Pharm - Contraceptives Flashcards
barrier method
provides mechanical/chemical barrier that prevents sperm from entering cervical cancer
hormonal method
inhibits ovulation, alters endometrium which decreases likelihood of implantation, and increases the thickness of cervical mucus to inhibit movement of sperm into cervical canal
intrauterine method
prevents fertilization by immobilizing sperm and interfering with their transport, and speeds movement of ovum through fallopian tubes
sterilization method
surgically blocking fallopian tubes to prevent conception or vas deferens to prevent passage of sperm into ejaculate
fertility awareness method
predicts most fertile time during menstrual cycle through recognition of signs and symptoms during cycle associated with ovulation
Given a woman seeking contraceptive method, identify the factors that affect her contraceptive choice and use that information to select the most appropriate method for her
a. Typical use/perfect use
b. Inherent efficacy
c. User technique
d. Age and fertility
e. Motivation
f. Frequency of sexual intercourse
g. Cost
h. Risk of STDs
i. How product works, non-contraceptive benefits, reversibility of methods
advantages of estrogen-progestin hormonal contraceptives
high efficacy, technique doesn’t affect efficacy, effective at every age group, not linked to intercourse, does not affect fertility, easily reversible, decreased dysmenorrhea, decreased menstrual blood loss, increased iron stores, decreased risk of osteoporosis
disadvantages of estrogen-progestin hormonal contraceptives
do not protect against transmission of STDs, not for <3 weeks post-partum, increased risk of blood clots (risk: ≥35y/o, previous clot, immobile, thrombophilia, transfusion at delivery, BMI≥30, postpartum hemorrhage, C-section, preeclampsia, smoker, thrombophilia), ongoing expense, increased risk of cervical cancer (esp. if positive HPV test)
advantages of progestin only contraceptives
high efficacy, technique doesn’t affect efficacy (except for with mini-pill), used across age groups, not linked to intercourse, IUDs used 6-8 weeks postpartum, Implanon 4 weeks later, injectables/pills after 6 weeks, can be used when breastfeeding, Depot/IUD preferred in those taking anti-epileptics
disadvantages of progestin only contraceptives
fertility takes 9-18 months to return with Depo→6-8 months to clear from body, do not protect against transmission of STDs, weight gain**, irregular periods/amenorrhea, breast tenderness, depression, headache, nervousness, tiredness, increased risk of ovarian cyst/ectopic pregnancy, reduction in bone density
advantages of barrier method
can be used in any age group, no effect on fertility, offer best protection against STDs, can be used as soon as medically permissible, can be used in breastfeeding, relatively ineffective, most are available OTC
- diaphragm: protects against STDs and PID
- condoms: protexts against bacterial and viral STDs, HSV, HIV, hepatitis, reduce infections transmitted by fluids from mucosal surfaces
disadvantages to barrier method
less efficacy that hormonal products, user technique affects efficacy, intercourse dependent (good is less frequent intercourse), possible toxic shock syndrome, irritation from spermicide, allergic reaction to rubber/spermicide
advantages to spermicides
STD protection, contraceptive protection immediate, effective for 1-8 hours, high safety low toxicity profile, can be purchased OTC, doesn’t require partner participation, can be used for immediate/back up method, can increase effectiveness of condoms/IUD/fertility awareness, can provide lubrication
disadvantages to spermicides
skin irritation (may increase risk of acquiring STD), temporary irritation of vulva/penis, allergy, increased incidence of yeast vaginitis
advantages to IUD
can be left in place for 12 years, can use in nulliparous, breastfeeding, immunocompromised, heart valve abnormalities, diabetes, hx of breast cancer. Venous thrombosis and C-section, rapid return to fertility
disadvantages to IUD
not well understood, spotting/bleeding/anemia, cramping, expulsion of IUD, pregnancy, uterine perforation, PID, no STD protection
advantages to emergency contraception (postcoital options)
in case of unprotected intercourse→reduces risk of pregnancy to 1-2% when used within 72-120 hours of intercourse, available OTC, rapid return to fertility, any age group, can be taken anytime during menstrual cycle
disadvantages to emergency contraception (postcoital options)
not for normal contraceptive use, not indicated for terminating existing pregnancy
contraindications to estrogen progestin hormonal contraceptives
i. History of CV disease: clotting disorders, complicated heart valve disease, stroke, ischemic heart disease, multiple risk factors for CV disease, HTN (>160/>100)
ii. Age ≥35 y/o and smoker ≥15 cigarettes/day **
iii. Known/suspected breast cancer or benign/malignant liver tumor
iv. Liver disease: active viral hepatitis/severe cirrhosis
v. Diabetes >20 years or evidence of micro/macrovascular disease
vi. Migraine with aura (any age) or Migraine without aura ≥35 y/o
vii. Major surgery with immobilization
viii. Pregnancy/lactation
contraindications to progestin only contraceptives
i. Pregnancy
ii. Undiagnosed vaginal bleeding
iii. Known/suspected breast cancer
iv. Hepatic tumor/active liver disease
contraindications to barrier methods
i. History of toxic shock syndrome
ii. Allergy to spermicide, rubber, latex or polyurethane, inability to learn correct insertion technique, abnormalities of vagina that would lead to unsatisfactory fit/placement, repeated UTI from diaphragm, full-term deliver in last 6 weeks/spontaneous or induced abortion/vaginal bleeding for any reason
contraindications to emergency contraceptives
suspected pregnancy
non-contraceptive benefits of estrogen-progestin
i. Relief of cyclical problems: decreased dysmenorrhea/menstrual blood loss, increased iron stores
ii. Decreased risk of osteoporosis
iii. Protects again ovarian/endometrial cancer
iv. Reduces incidence of functional ovarian cysts
non-contraceptive benefits of progestin only
i. No estrogen
ii. Decreases menses→decreased iron loss→decreased anemia
iii. Decreases dysmenorrhea
iv. Decreases risk of developing endometrial/ovarian cancer and PID
non-contraceptive benefits of barrier methods
i. Protection against STDs
ii. Reduced risk of PID
iii. Lower risk of cervical dysplasia/cancer
iv. Doesn’t cause systemic side effects nor alter endogenous hormone levels
v. Post-partum contraception to decrease risk puerperal infection (male condom)
non-contraceptive benefits of IUD
i. Can be used when breastfeeding
ii. Method of choice if they have: diabetes/vascular disease, current/past breast cancer, personal hx of DVT/PE, migraine with/without aura, HTN (≥160/≥100), stroke, SLE
drug interactions of estrogen-progestin
i. If taking antibiotics/rifampin they need back-up
ii. If taking anticonvulsants: avoid because can cause break-through bleeding
drug interactions of progestin only
antifungals, anticonvulsants, rifampin, St. John’s Wort
ADRs of estrogen-progestin
increased blood pressure, increase blood sugar, increase LDL cholesterol, cause gallbladder attacks, CV disease, headaches, thrombotic risk
mnemonic to remember the ADRs for estrogen-progestin
A: Abdominal pain (Gallbladder)
C: Chest pain (severe), couch, shortness of breath (MI)
H: Headache (severe), dizziness, weakness, numbness (Migraine)
E: Eye problems (vision loss/blurring), speech problems (Stroke)
S: Severe leg pain (calf/thigh) (Clot)
ADRs of progestin only
weight gain**, irregular periods/amenorrhea, breast tenderness, headache, depression, nervousness, tiredness, abdominal pain (increased risk of ovarian cyst/ectopic pregnancy)
ADRs of minera IUD specifically
cramping/pain, expulsion of IUD (~7%/year), pregnancy, uterine perforation, PID
ADRs of barrier methods
toxic shock syndrome, recurrent UTIs, allergic reaction, irritation, foul-smelling vaginal discharge from prolonged wear, pelvic discomfort, cramps, pressure on bladder/rectum, vaginal trauma/ulceration from excessive rim pressure/prolonged wear
ADRs of spermicides
skin irritation (can increase risk of acquiring STD), temporary irritation of vulva/penis (vaginal with prolonged/frequent exposure), allergy, increased risk of yeast vaginitis
ADRs of IUDs
spotting, bleeding, hemorrhage, anemia, cramping/pain, expulsion of IUD, pregnancy, uterine perforation, PID
ADRs of ella (emergency contraceptive)
headache, nausea, abdominal/upper abdominal pain, dysmenorrhea, fatigue, dizziness
ADRs of paragard (emergency contraceptive)
N/V
Plan B one step
available OTC, indicated in those ≥15y/o, needs to be taken within 72 hours of unprotected intercourse
Ella
delays ovulation for 5 days, needs to be taken within 120 hours of unprotected intercourse (repeat dose if vomiting happens within 3 hours of taking it), can be taken anytime during menstrua cycle
ParaGard
can be inserted up to 5 days after unprotected intercourse, no evidence of teratogenesis secondary to using it if pregnancy occurs, should start/resume regular contraception right away
Estrogen progestin hormonal contraceptive categories
- monophasics
- biphasics
- triphasics
- four phase
- extended cycle
- shortened hormone free interval
- patch
- ring
monophasics
ortho novum 1/35
biphasics
ortho novum 10/11
triphasics
ortho-tri-cyclen trivora
four phase
natazia
extended cycle
- jolessa
- seasonique
- quartette
shortened hormone free interval
loestrin 24 FE Yaz
patch
Xulane
ring
nuvaring
progestin only products
i. Intramuscular: DepoProvera
ii. Subcutaneous: Depo-subQ Provera 104
iii. Oral: Minipill (Ortho-Micronor)
iv. Implanted: Nexplanon
v. Intrauterine: Mirena and Kyleena
review chart on barrier methods
spermicide products
i. Film, suppositories, tablets: insert 15 minutes before intercourse and allow dissolution, remain effective for no more than 1 hour
ii. Foam, jelly, cream: immediately effective, last for at least 1 hour when used alone
- If used with diaphragm/cap: remains effective for 6-8 hours
Paragard IUD
i. Contains copper: probably interferes with sperm migration, increased ovum’s speed of transport through fallopian tubes, inhibits fertilization, interferes with implantation, produces atrophic endometrium when progesterone chronically released
ii. Can be in place for up to 12 years
emergency contraception products
i. Plan B One Step, Take Action, EContra EZ (contain levonorgestrel 1.5mg)
ii. Ella (Ulipristal)
iii. ParaGard T-380A IUD
