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Repro / GU > SM_225b: Pregnancy Prevention > Flashcards

SM_225b: Pregnancy Prevention Flashcards

1
Q

Describe contraceptive methods that keep sperm out of the vagina

A

Contraceptive methods that keep sperm out of the vagina

  • Abstinence / rhythm
  • Vasectomy
  • Barriers: male condoms, female condoms, diaphragm, cervical cap
  • Spermicides
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2
Q

Describe contraceptive methods that keep sperm out of the cervix

A

Contraceptive methods that keep sperm out of the cervix

  • Changes estrogen-dominant ovulatory cervical mucus to progestin-dominant mucus which inhibits sperm migration
  • Hormonal contraception
  • Progestin IUD
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3
Q

Describe contraceptive methods that prevent ovulation

A

Contraceptive methods that prevent ovulation

  • Systemic hormonal methods: combination oral, progestin-only oral, combination patch, combination vaginal ring, progestin injectable, combination injectable, progestin implant
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4
Q

Contraceptive method that prevents fertilization is ____

A

Contraceptive method that prevents fertilization is tubal ligation

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5
Q

Contraceptive method that alters tubal motility is ___

A

Contraceptive method that alters tubal motility is progestin-only methods

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6
Q

Describe contraceptive methods that prevent implantation and kill sperm

A

Contraceptive methods that prevent implantation and kill sperm

  • Endometrial atrophy: prevents implantation, hormonal contraception, progestin IUD
  • Endometrial inflammation: spermicidal, prevents implantation, copper IUD
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7
Q

Theoretical efficacy of contraception is ___ which requires ___

A

Theoretical efficacy of contraception is perfect use effectiveness which requires consistent and correct use

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8
Q

Use effectiveness is ____ and includes ____

A

Use effectiveness is typically observed effectiveness and includes inconsistent and incorrect use

  • Always lower than theoretical efficacy but how much lower varies with the method
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9
Q

Describe long-acting reversible contraception

A

Long-acting reversible contraception

  • Methods that require daily action have lower use effectiveness rate than weekly, monthly, or yearly methods
  • Separation of the act of contraception (decision) from the act of intercourse improves efficacy
  • Long-acting reversible contraception methods: hormone-releasing implants, IUDs, depo-injections - increasingly popular because of improved use effectiveness
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10
Q

Describe oral contraception

A

Oral contraception

  • Naturally occuring estradiol and progesterone have poor oral bioavailability and relatively short half-lives
  • Oral hormonal contraception utilizes chemically modified compounds that improve bioavailability and resist metabolism (longer half-lives)
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11
Q

Progestin contraception works primarily by ____

A

Progestin contraception works primarily by suppressing ovulation

  • Suppresses LH and LH surge
  • Decreases frequency of GnRH pulses
  • Thickens cervical mucus
  • Decreases motility of tubal cilia
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12
Q

Prolonged exposure to progestin leads to ____

A

Prolonged exposure to progestin leads to endometrial atrophy

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13
Q

Estrogen acts by ____

A

Estrogen acts by stabilizing the endometrium

  • Stimulates endometrial proliferation
  • Suppresses FSH
  • Contributes to suppression of LH surge
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14
Q

In hormonal contraception, progestin is sufficient to ____, while estrogen is added to ____

A

In hormonal contraception, progestin is sufficient to suppress ovulation, while estrogen is added to improve bleeding profiles

  • Combination (estrogen and progestin) and progestin-only are used
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15
Q

Initial progestins were based on _____ and had a side effect of _____

A

Initial progestins were based on nortestosterone (norethindrone) and had a side effect of acne and oily skin

  • Increased affinity to progestin receptor
  • Decreased anabolic effect
  • Slower metabolism
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16
Q

Drosiperone is a ____ with ____ and ____ activity

A

Drosiperone is a fourth-generation progestin with anti-mineralocorticoid and anti-androgenic activity

  • Analog of spironolactone
  • Reduces: acne, water and Na retention
  • Prescribed for acne or PMS
  • At risk for increase in K
17
Q

Primary estrogen in oral hormonal contraception is ____

A

Primary estrogen in oral hormonal contraception is ethinyl estradiol

  • Ethinyl group improves bioavailability and reduces metabolism
18
Q

Too much ethinyl estradiol results primarily in ____

A

Too much ethinyl estradiol results primarily in thrombotic complications

  • Increase in hepatic coagulation factors
19
Q

Too little ethinyl estradiol results in ____

A

Too little ethinyl estradiol results in endometrial spotting

20
Q

Estrogen effects and side effects are ___ related

A

Estrogen effects and side effects are dose related

  • Ovulation suppression: 20 mcg
  • Endometrial control: 30-35 mcg
  • Thrombotic complications: ≥ 50 mcg
21
Q

Describe oral contraception beneficial side effects

A

Oral contraception beneficial side effects

  • Less anemia
  • Decreased risk of endometrial cancer
  • Decreased risk of ovarian cancer
  • Decreased dysmenorrhea
  • Decreased PID
  • Increased bone density
22
Q

Describe combined oral contraception

A

Combined oral contraception

  • One pill daily
  • Classic regimen: 3 weeks of active pills, and 1 week of placebo with withdrawal bleeding
  • Monophasic and multiphasic: same combination of hormones in each pill vs variable concentrations of ethinyl estradiol and progestin
  • Newer regimens seek to reduce frequency and/or duration of bleeding and reduce risk of early follicular recruitment during placebo week
23
Q

Progestin only pills are administered ____ with the indication of ____

A

Progestin only pills are administered once per day with the indication of estrogen avoidance

  • No placebo pills / no withdrawal bleed
  • Estrogen avoidance: lactation, women at risk for thromboemboli, HTN
24
Q

Describe first pass metabolism of oral contraceptives

A

First pass metabolism of oral contraceptives

  • Blood from intestines passes first through liver where estrogen and progesteorne molecules are metabolized before blood gets to rest of body
  • Liver sees much higher drug levels than the rest of the body
25
Q

Homronal contraception with alternate delivery sites has ____

A

Homronal contraception with alternate delivery sites has improved compliance compared to oral daily pills

  • Bypasses GI absorption and first pass metabolism
  • Utilizes active drugs rather than oral prodrugs
  • Injectables, implants, transdermal patches, intravaginal rings
26
Q

Non-oral progestin-only injections include ____

A

Non-oral progestin-only injections include medroxyprogesterone acetate

  • Intramuscularly or subcutaneously
27
Q

Non-oral progestin-only subdermal implants are ____ with ____

A

Non-oral progestin-only subdermal implants are an implanted rod of etonogestrel with a 3-year duration

(long-acting reversible contraception)

28
Q

Intrauterine device is a form of ____ and can be ____ or ____

A

Intrauterine device is a form of long-acting reversible contraception and can be copper-containing or progestin-releasing

  • Copper-containing IUD: causes sterile inflammation of the endometrium, spermicidal, side effects of heavier menses / cramps / irregular bleeding
  • Progestin-releasing IUD: thickens cervical mucus, causes endometrial atrophy, possible side effects are less bleeding / decreases cramps / irregular breakthrough bleeding
29
Q

Copper-containing IUD has side effects of ____, ____, and ____

A

Copper-containing IUD has side effects of heavier menses, cramps, and irregular bleeding

30
Q

Progestin-releasing IUD has side effects of ____, ____, and ____

A

Progestin-releasing IUD has side effects of less bleeding, decreases cramps, and irregular breakthrough bleeding

31
Q

Spermicide is ____ and functions as a ____

A

Spermicide is nonoxynol 9 and functions as a surfactant that damages the cell membranes of sperm

32
Q

Condoms have the advantage of ____

A

Condoms have the advantage of protection from STDs

33
Q

Barrier contraception failure rates are ____ because ____

A

Barrier contraception failure rates are relatively high because closely associated with intercourse

34
Q

Describe emergency contraception

A

Emergency contraception

  • Hormonal regimen within 72 hours of exposure: high dose levonorgestrel (plan B)
  • Hormonal regi\men within 120 hours of exposure: anti-progestin (ulipristal acetate)
  • Mechanism: delays or alters ovulation, may impede tubal transport, prevents implantation through endometrial changes
  • Copper IUD inserted within 120 hours: prevents implantation and effective for this exposure and provides future contraception

Repro / GU (46 decks)

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