Hormonal Contraceptives (Segars) Flashcards
list some pharmacologic effects of HCs:
- 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
name the COC estrogens:
- Ethinyl estradiol (EE) - most common
- Estradiol valerate-synthetic prodrug of 17-beta estradiol
- Mestranol-metabolized to ethinyl estradiol
Ethynodiol and Norethindrone are what type of drugs?
-Progestin COCs –> 19-Nortestosterone-analog –> Estranes
Desogestrel, Dienogest, Levonorgestrel, Norgestrel, Norgestimate are what types of drugs?
-Progestin COCs –> 19-nortestosterone-analog –> Gonanes
Drospirenone is what type of drug?
Progestin COC –> Spironolactone analog
which progestins have the most pronounced progestinic activity?
Desogestrel and Levonorgestrel
which progestins have low progestinic as well as low estrogenic activity?
Ethynodiol and Norethindrone
how many days are hormones take in a 28 day pack?
21
what is the duration of usage of Norelgestromin?
7 day duration
It is a metabolite of Norgestimate (Gonane) available in a patch with Ethinyl estradiol
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)?
Etonogestrel (progestin-only implantable rod)
lasts 3 yrs
also have NuvaRing which has Ethinyl Estradiol
what sort of non-contraceptive effects of estrogens occur with: cholesterol, osteoclastic activity, anti-thrombin III, and bile acid levels?
they decrease
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?
they increase
serious adverse effects of HCs?
- systemic thromboembolism (MI/stroke/DVT/PE/intestinal ischemia)
- HTN
- GB disease
which categories of medical eligibility criteria for contraceptive use are the ones we should know?
3-a condition for which the theoretical or proven risks usually outweigh the advantages of using the method
List some MEC-4 contraindications for COC use (Laundry list):
- 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
List some MEC-4 contraindications for IUD (laundry list)
- 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
List some U.S. selected practice recommendations of contraceptive use (laundry list)
- 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
how can you be reasonably certain that a woman is not pregnant?
- <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
most effective, and reversible methods of HCs?
implant
IUD
most effective, permanent sterilization methods of HCs?
female-abdombinal, laparoscopic, hysteroscopic
male-vasectomy
intermediate effectiveness, and reversible methods of HCs?
injectable pill patch ring diaphragm
least effective and revesible methods of HCs?
male/female condom
pull out
sponge
spermicide
which method of HC needs ongoing evaluation for BP?
CHCs
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?)
- 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
