Women's health Flashcards
teratogenic list of meds
-warfarin
-phenytoin
-valproic acid
-carbamazepine
-lithium
-ace inhibitors/ARBs
-thalidomide
-ethanol
-statins
combined oral contraception
choose a formula based on fertility goals, pt preference, discussion of risk/benefit
risk of oral contraceptives
cancer, CV events/HTN, VTE, drug interactions
VTE abbr
venous thrombosis
concomitant use of antibiotic with oral contraceptive may result
in decreased contraceptive efficacy; however, this is category 1 under US MEC
concomitant use of P450 enzyme inducers (rifampin, phenytoin, carbamazepine, phenobarbital) may result in
decreased contraceptive efficacy
-if use COC, use higher doses (at least 35mcg EE) + high progestin, shorten hormone-free interval to 4 days or less
-avoid low progestin - the patch POP
-consider additional or alternative of birth control
concomitant use of anti-HIV protease inhibitors can
either increase or decrease serum levels of estrogens and progestins
(may need back up method)
drospirenone can cause
kyperkalemia if used with other agents that can increase K+ (ACEIs, heparin, aldosterone antagonists, etc).
benefits: on bone, menstrual effects, improved acne, PMDD, etc.
estrogen
excess: N/V, cervical mucorrhea, HTN, headache, breast tenderness, edema, melasma, bloating
def: early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea, vasomotor sxs
progestin
excess: breast tenderness, headache, fatigue, changes in mood
def: late breakthrough bleeding, hypermenorrhea, dysmenorrhea
androgen
excess: inc appetite, wt gain, acne, oily skin, hirsutism, dec libido, inc breast size, breast tenderness, inc LDL, dec HDL
amenorrhea
rule out other causes; can inc to more estrogenic formulation or to triphasic formulation to decrease amenorrhea
-not a concern if pt is happy
acne/oily skin/hirsutism
rule out of causes; switch to less androgenic formulation of progestin (or decrease progestin content)
3rd generation: desogestrel, norgestimate
4th generation: drospirenone
dienogest
Gi typically resolved in
1-3 months
decrease estrogen component will help with
nausea
decrease progestin component to help with
bloating and constipation
bleeding/spotting
common 30-50% when first initiated; often resolved by 3rd or 4th cycle
rule out causes inc medications (that increase metabolsim)
if spotting or bleeding before completing active cycle (late cycle (10-21d)
increase progestin to enhance endometrial support
-monophasic w/ higher progestin or triphasic with ing progestin
if spotting after withdrawl bleeding (early cycle (1-9d)
increase estrogen or decrease progestin in the early pills (triphasic)
if mid-cycle spotting/bleeding
increase both estrogen/progestin midcycle
if headaches start or worse after starting OC, need to rule out
other causes (take BP, ask about headache, any focal neurologic symptoms)
-if treated to OC use and are not serious, discontinue OC, lower estrogen dose, lower progestin, eliminate pill free interbal (only if HA occur during pill free interval)
decreased libido
ask about depressing
-if due to decrease in vag lubrication, switch to vag ring contraception
-inc estrogen
HTN
COC can cause small increase (6-8mmHg) in BP, regardless of estrogen dosage
-low dose: COC is acceptable in women younger than 35 years with well controlled and freq monitored HTN
-discontinuing COC usually restored BP to pretreatment values w/i 3-6 months
VTE
estrogen increases hepatic production of factor VII, factor X and fibrinogen in the coagulation cascade thus increasing the risk of thromboembolic events
