is recommended if 2 or more consecutive pills have been missed (<48 hrs since pill should have been taken)?

A

STOP and START OVER

26
Q

how do you manage PID in IUD/IUS users?

A

Treat the PID, counsel about condom use, and IUD does NOT need to be removed UNLESS she wants to discontinue OR no clinical improvement of PID (can consider removing)

27
Q

how long do you have for administering emergency contraceptives after unpotected sex?

A

up to 72 or 120 hrs

28
Q

MOA of Progestin (levonorgestrel) for emergency contraception?

A

Inhibition of ovulation (primary)

take a larger than usual dose of Levonogestrel at time of unprotected sex…sooner the better

if pregnancy has already occurred, these drugs will NOT terminate/abort pregnancy

29
Q

dosing of plan B (2 dose)?

A

1st dose: Take 1 (0.75 mg) tablet ASAP (within 72 hrs) of unprotected sex
2nd dose: take remaining table (0.75 mg) 12 hrs after 1st dose

30
Q

what is Ulipristal? MOA?

A

1-dose emergency contraception

MOA: progesterone receptor modulator; main action is inhibition of ovulation –> in mid-follicular phase results in inhibition of folliculogenesis and reduction in estradiol levels; at time of peak LH, follicular rupture is delayed by 5- days

Take tablet ASAP (within 120 hrs) of unprotected sex

31
Q

when can you start back up on COCs after emergency contraception?

A

d/t mechanism, start COC NO SOONER THAN 5 DAYS of ulipristal use AND use barrier method until next menstrual cycle

Repro 2-Unit 1 Pharm (3 decks)

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