Hormonal contraceptives: Segars Flashcards

1
Q

what are the pharmacologic effects of HCs

A
  • suppress function o hypthalamic pituitary ovarian 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

What are the 3 broad categories of HCs

A
  • Daily use (oral tablets)
  • Non Daily use
  • emergency use
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3
Q

what are the daily oral HC options

A
  • Combination (COC)
  • Progestin only (POP
  • Extended cycle
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4
Q

what are the non daily HC options

A
  • patch
  • Vaginal ring
  • Injectable (LARC): long acting reversible contraceptive
  • Implantable (LARC)
  • IUS/IUD (LARC)
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5
Q

what is the emergancy use contraceptive option

A

progestin only oral tablet

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6
Q

what are the different estrogen in COCs (comination oral contraceptives)

A
  • Ethinyl estradiol (EE): most common; longer half life and more active than estradiol
  • Estradiol valerate: synthetic pro-drug of 17-beta estradiol
  • Mestranol: gets metabolized to ethinyl estradiol
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7
Q

what are the broad different progestins in COCs

A
  • 19-Nortestosterone analogs: Estranes and Gonanes

- Spironolactone-analog

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8
Q

what are the Estanes in COCs

A
  • Ethynodiol

- Norethindrone

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9
Q

what are the Gonanes in COCs

A
  • Desogestrel
  • Dienogest
  • Levonorgestrel
  • Norgestrel
  • Norgestimate
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10
Q

what is the spironolactone analog in COCs

A

Drospirenone

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11
Q

What progestins have the most progestinic activity

A
  • Desogestrel

- Levonorgestrel

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12
Q

What progestins have the most estrogenic activity

A
  • Ethynodiol (most)

- Norethindrone (2nd)

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13
Q

what progestins have the most androgenic activity

A

-Levonorgestrel

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14
Q

Describe a monophasic combination of HCs

A

fixed dose of estrogen and progestin throughout cycle

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15
Q

describe Biphasic combination of HCs

A
  • fixed dose estrogen throughout cycle
  • lower progestin amount in 1st half, allowing endometrial proliferation
  • increased amount in 2nd half provides adequate secretory development
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16
Q

Describe triphasic HCs

A

increasing dose of estrogen (or progestin and estrogen) 3 times during the cycle

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17
Q

Describe Quadriphasic HCs

A

-DECREASING dose of estrogen and increasing dose of progestin 4 times during cycle

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18
Q

Describe non oral progestin: Norelgestromin

A
  • gonane family: “Gest”
  • metabolite of norgestimate
  • available in PATCH with EE (ethynyl estradiol)
  • 7 day duration *****
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19
Q

Describe non oral progestin: Etonogestrel

A
  • a vaginal ring with EE (3 weeks duration ***)or

- implantable rod with progestin only (3 YEARS duration)**

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20
Q

Describe non oral progestin: mydroxyprogesterone

A
  • progestin only

- long acting IM injections (3 month duration)

21
Q

Desribe the non oral progestin: Levonorgestrel

A
  • Progestin only IUD
  • Kyleena adn Mirena (5 years)
  • Skyla and Liletta (3 years)
22
Q

what is the non oral non hormonal contraceptive

A

-copper: non hormonal IUD (10 years)

23
Q

what is the long list of non contraceptive effects of estrogens

A

decrease in:

  • cholesterol
  • Osteoclastic activity
  • Anti-thrombin III
  • Bile acid levels

increase in:

  • Triglycerides and HDL-C
  • clotting factors
  • platelet aggregation
  • renin/aldosterone activity (Na/fluid retnention)
  • thyroid, corticosteroid, sex hormone binding globuline
  • Iron/TIBC and prolactin
  • Folate metabolism/excretion
24
Q

what are common adverse effects of HCs

A
  • irregular bleeding
  • breast tenderness
  • fluid retention (weight gain)
  • mood changes
  • headache and GI distress
  • Hyperkalemia
  • Acne/hirsutism/wt. gain: progestinic and androgenic effect . . . so choose a product without these effects
25
Q

Serious adverse effects of HC’s

A
  • systemic thromboembolism: MI/Stroke/DVT/PE/intestinal ischemia -> used copper or progestin only product
  • HTN
  • Gallbladder disease
26
Q

Do HC’s prevent or reduce the risk of STIs and HIV

A

no

27
Q

HCs can improve what hormone related events

A
  • irregular menstrual cycles
  • Dysmenorrhea
  • Menorrhagia
  • Functional ovarian cysts
  • Acne
  • Anemia
  • PMDD
  • Peri-menopausal symptoms
  • Hirsutism
28
Q

HCs can reduce risk of what cancers

A
  • ovary
  • endometrium
  • Colon/Rectum
29
Q

what # category of medical eligibility criteria for contraceptive use whould you NOT give therapy

A

4

30
Q

Contraindications for COC use

A
  • known/suspected pregnancy or <21-d post partum
  • vascular related disease
  • complications to valvular heart disease
  • Peripartum cardiomyopathy
  • rheumatic heart disease, especially if + for antiphospholipid antibody
  • Hepatic adenoma or malignant hepatoma
  • severe decompensated cirrhosis
  • acute/chronic solid organ transplant rejection or organ failure
  • Major surgery w/ prolonged immobilization
  • uncontrolled sever HTN (>160/>100)
  • Diabetes > 20 years
  • Migraine headaches with aura
  • acute/Flare viral hepatitis (initiation of therapy only)
  • SMOKING > 15/day in patients > 35 years old . . . ABSOLUTE CONTRAINDICATION
31
Q

contraindication for IUD use

A
  • known/suspected pregnancy
  • postpartum sepsis
  • immediate post sepsis abortion
  • Distorted uterine cavity
  • unexplained vaginal bleeding (initiation only)
  • Cervical cancer (initiation)
  • Current PID (initiation)
  • Pelvic TB (initiaion)
  • current purulent cervicitis (initiation)
  • confirmed gestation trophoblastic disease w/persistently elevated Beta-hCG levels (initiation)
  • Malignant gestational trophoblastic disease w/ evidence/suspicion of intrauterine disease (initiation)
32
Q

Drug interactions of HCs

A

-inducers of CYP3A4: antimicrobials, antivirals, anti seizure

33
Q

Describe the therapeutics of giving HCs

A
  • the timing is not that fast
  • need backup contraception while trying to reestablish new levels to blunt LH/FSH
  • exam/tests required to initiate therapy
  • need follow ups
  • 1 year of refills
  • manage bleeding irregularities
  • management of PID in IUD users
34
Q

How can a health care provider be reasonably certain that a female isn’t pregnant and can therefore give HCs

A
  • less than or equal to 7 days after start of normal menses
  • no intercourse since start of last menses
  • has been correctly and consistently using a reliable method of contraception
  • is less than or equal to 7 days after a spontaneous or induced abortion
  • is within 4 weeks postpartum
  • is fully or nearly fully breastfeeding, amenorrheic, and less than 6 months postpartum
35
Q

most effective form of contraception

A

-implant then IUD

36
Q

when can you start a patient on contraception

A

anytime as long as not pregnant

37
Q

Which contraceptive methods do you need to do bimanual exam and cervical inspection prior

A
  • copper IUD

- Levonorgestrel IUD

38
Q

Which contraceptive method do you need to measure blood pressure prior

A

combined hormonal contraceptive

39
Q

what backup answer should I never pick on the test

A

backup for 30 days

40
Q

which contraception method requires ongoing evaluation of BP

A

combined hormonal contraception . . all others follow ups are not REQUIRED but encouraged

41
Q

what if a patients misses a day or 2 of pills?

A

-take late or missed pill asap and continue therapy

42
Q

what if a patient goes over 48 hours or misses 2 pills

A

stop and start over

43
Q

management of PID in IUD and IUS users

A
  • treat the PID

- don’t have to remove the IUD

44
Q

What is the MOA of Progestin emergency contraception

A

(Levonorgestrel)

-inhibition of ovulation

45
Q

Describe 2 dose emergency contraception

A
  • first dose within 72 hours

- 2nd dose 12 hours after first dose

46
Q

Describe 1 dose emergency contraception

A

-take within 72 hours

47
Q

Describe Ulipristal (non progestin) emergency contraceptionn

A
  • 1 dose
  • within 120 hours
  • a progesterone receptor modulator
  • delays follicular rupture by 5-9 days
48
Q

Describe the initiation of COCs after emergency contraception

A

-start NO SOONER THAN 5 DAYS of ulipristal use and use barrier method until the next menstrual cycle