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Spring 2018 Pharm Exam 2 > Lecture 3: Contraceptive Methods > Flashcards

Lecture 3: Contraceptive Methods Flashcards

1
Q

When is peak fertility

A

Day 9-15 of menstrual cycle

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2
Q

What types of contraceptives are NOT reversible

A

surgical methods: tubal ligation, vasectomy

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3
Q

Which methods are quickly reversible when stopped?

Which method is reversible but NOT quickly?

A

Copper IUD, natural family planning, BC

Not quickly reversible = Depot Medroxyprogesterone

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4
Q

What 4 types of contraceptives can be used AFTER sex?

A
  1. Copper IUD (Most effective)
  2. Ulipristal
  3. “Plan B”: high dose progesterone pills
  4. Combo E/P pills
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5
Q

What 3 types of contraceptives can be used before sex and are permanent?

A
  1. Tubal ligation
  2. Vasectomy
  3. Transcervical sterilization
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6
Q

What 4 types of contraceptives can be used before sex, are short acting and non-hormonal?

A
  1. Family Planning
  2. Diaphragm
  3. M/F condom
  4. Cervical sponge/cap/spermicide
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7
Q

What 2 types of contraceptives used before sex, are short acting, hormonal and contain progesterone only?

What are the 3 forms of E/P combo?

A
  1. DMPA
  2. Prog pill
  3. vaginal ring
  4. transdermal
    \


patch
3. combo pill

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8
Q

What type of contraceptive used before sex, are long acting and non-hormonal?

What 2 types are hormonal?

A

non-hormonal
- copper IUD

hormonal

  1. implant
  2. prog IUD
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9
Q

What are the secondary benefits to contraceptives?

what 5 things can it help Tx?
(what does it control?)
(what does it prevent?)
(what does it decr the risk of?)

A
  1. Txs PMS, heavy pds, acne, dysmenorrhea, endometriosis
  2. Helps control menstrual cycle
  3. Prevent STIs
  4. Decr risk of ovarian, endometrial and colon CA
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10
Q

3 main ways E/P combo pills work?

A
  1. suppress follicle dev
  2. thicken cervical mucus
  3. inhibit ovulation
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11
Q

How do Progestins specifically work?

How do Estrogens specifically work?

A

P - suppresses LH, thickens mucus, atrophic endometrium

E- suppresses FSH, altered tubal transport

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12
Q

What type of estrogen is in the E/P combo?

2 types of progestin in the E/P combo?

A

E = ethyl estradiol

Progestin

  • monophasic (less withdrawal bleed)
  • multiphasic (mimics natural cycle–> incr estrogen over 3 wks)
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13
Q

What do ALL E/P combo cause and how can this be avoided?

A

ALL cause withdrawal bleeding

- avoid by using E/P combos continuously

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14
Q

What is one AE of the E/P combo that is caused by progestin but is mitigated by Estrogen?

A

P –> Androgen effects (acne, hirsutism, oily skin)

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15
Q

What a major secondary benefit of E/P combos?

A

decr risk of ovarian and endometrial cancer

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16
Q

Why is estrogen NEVER used alone?

caveat?

A

incr risk of endometrial CA

but can give to women w/ uterus

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17
Q

E/P combos:
how long is ring (Nuvaring) in for
How often change transdermal patch

A

Nuvaring = in for 3 wks

change transdermal patch = change weekly

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18
Q

CIs to combo E/P methods (8)?

A
  1. Uncontrolled DM (nephro, neuro & retinopathy)
  2. PMH of BCA
  3. high risk or h/o DVTs
  4. h/o ischemic heart dz
  5. uncontrolled BP (> 160/90)
  6. PMH/high risk for stroke
  7. Migraine w/aura
  8. Seizure d/o
  9. Smoker > 35
  10. Preg/Breastfeeding
  11. Vaginal bleed w/unknown cause
  12. Abn liver fxn
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19
Q

CIs to combo E/P methods (8)?

A
  1. Uncontrolled DM (nephro, neuro & retinopathy)
  2. PMH of BCA
  3. high risk or h/o DVTs
  4. h/o ischemic heart dz
  5. uncontrolled BP (> 160/90)
  6. PMH/high risk for stroke
  7. Migraine w/aura
  8. Seizure d/o
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20
Q

2 main types of IUDs

General MOA for IUDs

A
  1. Copper T IUD
  2. LNG-IUD

General MOA for IUDs: inhibits fertilization and 2ndarily inhibits fertilization

21
Q

similar MOA for copper IUD & LNG-IUDs

2 additional MOAs for LNG-IUD

A

decr sperm motility and viability

  1. inhibits ovulation
  2. thickens cervical mucus
22
Q

4 CIs to IUDs

A
  1. Current STI
  2. unexplained uterine bleeding
  3. deforming, large fibroids
  4. Wilson’s Dz or Copper allergy
23
Q

5 S/Es of IUDs

A
  1. uterine perforation w/insertion
  2. expulsion
  3. cramping after insertion
  4. PID
  5. Pain w/insertion
24
Q

When is there a risk of PID w/ IUDs

A

1st 30 days after insertion (insertion = opening of os)

25
Q

Main S/E a/w Copper IUD specifically? LNG-IUD?

A

Copper IUD –> heavy menses

LNG-IUD –> irreg spotting

26
Q

What is the problem getting preg w/IUD in?

A

get preg w/IUD = more likely ectopic

27
Q

What is the problem getting preg w/IUD in?

A

get preg w/IUD = more likely ectopic

28
Q

Major con a/w barrier methods?

A

short acting –> must have correct placement and must be used every time

Other cons: less eff than hormonal methods, lack sponaneity, messy, touch genitals, variable confidentiality, allergies to latex/spermicide

29
Q

2 major pros a/w barrier methods

A

STI protection and most dont need prescription

30
Q

What type of barrier method is hard to place, high failure rate and not commonly used

A

cervical caps

31
Q

4 types of Natural Family Planning

A
  1. Calendar method
  2. Cycle beads
  3. Cervical mucus
  4. Ovulation thermometer
32
Q

What color beads = peak fertility

what is cervical mucus like during ovulation?

what happens to temp before ovulation?

A

White beads

cervical mucus thinner during ovulation

temp incr before ovulation

33
Q

Major con of natural family planning methods?

A

Abstinence

- must avoid sex during peak fertility (about 7 days)

34
Q

What is the major problem w/the calendar method?

A

only effective for women w/regular cycles

35
Q

What can interfere w/cervical mucus and affects its accuracy (4)?

A
  1. infection
  2. douching
  3. breastfeeding
    4 perimenopause
36
Q

What method is for conceiving? what indicates ovulating

A

stick method

- 2 lines = ovulating

37
Q

What are the 5 types of Emergency contraceptives

A
  1. Levonorgesterol
  2. Ulipristal/Ella
  3. Copper IUD
  4. Combo E/P pills
  5. Mifepristone (not DoC for EC)
38
Q

What is the MOA for all ECs?

A

Delays ovulation

39
Q

Which type of EC is known as “Plan B”?

A

Levonorgesterol

40
Q

What is the general window for ECs?

But which type of EC has decr effectiveness after 72 hrs

A

general window = 120 hrs

Levonorgesterol has less effectiveness after 72 hrs

41
Q

What is the consideration when using E/P combo pills for EC?

A

must give multiple doses of E/Ps to mimic EC dose–> S/Es

42
Q

4 main S/Es a/w ECs

A
  1. uterine bleeding
  2. N/V
  3. HA
  4. abd pain
#2-4 = more w/ulipristal
#2 = a/w combo E/P
43
Q

CI to using emergency contraceptives

one exception?

A

Known pregnancy

exception - Ulipristal may cause early abortion (embryotoxic in animals)

44
Q

What is the 1 EC that can be used in all wt classes

A

Copper IUD

note: Ulipristal can be used w/higher BMI than Levonorgesterol

45
Q

What drug is used for medication induced abortion

What type of med is it?

A

Mifepristone

  • anti progesterone
  • competitive antagonist of PRM
46
Q

How long can mifepristone be used?
What should be done as f/u?
What other med is it given w/?

A
  • up to 9 wks
  • US to ensure effectiveness
  • given w/Misoprostol
47
Q

MOA of mifepristone: decidual breakdown, incr PG synthesis, sensitizes uterus to exogenous admin of PGs…. what is result?

A

cervix softens, uterine contraction –> destroy/shed lining –> abort pregnancy

48
Q

Major AE a/w Mifepristone?

CI w/?

A

Serious bleeding (rare)

CI w/glucocorticoids

49
Q

Other use for Ulipristal/Ella

A

Tx uterine fibroids

Spring 2018 Pharm Exam 2 (6 decks)

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