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Therapeutics - Exam 5 > Lectures 44,45, and 46 > Flashcards

Lectures 44,45, and 46 Flashcards

Contraception and Emergency Contraception This one is going to be a doozy

1
Q

types of hormonal contraceptives

A

implant
levonorgestrel IUD
depot shot
pill (COC/Progestin only)
Vaginal Ring
Patch

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2
Q

implant - hormone, efficacy, duration of actions, and return of fertility

A

progestin
over 99%
3 years
may be delayed or rapid return (within 6 weeks)

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3
Q

implant – SE serious

A

mood changes
headaches
acne

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4
Q

implant – SE common

A

pain with insertion
irregular bleeding for first 6 to 12 months (could lead to no bleeding, regular period, frequent spotting or bleeding)

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5
Q

levonorgestrel (LNG) IUD hormone, efficacy, duration of action, and return of fertility

A

progestin
over 99%
3 to 8 years
immediate

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6
Q

LNG IUD - SE serious

A

uterine perforation
expulsion
infection

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7
Q

LNG IUD - SE common

A

cramping with insertion, spotting for first 3 to 6 months, periods may become lighter or less frequent

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8
Q

Copper IUD hormone, efficacy, duration of action, and return of fertility

A

no hormone
over 99%
10 years
immediate

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9
Q

Copper IUD – SE serious

A

uterine perforation
expulsion
infection

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10
Q

Copper IUD – SE Common

A

cramping with insertion
spotting for first 3 to 6 months
periods may become heavier or stay about the same

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11
Q

DMPA shot – hormone, efficacy, duration of action, and return of fertility

A

progestin
96%
3 months
possible delayed return

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12
Q

DMPA shot – SE serious

A

lower bone density
heavy bleeding

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13
Q

DMPA shot – SE common

A

weight gain
change in acne, mood, or headaches
spotting between periods or no periods

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14
Q

DMPA shot – how to start

A

150 mg IM or SQ injection by PCP

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15
Q

Types of pills

A

combined (COC, CHC)
Norethindrone and Norgestrel
Drospirenone

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16
Q

COC – hormone, efficacy, duration of action, and return of fertility

A

estrogen/progestin
93%
QD
immediate

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17
Q

COC – SE serious

A

blood clots (estrogen related)
stroke

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18
Q

COC – SE common

A

nausea, spotting, and/or breast discomfort
change in mood or headaches

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19
Q

interactions of COCs

A

controversial antibiotic interactions
both increase and decrease

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20
Q

types of COCs

A

monophasic (same dose)
biphasic (varying dose of E/P with two strengths)
triphasic (varying dose of E/P with three strengths)
four phasic (varying dose of E/P with four strengths)

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21
Q

norethindrone (mini-pill) and norgestrel (otc) – hormone, efficacy, duration of action, and return of fertility

A

progestin
93%
QD
immediate

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22
Q

norethindrone (mini-pill) and norgestrel (OTC) – SE serious

A

severe headaches
heavy bleeding
ectopic pregnany

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23
Q

norethindrone (mini-pill), norgestrel (otc), and drospirenone (slynd) – SE common

A

spotting and menstrual changes (more so than COC)

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24
Q

norethindrone (mini-pill) and norgestrel (otc) – how to start

A

take daily within 3 hours of the same time
no placebo pills

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25
drospirenone (slynd) -- hormone, efficacy, duration of action, and return of fertility
progestin 93% QD immediate
26
drospirenone (slynd) -- SE serious
severe headaches hyperkalemia
27
dropsirenone (slynd) -- how to start
take daily with no placebo pills
28
vaginal ring types
monthly disposable (nuvaring, eluryng) annual resuable (annovera)
29
NuvaRing and Annovera -- hormone, efficacy, duration of action, and return of fertility
estrogen/progestin 93% in place for 3 weeks then ring free for 1 week immediate
30
NuvaRing and Annovera -- SE serious
blood clots stroke
31
NuvaRing -- SE common
nausea, spotting, breast discomfort change in mood or headaches
32
Annovera -- SE common
headache/migraine nausea and vomiting vulvovaginal infection, candidiasis
33
NuvaRing -- how to start
leave in place for 3 weeks remove for 1 week discard ring insert new ring after 7 days
34
Annovera -- how to start
leave in place for 3 weeks remove wash with mild soap and warm water pat dry place in case leave it out for one week reinsert into vagina after 7 days
35
patch types
norelgestromin and EE (xulane, zefmy) levonorgestrel and EE (twirla)
36
all patches -- hormone, efficacy, duration of action, and return of fertility
estrogen/progestin 93% 3 weeks immediate
37
all patches -- SE serious
blood clots
38
Xulane, Zefmy -- SE common
nausea spotting breast discomfort skin irriation changes in mood or headaches
39
Xulane, Zefmy -- how to start
transdermal, thin, beige SQUARE patch applied to upper outer arm, abdomen, buttock, or back keep on for 3 weeks remove and discard patch free for 7 days apply new patch
40
twirla -- SE common
nausea spotting increased weight skin irriation changes in mood or headaches
41
twirla -- how to start
transdermal, thin, beige CIRCLE plastic patch applied to abdomen, buttock, or upper torso (excluding breast) keep on for 3 weeks remove and discard go patch free for 7 days apply a new patch
42
EC -- efficacy, duration of action, and return of fertility
more effective the sooner it is used one insertion per copper iud, one rx per cycle of ulipristal acetate, and one OTC dose of levonorgestrel pill prn immediate
43
EC -- SE
nausea vomiting (if within 2 hours of dose, consider repeating) headache dizziness breast pain stomach pain next period may start early or late and may have spotting
44
Too much estrogen -- SE
bloating breast tenderness mood changes headache nausea heavy menses fibroid growth melasma vision changes cyclic weight gain
45
not enough estrogen SE
light mense vaginal dryness spotting no withdrawal bleeding
46
too much progesin SE
acne hirsutism decreased/increased sex drive (depends on person) depression increased appetite non cyclic weight gain less energy cholestatic jaundice yeast infections hair loss swelling in arms/legs
47
not enough progestin SE
breakthrough bleeding late in cycle no withdrawal bleeding heavy menses
48
combined medications -- SE serious
abdominal pain chest pain (SOB, cough) headache eye problems (double vision, blurry vision) severe leg pain
49
combined medications -- CI
under 21 days postpartum severe decompensated cirrhosis VTE, diabetes, vascular disease migraine with aura HTN and BP > 160/100 smoking > 15 per day and > 35 yo History of stroke current breast cancer major surgery with prolonged immobilization IHD liver tumor peripartum cardiomyopathy complicated solid organ transplant SLE and positive antiphospholipid antibodies
50
General approaches to starting
quick next period sunday when changing hormonal methods EC restarting after EC
51
quick start
anytime is reasonable certain person is not pregnant if more than 1-6 days after period start, use backup method for 2 to 7 days
52
next period start
start within 1-6 days of period start no backup method required
53
sunday start
start on sunday after period starts if more than 1-6 days after period start, use backup method for 2 to 7 days
54
when changing methods
switch method at any time or when due for next injection no backup needed if no gaps in treatment
55
EC start
within five days of unprotected vaginal intercourse levonorgestrel -- more effective the sooner it is used but could be less effective if < 165 pounds
56
Restarting after EC
If levonorgestrel, start/resume method immediately and use backup method for 7 days If ulipristal acetate, start/resume method five days after use and use backup method for 7 days
57
How would you treat SE of irregular bleeding?
take pills at same time each day ibuprofen 800mg tid x5d may improve with continued use
58
how would you treat SE of headaches?
d/c product if headaches get worse OTC pain relievers switch to continuous product if occurs during placebo
59
how would you treat SE of nausea?
take pills with food or at bedtime use continuous product if at start of cycle could improve on own with continued use
60
how would you treat SE of breast tenderness?
supportive bra OTC pain reliever use product with less estrogen
61
how would you treat SE of acne?
topical treatments different pill formulation (one that is less androgenic) use combined product if able
62
contraceptive treatment for transgender men
progestin-only CHC non-hormonal (copper IUD) irreversible (tubal ligation, excision of fallopian tubes)
63
contraceptive treatment for transgender women
condoms condoms with spermicide irreversible (orchiectomy, vasectomy)
64
Concerns of patients when bringing up contraceptions
feel unable to discuss concerns insufficient information about options lack of patient-centeredness inaccurate knowledge use of scare tactic and authority
65
approaches to minimize care concerns
tiered effectiveness reproductive life planning one key question PATH shared decision making others
66
tiered effectiveness approach
most effective reversible --> implant and IUD most effective permanent --> male/female sterilization second tiered in this order --> injectable, pill, patch, ring, diaphragm
67
one key question approach
would you like to become pregnant this year? yes -- assessment and care based on core preconception factors; folic acid supplementation no - discuss all available options, satisfaction, and accurate use IDK - pregnancy ambivalence; determine intervention and folic acid supplementation if potential
68
PATH approach
PA -- parenting attitudes, pregnancy attidues T -- timing H -- how important delay pregnancy is
69
shared decision making approach key steps
choice talk and information sharing option talk and deliberation decision talk and decision making

Therapeutics - Exam 5 (8 decks)

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