pre-IC16 & IC16 Flashcards
How does progestin and estrogen prevent ovulation?
Progestin block LH surge + estrogen suppress FSH release
Which substance provide most contraceptive effect?
Progestin
Which substance stabilize the endometrial lining and provide cycle control?
Estrogen
Will there be period for progestin only contraceptive?
No
Most commonly used estrogen
Ethinyl estradiol
Androgenic SE examples
Acne, oily skin, hirsutism
Usually, lower or higher estrogen dose is used?
Lower
Factors favoring higher doses of EE (30-35 mcg)
- Obesity or weight > 70.5 kg
- Early to mid cycle breakthrough bleeding/spotting
- Tendency to be non-adherent
Which is the ONLY progestin agent that does not have androgenic effects?
Drospirenone
Adverse effects of Drospirenone
hyperkalemia, thromboembolism and bone loss
Monophasic vs multiphasic COC
Mono: Same amounts of estrogen & progestin in every pill
Multi: Variable amounts of estrogen and progestin
Benefit of monophasic COC
Less confusing, less complicated miss-dosed instructions
Benefit of multiphasic COC
Tend to have lower progestin overall -> lesser side effects
Regimen for Conventional cycle COC
21 days active pill + 7 day placebo = 28 days
Which COC leads to lesser periods?
Extended-cycle / continuous COC
Regimen for Extended-cycle / continuous COC
84 days followed by 7 days placebo (no placebo at all for continuous)
Which method does not need backup contraceptive?
First Day Method
When to avoid/stop COC to prevent breast cancer?
Avoid: Age > 40; Family history/ risk factors of breast CA
Stop: Current/ recent PMH of breast CA (within 5 years)
Which substances could contribute to venous thromboembolism?
Estrogens & New generation progestins (esp Drosperinone, Cyproterone & Desogestrel)
Alternative contraceptive methods to avoid VTE
- Low dose estrogen with older progestins
- Progestin-only contraceptive
- Barrier methods
What to do if one COC pill is missed < 48h?
- Take the missed dose immediately and continue the rest as usual
- This may mean 2 pills on the same day
What to do if two or more consecutive COC dose missed (more than 48 hours)?
- Take the missed dose immediate and discard the rest of the missed doses
- Continue the rest as usual (may have 2 pills on the same day)
- Backup contraceptive required for at least 1 week
What to do If the COC pills were missed during last week of hormonal tablets (e.g. day 15-21)
- Finish remaining active pills
- SKIP hormone-free interval and start a new pack the next day
- Backup contraceptive for at least 1 wk
Contraindication with progestin only pill
current/ recent history of breast cancer
What to do If late POP dose by > 3 hours?
back up for 2 days
How to use transdermal contraceptives?
Applied once weekly for 3 weeks followed by 1 patch-free week
How long is vaginal ring used?
Used for 3 weeks then discarded
Transdermal patch/ vaginal ring has the highest risk of ____ compared to other methods
VTE
Regimen for progestin injections
IM injection every 12 weeks
SE for progestin injection
- Variable breakthrough bleeding esp the first 9 months
- Weight gain
- Short term bone loss
Limit use of progestin injection to no more than ____
2 years
Which IUD results in Heavier menses/bleeding ?
Copper IUD (compared to levonorgestrel)
MOA of IUDs
inhibition of sperm migration, damage ovum, disrupt transport of fertilized ovum.
If with progestin -> endometrial suppression, thicken mucus
3 categories of Long acting reversible contraception (LARC)
- Hormone releasing implant (Subdermal Progestin Implants)
- Levonorgestrel IUD (hormone releasing)
- Copper IUD
Proteinuria: 24h-urinary protein (UTP)
≥ 300 mg
Proteinuria: Dipstick protein
≥ 2+
Proteinuria: Urine protein: creatinine ratio (uPCR)
> 0.3 mg/dL
Signs of end- organ damage
- Platelet count < 100
- Neurological complications
- LFTs > 2X ULN
- Doubling of SCr in absence of other renal disease
- Pulmonary edema
Treatment for HTN in pregnancy
Nifedipine ER/ labetalol
Prevention of preeclampsia
Low dose aspirin (100mg or more daily)
Who should take aspirin for prevention of preeclampsia? and When??
HTN on previous pregnancy, multifetal gestation, autoimmune diseases, DM, CKD, etc
To be started after 12 weeks, ideally before 16 weeks, and continued till delivery
When does headache (For COC) usually occur?
During pill-free interval