Quiz 5: Contraceptives Flashcards

Question

First-day Start

Answer 1

**day 1 mens, not preg, no bu, delay-errors** * first pill on first day of next period * insures not preg * back up not needed * delay between visit and initiation - inc chance not start correctly

Answer 2

**bu 1-sun(mon=7), no preg, wkends!, delay, refills** * first pill first sunday of mens * back up req for 7 days if mens starts on monday * insures not preg * period free weekends * delay between visit and start * may be harder to get refills on weekends

Answer 3

Caution of thrombosis in obese women over 35y

Answer 4

**35\>15/40!!!, 35-40!, 20/↑met/tit/bu2-3**_mos_**** * Don't: * \>35y and \>15 cig/day * \>40y and any smoking * Caution against use 35-40y w/ reg smoking * Start with 20mcg EE to minimize Estrogen dose * smoking inc EE met, may need inc dose for efficacy * back up for 2-3mos

Answer 5

**_preg=↗coag_ + EE ⇒ 3-4wk pp** * preg = hypercoagulable state * Est inc risk of thromboembolism * delay COC 3-4wks postpartum

Answer 6

**EE→milk=adversely, !solo nut** * est may adversely effect breaskmilk * Am Academy Ped's advises against COC if breastmilk is sole source of nutrition

Answer 7

**fp hep/gi conj →gb→si→li flora unconj→blood, theory/no proof** * sex steroids abs in si and shunted to liver * 60% EE conj in intestinal mucosa and liver * excreted through gb to si * li bacteria un-conj est metabolites * free to be abs to blood * despite theoretical risk, bsa's not shown to dec COC efficacy

Answer 8

**v\<2h, n/v 2+d** * vomit \<2h after taking * severe v/d 2 or more days

Answer 9

* after 7 pills correctly, little risk of ovulation until 7 consecutive pills missed

Answer 10

1. missing pills early in packet 2. lower dose (20mcg EE) pills used

Answer 11

* 1-2 pills * take active pill ASAP, continue daily pills including today * consider EC if 1st week and unprotected intercourse * 3 or more pills, wks 1-2 * as above, plus back up/abs until 7 consecutive active pills * 3 or more pills, wk 3 * finish active pills in current pack * start new pack * skip placebo

Answer 12

* 1 pill * take active pill ASAP, continue daily pills including today * no back up * consider EC if 1st week and unprotected intercourse * 2 or more pills, wks 1-2 * as above, plus back/abs up until 7 consecutive active * 2 or more pills, wk 3 * finish active pills in current pack * start new pack * skip placebo

Answer 13

* unprotected sex in last 5 days * EC at once * 1 COC pill twice next day, continue pack * condoms for 7 days of renewed COC use * not in last 5 days * 2 COC's ASAP, continue pack * condoms for 7 days of renewed COC use

Answer 14

* 30-50% in first few months * 70-90% none by 3rd pack * management of bleeding... * before completing active pills * endometrial support - inc prog content * continued after withdrawal bleed * more E or less P * mid-cycle - etiology unk * try tri-phasic, inc E+P in middle pills

Answer 15

* insufficient data to determine effects * no large effect evident

Answer 16

## Footnote **new/↑: eval RFs, usually\<3mo :no proof △ pills**

Answer 17

* 7/4 placebo pills/cycle (4 shorter period) * EE + drosperinone (steroidal prog of spirolactone group) * antimineralocorticoid activity * mild diuretic = less water wt gain * dec bloating if caused by h2o ret, not nec cause * inc risk hyper K with (snak) * **S**pironolactone/eplerenone * chronic **N**SAID * **A**CE/ARB * **K** supp/salt subs

Answer 18

* = levonorgestrel + EE, #84 + #7 pills * Seasonale - 30+placebos * 1st COC for extened cycles (q3mo) * ↑spotting v #28 * Seasonique - 30+10 * LoSeasonique - 20+10 * 10s v placebo marketed: ↓spotting, shorter/lighter period

Answer 19

**levo+20, 1st contin/atro-endo, 41% spot\>6m** * levonorgestrel + 20mcg EE * 1st COC continuous use - no menses * atrophic endometrium - no need to slough * still many report spotting/bleeding * mfg reports 59% stopped bleeding after 6mo * 41% bleed beyond 6mo

Answer 20

**120eto+15 qd, ~PO-fp, 21/7** * soft, transparent, flexible copolymer ring, 2" dia * releases 120mcg etonorgestrel + 15mcg EE daily * abs rate sim to PO, no first pass effect * 21 day vag insert, discard and place new one 7 days later * expect menses during 7 days

Answer 21

**same** * 0.3% perfect use, 8% typical - both same as COC * AE's = COC

Answer 22

**ease, no spike/↓bl abn, fast+/- next cycle** * easy to use * slow, steady release of hormones (v. daily spike w/pills) * low levels of bleeding abnormalities * rapidly effective/reversible - most ovulate next cycle after stopping

Answer 23

**=coc risk, fall out, foreign body** * same risk as coc for mi, stroke, vte * ring expulsion "fall out" * "foreign body" sensation

Answer 24

**\<3 re, \>3 bu7 re/EC12 or new3** * \<3h - rinse lukewarm h2o, reinsert * \>3h wk 1 or 2 * rinse/reinsert * back up for 7d * EC if unprotected sex * \>3h wk 3 * discard, insert new ring * back up for 7d

Answer 25

**day 1 alone, 1-5/visit bu7** 1. insert 1st day of bleeding, no additional contraception 2. insert day 1-5 of bleeding, back up 7d (not diaphragm) * this is from package insert, very conservative, would probably be ok 3. insert day of office visit, back up 7d

Answer 26

**patch, 150 norelgestromin + 20 qd** * transdermal patch - thin, 3 layer, flexible, 20cm² * releases 150mcg norelgestromin and 20mcg EE daily

Answer 27

**same** * 0.3% perfect use, 8% typical - both same as COC * AE's = COC

Answer 28

**risk=coc, ↑60/Black Box, skin, Br sx** * same risk mi, stroke, vte as coc * 60% higher systemic hormone levels v. coc (no 1st pass) * Black Box Warning - poss inc vte risk, not conclusive * skin rxns * irritation, redness, rash - 3% d/c * rotate sites, do not apply over irritated/broken skin * breast sx * discomfort, engorgement, pain in cycles 1+2 * more common w/patch v. coc

Answer 29

**day 1, sun bu7** 1. apply 1st day of bleeding 2. apply 1st sunday, back up 7d

Answer 30

**re \< 24h \< new/bu7/EC** * \<24h * try to re-adhere with pressure, not adhesive or wrap * if no seal, replace * \>24h * start new patch cycle immediately -- new change date * back up 7d * offer EC if had unprotected sex

Answer 31

* prog=norethindrone * "minipills" * Nor-QD, Micronor, Ovrette * prog dose

active pill same time every day - mission critical d/t lower dose

Answer 32

**same, ↓dose→timing!** * 0.3% perfect use, 8% typical * d/t lower prog dose = **_shorter duration of action_** * late pill can compromise efficacy

Answer 33

1. **ovulation** inhibited in variable proportion of cycles 2. cervical **mucus** thickened, may prevent sperm penetration 3. reduced ovum **transport** through fallopian tube 4. altered endometrium, may inhibit **implantation**

Answer 34

* Safety - no EE, lower prog (no comparative data) * few contraindications * simple, fixed daily regimen - same pill every day * immediate reversibility

Answer 35

**bleeding △'s, timing/efficacy** * menstrual cycle disturbances * bleeding changes in **many/most** users * **short cycles, irregular periods, spotting most common** * vulnerable efficacy * must be taken **same time each day**

Answer 36

* known/suspected **preg** * known/suspected **BrCa** * undiagnosed abnormal vaginal **bleeding** * **hypersensitivity** to any component * benign or malignant **liver tumors** * acute **liver dz**

Answer 37

**no bu - 1-5d, 6-6pp, 21pp, next day _: bu2_** * may be started immediately w/o back up if: 1. during 1st 5 days of cycle 2. 6wk-6mo pp if fully breastfeeding and amenhrrheic 3. w/i 21d pp (not br.feed) 4. day after stopping another hormonal method * under any other circumstances must use back up 2 days

Answer 38

**no off days, 3h late - imm+bu48** * start next pack day after last pack is finished * no days off * 3hr late taking pill - * take immediately * back up 48h

Answer 39

* Depot medroxyprogesterone acetate (DMPA-IM) * 150mg deep IM injection * q3m

Answer 40

**0.3 - 3**% * 0.3% perfect use, 3% typical

Answer 41

**d/c delay - 10/50, q3m, BB min/WHO** * cannot d/c immediately * 10mos for 50% conception rate * 20mos to approach 100% * q3m return visits required * Black Box Warning - * Depo-Provera may cause sig loss in bone mineral density * increases with duration * may not be completely reversible * should only be used long term (2y) if no other adequate * WHO studies show it is reversible

Answer 42

**68mg eto, match SQ, 3y, _most eff hormonal_** * single matchstick sized soft medical polymer rod * contains 68mg etonorgestrel * inserted just under skin in arm * provides effective contraception for 3y * most effective hormonal method

Answer 43

**0.05/0.05% - _most effective hormonal method_**

Answer 44

**same + ease, discrete, rev 6w/2cy** * same as other prog only methods * ease of use - no regular user activity * discreet * reversibility - upon removal, ovulation for most returns within 6 wks, 2 cycles

Answer 45

**=POP, insertion issues, 1-5d : bu7** * same as other prog only methods * insertion complications * swelling, redness, bruising, pain (3.6%) * incorrect technique * clinician dependent - must be inserted by skilled, trained practitioner * immediately effective if inserted in 1st 5 days of bleeding * otherwise backup 7 days

Answer 46

* ParaGard - polyethylene with barium for X-ray visibility, wound with fine Cu wire * Mirena/Skyla/Liletta - levonorgestrel intrauterine systems

Answer 47

**ParaGard 0.6/0.8%** **Mirena 0.2/0.2%**

Answer 48

**prevent fert....** * ParaGard - imair sperm fx - **Cu spermicidal?** * Mirena * thickening cervical **mucus** * inhibit sperm **survival** * suppress **endometrium** * suppress **ovulation** in some women

Answer 49

**eff, ect, dur, $$** * highly effective * protect against ectopic preg * long-lasting * cost-effective

Answer 50

**irr mens early, insertion/pain/cramp/perf/null, expulsion2-10/null, strings** * menstrual disturbances - irregular bleeding common in early months * insertion cramping and pain * spontaneous expulsion - 2-10% in 1st year * perforation at insertion * string problems - missing strings may signal perforation or expulsion * w/o hx pregnancy * more difficult insertion * more risk expulsion

Answer 51

## Footnote **nonoxynol-9, surf/cm, solo/barrier**

Answer 52

* gels, creams, foams * useful immediately * with barrier, foam alone because if filles vaginal vault * suppositories, tablets - "inserts" --names can lead to errors * 10-15min to dissolve/disperse * film - inserted near cervix 15 min before intercourse

Answer 53

## Footnote **18/29%**

Answer 54

**OTC, imm eff, lube, no sys sfx** * no rx * effective immediately (some) * lubricating * no systemic sfx

Answer 55

**timing(15m/1-3h), irritation, messy, ↑lube** * timing intercourse * may be too early with suppositories, tablets and film * too late 1-3h * vaginal/penal irritation * messy * excessive lubrication

Answer 56

**6-8 \> 24/48, "jelly"** * dome-shaped latex cup inserted before intercourse * covers cervix * typically used with spermicide "jelly" (name issue) * timing concerns: * leave in place 6-8h after intercourse * no longer than * 24h diaphragm * 48h cervical cap

Answer 57

* diaphragm **6/16%** * cervical cap * null **10/16%** * parous **26/36%**

Answer 58

* latex - natural rubber * synthetic - polyurethane, polyisoprene * natural - lamb cecum - larger pores inc vuln to STI

Answer 59

## Footnote **polyurethane \> latex**

Answer 60

## Footnote **2/18%**

Answer 61

* Size - no standard * Thickness - no standard * Spermicide - not recommended d/t * no increased protection * increased irritation - poss inc vuln STI * Novelty Ingredients - some warn "not shown to decrease STI or pregnancy"

Answer 62

**STI, access, $$, port, no sys, ↘prej** * STI protection - **_best point_** * accessibility * $$ * portability * no sys sfx * may ↘prej

Answer 63

**↘sens↘spont, allergies**

Answer 64

* advantages * latex-free * protects outside vagina * can be inserted 8h before intercourse * disadvantages * dislike ring outside vagina * cumbersome * expensive v. male condoms

Answer 65

**post fluid exchange, preg 8↘0.5-2%** * contraception implemented after unprotected intercourse * efficacy: drops pregnancy rate following unprotected intercourse from 8% to 0.5-2% if utilized appropriately

Answer 66

**Yuzpe since '74, coc(50EE/250lev), 2 now, 2 @12h** **N/V d/t EE, Br tend, Irr bleed, HA**

Answer 67

**ovulytic/↓sperm tx, 72h, fat/nau/ha/↑bleed/low abd pain** * MOA: prevent ovulation (primary) and impair sperm transport * not abortifacient * Time window: up to 72h after unprotected intercourse * ADRs: * Fatigue * Nausea * HA * Heavier menstrual bleeding * Lower abdominal pain

Answer 68

**Plan B One-Step, 1.5mg levo** **no age rest, "17+", no ID/proof**

Answer 69

**Ella - sel PROG R mod/ag/ant props** **30mg \<120h, \>PROG only for BMI 26+** **HA, Abd pain, Nausea, Dysmenorrhea**

Answer 70

## Footnote **5d window, _\*\*99%\*\*_, !PID/gon/chlam**