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Repro > week five > Flashcards

week five Flashcards

1
Q

What are considered the most effective forms of contraception?

A

LARC (intrauterine, implants) + sterilization

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2
Q

What are considered moderately effective forms of contraceptives?

A

Injectables
OC
Transdermal systems
Vaginal ring

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3
Q

What are considered the least effective forms of contraceptives?

A

Diaphragm
Cervical caps
Condoms
Spermicides
Withdrawal
Periodic abstinence

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4
Q

What is LARC? What contraceptives fall in this group?

A

Long Acting Reversible Contraceptives
IUDs and implants

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5
Q

What hx is important to attain in the interview for contraception?

A

Medical hx
Surgical hx
Ob hx
Gyn hx
Hx STIs
Hx and current partners
Previous difficulties with contraceptive use
Frequency of intercourse
FHx inc vascular events or female cancers, esp thrombocytopenia

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6
Q

Advantages of FAB methods of contraceptives

A

Avoid pregnancy
Conceive
Detect pregnancy
Detect impaired fertility
Detect need for medical attention

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7
Q

Disadvantages of FAB contraceptive methods

A

No STI protection

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8
Q

When would FAB methods of contraception not be indicated?

A

Irregular cycles
Inability to interpret fertility signs correctly
Persistent reproductive tract infxn that affects signs of fertility

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9
Q

Condoms typical use pregnancy rate

A

15-18%

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10
Q

Condoms non-contraceptive benefits

A

Protection against STIs
Reduces risk of PID and subsequent protection of female fertility

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11
Q

Diaphragm MOA

A

Barrier to the ascent of sperm from vagina into uterine cavity and spermicidal activity

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12
Q

Diaphragm typical use pregnancy rate

A

12-16%

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13
Q

Diaphragm non-contraceptive benefits

A

Reduced risk of some STIs

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14
Q

Cervical cap MOA

A

Barrier to ascent of sperm from vagina into uterine cavity, spermicidal

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15
Q

Cervical cap typical use pregnancy rate

A

13-16%

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16
Q

Cervical cap non-contraceptive benefits

A

Reduces risk of some STIs

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17
Q

What are the different types of IUDs?

A

Copper IUD
LNG from lowest to highest dose: Skyla, Kyleena, Mirena + Liletta

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18
Q

CI for IUD

A

Distorted uterine cavity
Pregnancy
Known pelvic tuberculosis
Current breast cancer (for LNG)
Immediate post-septic abortion
Puerperal sepsis
Unexplained vaginal bleeding
Pts with ca awaiting tx
Endometrial ca
Current malignant gestational trophoblastic dz
Hepatiocellular adenoma or hepatoma (LNG)
Wilson’s disease or copper allergy (copper)
Current purulent cervicitis infxn with CT/GC or current PID (3+ Mo after resolution)

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19
Q

What recommendations can you give your patient to take before IUD insertion?

A

Ibuprofen
Mag phos
Cramp bark tincture
Paracervical block

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20
Q

MOA copper IUD

A

Copper enhances cytotoxic inflammatory response within endometrium; toxic to sperm and ova; impairs implantation

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21
Q

Best pt for copper IUD

A

Avoidance of exogenous hormones (breast cancer hx)
Continuation of pre IUD bleeding pattern
Desire for long term or emergency contraception

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22
Q

Non contraceptive benefits of copper IUD

A

Reduction of endometrial, cervical, and ovarian cancer
Menstrual cyclicity

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23
Q

Risks and SE copper IUD

A

Ectopic pregnancies
Uterine perforation
Expulsion
PID
Spontaneous abortion
High serum copper
Abnormal uterine bleeding
Inc flow

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24
Q

Life plan of copper IUD

A

10 years

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25
Q

LNG IUD MOA

A

Thickened cervical mucus to impede sperm from ascending into uterine cavity and changes endometrium to impair implantation

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26
Q

Candidates for LNG IUD

A

Same as copper IUD PLUS
Reduction of bleeding and anemia
Higher efficacy pregnancy prevention
Possible amenorrhea
Reduction of dysmenorrhea
Tx of endometriosis related pelvic pain
Emergency and ongoing contraception

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27
Q

Non-contraceptive benefits Mirena/LNG IUD

A

Dec menstrual flow
Improvement of dysmenorrhea
Tx iron def anemia related to HUB
Tx heavy bleeding a/w fibroids or adenomyosis
Protection of endometrium with estrogen therapy
Dec risk of endometrial, ovarian, cervical cancer
Dec risk PID
Dec risk VTE
Tx endometrial hyperplasia and cancer

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28
Q

Risks/SE of LNG IUD

A

Prolonged bleeding
Unscheduled bleeding
Amenorrhea
Spotting
Headache or migraine
Acne
Mastalgia
Vulvovaginitis
Abdominal/pelvic pain
Hair loss
Wt gain
Depression
Dec libido
Dizziness
Fatigue
Breast tenderness
Nausea
MSK pain
Infection, pain, itching at site

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29
Q

life span of LNG IUS

A

3 - Skyla
5 - Kyleena
6 - Liletta
8 - Mirena

30
Q

COCs MOA

A

Suppresses ovulation by dec GnRH and eliminating LH release mid cycle

Suppresses ovarian folliculogenesis via suppression FSH

Makes endometrium less suitable for implantation

Thickens cervical mucus dec ability of sperm to penetrate

Alters tubal transport of sperm and oocytes

31
Q

Typical use failure rate COCs

A

8%

32
Q

Non-contraceptive benefits COCs

A

Reduction of all cancer risks esp ovarian and endometrial
Reduction in ectopic pregnancy rates
Reduced risk PID
Reduced menstrual disorder sx
Dec risk benign breast disease
Improved acne
Dec bone density loss
Protection against RA and colon cancer

33
Q

SE/risks COCs

A

CV events
Venous thromboembolism
MI
Stroke
Lipid changes
PAD
Breast cancer
Cervical cancer and dysplasia
SLE
AUB/breakthrough bleeding
Breast tenderness
Headache
Wt gain
Nausea
Asthma

34
Q

Absolute CI for COCs

A

Current or hx DVT or PE
Current or hx stroke, HD
Known thrombogenic mutations
Multiple RF for arterial CVD
Complicated vascular disease
Current DM with nephropathy, retinopathy, or other vascular dz
DM over 20 yrs
Current breast cancer
SLE with high disease activity
Pregnancy
Lactation
Migraine with aura/focal Neuro sx
Major surgery with prolonged immobilization of legs
35 and smokes > 15 cigs
HTN 160+/100+ with concurrent vascular dz

35
Q

Relative CI for COCs

A

Postpartum < 21 days
Lactation 3 wks, pt with other RF VTE 4-6 weeks
Undiagnosed AUB
Malabsorption bariatric surgery
HTN
Past hx breast CA with no recurrence 5 yrs
Gallbladder dz
Liver enzyme affecting drugs
Migraine w/o aura
Tobacco, HTN, hyperlipidemia, obesity, DM
Age 35+ < 15 cigs
Superficial venous thrombosis
IBD with RF for VTE

36
Q

When would extended COCs be indicated?

A

Endometriosis
PMDD
Hyperandrogenism
Dysmenorrhea
Lifestyle wanting to dec frequency of menses

37
Q

WHO top tier contraceptive methods for older patients

A

IUDs
Implants
Sterilization

38
Q

Concerns of COCs in older patients

A

Inc risk VTE, stroke, MI, cervical cancer, breast cancer, bone density loss

39
Q

Typical failure rate contraceptive patch

A

0.7-0.88%

40
Q

When is there dec efficacy of the contraceptive patch?

A

BMI > 25

41
Q

Typical use failure rate vaginal ring

A

0.65%

42
Q

SE of vaginal contraceptive ring

A

Same as OCs
VTE
Arterial thrombosis

43
Q

What are some progestin only contraceptive options and their typical use failure rates?

A

Depo provera - 3%
Mini pill - 8%
Implants/nexplanon 0.38%

44
Q

Non contraceptive benefits depo provera

A

Dec risk ectopic pregnancy, endometrial ca, freq in sickle cell crisis
Improves endometriosis

45
Q

Adverse risks depo provera

A

Dec BMD
Wt gain
Menstrual pattern alterations
Delay of fertility after d/c

46
Q

Mini pill non contraceptive benefits

A

Dec endometrial ca risk

47
Q

SE mini pill

A

Irregular spotting
Amenorrhea

48
Q

Nexplanon SE

A

Irregular bleeding
Headache
Wt gain
Acne
Breast tenderness
Emotion lability
Abdominal pain

49
Q

What are the various methods of emergency contraception available?

A

LNG plan B
Paragard copper IUD
LNG IUD
Ulipristal acetate (Ella, Ella one, fibristal)
High dose COCs or progestin only OCs

50
Q

LNG plan B typical use failure rate and time to use after sexual activity

A

2.6%
72 hours

51
Q

paragard copper IUD typical use failure rate and time to use after sexual activity

A

0.1%
5-7 days

52
Q

CI Paragard copper IUD

A

GC/CT
Acute cervicitis

53
Q

LNG IUD typical use failure rate and time to use after sexual activity

A

0.3%
5 days

54
Q

Ulipristal acetate typical use failure rate and time to use after sexual activity

A

1.8%
120 hours

55
Q

Ulipristal acetate CI

A

Pregnancy
Breastfeeding
Don’t use contraceptives 5 days after use

56
Q

High dose COCs and progestin only OCs timeframe to take for emergency contraception

A

Within 72 hours best, up to 120 hours

57
Q

Gynecological presentations for HIV+ women

A

Candida vaginitis 4x+ per year
Abnormal cervical cytology
PID+ complications
Genital ulcer dz; more diff to treat
Menstrual abnormalities, inc early menopause

58
Q

Clinical presentation GC in women

A

Often asx
Vaginal mucopurulent dc and pruritis
Dysuria
Intermenstrual, prolonged, HMB
Inflamed cervix
Urethritis
PID
Bartholinitis

59
Q

GC complications in women

A

Acute PID
Bartholins gland abscess
Perihepatitis
Disseminated GC
Pregnancy complications

60
Q

Supportive tx GC

A

Immune supportive supplements
Alternating sitz baths
Warming sucks
Castor oil packs
Probiotics
Vaginal lactobacillus
Homeopathy

61
Q

Clinical presentation CT in women

A

Most asx
Cervicitis with mucopurulent dc and hypertrophic cervical ectopic
Acute urethral syndrome
Endometritis
PID and potential sequelae
Perihepatitis
Conjunctivitis
Pregnancy related complications

62
Q

What other STIs should be testing for with a CT dx

A

GC, HIV, syphilis

63
Q

Primary stage syphilis presentation

A

Painless ulceration chancre with raised borders and indurated base develops, LA frequently present

64
Q

Secondary stage syphilis presentation

A

Skin and mucus membranes
Generalized maculopapular rash on trunk and proximal extremities, spreads to entire body esp palms and soles

Mucus patches, condyloma Latium, generalized LA

CNS invasion of spirochetes (HA)

65
Q

Latent stage syphilis presentation

A

No apparent clinical dz present > 1 year
Not infectious sexually but transplacentally

66
Q

Tertiary syphilis presentation

A

CV, CNS, MS

67
Q

Pathognemonic CNS sx tertiary syphilis

A

Argyll Robertson pupil - no reaction to light, accommodation present

68
Q

How is syphillis dx and what is the required tx?

A

Dx - fresh specimens from lesions, dark field exam or fluorescent ab test; serological testing

Antibiotics necessary

69
Q

Dx criteria herpes

A

3+ of the following
2+ extragenital sx
Multiple bilateral genital lesions
Persistence of genital lesions > 16
Distal HSV lesions on fingers, buttocks, or oropharynx

70
Q

Genital herpes natural tx support

A

Stress management
Sleep hygiene
Sitz baths
Eliminate nuts, seeds, chocolate, refined carbs, sugars, salt, alcohol
Lysine supplements

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