Oral Contraceptives Flashcards
Tablets are taken daily which contain estrogen and/ or progestin whose purpose is to interfere with fertilization or implantation or both to prevent pregnancy and/ or control the menstrual cycle
Oral contraceptives
______ pills alter the dosage of estrogen and progestin throughout the cycle and
Combined
Ethinylestradiol + norgestimate examples are?
Ortho- Cyclen, Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo
Ethinyl estradiol or mestranol, synthetic _____
estrogen
Norethindrone, norethindrone acetate, ethanediol diacetate, norethynodrel, norgestrel, Levonorgestrel, desogestrel, gestodene, norgestimate, all ________
progestins
\_\_\_\_ \_\_\_\_\_ (mini-pills) are not as effective as combination pills a) Mechanism of action affects the cervical mucus and the endometrium, most likely changes tubal transport of oocyte and sperm
Progestin-only
Typical first-year failure of birth control is?
3%
Typical first-year failure rate (age < 22 years):
______?
4.7%
Mechanism of action:
_______ effects
a) Ovulation inhibited by suppression of FSH/ LH
b) Implantation inhibited by alteration of the endometrium
c) Ovum transport is accelerated
d) Luteorlysis may occur as estrogen causes progesterone level to fall
Estrogenic
Mechanism of action:
_____ effects
a) Thick cervical mucus interferes with sperm transport
b) Capacitation may be inhibited
c) Ovum transport may be slowed
d) Implatiaotn is hampered by suppression of the endometrium
e) Ovulation inhibited by hypothalamic-pituitary-ovarian disturbances
Progestational effects
Advantage contraceptive:
Excellent ______ against unwanted pregnancy; may lead to fuller sexual satisfaction due to a reduction in fear of pregnancy
protection
The advantage of contraceptives is ____ for most females?
safe
The advantage of contraceptive is less _____ blood flow (non-contraaceptive benefit)
Menstrual
The advantage of contraceptive is an improvement in facial ___ (non- contraceptive benefits)
acne
The advantage of contraceptive is woman controls own _____
fertility
The advantage of contraceptive is excellent _______ and easy to use
reversibility
An advantage of contraceptive is well _______
researched
An advantage may provide protection against ovarian and endometrial cancer, ectopic pregnancy, ____ _____ ____ (____) , functional ovarian cyst, endometriosis, uterine fibroids, among others
pelvic inflammatory disease (PID)
A disadvantage of contraception is:
a) May lead to _____ changes
mood
A disadvantage of contraception is:
b) No protection against _____
b) HIV
A disadvantage of contraception is:
c) ______ for some women
Expensive
A disadvantage of contraception is:
d) Rare circulatory _______ which may be dangerous
d) complications
A disadvantage of contraception is:
e) Increased risk of rare liver _____
e) tumors
A disadvantage of contraception is:
f) Pills must be taken _____ ____
f) every day
A disadvantage of contraception is:
g) Possible side effects such as ______, headaches, breakthrough bleeding
g) nausea
Undesirable Hormonal effects:
1) Excessive estrogenic effects
a) \_\_\_\_\_\_\_\_
b) nausea
c) chloasma
d) Cerebrovascular accidents (CVA)
e) Deep venous thrombosis (DVT)
f) Thromboembolic disease
g) \_\_\_\_\_\_ emboli
h) Telangiectasias
i) Hepatic adenoma/ adenocarcinoma
j) Cervical changes
k) \_\_\_\_\_\_ tenderness (secondary to
increased size)a) dysmenorrhea
g) Pulmonary
k) Breast
Deficiency in estrogen:
a) No withdrawal bleeding
b) Decreased duration in menstrual bleeding
c) Continuous spotting/ bleeding
d) breakthrough _______ on Day of cycle (DOC) 1 to 9
e) Atrophic vaginitis
d) bleeding
Excessive progestational effects
a) breast tenderness
b) transient hypertension
c) _______
d) fatigue
e) decreased libido
f) decreased duration in menstrual bleeding
g) increased ______
c) depression
g) appetite
Decreased Progestone effects
a) breakthrough _____ DOC 10 to 21
b) delayed menses
a) bleeding
Excessive androgenic effects
a) Hirsutism
b) Acne
c) Oily skin
d) ______
e) Increased Libido
d) Edema
Excessive estrogen/ deficient progesterone combination
a) __________
b) Menorrhagia
c) Nausea
d) _______
e) Headache
f) Irritability
g) bloating/ edema
h) _____
a) Dysmenorrhea
d) vomiting
h) syncope
Absolute contraindications for contraceptive
1) History of thromboembolic disorders
2) CVA (history of)
3) Coronary artery disease (CAD)
4) Known or suspected breast ________
5) Known or suspected estrogen-dependent neoplasia
6) Pregnancy
7) Benign or malignant liver tumor; impaired liver function
8) Previous cholelithiasis during pregnancy
9) Undiagnosed, abnormal uterine bleeding
4) carcinoma
Management/ Prescriptive Guidelines:
1. General considerations
a) Begin with low-dose combined or
multiphasic pill ( \_\_\_ mcg or less)
b) \_\_\_\_\_-only pills may be used in
women with a history of migraines
headaches, who are breastfeeding or who
have some contraindications to the
combination pills1) a) 35 mcg
b) Progestin
Patient education with contraception:
a) Instructions for use/ how the ___ works
b) “Missed” pills and backup contraception
a) pill
Adverse effects of contraception:
a) Abnormal menstrual bleeding: ____ ____ and spotting may be common; may need a higher dose
breakthrough bleeding
Adverse effects of contraception:
b) Amenorrhea or ______: Often caused by a low amount of progestin; may need dose increased
b) hypermenorrhea
Adverse effects of contraception:
c) Birth defects: Estrogen = pregnancy category ___, immediately discontinue oral contraceptives (OCs) if pregnant
c) X
Adverse effects of contraception:
d) ___: Estrogens promote certain types of breast CA family history should not take OCs
d) Cancer
Adverse effects of contraception:
e) ____: Risk is increased with age, dose, and length of therapy
e) Hypertension
Adverse effects of contraception:
f) Weight gain, increased _____, fatigue, depression, acne, and hirsutism: often caused by high amounts of progestin; may need a lower dose
appetite
Adverse effects of contraception:
g. Nausea, ______, and breast tenderness: Caused by high amounts of estrogen; may need a lower dose
g. edema
Adverse effects of contraception:
h. _______ disorders: Increased risk in some patients; OCs contraindicated inpatient with a history of thromboembolic disorders. CVA, CAD, or heavy smokers
h. Thromboembolic
Adverse effects of contraception:
i. Durg-drug interactions: Certain antibiotics and anticonvulsant decrease the effectiveness of OCs; OCs decrease the effectiveness of ____, _____ and certain oral hypoglycemic
i. warfarin, insulin
A flexible, prescriptive contraceptive ring, approximately 2 inches in diameter, for the purpose of preventing pregnancy
NuvaRing
Effectiveness:
NuvaRing typical failure rate: < ___ to __%
< 1 to 2%
Effectiveness of NuvaRing:
Reported manufacturer effectiveness: ___ to ___%
92 to 99.7 %
Mechanism of Action with NuvaRing:
1. Releases synthetic ______ (etonogestrel), Providing pregnancy protection for 1 month
estrogen and progestin
Mechanism of Action with NuvaRing:
2. Release of hormones is activated by _____ contact
vaginal
Mechanism of Action with NuvaRing:
3. Prevents _____; thickens the vertical mucus, inhibiting sperm penetration
ovulation
Mechanism of Action with NuvaRing:
4. May alter the _______ to affect implantation
endometrium
Advantages of NuvaRing:
- Convenient
- Once per ___ insertion
- month
Advantages of NuvaRing:
3. Easily
- reversible
Advantages of NuvaRing:
4. ____ ___require partner participation, thus sexual is not interrupted
- Does not
Advantages of NuvaRing:
5. Fewer ____ swings reported than with oral contraceptives
- mood
Advantages of NuvaRing:
6. Discreet: Usually, ____ be felt by the patient or partner
- cannot
Advantages of NuvaRing:
7. May lead to shorter, _____, and more regular menstrual periods.
- lighter
Advantages of NuvaRing:
8. Assume to offer additional similar non-contraceptive benefits of oral contraceptives ( e.g., decreased menstrual ____, improvement of facial acne, depression, etc.)
- cramps
The disadvantage of NuvaRing:
1. Similar to OCs ( e.g. ____ tenderness, headaches, weight gain, nausea, mood change, breakthrough bleeding, yet a lower incidence compared to oral contraceptives
breast
The disadvantage of NuvaRing:
2. Increased ____ discharge, irritation, or infection
vaginal
The disadvantage of NuvaRing:
3. Diaphragms, vertical caps, or shields ____be used as a back-up method of contraception while using the ring
cannot
The disadvantage of NuvaRing:
4. May ____depression in the patient previously diagnosed
worsen
The disadvantage of NuvaRing:
5. ____ protection from HIV/AIDS or STDs/STIs
No
Contraindications of NuvaRing:
1. Age > ___ years
- 35
Contraindications of NuvaRing:
- Smoking
- _____ high blood pressure
Uncontrolled
Contraindications of NuvaRing:
4. Controlled blood pressure but smoke > ___ cigarettes/ day
15
Contraindications of NuvaRing:
5. History of blood ____or any cardioembolic disorder (e.g. myocardial infection (MI)
clots
Management/ Prescriptive guidelines for NuvaRing:
1. Vaginally inserted __ time a month
one
Management/ Prescriptive guidelines for NuvaRing:
2. The ring is left in place for ___days (not more, not less)
21
Management/ Prescriptive guidelines for NuvaRing:
3. After ___ weeks, the ring is removed by the patients, allowing the menstrual cycle
three
Management/ Prescriptive guidelines for NuvaRing:
4. A new ring is then reinserted to continue pregnancy protection ( must be inserted on the same day of the week as it was inserted in the ____ ____ or pregnancy may occur)
last cycle
Management/ Prescriptive guidelines for NuvaRing:
5. If the ring slides out, it may be reinserted within ___ hours (backup method of contraception must be used if left out for more than the hours)
three
Management/ Prescriptive guidelines for NuvaRing:
6. Unopened packages must be protected from direct ____ or very high temperature
sunlight
A transdermal contraceptive patch release synthetic estrogen (Ethinyl estradiol) and progestin (norelgestromin) for the purpose of preventing pregnancy
Ortho Evra
Effectiveness of Ortho Evra:
Typical failure rate: < ___ to ___%
1 to 2%
Mechanism of action of Ortho Evra is?
Primarily prevents ______; similar to OCs
ovulation
Advantage of the Ortho Evra include:
- ____ per week administration
- Can be worn for three weeks
- Easily reversible
- Does not require partner participation, this sexual activity is not interrupted
- Once
Disadvantages of the Ortho Evra include:
1. Site ______
reactions
Disadvantages of the Ortho Evra include:
2. Others are similar to OCs such as breast ______, etc.
tenderness
Disadvantages of the Ortho Evra include:
3. No protection from ______
HIV/AIDs
Disadvantages of the Ortho Evra include:
4. Reduced effectiveness in women > ___ kg
90
Disadvantages of the Ortho Evra include:
5. Reduced effectiveness with concurrent administration of certain antibiotics, antifungals, anticonvulsant, __________, and others
St. John’s Wart
Disadvantages of the Ortho Evra include:
6. Increased risk for serious cardioembolic events (e.g. myocardial infarction, cerebrovascular accident, pulmonary embolus, etc. ); ___% more estroegne released than with oral contractpitves
60
Contraindications of Ortho Evra include:
- Age > ___ years
- smoking
- high blood pressure
- History of blood clots or andy cardioembolic disorder
35
Management/ prescriptive guidelines:
1) The first patch is applied to the arm, buttocks, torso (not _____), or abdomen on either the first day of her menstrual cycle (day one) or on the first Sunday following that day, whichever is preferred
breast
Management/ prescriptive guidelines:
2) The day of application is known from that point as the patch ___ day
change
Management/ prescriptive guidelines:
3) The patch is removed ____days later, and another patch is applied to an approved body location
4) The process is ____ again on the next patch change day
Management/ prescriptive guidelines:
5) On the following patch change day, the patch is removed and not replaced
3) seven
4) repeated
Management/ prescriptive guidelines:
6) Following a ___ day wait period, a new patch is applied on the next patch change day
7) If the patch stays off for > __ hours, restarting a new 4-week cycle is necessary, along with using a backup method of contraception
6) seven
7) 24
Long-acting progestin administered by intramuscular injection to prevent pregnancy and/or provide hormonal control of the menstrual cycle
Dep Provera (DMPA)
Effectiveness of Depo- Provera:
1. Typical first-year failure rate < __ %
< 1%
Mechanism of action for Depo Provera:
1) Suppresses follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thus blocking the ___ surge, which will inhibit ovulation
2) Thickens cervical mucus which interferes with sperm transport and penetration
3) Alters the endometrium by creating a thin, atrophic lining
1) LH
Advantages of Depo-Provera (DMPA):
1) Highly effective, _____ _____, convenient, not related to intercourse
2) Prolonged _______ possible with concomitant effects (decreased anemia, cramps, ovulatory pain)
3) Useful in reducing pain associated with endometriosis
4) ____ estrogen related side effects
5) Possible reduction in risk of PID and endometrial and ovarian cancer
1) long-acting
2) amenorrhea
4) No
Disadvantages of Depo-Provera (DMPA):
1) Menstrual irregularities: usually amenorrhea
2) Delayed return of fertility (up to ___ year)
3) An injection every _____ months
2) 1 year
3) three months
Undesirable effects of Depo-Provera (DMPA)::
1) Menstrual ______ (variable, individualized)
2) Other characteristics of progestins
3) Lipid changes: ______ in high-density lipoproteins (HDL) cholesterol
4) Possible reduction in bone density with long term use
5) Allergic reactions rare, but anaphylactic reactions may occur immediately following injection
1) irregularities
3) decrease
Absolute contraindications of DMPA:
1) _____ to DMPA
2) Unexplained abnormal uterine bleeding
3) Pregnancy
1) Allergy
Relative contraindications of Depo- Provera (DMPA):
1) Planning pregnancy within the year
2) Inability to _____ with menstrual irregularities
2) cope
Management/ prescriptive guidelines for Dep-Provera:
1) Risk factors screening
a) Pregnancy test if greater than ___ weeks
since three month period ended
2) General considerations
a) Injections are given deep intramuscularly
(IM). Repeat every three months, ___
week grace period.
b) Do not massage injection site after
administration
3) Patient education
a) A backup method should be used during
the first ____weeks after the injection
unless administered by DOC 5
1) a) 2
2) Two
3) 2 weeks
A single, thin flexible rod which contains etonogestrel, with the purpose to prevent pregnancy through a low diffusion of progestin form the rod
Nexplanon
The failure rate of Nexplanon?
0.01%
Mechanism of action of Nexplanon:
Same as other progestins; ___-acting reversible contraceptive (LARC)
long
Advantage of Nexplanon:
1) Continuous protection for ___ years
2) No estrogen related side effects
3) few serious system complications occur
4) Scanty or absent menses/ decreased anemia
5) May _____ risk of endometrial cancer
1) three
5) decrease
Management/ disadvantages of Nexplanon:
1) Requires informed consent
2) Irregular menstrual periods, including prolonged sense, _______ between periods, absent periods
3) The implant may be slightly visible initially
4) The initial expense is higher; informed consent required
2) spotting
An artificial device with either a metal wrapping for a chemically impregnated surface whose purpose is to prevent pregnancy; long-acting reversible contraceptive (LARC)
Intrauterine Device (IUD)
A T- shaped plastic device wrapped with fine copper wire can remain in the uterus up to 10 years
Copper Releasing (ParaGard)
A T- shaped plastic device also know as a levonorgestrel-releasing intrauterine system (LNG-IUS); can remain in the uterus up to 5 years
Progestin releasing (Mirena)
Effectiveness for Intrauterine Device (IUD):
Typical first-year failure rate: ___ to ___%
1 to 3%
Mechanism of action with an intrauterine device (IUD):
1) Immobilizes _____ and interferes with the migration of sperm from the vagina to the fallopian tubes
2) Speeds transport of the ovum through the fallopian tube
3) Inhibits fertilization
4) Causes lysis of the and/ or prevents implantation due to local foreign body inflammatory responses
1) sperm
4) blastocyst
Advantages of Intrauterine device (IUD):
1) Progestin- releasing IUDs may decrease menstrual loss and dysmenorrhea
2) Can prevent _______ Syndrome
Asherman’s
Disadvantages of Intrauterine device (IUD):
1) Pain and cramping may accompany use (up to 40% of removals related to pain)
2) Increase in _____ _____ resulting in anemia
3) Pregnancy
a) Spontaneous abortion is up to ___%
causes are IUD left in the uterus
b) Ectopic pregnancies occur in ___% of
users
2) menstrual bleeding
3) a) 50%
b) 5%
Undesirable effects of Intrauterine device (IUD):
1) _______, bleeding, hemorrhage, anemia
2) Cramping and pain
3) Expulsion of IUD: Up to ___% in the forest year
4) Lost IUD string
5) Pregnancy
6) PID: Rate is highest in the first __ weeks after insertion
1) Spotting
3) 10%
6) 6 weeks
Absolute Contraindications for Intrauterine device (IUD):
1) Active, recent or recurrent ____ _____, including GC and chlamydia
2) ________
1) pelvic infection
2) Pregnancy
Strong relative contraindications for the intrauterine device (IUD):
a) Risk of ____
b) Undiagnosed, irregular, or abnormal uterine _____
a) PID
b) bleeding
Management/ prescription guidelines for Intrauterine devices (IUD):
1) General considerations
a) Requires informed ________
b) Maybe inserted anytime during cycle;
expulsion greater during menses
c) May insert ___ to ____weeks postpartum
1) a) consent
c) 4 to 8 weeks
2) Patient education: Intrauterine devices (IUD)
a) How IUD works/ instructions for use
(check string, monitor ______, pain
control)
b) Danger signs (menses late, abdominal pain or
_______, fever, chills)
2) a) bleeding
b) dyspareunia
Flexible, dome- she’d cup constructed of latex rubber whose purpose is to prevent pregnancy by blocking the transport of sperm through the cervical os
Diaphragm/ Cervical Cap
Effectiveness of Diaphragm:
1) Typical fist year failure rate ruffly ____%
18%
The Mechanism of action of _____ includes:
1) Barrier against sperm transport
2) When used with spermicidal cream or gel, destroys the cell membrane of the sperm
diaphragm
Advantages of diaphragm include:
1) May provide _____ protection against STDs when used with spermicidal gel (e.g. those with nonoxynol-9)
2) Relatively safe and easy to use
3) Inserted before vaginal intercourse and, therefore, does not interrupt sexual activity
4) Provides ______ protection
1) some
4) immediate
Disadvantages/ undesirable effects of diaphragm:
1) Skin irritations may occur secondary to latex or spermicide
2) Possible increased risk of ___ ____ ___, vulvovaginitis
2) urinary tract infections
Contraindications/ relative risks for diaphragm:
1) ______ to rubber, latex, or spermicide
2) Inability to inset diaphragm
1) Allergy
Management/ prescriptive guidelines:
1) General considerations
a) Should check for holes tears periodically
b) Should have diaphragm refitted if ___ ___
exceeds 20 lbs.
c) Avoid ____-based lubricants (destroys the latex)
b) weight gain
c) oil
Management/ prescriptive guidelines
2) Patient education
a) Must be left in the vagina for at least ___ hours following intercourse
b) Must instill ________ in the vagina ( not removing diaphragm) for repeated intercourse
2) a) 6 hours
b) spermicide
Preparation which contains chemicals, nonoxynol-9 or octoxynol whose purpose is to destroy sperm cells, thereby preventing pregnancy
Spermicides
Effectiveness of spermicides:
Typical first-year failure rate: ____%
21%
Advantages of spermicides include:
1) Purchased over the counter (OTC)
2) Provides immediate protection against pregnancy; possibly affect the transmission of _____
3) Relatively safe
4) Enhances the effectiveness of barrier methods
2) STDs
Disadvantages/ undesirable effects of spermicides:
1) May cause vaginal or penile skin
2) Suppositories may dissolve incompletely
3) Unpleasant taste
1) irritation
Contraindication of Spermicides include?
allergy reaction
Sheath- like converting usually made of latex, which is inserted over the penis or into the begins; may or may not be impregnated with a spermicide; the purpose is to prevent pregnancy.
Condoms
Effectiveness of condom:
Typical first-year failure rate: Male ____% and female ____%
12%
21%
The advantage of condoms is?
1) Purchase OTC
2) Relatively safe
3) Provides _______ protection against pregnancy and transmission of most STDs
3) immediate
Disadvantages/ undesirable effect of condoms:
1) May produce less sensation
2) Condoms “break” or slop
3) Foreplay is interrupted
4) If natural skin condoms are used, there is no protection against _____
4) STDs
Contraindication of Condoms include:
1) Allergy to _____- or spermicide
rubber
Management/ Prescriptive Guidelines for Condoms:
1) General considerations
a) Latex provides a greater degree of protection against
STDs
2) Patinet education
a) avoid the use of oil-based lubricants
b) Lubrication will increase sensation
c) Reduce risk of condom breakage: Leave _____ inch of
empty space at end of condom
d) Effectiveness is increased if used with spermicide
2) c) 1/2
The mechanism used to either prevent fertilization or the implantation of a fertilized egg in the uterus
Emergency Contraception
Oral contraceptive called, “ the morning after pill”
a) Over the counter, without prescription for women 17 years of age and over; girls younger than 17 years need a prescription
b) Should be taken within 72 hours of unprotected intercourse
c) One should stress that this is NOT the “abortion pill”
Levonorgestrel (Plan B)
This is known as the abortion pill
Mifepristone
Intrauterine device insertion: ____ Releasing Intrauterine Device (IUD)
a) An alternative form of emergency contraception
b) Must be inserted within __ to __ days of intercourse
Copper
b) 5 to 6 days
Effectiveness of Plan B? ___%
85%
Copper releasing IUD: ____%
99%
Possible undesirable effects of Plan B
a) Nausea and vomiting
b) _______
c) Headache
d) Dizziness
e) ____ ______
f) fluid retention
g) Change in the timing or flow of the patient’s next menstrual period; may increase the length of periods
b) Fatigue
e) breast tenderness
Surgical procedure which interrupts either the fallopian tube or the vas deferens to prevent the passage of oocytes and sperm
Sterilization
Effectiveness of sterilization:
1) Failure rate
a) Females 1: ___
b) Male 1:____
a) 1:400
b) 1:600
Mechanism of action
- Female _____ ligation
- Male ________
- tubal
2. vasectomy
Advantages of Sterilization:
1) A _____ form of contraception for both male and female
2) Failure rated are ____
1) permanent
2) low
Major contraindication of Sterilization:
1) ______ regarding future childbearing
1) Indecision
Planned abstinence for sexual intercourse during that phase of the menstrual cycle when fertility is optimal, with the purpose of preventing pregnancy and enhancing the planning of family
Natural Family Planning
Effectiveness of Natural Family Planning:
Typical first-year failure rate: ____ %
20%
a) Record serial cycles, identifying longest and shorter cycles
b) Determine fertile phase by subtracting 18 days from the shortest cycle (earlier day of fertility) and 11 days from the longest cycle (latest day of fertility)
c) Abstain during this time frame
Calendar method
a) Record daily BBT prior to rising in AM over a 3 to 4 month period
b) The temperature drops 12 to 24 hours prior to ovulation; rises following ovulation due to production of progesterone
c) Avoid intercourse for 2 to 3 days prior to expected drop to approximately three days following the rise
Basal Body Temperature (BBT) Graph
a) Record changes in cervical mucus ( Spinnbarkeit ) over 3 to 4 month period
b) Notice when mucus changes from scant and thick amounts to thin, with increasing Spinnbarketi
c) Abstain from time of mucus changes until approximately 4 days after the change (mucus will resume thickness)
Cervical mucus test (Billings test)
a) The method that uses both the basal body temperature and cervical mucus techniques
Symptothermal Method
a) The patient relies on breastfeeding for natural family planning, as breastfeeding often delays the onset of ovulation and menstruation for approximately 6 months
Lactational Amenorrhea Method (Prolonged Breast-Feeding)
Disadvantages of natural family planning include:
1) ________ pregnancy
2) No protection against HIV/AIDS or STDs/ STIs
3) Some methods limit sexual activity for approximately ___% of the month
1) unintended
3) 25%
Management/ Prescriptive guidelines for natural Family Planning:
1) Patient education
a) Review back-up methods of contraception/____
protection
1) a) STD
