Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 2 - Exam 2 > Lecture 6 - Contraceptive Methods > Flashcards

Lecture 6 - Contraceptive Methods Flashcards

1
Q

When is the window of peak fertility?

A

day 9-15 of menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 7 main categories of contraception?

A 
surgical sterilization 
IUDs
combo estrogen/progestin methods
progestin-only methods
barrier methods
natural family methods (fertility awareness) 
Emergency contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some secondary benefits of contraceptives?

A 
treating PMS
treating heavy periods
menstrual cycle control
treating acne
preventing STIs
reducing risk of ovarian and endometrial cancer, colon cancer
treating dysmenorrhea and endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three brands of levonorgestrel IUDs?

A

Mirena (5 years)
Liletta (3 years)
Skyla (3 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do estrogen/progestins work?

A

suppressing follicle development
thickening cervical mucus
inhibiting ovulation

Progestin:

  • LH suppression
  • thick cervical mucous
  • atrophic endometrium

Estrogen:

  • FSH suppression
  • altered tubular transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the common toxicities of E/P contraceptives?

A

Estrogen/Progestin combo (patch, pills, +/- diaphragm)

N/V
HA
breast enlargement/tenderness
alterations in libido
breakthrough bleeding (lower dose OCs)
acne, oily skin, hirustism (progestin) 
hair loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the secondary benefits of E/P contraceptives?

A

improved acnes
regulation/control of menstrual cycle
ligher and shorter periods
improved cramps
bone protection if at risk for osteopenia
decreased risk of ovarian and endometrial cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What types of IUDs are available?

A

copper

LNG (levonorgestrel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MOA of IUDs

A

inhibit fertilization
secondary: inhibit implantation

Copper: reduces sperm motility and viability

LNG: inhibits ovulation, thickens cervical mucus, reduces sperm motility and viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the contraindications of IUDs?

A

current STIs (gonorrhea or chlamydia)
unexplained uterine bleeding
large deforming fibroids
Wilson’s disease or copper allergy (copper only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the side effects of IUDs?

A

uterine perforation (on insertion)
expulsion
cramping - after insertion, may persist for a few months
PID risk - first 30 days after insertion
Copper: heavy menses
LNG: irregular spotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Barrier contraceptives

A

less effective than hormonal therapy but may offer STI protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Natural family planning

A

selective abstinence during window of fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications of natural family planning?

A

only reliable for women with consistent 26-32 day cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the different types of emergency contraceptives?

A

Levonorgestrel (Plan B - OTC)

Ulipristal

Copper IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the effectiveness of emergency contraceptives?

A

LNG: 95% within first 24 hours –decreases after 72 hours –less effective if obese

Ulipristal and copper - high effectiveness to 120 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the MOA of emergency contraceptives?

A

delay ovulation

may also interfere with sperm migration and function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the side effects of emergency contraceptives?

A

uterine bleeding
N/V (more common with E/P and ulipristal)
HA, abdominal pain

Ulipristal may cause early abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If weight is a concern for emergency contraception, what option should you use?

A

Copper IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mifepristone

A

medication abortion
binds to P receptor with affinity greater than progesterone but non-activating –> ANTI-progesterone
breaks down maternal capillaries in decidua, increases prostaglandin synthesis, inhibits prostaglandin dehydrogenase to sensitize uterus to exogenous PG administration (misprostol)

efficacy 95-98% success up to 9 weeks
follow up to ensure effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which birth control methods are immediately reversible?

A

copper IUD
family planning
OCPs
barrier methods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which are the most effective forms of birth control?

A

IUD and surgery (vasectomy, tubal ligation, vasectomy)

LNG-IUD is more effective than tubal ligation

23
Q

What is considered “short acting” birth control?

A

anything you have to think about in a 3 month time frame

24
Q

What is the recommended form of birth control for adolescent girls?

A

IUD
since its so effective and you dont have to think about it

also continue to use condoms to protect against STIs

25
Q

Why do you make sure the pt doesn’t have STIs before inserting the IUD?

A

because you could spread the infection into the uterus and put the pt at risk of PID

26
Q

What is the effectiveness of natural family planning?

A

25% failure rate/year

27
Q

What are the most effective forms are contraceptives?

A

IUDs and sterilization

28
Q

Which methods of contraceptives have highest rate of failure?

A

barrier and fertility based methods

29
Q

Nexplanon

A

implant contraceptive –progestin etonogestrel

good for 3 years

SE: bleeding irregularities

fertility returns rapidly after removal

30
Q

IUD types

A

most cost effective of all reversible methods of contraception

ParaGard T - copper containing (non-hormonal) good for 10 years

Levonorgestrel:
Mirena - 5 years
Skyla - 3 years
Liletta - 3 years

31
Q

Which IUD has a secondary indication for heavy menstrual bleeding?

A

Mirena

32
Q

Which IUD is smallest in size?

A

Skyla

might be helpful for nulliparous women

33
Q

What are the benefits of IUDs?

A

no adherence
fertility is restored upon removal

all levonorgestrel -releasing IUDs can reduce dysmenorrhea

34
Q

What are the adverse effects of IUDs?

A

risk of uterine perforation on insertion

copper IUD –heavy bleeding and cramping

ovarian cyst risk for levonorgestrel IUDs

35
Q

What are the different methods are sterilization for contraceptives?

A

abdominally:
cut, cauterize, or clip fallopian tubes via laparoscopy or minilaprarotomy

Hysteroscopically:
Essure - tubual occlusion after 3 months

36
Q

Essure

A

stent like mesh placed in the fallopian tubes hysteroscopically to cause stenosis –form of sterilization

tubal occlusion should be confirmed 3 months post operatively
use a different for of contraception in the interim

37
Q

Most OCPs in the US are made of what?

A

estrogen ethinyl estradiol and a progestin (levonoregestrel, norethindrone, drospirenone, norgestimate, etc)

typically 21 days of active tablets and 7 days of placebo

38
Q

Monophasic vs multiphasic OCPs?

A

monophasic is a fixed dose of estrogen and progestin in each active pill

39
Q

Can you skip the placebo pills for OCPs?

A

any traditional 21/7 OCPs can be used continuously by skipping those placebo pills

40
Q

What are the secondary benefits to OCPs?

A

reduce risk of epithelial ovarian and endometrial cancer (this benefit is detectable after 1 year of and appears to persist for years after discontinuation)
reduction in dysmenorrhea
lower incidence of ectopic pregnancy
increase sex hormone binding globulin and decrease free testosterone concentrations —improves hirsutism and acne

off label to treat PCOS

41
Q

What are the adverse effects of OCPS?

A

estrogen:
Nausea
breast tenderness and enlargement

42
Q

Estrogen containing contraceptives are contraindicated in who?

A 
Smokers (>15/day) >35y/o w/:
HTN
CAD
HF
CVD
DM with end organ damage 
OR 
migraine HA w/ focal neuro sxs 
those at risk for VTE

hx of breast cancer
thromboemobilic disorder
liver disease

43
Q

Progestin only pills

A

taken daily without hormone free interval
MUST be taken at the SAME TIME everyday

good for breastfeeding women
and
those in whom estrogen in poorly tolerated or contraindicated

44
Q

Which drugs have been reported to decrease the efficacy of OCPs when taken together?

A 
Rifampin 
HIV drugs
anticonvulsants
St Johns wort 
PCNs
tetracyclines
45
Q

Depo injections for contraception

A

medroxyprogesterone acetate (IM or SQ)

can only be used for up t 2 years before discontinuation d/t decrease bone mineral density (reversible once stopped)

SE: weight gain, HA, decrease in bone density

the return of fertility can be delayed 6-12 months (10 month average)

46
Q

Transdermal patch

A

Xulane, Ortho Evra

ethinyl estradiol + norelgestromin

new patch each week, for three weeks, then 1 week no patch

less effective in obese pts

47
Q

NuvaRing

A

vaginal contraceptive ring
no fitting necessary

left in place for 3 weeks

ethinyl estradiol + etonogestrel

if removed for more than 3 hours, must go on back up OCPs for 7 days

48
Q

Which emergency contraceptives are available OTC?

A

progestin only –levonorgestrel

should be taken within 72 hours

SE: HA
abdominal pain
breast tenderness

49
Q

Antiprogestin ECPs

A

Ulipristal acetate (Ella)

Rx only

5 days after unprotected sex
most effective hormonal option for emergency contraception

Ulipristal acetate should be considered first-line hormonal option for emergency contraception especially for overweight or obese women

50
Q

What is considered first-line hormonal option for emergency contraception especially for overweight or obese women?

A

Ulipristal

51
Q

Copper IUD as emergency contraception

A

most effective method

should be inserted within 5 days of unprotected sex

52
Q

Diaphragms

A

must be placed 6 hours before sex and left in for 6 hours after sex
can not be left in for more than 24 hours d/t TSS
must add spermicide every time

53
Q

Male vs female condoms

A

Female condoms actually protect against STIs better than males condoms

Pharm 2 - Exam 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions