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
