Quiz 4 - Contraception

Question 1

Main questions to ask to determine medical eligibility criteria for contraceptions

Answer 1

-personal or family hx of clotting disorders, cancer
-migraines with aura
-HTN
-nicotine ues
-liver/gallbladder disease
-prior BC - what worked and what didn’t?

Question 2

What should you use with a diaphragm or female barrier method?

Answer 2

Spermicide gel.

Question 3

When placing an IUD, ask about _____

Answer 3

Last pap - if they’re due, then you can get it at the same time!

Question 4

For patients with LNG IUD, implant, injectable and CHC use, they should use a back up method of BC or abstain for ______ if the BC method is started ____ after their period started

Answer 4

7 days
5-7days

Question 5

For P.O.P, you should use back up method for __ days if started ____ after the start of menses.

Answer 5

2 days (48hrs)
5 days

Question 6

What should you measure before prescribing CHCs?

Answer 6

BP

Question 7

Which BC is best for PMDD, PCOS and bloating?

Answer 7

4th gen Drosperinone (w/spironolactone)

Question 8

What is special about the 1st generation Progestins?

Answer 8

Less potent (more possibility of unscheduled bleeding)
Norethindrone, medroxyprogesterone.

Question 9

Norethindrone and medroxyprogesterone are ____ generation progestins

Answer 9

1st.

Question 10

Levonorgestrel and norgestrel are ____ generation progestins

Answer 10

2nd

Question 11

What is special about 2nd generation progestins.

Answer 11

More potent with longer half life
Potential for INCREASED androgenic activity

Levonorgestrel, norgestrel

Question 12

Desogestrel, norgestimate, gestodene, etonorgestrel are _____ generation progestins

Answer 12

3rd gen

Question 13

What is special about 3rd gen progestins?

Answer 13

Less androgenic activity
Slightly higher risk for thrombosis

Desongestrel, norgestimate, gestodene, etonorgestrel

Question 14

Drospirenone and dienogest are ____ generation progestins

Answer 14

4th gen

Question 15

What’s special about 4th gen progestins?

Answer 15

Compounded th spironolactone
Great for PMDD and PCOS and bloating.

Drosperenone, dienogest.

Question 16

Progestin does these 3 things:

Answer 16

Thickens cervical mucus
Stops ovulation
Thins the uterine lining

Question 17

EE (ethinyl estrodiol) does these 3 things:

Answer 17

Inhibit ovulation
Stabilizes uterine lining
Increase sex hormone binding globulin to decrease androgenic activity.

Question 18

Why should we be wary prescribing EE post partum?

Answer 18

It could limit breast milk production

Question 19

What are the warning signs of CHC/EE?

Answer 19

ACHES
Abd px
Chest px
Headache
Eye px
Severe leg pain/swelling (or one-Sided symptoms)

Question 20

What are the 6 ways to be reasonably certain a woman is not pregnant?

Answer 20

-Less than or at day 7 from start of last menses
-No sexual intercourse since the start of last period
-Correctly and consistently using a method of BC
-less than or at 7 days from spontaneous or induced abortion
-4weeks PP (wary of increased VTE risk)
-Fully (>85%) breastfeeding, amenorrheic and <6mo PP.

7,7, no sex, BC, 4, BF

Question 21

What is 7, 7, no sex, BC, 4 and BF?

Answer 21

Ways to be reasonably certain a woman is not pregnant.

Question 22

What is the low dose range of EE?

Answer 22

10-35mcg

Question 23

Which women do better at the higher end of LOW DOSE range of EE?

Answer 23

Women with heavier flow and obese women.

Question 24

What are some side effects from too much progestin?
Too little?

Answer 24

Too much: increased appetite, wt gain, fatigue, mood changes
Too little: late breakthrough bleeding, amenorrhea

Question 25

what are some SEs of too much EE? Too little?

Answer 25

Too much: nausea, bloating, HTN , breast tenderness, edema
Too little: early/mid-cycle breakthrough bleeding, increased spotting.

Question 26

Why would a side effect of amenorrhea (with too little progestin) be concerning to the patient?

Answer 26

They might be always worried that they are pregnant.

Question 27

T/F: for continuous use, the Annovera ring can be kept in for the whole year.

Answer 27

False. The Annovera is approved for 13 cycles (3wks in and 1 wk out). If you leave it in continuously, then it’s only good for 39 consecutive weeks.

Question 28

What conditions could Depo be good for?

Answer 28

Endometriosis, fibroids, and heavy cycles - suppresses that estrogen!

Question 29

Patient teaching with Depo

Answer 29

-long term use can decrease bone mineral density. Use vit D and Ca and weight bearing exercise .

Question 30

What is the administration window for Depo?

Answer 30

11-13 weeks.

Question 31

If a patient comes in at 15weeks for Depo shot, you can give it to them.

Answer 31

True HOWEVER, you must first discuss last intercourse, and do a pregnancy test. If no intercourse and pregnancy test negative, you may administer, however have the patient return in 2 weeks for a repeat pregnancy test to make sure that an early pregnancy wasn’t missed with the first test.

Question 32

T/F; fertility returns immediately after Depo use.

Answer 32

False. There may be a 4-18mo delay in return of fertility after last injection.

Question 33

If ulipristal acetate (UPA) is used as EC, then you should wait _______ to start any other hormonal contraceptions. Why?

Answer 33

At least 5 days
Because UPA will interfere with the effectiveness of the other contraceptive.