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Women's health + Pharm > Women's health lecture 2 > Flashcards

Women's health lecture 2 Flashcards

1
Q

How many pregnancies in US are unplanned?

A

More than 50%

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2
Q

Two general MOA for contraception

A
  1. Inhibit the development and release of egg
  2. imposing a mechanical, chemical or temporal barrier between the sperm and egg
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3
Q

What is considered a barrier between sperm and egg (not expected)

A

intrauterine contraception

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4
Q

Secondary mechanism

A

alter the ability of the fertilized egg to implant and grow

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5
Q

What is provider’s obligation?

A

Knowledge of all agents and ability to explain to patient in language they can understand

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6
Q

Pearl Index of contraception

A

the measure of unintended pregnancies from 100 women during 1 year of contraceptive use

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7
Q

The most effective contraceptive

A

implant at 0.05 then IUS at 0.2-0.8

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8
Q

Contraindications to hormonal contraceptives in general

A
  • known or suspected pregnancy
  • thrombosis disorder
    -hepatic tumor or active liver disease
    -undiagnosed abnormal genital bleeding
    -breast cancer
    -allergy
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9
Q

What are considered LARC

A

Nexplanon, IUD, injectable Depro

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10
Q

When to switch out the Nexplanon?

A

3 years

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11
Q

MOA of Nexplanon

A

thickening of the cervical mucus and inhibiting ovulation

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12
Q

what hormone is in Nexplanon?

A

Progestin (etonogestrel)

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13
Q

Can Nexplanon be inserted after delivery?

A

Yes

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14
Q

SE of Nexaplanon

A

Irregular bleeding, weight gain, HA, mood swing, acne
does NOT affect bone mineral density

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15
Q

Risk of Nexaplanon

A

complications associated with implantation and removal, can travel, be careful of the neural vascular bundle

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16
Q

Hormonal IUD for bigger diameter

A

Mirena and Liletta

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17
Q

Hormonal IUD with smaller diameter

A

Kyleena and Skyla

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18
Q

Non hormonal IUD

A

Copper T IUD

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19
Q

How long does the copper IUD last for

A

10 years

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19
Q

How long does the copper IUD last for

A

10 years

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20
Q

MOA for copper IUD

A

acts as a spermicide

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21
Q

SE of copper IUD

A

heavier, longer periods, spotting in between, cramping

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22
Q

Risk of copper IUD

A

Pelvic inflammatory disease, ectopic pregnancy, uterine perforation, expulsion

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23
Q

Contraindication for copper IUD

A

Wilson’s disease

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24
Q

IUD with progestin MOA

A

may thicken the mucus of the cervix, thinking of the uterine lining

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25
Q

Which IUD can be used for 8 years

A

Mirena and Liletta

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26
Q

Which IUD can be used for 5 years

A

Kyleena

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27
Q

Which IUD can be used for 3 years

A

Skyla

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28
Q

SE of hormonal IUD

A

Irregular bleeding, amenorrhea, abdominal/pelvic pain

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29
Q

Risk of hormonal IUD

A

PID, severe infection, ectopic pregnancy, uterine perforation, expulsion, ovarian cyst

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30
Q

Benefits associated with hormonal IUD

A

decrease menstrual blood loss and severity of dysmenorrhea

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31
Q

When is the best time for IUD insertion

A

when the patient is menstruating

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32
Q

What do you need to confirm before IUD insertion?

A

Pregnancy and negative STD

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33
Q

Can IUD be inserted immediately postpartum?

A

Yes, 10 minutes of placenta delivery

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34
Q

When is the expulsion rate highest for IUD

A

done immediately postpartum

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35
Q

How to remove IUD if it is imbedded in the uterine wall?

A

Hysteroscopy

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36
Q

How to remove the IUD if it perforates

A

laparoscopic removal

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37
Q

Risks associated with IUD

A

Infection is likely in the first 20 days after insertion

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38
Q

Do you need to remove the IUD if the patient acquires STD while it is in place?

A

No, as long as there aren’t any signs of spreading to the endometrium or fallopian tube

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39
Q

Do you need to remove the IUD if the patient acquires STD while it is in place?

A

No, as long as there aren’t any signs of spreading to the endometrium or fallopian tube

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40
Q

When is expulsion the greatest with IUD

A

first few months of use

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41
Q

How long does injectable hormonal contraceptive last

A

13 weeks up to 15 weeks

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42
Q

When do you give the injectable

A

within first 5 days of the current menstrual period

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43
Q

Is the injectable a sustained release of progestin?

A

No, higher peaks and then sustained levels of progestin

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44
Q

MOA for injectable

A

inhibits the secretion of LH which prevents follicular maturation and ovulation cause cervical mucus to thicken

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45
Q

the concern about injectable effectiveness

A

not as effective with ovulation suppression as OCP since it cannot suppress the FSH

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46
Q

indication for injectables

A

breastfeeding, smokers, HTN, >35 y/o, seizure disorders

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47
Q

contraindication of injectables

A

unevaluated vaginal bleeding, suspected pregnancy, malignancy of the breast, sensitivity to DMPA ingredients

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48
Q

SE of injectables

A

Measurable weight gain, irregular bleeding, amenorrhea, BONE LOSS due to suppression of estradiol

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49
Q

Benefits of injectables

A

decrease the risk of endometrial carcinoma and IDA, improves pain associated with endometriosis

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50
Q

COC of hormonal contraceptive

A

ethinyl estradiol or estradiol valerate with 19-nortesterones or spironolactone derivative

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51
Q

Monophasic

A

The same goes in each pill each day of the month

52
Q

Monophasic

A

The same does in each pill each day of the month

53
Q

Biphasic

A

deliver the same amount of estrogen each day while progestin does is increased halfway

54
Q

Triphasic

A

Three varying doses of hormones in the pill pack

55
Q

Which physic regimen is associated with breakthrough bleeding

A

triphasic

56
Q

Continuous regimens benefits

A

shorter and less frequent menses

57
Q

Continuous regimens SE

A

higher rate of breakthrough bleeding
- worse the first 12 weeks cycle

58
Q

estrogen specific side effect

A

bloating and weight gain, breast tenderness, nausea, fatigue, headache, HTN

59
Q

COC contraindication

A

-35 y/o who smokes >15 cigarettes/day
-history of CAD, CHF, or cerebral vascular disease
- history of thromboembolic disease
- undiagnosed abnormal vaginal bleeding
- known breast cancer

60
Q

POP MOA

A

makes the mucus thick and relatively impermeable, thins endometrium

61
Q

who are ideal patient for POP

A

lactating women, women over age 40, women with contraindication to estrogen component

62
Q

Disadvantage of POP

A

-> 3 hours late, need backup method
- start on the first day of menus
-poor cycle control
-continuous regimen

63
Q

Oral contraceptive SE

A
  • breakthrough bleeding
  • amenorrhea and post pill amenorrhea
    -venus thrombosis
    -PE
    -stroke
64
Q

Advantages of oral contraceptive

A

*predictable, shorter and less painful periods
* reduce the risk of iron deficiency
* lower incidences of endometrial and ovarian cancer
* lower incidence of benign breast and ovarian disease
* decrease the risk of ectopic pregnancy

65
Q

Oral contraceptive disadvantages

A
  • may interact with other medications
  • antibiotics may alter the intestinal flora and thought to interfere with absorption, but efficacy is not reduced
66
Q

First day start with OCP

A

*provides maximum contraceptive effect
* no back up form is needed

67
Q

Sunday start with OCP

A

*use secondary form for first 7 days

68
Q

Quick start with OCP

A

*back up is needed for the first 7 days

69
Q

Transdermal patch usage

A

*Start during the first 5 days of period
* replace every 3 weeks
*4th week is patch free
* place on the buttocks, upper outer arm, or lower abdomen

70
Q

What hormones does transdermal patch contains?

A

Estrogen and progestin (xulane)

71
Q

Do not used ________ if BMI is >30

A

transdermal patch

72
Q

What hormones does contraceptive vaginal ring contains?

A

Estrogen and progestin

73
Q

When to change the vaginal ring

A

change once a month, 3 weeks in and 1 week out

74
Q

How long can you take out the vaginal ring for without altering the efficacy

A

up to 3 hours

75
Q

Advantage of thing ring

A

*less breakthrough bleeding than OCP
* Less GI SE and medication interactions

76
Q

Is the ring temperature sensitive?

A

Yes, store at room temp

77
Q

Condoms is __________

A

Only reliable, nonpermanent method of contraception available to men

78
Q

concerns with natural membrane condom

A

*Does not block HIV and other STDs
*damaged by oil based lubricants

79
Q

When to seek emergency contraceptive if there was breakage or slippage of the condom

A

Within 120 hours

80
Q

Slippage and breakage rate of male condom

A

5-8%

81
Q

Slippage and breakage rate of female condoms

A

3%

82
Q

What is placed on the diaphragm?

A

Spermicide

83
Q

What does the diaphragm covers?

A

Anterior vaginal wall and cervix

84
Q

How to tell if the diaphragm is placed correctly?

A

If the cervix can be felt through the dome of the diagphragm

85
Q

When to insert the diaphragm

A

up to 6 hours before intercourse

86
Q

How long do you leave the diaphragm in for?

A

6-8 hours after, max is 24 hours

87
Q

What to do if additional intercourse is desired during the 6-8 hour window?

A

Apply additional spermicide without removing the diaphragm

88
Q

Oil lubricants can damage _______

A

Diaphragm, cervical cap, condom

89
Q

What is the common size of the diaphragm?

A

75mm

90
Q

Diaphragm usage is twice likely to have_____

A

UTI

91
Q

How long is the cervical cap left in place for?

A

6 hours after, max 48 hours

92
Q

______is not necessary for repeated intercourse when using cervical cap

A

additional spermicide

93
Q

How long can the contraceptive sponge used for repeated intercourse

A

24 hour period

94
Q

How long is the contraceptive sponge left in for?

A

6 hours after intercourse, up to 30 hours

95
Q

What is the most common ingredient in spermicides

A

Nonoxynol- 9

96
Q

When do you place the spermicide?

A

10-30 minutes before each act of intercourse

97
Q

How long is the spermicide effective for?

A

no more than 1 hour

98
Q

How long do you need to chart when using the calendar methods

A

6 months

99
Q

How is the fertile period determined

A

subtracting 18 days from the total length of the shortest cycle

100
Q

How to determine the last day of fertile period

A

subtract 11 days from the total length of the longest cycle

101
Q

When do you check the basal body temperature

A

immediately upon awakening

102
Q

What temperature and pattern determines ovulation

A

Biphasic pattern with rise of 0.5-1F

103
Q

When looking at the mucus, when are you most fertile?

A

watery, thin, “stretchy” (EWCM - egg white cervical mucus)

104
Q

Lactational amenorrhea MOA

A

suckling = elevated prolactin level which suppresses GnRH from hypothalamus

105
Q

Does emergency contraceptive cause abortion?

A

No, it only prevents the fertilized egg from implantation

106
Q

Which emergency contraception can be used regardless of weight or BMI?

A

IUD

107
Q

When is the copper EC inserted?

A

Within 5 days of unprotected intercourse

108
Q

Liletta and Mirene use in EC (off label)

A
  • inserted within 5 days
  • reduces menstrual bleeding and discomfort
109
Q

Antiprogestin commercial names

A

Ella, ellaOne, fibristal

110
Q

MOA of antiprogestin

A

selective progestin receptor modulator
more effective than progestins

111
Q

When can you take Ella?

A

within 5 days of UPI

112
Q

Levonoregestrel or plan B contains what hormone?

A

Progestin

113
Q

When to take the plan B?

A

within 72 hours of UPI

114
Q

What is Yuzpe

A

EC pill that contains combined estrogen and LNG contraceptive pill

115
Q

When do you need to take Yuzpe?

A

within 72 hours

116
Q

SE of Yuzpe

A

severe nausea and vomiting

117
Q

What can interfere with Ella?

A

progestin contraceptive

118
Q

When can you take progestin contraceptive after taking Ella?

A

5 days after UPA administration

119
Q

Concern with oral EC pills

A

efficacy decrease with increasing BMI

120
Q

Are there contraindication with taking a second dose if you vomited 3 hours after taking it?

A

No

121
Q

Which EC pill can you start contraceptive immediately?

A

LNG, levonoregestrel, also called Plan B

122
Q

Risk indicator for regret about sterilization

A

*younger than 25
*minority status
*less access to information or support from other procedure

123
Q

Is vasectomy immediate sterilization?

A

No
*multiple ejaculations are required before the collecting system is emptied of sperm

124
Q

how is azoospermia confirmed?

A

Semen analysis
*may be checked at 8-10 weeks

125
Q

Laparoscopy conducted

A

occlusion of Fallopian tube

126
Q

is the most common surgical approach for tubal ligation in the world

A

Minilaparotomy

127
Q

Essure

A

titanium-Dacron spring device places into the tubal Ostia bilaterally

128
Q

Complication with essure

A

ectopic pregnancy, persistent pain, uterine perforation, prolonged heavy bleeding, migration of device

Women's health + Pharm (10 decks)

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