LEC8

Question 1

Non pharmacologic Therapy for contraception

Barrier Techniques contraception

4CD

Answer 1

1-Diaphragms (<24hrs)
2-Cervical Cap(<48)
3-Condom(protect against std)
4-Condoms with spermicides (increase vulnerability to std)
5-Female condom (worse than male condom)

Question 2

Pharmacologic Therapy for contraception

mention them

Answer 2

1-Spermicides and Spermicide Implanted Barrier Techniques
2-The vaginal contraceptive sponge (Today) (<24hrs) to avoid TSS
3-Hormonal Contraception (estrogen with progestin or progestin alone)

the sponge must be left in place for at least 6 hours before removal

Question 3

Non contraceptive benefits of OCs include

Answer 3

 Decreased menstrual cramps and ovulatory pain;
 Decreased menstrual blood loss;
 Improved menstrual regularity;
 Decreased iron deficiency anemia;
 Reduced risk of ovarian and endometrial cancer;
 Reduced risk of:
Ovarian cysts
pregnancy oEctopic
Endometriosis
Uterine fibroids, and benign breast disease,
Pelvic inflammatory disease.

Question 4

The main safety concern about CHCs is?

Answer 4

is their lack of protection against STDs.
Encourage use of condoms to prevent STDs

Question 5

Considerations with use of Combined Hormonal Contraceptives (CHC)

when to give Women over 35 Years of Age CHC?

Answer 5

May be considered in healthy nonsmoking women older than 35 years.

CHCs are not recommended for women older than 35 years with
Migraine
Uncontrolled hypertension,
Smoking or diabetes with vascular disease

Question 6

(1)Progestin-only methods should be considered in which group of women?

Answer 6

1-Women older than 35 years who smoke.
2-women who develop migrane on CHC.
3-women with Systemic Lupus Erythematosus.
4-women over 35 yo and over 90kg.

Question 7

OCs have been associated with an
increased risk of 1-……… 2-………..

Answer 7

myocardial infarction (MI) and stroke

Question 8

Use of low-dose CHCs is acceptable in HTN women under the following criteria

Answer 8

1- women younger than 35 years with
2-well-controlled
3- monitored hypertension

uncontrolled HTN is systolic >100 and diastolic >160

Question 9

Hypertensive women with 1) end-organ disease or 2)who smoke should avoid ………..?

Answer 9

should not use CHCs

Question 10

contraceptives

Women younger than 35 years with diabetes but no vascular disease
who do not smoke can take …………?

Answer 10

can safely use CHCs

Question 11

progestin and Estrogens effect on lipids?

Answer 11

1- progestins: Decrease (HDL)
increase (LDL).
2- estrogen: Decrease (LDL)
increase (HDL).

Question 12

what contraceptives that has no effect on lipids

Answer 12

low Dose CHC and levonorgestrel

Question 13

Women with controlled dyslipidemias can safely use ……….?

Answer 13

can use low-dose CHCs, with monitoring of fasting lipid profiles.

Question 14

Women with uncontrolled dyslipidemias should use …………?

Answer 14

METFORMIN

Question 15

the following OCs has increased risk of thrombosis

DDN

Answer 15

oOCs containing desogestrel, drospirenone, and norgestimate

Question 16

contraceptives

Migranes without aura can safely take ……….?

Answer 16

 CHCs

Question 17

Women who develop migrane on CHC should……….?

Answer 17

should immediately discontinue their use

Question 18

The choice to use CHCs should not be influenced by……… Rather by ……….?

Answer 18

1-The presence of benign breast disease or A family history of breast cancer with either BRCA1 or BRCA2 mutation,

2-current or past history of breast cancer should not use CHCs.

Question 19

Monophasic OCs means?

Answer 19

Contain a constant amount of estrogen and progestin for 21 days, followed by 7 days of placebo.

Question 20

Biphasic and triphasic pills means?

Answer 20

Contain variable amounts of estrogen and progestin for 21 days and are followed by a 7-day placebo phase.

Question 21

Increases the number of hormone-containing pills from 21 to 84 days, Followed by a 7-day placebo phase results in?

Answer 21

Resulting in four menstrual cycles per year

Question 22

The progestin-only “minipills tend to be 1-…………
2-………….?

Answer 22

1-less effective than combination OCs.
2-are associated with irregular and unpredictable menstrual bleeding.(مهم)
3-associated with more ectopic pregnancies.

Question 23

contraceptives

 In the first-day start method means?

Answer 23

women take the first pill on the first day of the next
menstrual cycle.

Question 24

contraceptives

 In the Sunday start method

Answer 24

the first pill is taken on the first Sunday after starting
the menstrual cycle.

Question 25

what people could use low Dose OC’s or norethindrone?

they are 4

Answer 25

1) Adolescents,
2) underweight women (<50 kg [110 lb]),
3) women older than 35 years,
4)perimenopausal

Question 26

these low-estrogen OCs Side effects

Answer 26

1-more breakthrough bleeding
2-increased risk of contraceptive failure.

Question 27

discontinue CHCs upon getting these Side effects

ACHES

Answer 27

1-abdominal pain,
2- chest pain,
3- headaches,
4- eye problems,
5- severe leg pain.

Question 28

OC’s interact with ……… and …………, it is also beneficial to consider the use of …………..

Answer 28

1-Rifampin
2-Antibiotics
it also benefecial to consider nonpharm conraceptives when you use those drugs with OC’s

Question 29

FDA approved first line option as Emergency contraceptives is?

Answer 29

Progestin-only and progesterone receptor modulator

Question 30

mention the Drugs used for Emergency contraception

3

Answer 30

1-Yuzpe (more side effects)
2- levonorgestrel-containing formulation( within 72hrs of unprotected intercourse)
3- Ulipristal (SERM) (Within 120hrs of unprotected intercourse)

Backup nonhormonal contraceptive methods should be used after EC for at least 7 Days

Question 31

women using Estrogen patch are exposed to more estrogen which leads to?

Answer 31

increased thromboembolic risk

Question 32

mention an Example of a vaginal ring and how to use it

Answer 32

Nuva Ring:
The ring should be inserted on or prior to the fifth day of the cycle,
One week should lapse:before the new ring is inserted on the same day of the week as it was for the last cycle.

A second form of contraception:
* Should be used for the first 7 days of ring use or
* if the ring has been expelled for than 3 hours.

Question 33

Who would benefit from minipills (progestin only) OC’s

Answer 33

1– Those who are breast-feeding,
2– Intolerant of estrogens,
3–Those with concomitant medical conditions in which estrogen is not recommended.

Question 34

• Injectable and implantable contraceptives are benefecial for?

simple answer

Answer 34

adherence issues

Question 35

advantge of Long acting progestin contraception of CHC;s

Answer 35

• Pregnancy failure rates with long-acting progestin contraception are lower than with CHC’s

Question 36

Injectable Progestins examples

Answer 36

1-Depot medroxyprogesterone acetate (DMPA) 150mg.
2- 104 mg of DMPA (Depo- SubQ Provera 104)

Return of fertility may be delayed after discontinuation

Question 37

DMPA Depot medroxyprogesterone acetate can be used immediatly in …………. women, who are not …………….,

Answer 37

1-Postpartum
2-breast feeding (if shes breastfeeding delay therapy for 6 weeks)

Question 38

how long is it ok to take DMPA and what is the most prominant side effect

Depot medroxyprogesterone acetate

Answer 38

DMPA should not be continued beyond 2 years.
the most prominant S/E is reduction in bone mineral density.

Question 39

mention an example of Subdermal Progestin Implant and its major S/E

Answer 39

NEXPLANON (3years of recommended use)
major S/E is oThe major adverse effect is irregular menstrual bleeding

It does not appear to decrease BMD.
Fertility returns within 30 days of removal.

Question 40

mention examples of Intrauterine Devices and thier recommended use period

4 Examples

Answer 40

1-ParaGard(copper) (used for 10 years).
2-Mirena (5 years) release levonorgestrel.
Liletta, and Skyla (3 years) release levonorgestrel.