Week 3 pt 1 highlights Flashcards
Name an effective form of preventative care
Contraception
What is key to contraceptives?
Patient education is key
True or false: No contraceptive method is effective if used incorrectly
True
What is the goal of contraception?
Prevent sperm and oocyte from uniting
True or false: The U.S. has the highest rate of unintended pregnancy in the industrialized world.
True
___% of pregnancies that occur among American women each year are unplanned
45%
True or false: Access to contraceptives is a concern in the US
True
Contraceptives work by either by inhibiting the _____________ or release of the ________ OR by blocking the meeting between the ova and sperm.
development; ova
What is the approach to discussing contraception with patients?
Shared decision-making approach
What are 3 factors affecting contraception choice?
1) Freq. of delivery
2) STD protection
3) Future fertility plans (PATH)
Define PATH
1) Pregnancy Attitudes: Do you plan to have (more) children in the future?
2) Timing: If yes, when might that be?
3) How important is it to you to prevent pregnancy until them?
What is the Pearl Index (PI)?
the number of contraceptive failures per 100 women
True or false: All contraceptives that inhibit the development and release of the egg contain hormones
True
Do contraceptives that impose a mechanical, chemical, or temporal barrier between sperm and egg contain hormones?
no hormones except some IUDs
Name a type of birth control with efficacy equal to or BETTER than permanent sterilization
LARC (Long-Acting Reversible Contraception)
Give 3 examples of LARCs
1) Implantable rod (Nexplanon) 3 years
2) Intrauterine device (Copper IUD or Levonorgestrel IUD) 3-10 years
3) Injectable (Depo-Provera) every 3 months
The most used and safest method of interval contraception worldwide is what?
IUD
Nexplanon: What is the only absolute contrainidcation?
Breast CA in past 5 yrs
What hormone does nexplanon have? How effective it is? What are possible side effects?
1) Steady low dose of progestin
2) 99.95% effective, lasts for up to 3 years
3) Increased risk of irregular bleeding, headaches, DVT, wt. gain, breast tenderness
What form of birth control can be used as emergency contraception?
IUDs
What must the provider see with IUDs?
Provider must see strings
What is the first step if a pt has an IUD and abd/ pelvic pain? What is the second step?
1) hCG.
2) pelvic exam (look for strings; If no strings, TVUS.)
Mirena and Kyleena are T-shaped devices containing ___________ that is placed by healthcare provider
progestin
What is the MOA of the copper IUD (Paragard)?
1) Inhibits fertilization in the uterus
2) Impairs sperm transport through the uterus
3) Prevents implantation
4) Copper acts as spermicide
IUD with progestin: Local progesterone effect is used to relieve pain related to ______________ and _____________
endometriosis and adenomyosis
Which type of birth control may make periods heavier and more painful?
Copper IUD (Paragard)
Which pts may benefit from STD screening prior to insertion of an IUD?
High risk patients
If a pt becomes pregnant with an IUD, what is a concern?
extrauterine pregnancy.
What is a rare side effect of IUDs?
Perforation of uterus
IUDs:
1) What is the a risk of when there’s a pregnancy?
2) What is there a 40% chance of with an intrauterine pregnancy and IUD?
1) Higher risk of preterm L&D
2) 40% will spontaneously abort in first trimester
Pregnancy with an IUD: Can you ever remove them while pregnant? Explain
1) If string visible, offer removal and may decrease risk of spontaneous abortion by 30% (debatable)
2) If string not visible, instrumental removal can be performed but may disrupt pregnancy
3) If left in place, pregnancy may proceed uneventfully
OCPs:
1) Are OCPs are a very effective form of birth control?
2) When do you start it? Why?
1) Yes
2) Pills started 1st day of menstruation (bleeding)
-Dosed at the lowest estrogen level needed to prevent breakthrough bleeding
Most OCPs contain both __________ and __________ (COC/COCP)
estrogen and progestin
When are OCPs (COC/ COPC) taken?
Taken QD x 3 wks
Followed by QD x 1 week of placebo pills
COC/COCP:
1) ____________ painful periods (dysmenorrhea), acne, symptoms of PCOS.
2) ____________ androgenic symptoms
3) ____________ ovarian cysts
4) _____________ risk of ovarian cancer
1) Decrease
2) Decreased
3) Reduce
4) Reduce
COC/COCP MOA:
1) Progesterone suppresses secretion of ______ and, in turn, ovulation.
2) Estrogen suppresses secretion of __________.
1) LH
2) FSH
MOA of COC/COCPs: Describe the effects of progesterone
1) Suppresses secretion of LH and, in turn, ovulation
2) Thickens cervical mucus which inhibits sperm migration
3) Creates unfavorable atrophic endometrium for implantation
4) Thins endometrium/atrophy
5) Alters fallopian tube peristalsis
MOA of COC/COCPs: Describe the effects of estrogen
1) Suppresses secretion of FSH
2) Prevents maturation of a follicle
3) Regulates menstrual cycle
4) Modest contraceptive effect
5) Improves cycle control by stabilizing the endometrium
6) Less breakthrough bleeding
COC/COCP types:
1) Monophasic: Contain a __________ amount of estrogen and progestin in each active pill.
2) Biphasic: Deliver the same amount of _________ each day while _____________ dose is increased halfway through cycle.
3) What are triphasic COCPs?
1) constant
2) estrogen; progestin
3) 3 different doses of progestin and estrogen that change approximately every 7 days.
OCPs:
1) Predictable, _______, and less painful periods
2) Reduce the risk of ___________________.
3) Lower incidence of ____________ and _________ cancers
4) Decrease risk of __________ pregnancy
5) Reduced _____________ pregnancy
1) shorter
2) iron-deficiency anemia
3) endometrial and ovarian
4) ectopic
5) undesired
What type of migraine is an absolute contraindication of COCPs?
Migraine (w aura)
COCPs ____________ risk of endometrial, ovarian, colorectal CA
decrease
Which 2 ways to start an OCP require a backup form of contraceptive & for how long? Which doesn’t?
1) Sunday start + quick start: first 7 days
2) First day start no backup needed
Which type of OCP is not reliable? Why?
1) Progestin Only Pill (POP) OCPs
2) must be taken at the same time each day/1st day menses
3hrs late = use backup method
What type of OCP is a good option for women who cannot take pills with estrogen?
Progestin Only Pill (POP) OCPs
The only absolute contraindication to progesterone pills is what?
Progesterone-sensitive breast CA
Emergency Contraception:
Works by preventing _______________ and __________
ovulation and implantation
Emergency contraception:
True or false: Will not terminate an existing pregnancy
and has no medical contraindications
True
List 3 types of emergency contraception
1) Plan B
2) Ella
3) Paragard
Why might paragard be a good emergency contraceptive choice? (Despite being difficult to get an appointment/exam)
Can be used in individuals of any weight or body mass index without a decrease in EC efficacy
“Plan B or Morning after pill”:
1) What is the MOA?
2) What is it?
3) Who should you offer it to?
4) Is it an appropriate form of regular birth control?
1) Blocks LH surge (follicular phase)
2) High dose progestin-only pills
3) Should be offered to every victim of sexual assault
4) Not appropriate for routine birth control
When must you use a Plan B pill?
Must use within 72hrs
What type of emergency contraception can be used Up to 120hrs (5d)?
Ella + (Paragard Within 5 days)
Estrogen/Progestin combination (OrthoEvra):
1) Release more than _____% more estrogen than OCPs
2) May not work in women over ______kg (198 pounds)
1) 60%
2) 90kg
1) When do you start the patch?
2) Where is it placed?
3) What is a big downside?
1) First 5d of period
2) Clean, dry skin of buttocks, upper outer arm, lower abdomen
3) No regular swimming
Depo-Provera:
1) What hormone(s) do/does it have?
2) How often is it given? Where?
3) What is a major risk? What do you need to do bc of this?
1) Progestin only (Medroxyprogesterone acetate)
2) IM injection q three months (arm or glutes)
3) Risk of osteoporosis; limit to 2 years of use
1) How effective is the NuvaRing? What hormone(s) do/does it have?
2) How effective is the male condom?
1) 91%; combined estrogen/progestin contraception
2) 82%
NuvaRing:
1) What hormone(s) does it release?
2) What allows for greater compliance?
3) How long can a pt take it out?
1) Releases sustained amount of estrogen and progestin daily
2) Placed once a month (left in place for 3 weeks)
3) Up to 3 hours without altering efficacy
List 2 pros of the NuvaRing
1) Less breakthrough bleeding compared to OCPs
2) Fewer GI side effects and potential for medication interactions
Condoms provide a __________ between sperm and egg/efficacy enhanced by reservoir tip
barrier
1) What is a major downside of condoms?
2) Are they the only reliable, nonpermanent method of contraception available to men?
1) Damaged by oil-based lubricants/spermicide
2) Yes
