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CMN572-801 > Module 1 - Contraceptives > Flashcards

Module 1 - Contraceptives Flashcards

1
Q

Types of Barrier Methods

A

Diaphragm
Vaginal sponge
Males Condoms
Female Condoms
Spermicides

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2
Q

Diaphragm
-reusable or one time use?
-can spermicide be used?
-things to remember
-timeline of placement before sex; how long can it stay in after sex

A

-reusable
-yes, spermicide
-NEEDS TO BE FITTED. MUST BE REFITTED WITH WT GAIN/LOSS, AFTER PREGNANCY
-can be placed up to 2 hours prior to sex. must stay in place 6 hours after intercourse

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3
Q

Diaphragm
-contraindications (7)

*allergy, HIV, TSS, anatomy, UTIs, user error, 6wks PP

A

-silicone/spermicide allergy
-high risk for HIV infection or dx w/ HIF infection
-hx of toxic shock syndrome
-hx of frequent UTIs
-abnormalities of uterine anatomy that prevent a satisfactory fit
-inability to insert correctly
-full-term pregnancy delivered w/i prior 6 weeks

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4
Q

Vaginal Sponge
-can spermicide be used?
-how long must person leave in place after intercourse?

A

-Yes, meant to be used with spermicide
-6 hours

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5
Q

Vaginal Sponge
-contraindications (5)

*allergy, HIV, TSS, menses, PP

A

-must be 6wks PP
-no use during menses
-no use w/ hx of TSS
-risk of HIV infection
-allergy

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6
Q

Male condoms
-contraindications
-can oil based creams/lubricants be used with condom?

A

-allergy to latex or spermicide
-do not use oil based creams/lubricants

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7
Q

Female condoms
-safe for those with latex allergies?
-contraindications?

A

-Yes
-None

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8
Q

Spermicides
-can it be used alone or does it need condom/diaphragm?
-contraindications

A

-yes, can be used alone or with condom. more effective if used with condom.
-allergy, HIV infection/high risk for HIV infection

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9
Q

Spermicides
-how long before intercourse can spermicides be placed inside the vagina?
-SE

A

-minimum 15 minutes before intercourse; can wait up to 1-3hr before intercourse
-sensitivity rxn

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10
Q

Combined Hormonal Contraception
-contraindications (most important)

A

age >=35 and smokes >=15 cigarettes/day

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11
Q

Combined Hormonal Contraception
-absolute contraindications
*circulatory (9)

A

BP >= 160/100
Uncontrolled HTN
Complex valvular heart disease
Hx stroke
Multiple risk factors for coronary artery disease
Peripartum cardiomyopathy
Hx of ischemic heart disease
Thromboembolic disorder (pulmonary embolus thormbogenic mutations; major surgery with prolonged immobilization)
Hx of (or current) thrombophlebitis

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12
Q

Combined Hormonal Contraception
-absolute contraindications
*digestive

A

acute viral hepatitis
active liver cirrhosis or liver CA

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13
Q

Combined Hormonal Contraception
-absolute contraindications
*endocrine

A

diabetes 20 years
diabetes w/ end-organ damage
complicated solid organ transplant

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14
Q

Combined Hormonal Contraception
-absolute contraindications
*immune

A

hx of lupus w/ + antiphospholipid antibodies

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15
Q

Combined Hormonal Contraception
-absolute contraindications
*nervous

A

migraine with aura

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16
Q

Combined Hormonal Contraception
-absolute contraindications
*reproductive

A

less than 21 days PP (risk for thromboembolism)
pregnancy, known or suspected
current breast CA

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17
Q

Combined Hormonal Contraception
-relative contraindications
*circulatory (6)

A

age >=35 and smokes <= 15 cigarettes per day
SBP 140-159mmHg or DBP 90-99mmHg
well controlled HTN
hyperlipidemia
prolonged immobility
hx of superficial venous thrombosis

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18
Q

Combined Hormonal Contraception
-relative contraindications
*digestive

A

active gallbladder disease
malabsorptive bariatric surgery
hx of cholestasis

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19
Q

Combined Hormonal Contraception
-relative contraindications
*nervous

A

migraine w/o aura
migraine HA that starts after OC initiation
use of oxcarbazepine, lamotrigine, barbiturates, phenytoin, carbamazepine, primidone and/or topiramate

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20
Q

Combined Hormonal Contraception
-relative contraindications
*reproductive

A

<42 days PP (risk for venous thromboembolism may still be present)
past hx of brst CA, not no active disease for 5 years

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21
Q

Combined Hormonal Contraception
-relative contraindications
*other

A

conditions that make it difficult to take pills consistently

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22
Q

Combined Hormonal Contraception
-EB’s Contraindications (10)

A
  1. SMOKER age >=35yr
  2. hx of clot (MI, DVT, stroke)
  3. hx of current breast CA
  4. uncontrolled HTN/DM
  5. prolonged immobilization
  6. triglycerides
  7. active/liver disease
  8. women at risk for cardiac dx
  9. active SLE (lupus)
  10. undiagnosed vag. bleeding
23
Q

Combined Hormonal Contraception
-how much ethinyl estradiol in oral contraceptive

A

35mcg

24
Q

Combined Hormonal Contraception
-how does it work?

A

-suppressing pituitary gonadotropins (FSH and LH) = inhibiting ovulation
-increasing viscosity of cervical mucous, reduce endometrial thickness (reducing chances of implantation)

25
Q

Combined Hormonal Contraception
-dose-related SE of OC’s
*Too much estrogen

A

N, bloating, HTN, breast tenderness, edema

26
Q

Combined Hormonal Contraception
-dose-related SE of OC’s
*Too little estrogen

A

early or midcycle breakthrough bleeding, increased spotting

27
Q

Combined Hormonal Contraception
-dose-related SE of OC’s
*Too much progestin

A

inc. appetite, wt. gain, fatigue, mood changes

28
Q

Combined Hormonal Contraception
-dose-related SE of OC’s
*Too little progestin

A

late breakthrough bleeding, amenorrhea

29
Q

Combined Hormonal Contraception
-noncontraceptive health benefits of OC

A

-dec menstrual flow and dysmenorrhea, improvement of menstrual sx
-improvement of acne, regularity of menses, protection against anemia, reduced ovarian cysts
-reduced incidence of endometrial CA, colorectal CA, gynecological diseases that cause infertility

30
Q

Combined Hormonal Contraception
-impact on milk supply

A

Decreases milk supply

31
Q

Combined Hormonal Contraception
-serious/life-threatening complications

A

-thrombophlebitis/thromboembolism
-hepatocellular adenomas
-stroke
-gallbladder disease
-HTN

32
Q

Combined Hormonal Contraception
-SE

A

-N, fatigue, acne, mild HA
-Inc. appetite
-breast fullness and/or tenderness
-cyclic wt gain and fluid retention
-BREAKTHROUGH BLEEDING (esp first 3MO of use)
-decreased menstrual flow and/or amenorrhea

33
Q

Combined Hormonal Contraception
-education

A

ACHES
-severe abd pain
-severe chest pain
-severe HA
-eye problems
-severe leg pain

34
Q

Combined Hormonal Contraception
-F/U

A

weight and BP after 3MO on OC, then annually as clinically indicated

35
Q

Combined Hormonal Contraception
-missed pills
*1 missed pill
*2 missed pills (consecutively)
*3 or more missed pills

A

*take ASAP; if not remembered until next pill, take 2 pills
*take 2 pills per day for next 2 days, then resume 1 pill per day
-used additional contraception for remained of cycle
*depends on what type of OC, and where in pack the pills were missed; refer to product info for that OC

36
Q

Contraceptive Patch
-what hormones are used?
-does it have noncontraceptive health benefits?
-does it decrease milk production?
-SE

A

-estrogen and progestin
-yes
-yes
-breakthrough bleeding (esp. first 3MO), irritation at application site

37
Q

Contraceptive Patch
-appropriate locations
-partially detached patch instructions
-what to look out for
-F/U

A

-upper arm, back, abd, buttock (NO BREAST)
-can reapply or tape as long as it hasn’t been off for 24 hrs
-ACHES (severe abdominal pain, severe chest pain, severe AH, eye problems, severe leg pain)
-wt check and BP after 3MO, then annually

38
Q

Contraceptive Vaginal Ring
-what hormones are involved?
-does it have noncontraceptive health benefits?
-SE
-education

A

-estrogen and progestin
-yes
-vaginitis, skin irritation; all other SE are same (breast tenderness, BTB, etc.)
-insert deep/posterior, leave in during sex; keep out of direct sunlight; can reinsert <3hr w/o backup method (otherwise backup method for 7 days)

39
Q

Emergency Contraception
-efficacy
-types for 72hrs from intercourse; types for 120hrs from intercourse
-teratogenic effects?

A

-85%
-Plan B (no prescription needed); Ella or Copper IUD
-no reports of teratogenic effects

40
Q

Emergency Contraception
-contraindications
-when is it less effective?

A

-copper IUD in pregnancy (suspected)
-less effective in higher BMI (Plan B BMI>25; Ella BMI>34)

41
Q

Emergency Contraception
-Considerations

A

-Insulin-dependent diabetics require closer monitoring
-higher BMI –> less effective (but still offer)
-bariatric surgery –> malabsorptive process –> less effective
-copper IUD –> check for strings monthly and after sex

42
Q

Emergency Contraception
-F/U

A

-no menstrual bleeding w/i 3 weeks of emergency oral contraception
-less than 2 days bleeding
-signs of early pregnancy
-annual examinations as clinically indicated
-ongoing contraception counseling

43
Q

IUD
-hormone involved
-impacts on breastfeeding
-SE

A

-progesterone (levonorgestrel)
-no impact on breastfeeding
-abd adhesions/infections, sepsis, cervical infection/erosion; spotting/heavy flow; embedding

44
Q

IUD
-absolute containdications

A

pregnancy, current STD, unexplained vaginal bleeding, anatomical abnormality, fibroids, cervical/endometrial cancer, infections, postpartum endometritis; infected abortion, pelvic TB; gestational trophoblastic disease

45
Q

IUD
-how long each lasts:
*skyla
*liletta
*kyleena
*mirena
*paragard

A

*3yr
*up to 6yr
*every 5yrs
*every 5yrs
*10yrs

46
Q

Progestin-only contraceptive
-MOA
-available forms

A

-suppresses ovulation, creates thin/atrophic endometrium; thickens cervical mucous making sperm penetration difficult
-progestin-only OC (mini pill), depo provera, nexplanon

47
Q

Progestin-only contraceptive
-Mini pill
*age
*effect time has on function
*sx

A

-<40yrs
-take at same time everyday (w/i 3 hour window)
-GI upset, breast tenderness, dec. libido; severe HA or HTN

48
Q

Progestin-only contraceptive
-Mini pill
*benefits
*SE
*education

A

*protection against endometrial CA, dec. risk of PID, dec. menstrual cramps, evetually less heavy bleeding and shorter menses; dec premenstrual syndrome sx; dec breast tenderness
*inc. risk of ectopic pregnancy
*spotting, BTB; can start anytime in cycle (use backup method x1 week); if pill missed, take ASAP (use backup method 48hrs)

49
Q

Progestin-only contraceptive
-Mini pill
*F/U (when D/C needs to happen)

A

new onset of migraine, new CV risk = D/C this med

50
Q

Progestin-only contraceptive
-Mini pill
*when should patient return for F/U?
*how much supply at one time can you prescribe?

A

-3M
-6M

51
Q

Progestin-only contraceptive
-Depo Provera
*advantages
*how often?
*SE
*lactation effects?
*good for certain patients

A

*dec risk of ectopic pregnancy, risk of endometrial CA, frequency of SSSC, improves endometriosis
-IM q 12 weeks
-decreases bone density (GIVE Ca2+ supplement); irregular + prolonged bleeding (first 6 months); amenorrheic by 1 yr; weight gain; mood changes; depression
-no impact on lactation
-lactating/postpartum patients, sickle cell anemia; PID hx

52
Q

Nexplanon
-how long does this last?
-does this impact lactation?
-SE
-use caution in these patients

A

-3Y
-no
-irregular menses; follicular cysts (resolve on own); fluid retention; increased acne; weight gain
-DM, depression, HTN

53
Q

Nexplanon
-contraindications
-can it be seen on x-ray?

A

-known/suspected pregnancy
-current or past hx of clot
-all liver tumors
-active liver disease
-undiagnosed vag bleeding
-known/suspected breast CA/ personal hx of breast CA
-allergic rxn to components of nexplanon (barium)

-yes

CMN572-801 (2 decks)

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