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PHCY 320 > L 05 & 06 Contraception > Flashcards

L 05 & 06 Contraception Flashcards

1
Q

What effect has successful family planning?

A

A positive impact on women, couples and families, and society
Premature babies can be born if subsequent become pregnant straight after another.
Preëclampsia or gestational diabetes may occur

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2
Q

What is the proportion of unintended & unwanted pregnancies in NZ?

A

Unintended 30 to 50 %

Unwanted 14 %

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3
Q

How many abortions have been done in NZ? Is it legal in NZ?

A

2% and yes it is legal in NZ now.

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4
Q

What are the options available?

A

Combination hormonal or progesterone-only pills
Injectables
LARC= Long-acting reversible contraception
Barrier method
Sterilization
Fertility awareness

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5
Q

What is conception?

A

When sperm meets an eggs

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6
Q

What is contraception?

A

When we prevent them from the meeting.

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7
Q

How can we stop contraception?

A

We can stop The ovulation
By stopping The Implantation
By preventing sperm from fertilizing the ovum

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8
Q

How many Types of Oral Contraceptives?

3 types

A

I) Combined pills: oral it has estrogen and progesterone
II) Mini pills: contain Progestin-only
III) Emergency ECP: Contain levonorgestrel (progestin)

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9
Q

What is the Primary and Secondary use of OC? (so do not just think patient only using this for pregnancy)

A 
Primary: Prevent pregnancy
Secondary: Irregular menstruation
Polycystic ovary syndrome
Acne control
Uterine bleeding
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10
Q

Hormonal contraception therapy available and what are those?

A

Combination: pill, vaginal ring
Most common and available various dosages and cycles (estrogen and progestin)

Progestin Only: has a pill, long-acting/ depot injection, Implant, Levonorgestrel IUD
They have only progesterone/progestin

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11
Q

What are the advantages of Progestin-only contraceptives?

A

Women with Cardiovascular risk, Diabetes, Migraine, Postpartum or Breastfeeding
Women who are not good Compliant

Remember: Progestin is an artificial form of progesterone

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12
Q

Which birth control is more effective than the other?

A

Very effective: Implant, IUD

least effective: Pills, Ring, Pill, condoms

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13
Q

Will Taking antibiotics stop hormonal contraceptives like the pill working?

A

Yes, Certain but NOT all antibiotics may interfere with the hormonal pill

(Combination Oral contraceptives called) Drospirenone and cyproterone are anti-androgenic and therefore most effective for treating acne

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14
Q

What is an advantage of using combination oral contraceptives pills?

A

The pill does not have hormone-free interval so no sugar pills, so just take the hormonal pills continuously
So no fluctuation of hormones of start and stop pills so women find less adverse effects
Less worry for women of missing any pills

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15
Q

Combined oral contraceptives are Not for use of?

A

over 50 years of age as they cause stroke or clot

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16
Q

PoP pills or mini pills how to take?

A

Just start taking no need to worry about anything as they do not have any sugar pill or any specif day to start

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17
Q

How to take combined pills?

A

Start at the blue zone of the strip, the blue zone is the active pills total of 21 pills and then 7 (hormone-free) pills are sugar pills so do not start them for contraception.

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18
Q

What does it mean of ED written in the pill pack mean?

A

Every Day

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19
Q

How do you choose a reasonable option for different groups of women?

A

First-time COC user use: 30/35 mcg ethinylestradiol with either 150mcg levonorgestrel or 500mcg norethisterone
A lower dose is recommended for older patients over 40
Whether patient seeks noncontraceptive benefits from medicine
Or if the patient experiences adverse effects then maybe another formulation may be tried

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20
Q

What kind of side effects do different types of hormones show?

A 
An estrogenic adverse effect is:
Bloating, Nausea vomiting,
Breast fullness
Irritability
Headache
Progesterone adverse effect:
Headache
Breast pain
Hypertension
Adrenergic adverse effect:
Acne and oily skin
Weight gain
Depression
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21
Q

Effectiveness of Combined VS single progestogen hormonal pill?

A

The combination is more strong vs single less strong
Combination pills are 99.9 percent effective; single 99 % effective
Nearly no chance of pregnancy but it has a bit chance of getting pregnant

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22
Q

Quiz: For menopausal women aged over 50 when is it safe to stop using contraception?

A

12 months after the last period (to make sure it is safer and secure More assurance)

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23
Q

How do OCs usually work and how do they prevent conception?

A

Change release of hormone FSH and LH
Prevent ovulation /egg release
Prevent attachment of egg to the uterus
Prevent sperm from reaching the egg by thickening the cervical mucus

24
Q

How does the combination OC work?

A

changes the release of a hormone(LH, FSH )
Prevent ovulation
Prevent attachment of eggs
Prevent sperm from reaching the egg/ thicken cervical mucus

25
Q

What is the Mechanism of Different Hormonal Contraception?

A

MoA of Estrogen: Block the development of the ovarian follicle
MoA of Progesterone: Inhibit LH thus prevent ovulation and less suitable for the passage of sperm
MoA of Estrogen and progestogen: alter the endometrium to discourage implantation

26
Q

How does the mechanism for hormonal contraceptives work?

A

It works by a feedback loop. Continuous high levels of estrogen and progesterone level inform the hypothalamus not to do ovulation work as the hypothalamus feels that the body already had a baby or pregnancy as the body has high levels of estrogen and progesterone and they are associated with pregnancy. The hypothalamus reads oral hormonal pills as pregnancy and stops ovulation or shutting down the system.

The Mechanism:
Hypothalamus=>Anterior pituitary=> Estrogen shutting down FSH & Progesterone shutting down LH as the body takes pills => No release of eggs (ovulation)=> as both hormones are absent so they alter the endometrium (make it thinner so no way to implant)

27
Q

What is the MoA of Condom?

A

Barrier effect which reduces transmission

28
Q

What are the health benefits of Contraception?

A

Condom: Prevent HIV,STD, AIDS, stop transmission
Pill: Reduce Endometrial cancer
Combination OC: reduce risk of Ovarian and Endometrial cancer
Withdrawal bleeding and dysmenorrhea(irregular period)
Acne
Reduce Perimenopause problems

29
Q

What are the health risks of using OC?

A 
Over 35 and who smoke
Myocardial infarction
Ischemic stroke
VTE
Breast cancer
30
Q

What is the Mini Pill or pop pill (progesterone only pill)?

A

It has NO estrogen. Only has progesterone.
Usually given to women who are contraindicated to estrogen. I.e older women, smokers, breastfeeding

Effects last for 24 hours and must take next pill within the 3 hours’ time period

31
Q

How to deal with missed POP/Mini pills? If more than 3 hours late for POP or Mini pills (27 h after)?

A

If less than 3 hours then just continue with the next pill
In NZ it Depends on what pills are you on if you are
Cerazette can be late up to 12 hours. You can take a missed pill as soon as you remember within that time. If more than 12 h late then take a missed pill, and continue normal pack and also use extra 2 days for precautions
If not Cerazette then take the missed pill and take the rest of the packet and continue the extra 2 days for extra precautions.

32
Q

Which one are traditional contraceptives?

A

The pills with sugar pills on the strip

33
Q

How to deal with Missed Combination contraceptive pills?

A

Traditional: if Less than 12hr then take the next pill and continue as normal

  • If more than 12 hours then it depends on the pill cycle
  • If you are near sugar tablets the week before or the week after then you are not safe from getting pregnant. as contraceptives need to be taken continuously for 7 days
  • If you miss 8 pills in week 2 then continue missed dose and continue COC and finish the pack and continue 7 days extra
  • If you miss 2 or more pills from 15 –21 days cycle on the strip continue missed dose and continue COC and finish an extra 7 days continue
  • If you miss 2 or more tablets in week 1 then continue missed dose and continue COC and 7 days extra take pills (in general strait before and after sugar pill is the problem)
34
Q

What should do if a patient vomits or has diarrhea after taking the pill?

A

Within 2 hours take another pill

If diarrhea for more than 24 hours then an additional method should be taken

35
Q

How to deal with contraception during other medical conditions?

A

2 antibiotics interfere with Pills
Rifampicin and rifabutin
Other than that most antibiotics are fine and do not need extra precautions

36
Q

Contraception during a migraine?

A

Women usually get migraines as estrogen and progesterone fluctuation occur during taking the pills so for them the best option is to take mini pills where they do not have sugar pills.

37
Q

What are the risk factors for Contraception in women?

A

They should not go combination pills as they might cause stroke and less effective
The best option is a progesterone-only pill or IUD or Vasectomy of the partner or barrier method

38
Q

Contraceptive use with other medicine or medical conditions?

A

Epilepsy patient or Antiepileptic drugs decrease contraceptive blood levels of estrogen and progestin
So they might not have good coverage.
So just change the option of choosing contraceptives to choose BDMPA or IUD is the better option for then

39
Q

Drug interaction with oc?

A

Lamotrigine and OC pills can increase the drug level and the effect of Lamotrigine (antiepileptic) in the blood.

Rifampin is an enzyme inducer that reduces hormone levels

40
Q

Quiz: Exam question:

A

A 23-year-old frantic woman comes to the pharmacy asking for help in choosing a home pregnancy test. She says she forgot to take her COC pill over the weekend, missed Saturday and Sunday and she worried that she might be pregnant. She started her last period 18 days ago. You recommend that she

41
Q

Condoms

A

Reduces risk of sexually transmitted infection

STI or HIV, herpes,

42
Q

Benefits of using condoms?

A

STI suppression
Re-partnering especially elderly
AIDS suppression
HIV suppression

43
Q

Condom preservation?

A

There is still a chance of being pregnant Not a good option

44
Q

Diaphragm

A

Not good as pregnancy rate is high

45
Q

What are Spermicides?

A

It is a chemical contraceptive barrier
Kills sperm
But the highest rate of pregnancy is so useless

46
Q

What is IUD (Intrauterine Devices)?

A

2 types i)Hormone releasing ii)Copper releasing

47
Q

Benefits:IUD

A

The best option and now popular and Funded
Long action like 5yers and Very effective and Less side effect
Prevent endometrial hyperplasia
Good coverage
Reduce heavy bleeding
Rapid return to fertility after IUD discontinued

48
Q

The problem with copper IUD is?

A

Can cause quite a heavy period of bleeding

Irritation occurs some time

49
Q

Mechanism of Action of IUD?

A

Inhibit sperm function
Inhibit fertilisation
Inhibit sperm function
Suppresses the endometrium

50
Q

Pros and cons of IUDs?

A

Pros: Effective
The long term so patient compliance
Can be used while breastfeeding

Cons: Expensive but now funded in NZ
Irritation
No STI or HIV protection

51
Q

A woman who is 6 weeks postpartum and breastfeeding seek contraception. She would like to have another child in 2 years. Is the following method the preferred method of contraception?

A

Jadelle (Levonorgestrel implants)
Progestin only pill
Both

52
Q

Adverse effects of oral contraceptive preparations containing both estrogens and progestins include an increased incidence of all of the following

A

DVT
Cerebral vascular accidents(stroke)
Hypertension
Gallbladder disease

53
Q

What is Sterilisation?

A

It is permanent but sometimes can be reversed
Can be done in both Male and female
For Female:
Tubal sterilization: Block the fallopian tube
Transcervical sterilization: Tiny coil inserted to the cervix
For Male:
Just cut the ducts which carry sperm
Male sterilization also called Vasectomy
Safer quick and less expensive

54
Q

What is Vasectomy?

A

Just cut both sides of males vasdeferens
But IMPORTANT to remember: Guys need to check sperm count after surgery as it remains in the duct for 2 to 3 months. So precaution may be used before sexual intercourse.

55
Q

What are the other methods of contraception?

A

Withdrawal before ejaculation
Douching: using some kind of detergent to kill the sperm
Standard days method: Couple avoid sex between 8-19 of each menstrual cycle for women w/cycle between 26 to 31 days

56
Q

Why do you think there are no pills for males?

A

Trust issue
More than 50 % do not trust
Harder to reactivate the sperm
Harder to stop the sperm

57
Q

Why don’t guys have pills?

A

Lack of Trust

PHCY 320 (7 decks)

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