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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

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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
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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
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4
Q

What are the three brands of levonorgestrel IUDs?

A

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

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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
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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
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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

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8
Q

What types of IUDs are available?

A

copper

LNG (levonorgestrel)

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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

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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)

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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

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12
Q

Barrier contraceptives

A

less effective than hormonal therapy but may offer STI protection

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13
Q

Natural family planning

A

selective abstinence during window of fertility

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14
Q

What are the contraindications of natural family planning?

A

only reliable for women with consistent 26-32 day cycles

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15
Q

What are the different types of emergency contraceptives?

A

Levonorgestrel (Plan B - OTC)

Ulipristal

Copper IUD

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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

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17
Q

What is the MOA of emergency contraceptives?

A

delay ovulation

may also interfere with sperm migration and function

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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

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19
Q

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

A

Copper IUD

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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

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21
Q

Which birth control methods are immediately reversible?

A

copper IUD
family planning
OCPs
barrier methods

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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
Why do you make sure the pt doesn't have STIs before inserting the IUD?
because you could spread the infection into the uterus and put the pt at risk of PID
26
What is the effectiveness of natural family planning?
25% failure rate/year
27
What are the most effective forms are contraceptives?
IUDs and sterilization
28
Which methods of contraceptives have highest rate of failure?
barrier and fertility based methods
29
Nexplanon
implant contraceptive --progestin etonogestrel good for 3 years SE: bleeding irregularities fertility returns rapidly after removal
30
IUD types
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
Which IUD has a secondary indication for heavy menstrual bleeding?
Mirena
32
Which IUD is smallest in size?
Skyla might be helpful for nulliparous women
33
What are the benefits of IUDs?
no adherence fertility is restored upon removal all levonorgestrel -releasing IUDs can reduce dysmenorrhea
34
What are the adverse effects of IUDs?
risk of uterine perforation on insertion copper IUD --heavy bleeding and cramping ovarian cyst risk for levonorgestrel IUDs
35
What are the different methods are sterilization for contraceptives?
abdominally: cut, cauterize, or clip fallopian tubes via laparoscopy or minilaprarotomy Hysteroscopically: Essure - tubual occlusion after 3 months
36
Essure
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
Most OCPs in the US are made of what?
estrogen ethinyl estradiol and a progestin (levonoregestrel, norethindrone, drospirenone, norgestimate, etc) typically 21 days of active tablets and 7 days of placebo
38
Monophasic vs multiphasic OCPs?
monophasic is a fixed dose of estrogen and progestin in each active pill
39
Can you skip the placebo pills for OCPs?
any traditional 21/7 OCPs can be used continuously by skipping those placebo pills
40
What are the secondary benefits to OCPs?
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
What are the adverse effects of OCPS?
estrogen: Nausea breast tenderness and enlargement
42
Estrogen containing contraceptives are contraindicated in who?
``` 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
Progestin only pills
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
Which drugs have been reported to decrease the efficacy of OCPs when taken together?
``` Rifampin HIV drugs anticonvulsants St Johns wort PCNs tetracyclines ```
45
Depo injections for contraception
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
Transdermal patch
Xulane, Ortho Evra ethinyl estradiol + norelgestromin new patch each week, for three weeks, then 1 week no patch less effective in obese pts
47
NuvaRing
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
Which emergency contraceptives are available OTC?
progestin only --levonorgestrel should be taken within 72 hours SE: HA abdominal pain breast tenderness
49
Antiprogestin ECPs
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
What is considered first-line hormonal option for emergency contraception especially for overweight or obese women?
Ulipristal
51
Copper IUD as emergency contraception
most effective method | should be inserted within 5 days of unprotected sex
52
Diaphragms
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
Male vs female condoms
Female condoms actually protect against STIs better than males condoms

Pharm 2 - Exam 2 (7 decks)

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