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Repro II - Pharm, CLMD (Tobin) > Lecture 3: Contraception and Sterilization > Flashcards

Lecture 3: Contraception and Sterilization Flashcards

1
Q

Which general class of contraceptives provide the most effective reversible contraception?

A

Hormonal contraceptived

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2
Q

What is the implantable hormonal contraceptive called?

A

Etonogestrel rod implant (Nexplanon)

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3
Q

What hormones are contained in the combo oral contraceptives; describe how each hormone contributes to its function?

A
  • Progesterone = major player –> suppresses LH and therefore ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium
  • Estrogen: mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
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4
Q

How does the progestin-only oral contraceptive (mini-pill) work; chance of ovulation; and who is it mainly used in?

A
  • MOA is primarily making cervical mucous thick and impermeable
  • Ovulation continues in about 40% of users
  • Mainly used in breastfeeding women and women who have contraindication to estrogen
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5
Q

When using a progestin-only OC (mini-pill) when must the patient take the pill and what if they mistime a dose?

A
  • Because of low dose, they MUST be taken at same time everyday starting on first day of menses
  • If pt is >3 hours late taking pill should use backup method for 48 hours
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6
Q

What are 4 benefits to using hormonal oral contraceptives?

A
  • Menstrual cycle regularity
  • Improve dysmenorrhea (painful periods)
  • ↓ risk of iron deficiency anemia (shorter and less heavy cycles)
  • Lower incidence of endometrial and ovarian cancer, benign breast and ovarian disease (cysts)
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7
Q

What are some of the side effects associated with oral contraceptives?

A
  • Breakthrough bleding: 10-30% experience during first 3 months of use (make sure to counsel it will improve!)
  • Amenorrhea
  • Mild AE’s: bloating, weight gain (perceived), breast tenderness, nausea, fatigue, and HA
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8
Q

What is a contraindication for using hormonal oral contraceptives?

A

Migraine WITH aura

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9
Q

What are 5 serious AE’s associated with hormonal oral contraceptives?

A
  • Venous thrombosis
  • Pulmonary embolism
  • Cholestasis and GB disease
  • Stroke and MI
  • Hepatic tumors
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10
Q

What is the name of the hormonal contraceptive transdermal patch; how often is it applied?

A
  • OrthoEvra
  • Apply one patch weekly for 3 weeks
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11
Q

Caution should be used when using the transdermal OC, orthoevra, in whom?

A

Women >198 lbs.

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12
Q

There is a greater risk of what AE associated with the transdermal patch, Orthoevra?

A

Greater risk of thrombosis

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13
Q

What are the benefits of the hormonal contraceptive ring, NuvaRing?

A
  • Combo of progesterone and estrogen
  • Associated w/ greater compliance due to once a month use
  • Can be removed for up to 3 hours without affecting efficacy
  • Better tolerated since not going thru GI tract and less breakthrough bleeding
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14
Q

Who can’t use combination contraceptives?

A
  • Women over 35 who smoke cigs
  • Women w/ personal hx of thromboembolic event
  • Women w/ hx of CAD, cerebral vascular disease, CHF or migraine w/ aura, uncontrolled HTN
  • Women w/ moderate to severe liver disease or liver tumors
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15
Q

Caution should be used in women with which underlying conditions when considering combination contraceptives?

A
  • Diabetes
  • Chronic HTN
  • SLE
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16
Q

What is the name of the injectable hormonal contraceptive?

A

Depo medroxyprogesterone acetate (DepoProvera)

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17
Q

How long does injectable, DepoProvera, maintain contraceptive level of progestin; when is it preferred to be given?

A
  • Maintains contraceptive level of progestin for about 14 weeks
  • IM injection every 11-13 wks, preferred to be given within first 5 days of menses and if not, use a back up method for 2 weeks
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18
Q

What is the MOA of the injectable contraceptive, DepoProvera?

A
  • Thickens cervical mucous
  • Decidualization of the endometrium
  • Blocks the LH surge and ovulation
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19
Q

What is the efficacy of the injectable contraceptive, DepoProvera?

A

Roughly equivalent to sterilization and is not altered by weight

20
Q

Which AE associated with DepoProvera caused the FDA to issue a black box warning; what is this warning?

A
  • Alterations of bone metabolism assoc. w/ ↓ estrogen levels
  • Particular concern in adolescents
  • Reversible after discontinuation
  • BLACK BOX = if used for more than 2 years should consider alternative method
21
Q

Side effects associated w/ injectable, DepoProvera?

A
  • Alterationsinbone metabolism
  • Irregular bleeding –> ↓ with use, but 25% will discontinue within one year
  • Weight gain
  • Exacerbation of depression
22
Q

What is a strategy for improving the bleeding profile in someone suffering from irregular bleeding while on DepoProvera?

A

Short term use of estrogen add back (usually wait till after receiving 2nd dose)

23
Q

What are some of the underlying conditions where the contraceptive DepoProvera can still be used?

A
  • Women w/ seizure disorders
  • Sickl cell anemia
  • Anemia secondary to menorrhagia
  • Endometriosis
  • ↓ risk of endometrial hyperplasia
24
Q

List 4 indications for choosing the contraceptive DepoProvera?

A
  • Desire for effective contraception
  • Need a method w/ better compliance
  • Breastfeeding
  • Can be used when estrogen is contraindicated
25
Q

List 5 contraindications for the use of the contraceptive DepoProvera?

A
  • Known or suspected pregnancy
  • Unevaluated vaginal bleeding
  • Known or suspected malignancy of the breast
  • Active thrombophlebitis or current/past hx of thromboembolic events or cerebral vascular disease
  • Liver dysfunction/disease
26
Q

How long is the long acting reversible contraceptive (LARCS), Nexplanon good for?

A

Used for 3 years

27
Q

What is the MOA of the long acting reversible contraceptive (LARCS), Nexplanon?

A
  • Thickens cervical mucous
  • Inhibits ovulation
28
Q

List 6 side effects associated with the long acting reversible contraceptive (LARCS), Nexplanon?

A
  • Irregularly irregular vaginal bleeding
  • HA
  • Vaginitis
  • Weight increase (mild)
  • Acne
  • Breast pain
29
Q

What are the contraindications for use of the long acting reversible contraceptive (LARCS), Nexplanon?

A
  • Known or suspected pregnancy
  • Current (yes) or past hx of thrombosis or thromboembolic disorders (consideration)
  • Liver tumors or active liver disease (poorly metabolized)
  • Undiagnosd abnormal uterine bleeding
  • Known or suspected breast cancer (only absolute)
30
Q

What are the names of the 5 hormone containing IUD’s?

A

- Copper T (Paragard)

  • Levonorgestrel releasing = Mirena and Skyla + Liletta and Kyleena
31
Q

What are some of the risks associated with IUDS?

A
  • ↑ risk of infection within first 20 days post-insertion
  • ↑ risk of ectopic pregnancy if pregnancy would occur
  • Risk of uterine perforation at time of insertion requiring laparoscopy for removal
  • Risk of malposition and necessitating hysterscopy for removal
32
Q

List 6 contraindications to using IUDS; which are specific to levonorgestrel containing and which to Copper T?

A
  • Breast cancer - levonorgestrel containing only
  • Recent puerperal sepsis
  • Recent septic abortion
  • Active cervical infection
  • Wilson disease - Copper T only
  • Uterine malformations (uterine septums/fibroids/enlarged >10cm)
33
Q

Which IUDS are used for 5 years and which are used for 3 years?

A
  • Mirena/Kyleena are used for 5 years
  • Liletta/Skyla used for 3 years
34
Q

List 4 benefits to using the levonorgestrel containing IUDS.

A
  • ↓ in menstrual blood loss (up to 50%)
  • Less dysmenorrhea (painful periods)
  • Protection of endometrial lining from unopposed estrogen
  • Convenient and long term
35
Q

How long is the Copper T IUD, Paragard, used for and what is it’s MOA?

A
  • Used for 10 years
  • Copper interferes w/ sperm transport or fertilization and prevention of implantation
36
Q

Women who use diaphragms as a method of contraception are more likely to get what?

A

UTI’s

37
Q

What are the contraindications to using emergency contraception?

A

NO medical contraindication to use

38
Q

Which hormone is found in Plan B and how quickly must use take it?

A
  • Progestin only (levonorgestrel) 2 pills taken 12 hrs apart
  • Must be used within 120 hrs after unprotected intercourse
39
Q

How long after unprotected sex can you take the emergency contraceptive, Ella; what is it’s MOA?

A
  • Indicated for up to 5 days after unprotected sex
  • Postpones follicular rupture / inhibit or delay ovulation
40
Q

How long after vasectomy does it take for complete azoospermia?

A

Takes about 10 weeks

41
Q

What are the benefits and risks to using electrocautery for female sterilization?

A
  • Fast!
  • ↑ risk of thermal injury to surrounding tissue
  • Poor reversibility
  • Greater risk of ectopic pregnancy
42
Q

What are the differences between hulka anf filshie clips used for female sterilization?

A
  • Hulka = MOST reversible method, but greatest failure rate >1%
  • Filshie = lower rate of failure because of larger diameter
43
Q

Female sterilization is done using which methods?

A
  • Laparoscopy
  • Mini-laparotomy
  • Hysteroscopy
  • At time of C-section
44
Q

Why is the use of salpingectomy as a means of female sterilizaton increasing in use?

A

Due to recent literature regarding decrease in ovarian cancer risk

45
Q

What is the most common method of female sterilization throughout the world and how is it done?

A
  • Mini-laparotomy
  • Use small infra-umbilical incisions in postpartum period or suprapubic incisions as an interval procedure

Repro II - Pharm, CLMD (Tobin) (20 decks)

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