Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

endo y3s1 > IC17 Contraceptives > Flashcards

IC17 Contraceptives Flashcards

1
Q

barrier methods

A
  1. male condom
  2. female condom
  3. diaphragm with spermicides
  4. cervical cap
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

barrier methods: male condom

c/i, adv & disadv

A
  • Allergy to latex/ rubber
  • STI protection
  • High user failure rate
    Poor acceptance
    Possibility of breakage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

barrier methods: female condom

c/i, adv & disadv

A
  • Allergy to polyurethane
    Hx of toxic shock syndrome (HSS) if not removed for long time
  • Can be inserted ahead of time
    STI protection if used correctly
  • Very high user failure rate
    Dislike of ring hanging outside vagina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

barrier methods: diaphragm with spermicide & cervivcal cap

c/i, adv & disadv

A
  • Allergy to latex, rubber or spermicide
    Recurrent UTIs
    Spermicide causes disturbance in bacteria within region
    Hx of TSS
    Abnormal gynaecological anatomy
  • Low cost
    reusable
  • High user failure rate
    Low protection against STIs
    Increased risk of UTI
    Cervical irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

COC: role of hormones

progestin & estrogen

A

Progestin
* Thicken cervical mucus
prevent sperm penetration
slows tubal motility → delay sperm transport
Induce endometrial atrophy → even IF egg is fertilised, cannot be implanted
* Blocks LH surge + (oestrogen) suppresses FSH release ⇒ prevents ovulation
LH → stimulates ovulation; blocking of LH = no egg produced
FSH → stimulates follicle production; blocking = no egg

Oestrogen
Stabilises endometrial lining & provide cycle control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

COC: SE of progestin

A

acne, oily skin, hirsutism (growth of hair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

COC: possible benefit of progestin

A

Late cycle breakthrough bleeding → to prevent bleeding at end of cycle
Painful menstrual cramps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

COC: types of progestin

A

drosperinone & cyproterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COC: types of progestin
drospirenone

effect, benefits, SE

A

Analogue of spironolactone
may have diuretic effects; to monitor K+ & fluid status
Lesser water retention

Anti-mineralocorticoid + some anti-androgenic action
Lesser acne; ideal for patients with acne/ oily skin

SE: hyperkalemia, thromboembolism & bone loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

COC: types of progestin
Cyproterone

indication, effects, SE

A

treatment of excessive-androgen related conditions (severe acne, hirsutism)

Have anti-androgenic, antigonadotropic effects

SE: high risk of thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

COC: estrogen

types & doses

A

Types: Ethinyl estradiol (EE), estradiol valerate, esterol, mestranol

Doses:
High: ≥50 μg
moderate/ standard: 30-35 μg
Low: 15-20 μg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

COC: estrogen

problem of high doses

A

associated with vascular, embolic events, cancer & significant AE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COC: estrogen (factors favouring lower dose)

A
  • Adolescence
  • Underweight (<50 kg)
  • Age > 35 years ⇒ higher risk of SE
  • Peri-menopausal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COC: estrogen (factors favouring higher dose)

A

obesity/ weight > 70.5kg
* More production of oestrogen; higher dose required to stimulate -ve feedback loop
* EE highly protein bound & enters fatty tissues → will lower plasma conc of oestrogen

Early to mid-cycle breakthrough bleeding/ spotting
Due to cycle not being fully suppressed

Tendency of non-adherence
Can counteract by increasing dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

COC: Types of COC

A
  1. monophasic
  2. multiphasic
  3. conventional
  4. extended-cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

COC: Types of COC
monophasic

hormones in pills

A

Same amounts of oestrogen & progestin in every pill
Less confusing, less missed-doses instructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

COC: Types of COC
multiphasic

hormones in pills

A
  • Variable amounts of oestrogen & progestin; mimics body cycle
    more oestrogen in early cycle, more progestin in late cycle
  • Tend to have lower progestin overall ⇒ reduced SE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

COC: Types of COC
conventional

hormones in pills, benefits for new type

A

21 active pills + 7 days placebo = 28 days

(newer) 24 days active pills + 4 days placebo = 28 days
* 3 additional active pill shortens pill-free interval → reduce hormone fluctuations between cycles
* Overall lesser SE (withdrawal effects; headache & mood swings)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

COC: Types of COC
extended cycle

hormones in pills, purpose of placebo

A

84 days active pills + 7 days placebo = 91 days
* Ensures no period for 84 days
* Placebo → to regulate hormones & ensure patient can still produce own hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

COC: Initiation methods (3)

when to start, need for backup contraceptives

A

First day method
* Start on first day of menstrual cycle
* No backup contraceptive required if pill taken on first day of cycle
Due to ovulation not occurring yet ⇒ new follicle not stimulated

Sunday start method
* Start on first sunday after menstrual cycle begins
* Require backup contraceptive for at least 7 days
* May provide weekends free of menstrual periods

Quick start
Require backup contraceptive for at least 7 days + until next menstrual cycle begins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

COC: Initiation methods
purpose of backup contraceptives

A

Due to uncertainty of where the patient is at in the menstrual cycle → might have ovulation already hence still need barrier contraceptive to prevent fertilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

COC: additional benefits

RAP PIC

A
  • Improvement in menstrual regularity
    Know when bleeding will occur + how much blood will be lost
  • Better for Acne
  • Premenstrual dysphoric disorder
  • Iron-deficiency anaemia
    Some pills contain iron
    Good for patients with heavy flow → risk of anemia
  • Help with management of polycystic ovary syndrome
  • Reduced risk from:
    ovarian & endometrial cancers → but might increase risk of breast cancer
    ovarian cysts, ectopic pregnancy, pelvic inflammatory diseases, endometriosis, uterine fibroids, benign breast disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

COC: risks of taking

A
  1. breast cancer
  2. venous thromboembolism
  3. MI/ Stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

COC: risks of taking
breast cancer

individuals with higher risks, who should avoid

A
  • In those currently using/ previously used COC
  • Increases risks with duration of use & age >40
  • Healthy & young: benefits of pregnancy prevention > risks of cancer
  • After discontinuation, risks return to same levels as those who never use COC

Patients with following conditions to avoid:
* Age > 40 years old
* Family history/ risk factors of breast cancer
Oestrogen → stimulator of breast cancer; receptor is present throughout body in individuals with breast cancer risks (& breast cancer patients)
* current/ recent history of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

COC: risks of taking
VTE

causes (E & P), RF, considerations of those with high risk

A

Estrogens increase hepatic production of factor VII, factor X & fibrinogen of coagulation cascade
* Distributed to all parts of body
* Increase in clotting factors ⇒ more likely for clot formation

New generation progestins (ie: Drosperinone, Cyproterone & Desogestrel) → unknown MOA, possibly increase protein C resistance
* Have antithrombotic activity; resistance ⇒ more thrombotic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

COC: risks of taking
VTE

RF, considerations of those with high risk

A

Risk factors
>35 year old, obesity, smoking, immobilisation, cancer, hereditary thrombophilia

Considerations for individuals with clotting risk factors:
* Low dose oestrogen with older progestin
Ideally to avoid oestrogen in totality
* Progestin-only contraceptive
* Barrier methods ⇒ general choice, especially if have initial clot & elevated levels of clotting factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

COC: risks of taking
MI/ Stroke

hormone associated, absolute c/i, considerations for those with risk

A

oestrogen

Migraine with aura (flashing light; blind spots) ⇒ absolute contraindications to ALL COC; to use progestin-only/ barrier methods

Considerations for individuals with risk factors (similar to clotting):
* Low dose oestrogen
* Progestin-only
* Barrier methods

28
Q

COC: absolute contraindications

B3DSM P1ICH (total 15)

A
  • Current breast cancer/ recent hx of breast cancer within 5 years
  • Hx of deep vein thrombosis [DVT]/ pulmonary edema [PE], acute DVT/ PE, DVT/ PE patients on anticoagulant therapy
  • Major surgery with prolonged immobilisation
  • <21 days postpartum with other risk factor
  • <6 weeks postpartum if breastfeeding
  • Thrombogenic mutations
  • SLE with or unknown APLA (antiphospholipid syndrome)
  • Migraine with aura
  • BP: SBP > 160mmHg / DBP > 100mmHg ⇒ stroke risk
  • HTN with vascular disease
  • Current/ hx of ischemic heart disease
  • Cardiomyopathy
  • Smoking ≥ 15 sticks/day AND age ≥ 35yo
  • Hx of cerebrovascular disease
  • Diabetes >20 yrs or w/complications
    If diabetes recently diagnosed, technically still can use COC
29
Q

COC: AE

A
  1. bleeding breakthrough
  2. acne
  3. bloating
  4. N/V
  5. headache
  6. menstrual pain
  7. breast tenderness/ weight gain
30
Q

COC: AE management

bleeding breakthrough, acne, bloating

A

Bleeding breakthrough → commonly due to oestrogen; will cause build up of fluids
* early/ mid cycle ⇒ increase oestrogen
* Late cycle ⇒ increase progestin

Acne
* Change to less androgenic progestin
* Consider increasing oestrogen
* If on progesterone only pills ⇒ change to COC

bloating
* Reduce oestrogen
* Change to progestin with mild diuretic effect (ie drospirenone)

31
Q

COC: AE management

N/V, headache, menstrual pain, breast tenderness/ weight gain

A

N/V
* Reduce oestrogen
* Take pills at night/ change to POP

Headache
* Exclude migraine with aura first ⇒ if present, to stop medications immediately
* Usually occurs during pill-free week ⇒ switch to extended cycle/ continuous/ shorter pill interval
Due to fluctuation of hormone levels

Menstrual cramps ⇒ increase progestin/ switch to extended cycle/ continuous

Breast tenderness/ weight gain ⇒ keep oestrogen & progestin as low as possible

32
Q

COC: AE counselling

when does AE usually occur, how long to persevere

A

AE usually occur during early COC use
* Will generally improve by 3rd-4th cycle after body adjust to hormone levels (stabilisation)
* Important to check if patient still have any effects → if have, need to change products

To persevere on COC for 2-3 months before changing products unless have severe AE
* VTE, stroke, migraine with aura, MI

33
Q

COC: problems of DDI

What to avoid

A

Will affect concentration of contraceptives in body ⇒ increase risk of pregnancy
Commonly avoid CYP enzyme inducers

34
Q

COC: DDI (drugs involved & how it affects)

A

Rifampicin
* (significant interactions) Can alter gut flora → will alter metabolism of COC ⇒ less active COC
Same for other ABs but less significant than rifampicin
* Use additional contraceptive (barrier method) till rifampin discontinued for ≥7 days
Generally recommended if patient given AB

Anti-convulsants
* Reduce free serum concentrations of both oestrogen & progestin
* Examples: Phenytoin, carbamazepine, barbiturates, topiramate, oxcarbazepine, lamotrigine (effects interfered by oestrogen levels in body)

HIV antivirals
Reduces effectiveness of both COC & AV

35
Q

COC: missed dose
Missing 1 dose (<48 hours since pill should be taken)

A

Take missed dose immediately & continue the rest as usual
* Aka taking 2 pills on same day
* If miss day 15 pill → on day 16, take the day 15 & day 16 pills

No additional contraceptive methods required

36
Q

COC: missed dose
If ≥2 consecutive dose missed (>48 hours)

A

Take missed dose immediately & discard the rest of the missed dose
Backup contraceptive required for at least 1 week

Example: missing days 10-13 pills (4 days missed)
* Day 14: To take missed day 10 pill AND day 14 pills
* Throw away days 11-13 pills
* Day 15: continue as per normal

37
Q

COC: missed dose
If pills missed during last week of hormonal tablets (days 15-21)

A

Finish remaining active pills in current pack
Skip hormone free-interval (days 21-28) & start a new pack the next day
Back up contraceptive required for at least 1 week

Example: missing days 15-19 (5 days) → same idea regardless of number of days missed
* Day 20: To take missed pill from day 15
* Continue taking missed dose of days 16-19 in the time frame of days 21-24
* By right, the hormonal pills should end on day 24 NOW, instead of the usual day 21 (5 days late)
* Days 15-19 hormonal pill ⇒ taken during days 20-24 instead
* Discard non-hormonal pills from days 21-28
* Day 26: To start on a fresh pack, day 1 of hormonal pills again.

38
Q

POP: administration time

A

Need to take everyday at the SAME time for entire cycle

39
Q

POP: indications & reasons

A
  • Patient is breastfeeding
    Interferes with prolactin production (changes production of milk)
    Generally avoid oestrogen when breastfeeding
  • Intolerant to oestrogen (have N/V)
40
Q

POP: c/i

A

current/ recent hx of breast cancer

41
Q

POP: Types of pills

Number of active pills

A
  • Norethindrone (norethisterone) or levonorgestrel→ 28 active pills; continuous
    Pill only stops ovulation but not follicle stimulation
    Miss dose = LH increases & ovulation occurs
  • Drospirenone → 24 active pills, 4 inactive
    Have longer t1/2, hence lesser active pills
42
Q

POP: How to start

A
  • Within 5 days of menstrual cycle/bleeding → no back up contraceptive needed
  • Any other day → back up contraceptive for 2 days (7 days for drospirenone)
43
Q

POP: Missed dose

N/L & D

A

N/L: If late dose by > 3 hours ⇒ take extra (2 pills total) & continue; backup contraceptive for 2 days
* More time sensitive
* May cause increased LH, causing follicle to rupture ⇒ ovulation occurs

Drospirenone:
* if <24h, take extra and continue
* if ≥2 active pills missed, backup needed for 7 days

Taking extra
Take 1 immediately once discovered dose is missed + other 1 at normal time when usually take the pill the NEXT day (as scheduled)

44
Q

Progestin injections: administration method

things to note

A

IM injection every 12 weeks
Ideal for patients with adherence issues
But require regular doctor visit → check if patient willing to do so

45
Q

Progestin injections: impact on fertility

A

Return to fertility might be delayed

46
Q

Progestin injections: SE

A

Will have variable breakthrough bleeding especially the first 9 months (most freq SE)
* 50% become amenorrheic (no period) after 12 months
* 70% after 2 years
* Note: body will be used to effects & change in hormonal levels in LR ⇒ lesser of such SE

Weight gain → more than other types of contraceptives

Short term bone loss → bone mineral density decreases [FDA black box warning]
Patients with higher risk (& should avoid):
- Older women
- Have other osteoporosis risk factors → ie LT steroid use
- If require >2 years of use, should evaluate other contraceptives

47
Q

Transdermal contraceptives: components

A

oestrogen & progestin

48
Q

Transdermal contraceptives: when will effectiveness be reduced

A

patients >90kg

49
Q

Transdermal contraceptives: application

A

once weekly every 3 weeks followed by 1 patch-free week
Ideal for patients with adherence issues

50
Q

Transdermal contraceptives: SE

A

similar to COC + application site reactions

51
Q

Vaginal rings: compnent

A

oestrogen & progestin

52
Q

Vaginal rings: usage

A

Used for 3 weeks then discarded

53
Q

Vaginal rings: SE

A

Similar to COC + tissue irritation + risk of expulsion

54
Q

Transdermal patch + Vaginal rings: risk of estrogen

A

Continuous, higher exposure to oestrogen ⇒ increased risk of VTE

55
Q

LARC: Benefits

A
  • Highly effective: typical-use rates ≈ perfect-use rates ≈ <1%
  • Easy to use, cheap
  • Effects quickly reversible upon removal → no long term effects on fertility (within 12 months will return to normal)
56
Q

types of LARC

A
  1. subdermal progestin implant
  2. levonogestrol IUD
  3. copper IUD
57
Q

subdermal progestin implant

component, how long it lasts, problem with continued use

A
  • Single 4 cm long implant, containing 68 mg of etonogestrel ⇒ long acting
  • Lasts for 3 years then replaced
  • Might cause irregular bleeding pattern with continued use
    Amenorrhea (22%), prolonged bleeding (18%), spotting (34%) & frequent bleeding (7%)
58
Q

IUD: MOA

additional: progestin

A
  • inhibition of sperm migration, damage ovum, damage/disrupt transport of fertilised ovum ⇒ no pregnancy can occur.
  • If used with progestin → endometrial suppression, thicken mucus
    Decrease movement of sperm
59
Q

IUD: who should avoid

A

pregnant, current STI, undiagnosed vaginal bleeding, malignancy of genital tract, uterine anomalies or uterine fibroids

60
Q

IUD: general risks

A

uterine perforation, expulsion, pelvic infection

61
Q

levonogestrol IUD

effects, ideal users, when to replace

A
  • (progestin) decrease in menstrual flow → usually spotting/ amenorrhea
  • Ideal if concomitant menorrhagia (bleeding >7 days/ heavy bleeding)
  • Used for 5 years then replaced
62
Q

Copper IUD

effects, ideal users, when to replace, additional indication

A
  • Heavier menses/ bleeding (compared to levonorgestrel) ⇒ increase by ~35% average monthly blood loss
  • Ideal if concomitant amenorrhea
  • Used for 10 years then replaced
  • Can be used as emergency contraceptive ⇒ most effective
63
Q

emergency contraceptives: Options & % pregnancy avoided

A
  1. copper IUD (>99%)
  2. ella tablets; ulipristal 30mg (60-80%)
  3. prostinor; levonogestrol 0.75 mg
64
Q

emergency contraceptive: copper IUD

How to use after unprotected intercourse; MOA

A

Insert within 5 days

Inhibition of sperm migration, damage ovum, damage/ disrupt transport of fertilised ovum

65
Q

emergency contraceptive: ella tablets

How to use after unprotected intercourse; MOA, additional notes

A

Take 1 tablet ASAP, within 5 days (120 hours)

Progestin receptor modulator
* Slows release of GnRH → inhibit ovulation (reduce LH production)
* Thins uterine lining
* Directly inhibit follicular rupture

AVOID:
* Patients currently taking progestin-containing OC (will reduce effectiveness)
Take progestin ONLY 5 days after ella tablet

66
Q

emergency contraceptive: prostinor tablets

How to use after unprotected intercourse; MOA, additional notes

A

Take 2 tablets ASAP, preferably within 12 hours but not more than 72 hours

Progestin: slow release of GnRH inhibiting ovulation & thins uterine lining

Less effective in morbidly obese patients

67
Q

emergency contraceptive: ella & prostinor tablets

SE; how to manage

A

nausea SE is common

If patient vomits within 3 hours of taking tablet, to REDOSE

endo y3s1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions