Quiz 2 Contraception

Question 1

Estrogen-Progestin absolute contraindications

Answer 1

35+yrs and smoking 15+cigs
<21 days postpartum
>160/100, CAD risk factors
VTE/hx, thrombophilia
long/complicated DM
ischemic heart disease, stroke, complicated valvular disease
lupus, migraine w aura, breast CA, cirrhosis, transplant, hepatocellular adenoma, malignant hepatoma

Question 2

Estrogen-progestin relative contraindications

Answer 2

35+yrs and smoking <15cigs
breastfeeding <42 days postpartum
>140/90 or well controlled on meds
symptomatic cholelithiasis, anticonvulsants
bariatric surgery, migraines w/o aura but 35yrs+, breast CA remission >5 years

Question 3

progestin-only (pill/depo/implant) contraindications

Answer 3

absolute: current breast CA
relative: bariatric surgery, ischemic heart disease, stroke hx, lupus, migraine w aura, severe cirrhosis, certain anticonvulsants, hepatocellular adenoma, malignant hepatoma

Question 4

levonorgestrel IUD absolute contraindications

Answer 4

postseptic abortion, postpartum sepsis, gestational trophoblastic disease, current breast CA, distorted uterine cavity

Question 5

levonorgestrel IUD initiation contraindications

Answer 5

cervical/endometrial CA, unexplained vaginal bleeding, PID, purulent cervicitis, gonorrhea/chlamydia, pelvic TB

Question 6

levonorgestrel IUD relative contraindications

Answer 6

ischemic heart disease, lupus, severe cirrhosis, hepatocellular adenoma, malignant hepatoma, ^STD risk, transplant

Question 7

IUD copper (paraguard) absolute contraindications

Answer 7

same as levonorgestrel except use in Breast CA, possible cervix

Question 8

IUD copper (paraguard) relative contraindications

Answer 8

severe thrombocytopenia, increased risk of STDs, transplant

Question 9

Estrogen-progestin contraceptives MOA

Answer 9

ovulation suppression, thickening of cervical mucus, endometrial changes that interfere w sperm to egg transport and implantation

Question 10

Estrogen progestin contraceptives

Answer 10

9% failure with typical use and 0.3% with perfect use at 1 yr

Question 11

Estrogen-progestin SE

Answer 11

nausea, bloating, HA, mastalgia, depression, acne, hirsutism

Question 12

Estrogen-progestin break thru bleeding

Answer 12

self limiting after 3 months, if persists change pill

Rule out pregnancy for amenorrhea

Question 13

Combined oral contraceptives

estrogen type and progestin

Answer 13

all use ethinyl estradiol 10-50ug (start with 30-35ug) w different progestin types

Question 14

combined oral contraceptives have high VTE risk when

Answer 14

50ug estrogen

3rd generation progestins (norgestimate and desogestrel) ^VTE risk but less androgenic

Question 15

COC dosing

Answer 15

21/7 regimen 21 active and 7 placebo, can take active pills continuously with 4 yearly scheduled withdrawal bleeds

Question 16

COC initiation

Answer 16

recommended: quick start
alternative: 1st day of menses or 1st sunday (25% of women will not follow thru)

Question 17

Weekly hormonal patch (ortho evra, xulane)

Answer 17

releases 20mu/day ethinyl estradiol and 150ug/day norelgestromin
produces higher serum estrogen levels=^clot risk
may cause local irritation, reduced efficacy >90kg

Question 18

Nuva ring

Answer 18

15ug/day ethinyl estradiol and 120ug/day of etonogestrel
3week or 4week cycle
50% of systemic exposure with COCs, same clot risk

Question 19

progestin only BC MOA

Answer 19

thickens cervical mucus and thins endometrial lining

Question 20

Progestin only pill (micronor) efficacy

Answer 20

0.3% failure rate w perfect use, 9% w typical use

Question 21

Progestin only pill used in women w contraindication to ____ including

Answer 21

estrogen, including breast feeding women after 6wks postpartum

Question 22

progestin only pill dosing and SE

Answer 22

1 pill same time everyday, no placebos

SE: irregular bleeding

Question 23

Progestin only injection (Medroxyprogesterone) efficacy

Answer 23

0.2% failure w perfect use, 6% w typical use

Question 24

medroxyprogesterone dosing

Answer 24

150mg IM or 104mg subQ, q3mo, hormone levels persist for 4mo (2-4wk safety margin)

Question 25

Medroxyprogesterone SE

Answer 25

irregular bleeding, weight gain (5lb/year), amenorrhea