Test 3 Flashcards
Basal body temp education for prevention of pregnancy
- For contraception: avoid intercourse from beginning of cycle (or at least from day 4) until BBT elevated x3 days
- take daily with 0.1 degree thermometor and record
- take temp after minimum 3 consecutive hrs of sleep, before rising, eating, or drinking
- Preovulation temps suppressed by estrogen; postovulation temp increased 0.4-0.8 degrees by progesterone
- temps rise 1-2 days after ovulation and remain elevated 12-16 days until menstruation begins
- Stress, travel, illness, medication, strenuous exercise, and suddent wt changes impact ovulation
Effects of CHC on bronchodilators
- Combination oral contraceptives may potentiate the action of bronchodilators
Education of pt using calendar method
- avoid intercourse during fertile period
Fertile period: - first day is total length of shortest cycle minus 18 days
- last day is total length of longest cycle minus 11 days
28-18=10
28-11=17
day 10-17-avoid unprotected sex
28 day cycles
Advantages of cervical cap over diaphragm
Cervical caps provide up to 48 hrs of protection after insertion, diaphragms provide 6 hrs of protection after insertion
Cervical caps are more effective for women who have never been pregnant or given birth vaginally
Diaphragms may cause more vaginal irritation, discromfort and increase UTI risk for pts prone to UTIs
Cervical cap comes in 3 different sizes
Why would pt benefit from levonorgestrel-containing IUD vs Copper IUD
Levonorgestrel IUDs decrease menstrual blood loss up to 50% and the severity of dysmenorrhea
Levonorgestrel IUDs can be used to treat idiopathic menorrhagia and heavy menstrual bleeding-associated adenomyomas and leiomyomas and are an acceptable alternative to endometrial ablation or hysterectomy
Some pts have heavier menstrual bleeding and cramping with Copper IUDS
Pt may have copper allergy
Mechanism by which Cytochrome P-450 increases production of liver enzymes and decrease effect of COCs
- Cytochrome P450 (CYP450) enzymes in the liver and gut metabolize COCs.
- Medications that interact with CYP450 enzymes taken with birth control causes body to metabolize birth control more quickly, making it less effective
Where to give Depo in obese pts
* deltoid muscle in the upper arm is the preferred site for most intramuscular (IM) injections in obese patients
- avoid injecting into gluteal sites in obese females, as the thick subcutaneous tissue can increase the risk of failure; longer needle may be needed
Mechanism of action in emergency contraceptives
- inhibits or delays ovulation; will not disrupt established pregnancy d/t little endometrial effect
- copper IUD prevents fertilization interfering with implantation
- MOA varies depending on day of cycle intercourse occurs and EC administered
Follow-up for hysteroscopic sterilization procedure (tubal ligation)
At 3 months, low-pressure hysterosalpingogram to confirm the correct placement of the micro-inserts and blockage of the fallopian tubes
Which birth control method is NOT recommended for pt that wants to get pregnant within a year?
Depo-return to fertility may be delayed 6-12 months or longer after injection
Most common side effect of implant (Nexplanon)
irregular bleeding, unpredictable vaginal bleeding that may continue for several months of use
How to educate obese pt on LAM method? What contraceptive would you recommend afterward?
- natural protection for 6 months after birth
- pt w/ higher BMI associated with shorter duration of lactational amenorrhea with earlier return of menses during lactation
- if menses returned or long periods w/o breastfeeding or supplementation-do not recommend
- Progestin-only contraceptives, IUDs and implants due to potential milk supply issues d/t estrogen
Education for patients using LAM at PP visit
- does not protect against STDs-use condoms
- resumption of ovulation and fertility cannot be accurately predicted; can become pregnant while breastfeeding and before the first menstrual period.
- Women who are uncertain about meeting the LAM criteria she should begin a reliable method of BC immediately.
- LAM for contraception: must breastfeed on demand over each 24-hour period, with no formula or food supplementation
Expected side effects of low-dose COCs
Nausea , breakthrough bleeding, leukorrhea, increased LDL decreased HDL, fatigue , chloasma, changes in the clotting cascade, and pruritus, decreased libido
What is typical use failure rate?
rate seen when the method is actually used by patients, factoring in the mistakes in usage everyone will make from time to time and actual non-compliance
What is perfect use failure rate?
failure rate inherent in the method if the patient uses it correctly 100% of the time
What birth control method is NOT recommended to perimenopausal women with regular periods
Estrogen-containing methods
Educate for permanent sterilization
*Female sterilization is permanent
How to educate on Nuvaring and Annovera use
left in place for 21 days and then removed for 1 week
What is an absolute contraindication for CHCs?
- If pt is pregnant history of blood clot (PE DVT)
According to WHO women with superficial thrombophlebitis can use CHCs
How can you tell if a pt is reasonably not pregnant?
2 weeks PP would be considered reasonably not pregnant, 2 months PP if fully or nearly fully breastfeeding would be considered reasonably not pregnant
What vital sign is the most important for birth control initiation?
Blood pressure
Is cytotec recommended for IUD placement?
- Cytotec is not recommended for routine IUD placement
- It may be helpful in special circumstances such as women with recent failed IUD insertion
Mechanism of action for hormonal contraceptive methods
- Hormonal contraceptives include methods that have combined estrogen and progestin formulations with different delivery systems.
MOA: - GnRH is suppressed, which in turn suppresses FSH and LH inhibiting ovulation.
- Ovum/tubal transport is altered
- Cervical mucus thickens, inhibiting sperm transport
- Implantation is inhibited by suppression of the endometrium and alteration of uterine secretions.
What hormone is released from Nexplanon?
Etonogestrel (a progestin-only implant)
Physiologic effects exerted by estrogen component of CHCs and what serum level is decreased?
The estrogenic component acts by suppressing secretion of FSH, preventing maturation of a follicle as well as potentiation of the action of the progestational agent.
Effectiveness of patch in obese patients
- Body weight is associated with lower serum levels of the hormones in patch users, but only limited and inconsistent evidence suggests that a person weighing more than 90kg (198lbs) may be at higher risk of pregnancy
Extended cycle with OCPs compared to a traditional cycle
Headache and unpredictable bleeding
Advice for pt who missed pills over weekend (3 days)
If 3 pills, use backup method and start new pack
COCs may diminish efficacy of what med?
Acetaminophen
How do you start COCs after first trimester miscarriage?
Immediate
What pts are IUDs not appropriate for?
gestational trophoblastic disease, copper allergy, Breast cancer, BF, migraines w/ aura
What combination of oral contraceptives is least appropriate for what pt?
Hx or risk of DVT/PE
Emergency contraceptive options
- combined estrogen-progestin regimen, which consists of two doses- each containing 100 micrograms of ethinyl estradiol plus 0.5 of levonorgestrel-taken 12 hours apart
- Progestin-only regimen which consist of a total of 1.5 mg levonorgestrel
- copper IUD
How soon are pts who get depo shot protected from pregnancy?
First 5 days of menses-immediate
Non-contraceptive benefits
lower rates of PID, reduced incidence of benign breast conditions
fewer ectopic pregnancies, low incidence of endometriosis,
When is backup method recommended with vaginal ring?
if CVR has been out of vagina longer than 3 hours
Most appropriate birth control for lupus pt
progestin-only
What combination methods are safe options for patients
Seizure pts are at increased risk
Do patch and vaginal ring have similar efficacy?
- patch and vaginal ring have the same theoretical efficacy and typical use failure rates as COCs
What do monophasic oral contraceptives contain?
deliver the same amount of estrogen and progestin each day for 21 days. In the final week, you either take no pills or placebo pills
Spermicide protection when used alone
Many forms of spermicides are effective for only 1 hour after they are inserted
What conditions can oral contraceptives reduce?
ovarian, uterine, and endomentrial cancer
Female condom
Can be inserted up to 8 hours before intercourse or as little as 2 hours before intercourse
Management of breakthrough bleeding with Nexplanon
Estrogen and NSAIDs
Depo advantages
protection from cancer of uterus and ectopic pregnancy
Pregnant pt with IUD and visible strings, what is recomendation?
Remove IUD if strings visible
Most common side effect of contraceptive pills
nausea, h/a, breakthrough bleeding
Where should patch be applied?
upper arm and abdomen
If pt misses mini pill in morning, when should she take the next one?
If a pill missed by more than 3 hours after your routine time, take the missed pill as soon as you remember it, even if it means taking two pills in one day. Either avoid sex or use a backup method for the next 48 hours
