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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
Main S/E a/w Copper IUD specifically? LNG-IUD?
Copper IUD --> heavy menses | LNG-IUD --> irreg spotting
26
What is the problem getting preg w/IUD in?
get preg w/IUD = more likely ectopic
27
What is the problem getting preg w/IUD in?
get preg w/IUD = more likely ectopic
28
Major con a/w barrier methods?
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
2 major pros a/w barrier methods
STI protection and most dont need prescription
30
What type of barrier method is hard to place, high failure rate and not commonly used
cervical caps
31
4 types of Natural Family Planning
1. Calendar method 2. Cycle beads 3. Cervical mucus 4. Ovulation thermometer
32
What color beads = peak fertility what is cervical mucus like during ovulation? what happens to temp before ovulation?
White beads cervical mucus thinner during ovulation temp incr before ovulation
33
Major con of natural family planning methods?
Abstinence | - must avoid sex during peak fertility (about 7 days)
34
What is the major problem w/the calendar method?
only effective for women w/regular cycles
35
What can interfere w/cervical mucus and affects its accuracy (4)?
1. infection 2. douching 3. breastfeeding 4 perimenopause
36
What method is for conceiving? what indicates ovulating
stick method | - 2 lines = ovulating
37
What are the 5 types of Emergency contraceptives
1. Levonorgesterol 2. Ulipristal/Ella 3. Copper IUD 4. Combo E/P pills 5. Mifepristone (not DoC for EC)
38
What is the MOA for all ECs?
Delays ovulation
39
Which type of EC is known as "Plan B"?
Levonorgesterol
40
What is the general window for ECs? | But which type of EC has decr effectiveness after 72 hrs
general window = 120 hrs Levonorgesterol has less effectiveness after 72 hrs
41
What is the consideration when using E/P combo pills for EC?
must give multiple doses of E/Ps to mimic EC dose--> S/Es
42
4 main S/Es a/w ECs
1. uterine bleeding 2. N/V 3. HA 4. abd pain ``` #2-4 = more w/ulipristal #2 = a/w combo E/P ```
43
CI to using emergency contraceptives one exception?
Known pregnancy exception - Ulipristal may cause early abortion (embryotoxic in animals)
44
What is the 1 EC that can be used in all wt classes
Copper IUD | note: Ulipristal can be used w/higher BMI than Levonorgesterol
45
What drug is used for medication induced abortion | What type of med is it?
Mifepristone - anti progesterone - competitive antagonist of PRM
46
How long can mifepristone be used? What should be done as f/u? What other med is it given w/?
- up to 9 wks - US to ensure effectiveness - given w/Misoprostol
47
MOA of mifepristone: decidual breakdown, incr PG synthesis, sensitizes uterus to exogenous admin of PGs.... what is result?
cervix softens, uterine contraction --> destroy/shed lining --> abort pregnancy
48
Major AE a/w Mifepristone? CI w/?
Serious bleeding (rare) CI w/glucocorticoids
49
Other use for Ulipristal/Ella
Tx uterine fibroids

Spring 2018 Pharm Exam 2 (6 decks)

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