Q6 - Menstruation, Menopause, Contraception And Pregnancy Flashcards
Monophonic COC (same dose of progestin and estrogen in active pills)
-June FE, Microgesting Fe, Sprintec, Loestrin, Yasmin
LOW estrogen.
Biphasic COCs – same dose of estrogen, progestin dose decreased ½ way
Extended cycle formulations (Seasonique) <- why would someone want an extended cycle formulation?
Decrease the amount of bleeding they have throughout the year.
What is different about Amethyst?
Continuous COC - no placebo pills so no periods. Menstrual related anemia and menstrual migraines.
Only approved continuous COC, however others are used off label this way as well.
Starting COCs?
“Quick start” - use back up protection for 7 days with COC, but with protestin only pills, quick start only requires back up protection for first 48hours.
Sunday start
First day of Menses
Missed dose of COC?
1 pill is late or missed - take as soon as you remember. No back up needed
48hrs of missed pills? Take one as soon as you remember, and discard the other one. Skip placebo week. Back up for 7 days.
Progestin only pill Late pill (>3hrs)? - take as soon as you remember and back up protection for 48hrs.
SEs tend to decrease _____ after starting OCPs.
3months
Xulane, Zafemy, Twirla
Contraceptive patches
Contraceptive patches have ______ estrogen exposure than COCs. What does this mean?
Higher.
CI are more strict - higher risk of clotting
What could happen with obese patients on contraceptive patches?
Decreased contraception effectiveness in Those who weigh >198lbs
postpartum women should NOT be given a ________ - why?
Patch. Higher concentration of estrogen, so higher blood clotting risk.
NuvaRing and Annovera.
SE?
Vaginal ring. Same SE profile as COCs.
Annovera is reusable - 1 ring for the whole year.
Most effective forms of reversible contraception?
IUDs
IUD AEs?
Uterine perforation, PID, embedment, IUD breakage.
Nexplanon - 3 year implantable progestin only.
1st line for menstrual cramps?
CI?
NSAIDS - started 1-2 days prior to onset of menses or at the start. Decrease prostaglandin synthesis.
Renal impairment
1st line for Dysmenorrhea
NSAIDS – start 1-2 days prior to your period. CI in renal impairment.
1st line for amenorrhea
AFTER identifying cause – nutrition, hormonal, endocrine disorder)
Transdermal estrogen patch + cyclic (long term) oral progestins.
Tx of heavy menstruation
AFTER ruling out other causes)
NSAIDS, CHCs, Progestins, Iron supp (WITH stool softener)
TXA
TXA MOA? AEs?
Prevent fibrin degradation to reduce bleeding. AEs? Abd px, HA, back px, MSK px and sinus symptoms.
Menopause is a decrease in __________ which causes ____ to increase, leading to __________ symptoms
Estrogen/progestin, FSH, vasomotor
Expected results of estrogen to treat menopause?
Estrogen Decreases LH and helps with maintaining temp control and bone mineral density
SE and CI for Estrogen replacement therapy
SE – dementia, clots, breast cancer, ovarian cancer, increase HDL, TG, decreases LDL
CI – hx breast ca, active VTE, coagulopatheis, hepatic impairment or pregnancy.
Progestin replacement therapy in menopause
MOA: suppresses release of FSH and LH. SE – mood disorders and spotting.
Would topical estrogen formulation be helpful for someone experiencing mental fogginess, HA, night sweats and vaginal dryness?
No
HRT comes in 4 different options:
Topical estrogen only
Systemic estrogen only
Systemic combination (estrogen and progestin)
Systemic progestin only.
T/F: HRT patch must be removed prior to MRI?
True
Approved Non-hormonal method for VMS in menopause tx? MOA? BBW? SE?
Paroxetine (Brisdelle)
MOA: SSRI regulate body temp
BBW: suicide
SE: sedation, insomnia, restlessness, tremor, weakness, dry mouth, constipation, diaphroesis. 4 weeks to take effect
Treatment for Dyspareunia? MOA? SE? What line?
Ospemifene – oral estrogen agonist/antagonist – short term use only. Hot flashes, vaginal discharge, hyper hidrosis.
Only for severe not treated with vaginal estrogen gel
Intrarosa – clinical considerations?
Used to treat dyspareunia. Can take 12 weeks to see results. Moderate to severe vaginal dryness and dyspareunia. Administer 1 vaginal insert at bedtime QD.
Teratogens:
Acne: Isotretinoin, topical retinoids
Antibiotics: quinolones, tetracyclines
Anticoagulants: warfarin
Dyslipidemia, HF and HT: statins, RAAS inhibitors (ACE inhibitors, ARBs, aliskiren, sacubitril/valsartan)
Hormones: estradiol, progesterone, raloxifene, testosterone
Migraine: dihydroergotamine
Others: hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, valproic acid/divalproex
Meds for heartburn in pregnancy?
Tums, simethicone.
Tx Constipation in pregnancy?
Metamucil with LOTS of fluids
Docusate.
Cough/cold/allergies in pregnancy
Cromolyn, Benadryll, loratadide, cetirizine, fluticasone. Avoid products with alcohol.
Phenelyphrine and Sudafed are NOT to be used in 1st trimester because they can cause constriction of blood vessels to the fetus.
Pain in pregnancy
Tylenol - no more than 3.5G/day (less than normal 4G)
NO NSAIDS/opioids (xcept for aspirin in preeclampsia prevention)
Infection in pregnancy
PCN, cefalosporins, erythromycin, Azithromycin, topicals.
NOT SAFE: FQ, tetracyclines, doxy
UTI in pregnancy
Cephalexin, ampicillin (w/Clav).
Nitrofurantoin/bactrim reserved for last line - can cause hemolytic anemia/increased chance of jaundice.
T/F: all bacteriuria in pregnancy must be treated
True. Whether symptomatic or not.
Macrobid and bactrim in pregnancy
Last line. - not for first trimester or >36wks.
T/F: ibuprofen and Tylenol safe while breastfeeding
True.
