oral contraceptive piils

Question 1

what is contraception

Answer 1

prevention of pregnancy by
interfering with the normal process of ovulation, fertilization, and
implantation

Question 2

most pop method of contraception among female adolescent

Answer 2

ocp

Question 3

moa of ocp

Answer 3

1. estrogins and progestins inhibit fsh and lh levels so prevent ovulation.
2. progestin makes cervical mucus thicker
3. progestin only prvent the thickening of endometrial lining as there constant low levels of progestins so abortificient effect.

Question 4

effect of ocps on ovaries

Answer 4

1. absence of normal ovarian function and morphology like corpora lutea, larger follicles.
2. ovaries beocme smaller

Question 5

effect of ocps on uterus

Answer 5

hypertrophy and polpys in cervix
19 nor progestins glandular atrophy and less bleeidng

Question 6

effects of ocps on breast

Answer 6

breast enlargement adn combined pills suppress lactation

Question 7

endocrine effects of combined pills

Answer 7

1. prevention of the normal premenstrual rise and mid-cycle
   peaks of LH and FSH and of the rise in progesterone during
   the luteal phase;
2. Increased globulin, ceruloplasmin, transferrin, coagulation
   factors and renin substrate,
   increased fibrinogen
   synthesis can raise the erythrocyte sedimentation rate;
3. reduced carbohydrate tolerance
4. decreased albumin and haptoglobulin synthesis

Question 8

combination of combined pill

Answer 8

ethyl estradiol/mesotranol with norethisterone,
levonorgestrel, ethynodiol, desogestrel or gestodene,

Question 9

monophasic pill routine?

Answer 9

taken for 21 days. 7 days pills (placebo) with a diff color—withdrawal bleeding after 21 days

Question 10

natural progestins route

Answer 10

im

Question 11

synthetic progestins route

Answer 11

peroral

Question 12

1st gen progestins in ocps name

Answer 12

norethynodrel, norethindrone,
lynestrenol and ethynodiol diacetate.

Question 13

1st gen ocps adeverse efeect

Answer 13

androgenic effects

Question 14

2nd gen name

Answer 14

levonorgestrel.

Question 15

3rd gen names

Answer 15

norgestimate,
desogestrel, gestodene.

Question 16

4th gen progestins

Answer 16

as drospirenone, nomegestrol acetate or dienogest.

Question 17

4th gen pills combo

Answer 17

Yasmin (ethinylestradiol
and drospirenone),
Zoely (estradiol hemihydrate
and nomegestrol acetate)
Qlaira (estradiol
valerate and dienogest).

Question 18

drosprienone benefits

Answer 18

anti mineral corticoid, anti androgenic, decrease dysmennorhea, treat htn, missed pill window,

Question 19

diane 35 conctists of

Answer 19

ee +cyproterone acetate(3rd gen)

Question 20

diane 35 used in

Answer 20

advanced prostatic cancer-symptomatic relief,
used to treat androgen-
dependent conditions in women such as acne,

seborrhea, hirsutism, female pattern hair loss,
and hyperandrogenism due to PCOs

Question 21

monophasic form?

Answer 21

(constant dosage of both
components during the cycle)

Question 22

bi or triphasic form?

Answer 22

dosage of one or
both components is changed once or twice
during the cycle

Question 23

pop pills ?

Answer 23

no period during that time, 28 active pills all in the same colour.

Question 24

monophasic 4th gen pill eg

Answer 24

yasmin(ee+drospirernone)

Question 25

conditions for higher estrogen pill in coc

Answer 25

break through bleeding (BTB)/spotting or amenorrhea,
multiple cardiovascular/VTE risk factors such as >35 yr. old,
obese, smoker, diabetes mellitus, hypertension,

Question 26

conditions for low estrogen pill in coc

Answer 26

develops breast tenderness/enlargement or darkening of facial
skin,
has nausea

Question 27

extended cycle ocps eg?

Answer 27

seasonique( ee+levonorgestrel)
84/7
period expected every 3 months and happens for 4 days

Question 28

besides contraception, other indications for cocps

Answer 28

Menstrual related disorders such as
dysmenorrhea, irregular menstruation,
fibroids, endometriosis-related pain
* HRT
* PCOS
* Hyperandrogenaemia

Question 29

antiandrogenic effects of cocps

Answer 29

Oestrogen stimulates sex hormone binding globulin
(SHBG) liver synthesis that in turn reduces the amount
of biologically active androgen.

• Decreases gonadotrophin secretion that inhibits LH-
  related testosterone production by theca cells in the ovaries.
• Progestins block 5α-reductase activity, and decrease
  testosterone receptor expression and gonadotrophin
  (FSH, LH) synthesis.
• Both components of COCPs lower the levels of
  adrenocorticotropic hormone (ACTH) that in
  consequence has inhibitory effect on adrenal
  androgenesis (dehydroepiandrosterone and
  dehydroepiandrosterone sulphate production

Question 30

mild se of cocps

Answer 30

Nausea, mastalgia, breakthrough bleeding, and edema.
Increases in ESR bec of high fibrinogen levels
Headache is mild and often transient.

Question 31

moderate se

Answer 31

breakthorugh bleeding esp with pops. made better with triphasic drugs
Weight gain is more common with the combination
agents containing androgen-like progestins
Increased skin pigmentation
Acne may be exacerbated by agents containing
androgen-like progestins
Hirsutism may also be aggravated by the “19-
nortestosterone” derivatives
Vaginal infection

Question 32

severe se of cocps

Answer 32

Venous thromboembolic disease,
mi,
increased risk of breast cancer and cervical cancer
dec risk of endometrial and ovarian cancer
Gastrointestinal disorders Cholestatic
jaundice and cholecystitis
* Depression

Question 33

cocp and progestin only pills metabolized by

Answer 33

cytochrome p450 in the liver

Question 34

what drugs decrease the efficacy of ocps

Answer 34

enzyme-inducing drugs suchas rifampicin and rifabutin,
carbamazepine, phenytoin.
antibiotics such as amoxicillin, cause failure of the combined
pill.
these drugs increase the clearance of ocps pills by the cytochrome p450 enzyme

Question 35

absolute contraindications of ocps

Answer 35

pregnancy;
* thrombo-embolism;
* multiple risk factors for arterial
disease;
* ischemic heart disease;
* severe hypertension;
* breast or genital carcinoma;
* undiagnosed vaginal bleeding;
* breast-feeding;
* porphyria(p450 req heme for synthesis and thus porphyria can worsen

Question 36

Relative contraindications

Answer 36

uncomplicated migraine,
* cholelithiasis,
* hypertension,
* dyslipidemia,
* Diabetes mellitus, varicose
veins,
* severe depression,
* long-term immobilization,
sickle-cell disease,
inflammatory bowel disease.

Question 37

pops consists of

Answer 37

norethisterone, levonorgestrel or ethynodiol or
drosiperinone

Question 38

pops should be taken

Answer 38

at the same time everyday,taken continously w/o break
3-hour progestogen-only pill must be taken within 3
hours of the same time each day – for example
Norgeston and Noriday
* 12-hour progestogen-only pill (desogestrel pill, such as
Cerazette) must be taken within 12 hours of the same
time each day.
Offers an alternative when oestrogens are
contraindicated

Question 39

long acting pops?

Answer 39

medroxyprogesterone acetate (DMPA) every 3 months.
This is effective and safe. However, menstrual
irregularities are common, and infertility may persist
for many months after cessation of treatment.
Levonorgestrel implanted subcutaneously in non-
biodegradable capsules. It avoids first-pass
metabolism. The capsules release their progestogen
content slowly over 5 years. Irregular bleeding and
headache are common.

Question 40

emergency cops?

Answer 40

Levonelle Contains high dose progesterone (levonorgesterel)

Question 41

levonelle taken when post coitus?

Answer 41

1500mcg tablet taken as soon as possible after
unprotected intercourse (up to 72 hours after)
* Preferably within 12 hours, no later than 72 hours

Question 42

levonelle se

Answer 42

nause and vommittting