Module 1 - Contraceptives Flashcards
Types of Barrier Methods
Diaphragm
Vaginal sponge
Males Condoms
Female Condoms
Spermicides
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
-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
Diaphragm
-contraindications (7)
*allergy, HIV, TSS, anatomy, UTIs, user error, 6wks PP
-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
Vaginal Sponge
-can spermicide be used?
-how long must person leave in place after intercourse?
-Yes, meant to be used with spermicide
-6 hours
Vaginal Sponge
-contraindications (5)
*allergy, HIV, TSS, menses, PP
-must be 6wks PP
-no use during menses
-no use w/ hx of TSS
-risk of HIV infection
-allergy
Male condoms
-contraindications
-can oil based creams/lubricants be used with condom?
-allergy to latex or spermicide
-do not use oil based creams/lubricants
Female condoms
-safe for those with latex allergies?
-contraindications?
-Yes
-None
Spermicides
-can it be used alone or does it need condom/diaphragm?
-contraindications
-yes, can be used alone or with condom. more effective if used with condom.
-allergy, HIV infection/high risk for HIV infection
Spermicides
-how long before intercourse can spermicides be placed inside the vagina?
-SE
-minimum 15 minutes before intercourse; can wait up to 1-3hr before intercourse
-sensitivity rxn
Combined Hormonal Contraception
-contraindications (most important)
age >=35 and smokes >=15 cigarettes/day
Combined Hormonal Contraception
-absolute contraindications
*circulatory (9)
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
Combined Hormonal Contraception
-absolute contraindications
*digestive
acute viral hepatitis
active liver cirrhosis or liver CA
Combined Hormonal Contraception
-absolute contraindications
*endocrine
diabetes 20 years
diabetes w/ end-organ damage
complicated solid organ transplant
Combined Hormonal Contraception
-absolute contraindications
*immune
hx of lupus w/ + antiphospholipid antibodies
Combined Hormonal Contraception
-absolute contraindications
*nervous
migraine with aura
Combined Hormonal Contraception
-absolute contraindications
*reproductive
less than 21 days PP (risk for thromboembolism)
pregnancy, known or suspected
current breast CA
Combined Hormonal Contraception
-relative contraindications
*circulatory (6)
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
Combined Hormonal Contraception
-relative contraindications
*digestive
active gallbladder disease
malabsorptive bariatric surgery
hx of cholestasis
Combined Hormonal Contraception
-relative contraindications
*nervous
migraine w/o aura
migraine HA that starts after OC initiation
use of oxcarbazepine, lamotrigine, barbiturates, phenytoin, carbamazepine, primidone and/or topiramate
Combined Hormonal Contraception
-relative contraindications
*reproductive
<42 days PP (risk for venous thromboembolism may still be present)
past hx of brst CA, not no active disease for 5 years
Combined Hormonal Contraception
-relative contraindications
*other
conditions that make it difficult to take pills consistently
Combined Hormonal Contraception
-EB’s Contraindications (10)
- SMOKER age >=35yr
- hx of clot (MI, DVT, stroke)
- hx of current breast CA
- uncontrolled HTN/DM
- prolonged immobilization
- triglycerides
- active/liver disease
- women at risk for cardiac dx
- active SLE (lupus)
- undiagnosed vag. bleeding
Combined Hormonal Contraception
-how much ethinyl estradiol in oral contraceptive
35mcg
Combined Hormonal Contraception
-how does it work?
-suppressing pituitary gonadotropins (FSH and LH) = inhibiting ovulation
-increasing viscosity of cervical mucous, reduce endometrial thickness (reducing chances of implantation)
Combined Hormonal Contraception
-dose-related SE of OC’s
*Too much estrogen
N, bloating, HTN, breast tenderness, edema
Combined Hormonal Contraception
-dose-related SE of OC’s
*Too little estrogen
early or midcycle breakthrough bleeding, increased spotting
Combined Hormonal Contraception
-dose-related SE of OC’s
*Too much progestin
inc. appetite, wt. gain, fatigue, mood changes
Combined Hormonal Contraception
-dose-related SE of OC’s
*Too little progestin
late breakthrough bleeding, amenorrhea
Combined Hormonal Contraception
-noncontraceptive health benefits of OC
-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
Combined Hormonal Contraception
-impact on milk supply
Decreases milk supply
Combined Hormonal Contraception
-serious/life-threatening complications
-thrombophlebitis/thromboembolism
-hepatocellular adenomas
-stroke
-gallbladder disease
-HTN
Combined Hormonal Contraception
-SE
-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
Combined Hormonal Contraception
-education
ACHES
-severe abd pain
-severe chest pain
-severe HA
-eye problems
-severe leg pain
Combined Hormonal Contraception
-F/U
weight and BP after 3MO on OC, then annually as clinically indicated
Combined Hormonal Contraception
-missed pills
*1 missed pill
*2 missed pills (consecutively)
*3 or more missed pills
*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
Contraceptive Patch
-what hormones are used?
-does it have noncontraceptive health benefits?
-does it decrease milk production?
-SE
-estrogen and progestin
-yes
-yes
-breakthrough bleeding (esp. first 3MO), irritation at application site
Contraceptive Patch
-appropriate locations
-partially detached patch instructions
-what to look out for
-F/U
-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
Contraceptive Vaginal Ring
-what hormones are involved?
-does it have noncontraceptive health benefits?
-SE
-education
-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)
Emergency Contraception
-efficacy
-types for 72hrs from intercourse; types for 120hrs from intercourse
-teratogenic effects?
-85%
-Plan B (no prescription needed); Ella or Copper IUD
-no reports of teratogenic effects
Emergency Contraception
-contraindications
-when is it less effective?
-copper IUD in pregnancy (suspected)
-less effective in higher BMI (Plan B BMI>25; Ella BMI>34)
Emergency Contraception
-Considerations
-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
Emergency Contraception
-F/U
-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
IUD
-hormone involved
-impacts on breastfeeding
-SE
-progesterone (levonorgestrel)
-no impact on breastfeeding
-abd adhesions/infections, sepsis, cervical infection/erosion; spotting/heavy flow; embedding
IUD
-absolute containdications
pregnancy, current STD, unexplained vaginal bleeding, anatomical abnormality, fibroids, cervical/endometrial cancer, infections, postpartum endometritis; infected abortion, pelvic TB; gestational trophoblastic disease
IUD
-how long each lasts:
*skyla
*liletta
*kyleena
*mirena
*paragard
*3yr
*up to 6yr
*every 5yrs
*every 5yrs
*10yrs
Progestin-only contraceptive
-MOA
-available forms
-suppresses ovulation, creates thin/atrophic endometrium; thickens cervical mucous making sperm penetration difficult
-progestin-only OC (mini pill), depo provera, nexplanon
Progestin-only contraceptive
-Mini pill
*age
*effect time has on function
*sx
-<40yrs
-take at same time everyday (w/i 3 hour window)
-GI upset, breast tenderness, dec. libido; severe HA or HTN
Progestin-only contraceptive
-Mini pill
*benefits
*SE
*education
*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)
Progestin-only contraceptive
-Mini pill
*F/U (when D/C needs to happen)
new onset of migraine, new CV risk = D/C this med
Progestin-only contraceptive
-Mini pill
*when should patient return for F/U?
*how much supply at one time can you prescribe?
-3M
-6M
Progestin-only contraceptive
-Depo Provera
*advantages
*how often?
*SE
*lactation effects?
*good for certain patients
*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
Nexplanon
-how long does this last?
-does this impact lactation?
-SE
-use caution in these patients
-3Y
-no
-irregular menses; follicular cysts (resolve on own); fluid retention; increased acne; weight gain
-DM, depression, HTN
Nexplanon
-contraindications
-can it be seen on x-ray?
-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
