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Pharmacotherapy > Womens Health > Flashcards

Womens Health Flashcards

1
Q

Which contraceptive tier is more effective?

A

Tier 1

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2
Q

Tier 1 contraceptive methods

A

Implant
Vasectomy
Tubal occlusion
IUD

After procedure require little or nothing to do or remember

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3
Q

Tier 2 contraceptive method

A

Injectable: Get repeat injections on time
Pill: take pill each day
Patch: keep in place or change on time
Ring: keep in place or change on time

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4
Q

Tier 3: least effective

A 
Use correctly everytime you have sex:
Male or female condom
Diaphragm
Sponge
With-drawl
Spermicides

Abstain or use condom on fertile days:
Fertility awareness based methods

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5
Q

What are key points to consider when selecting contraceptives

A

Evaluate for contradictions

Present all medically appropriate contraceptive options: discuss pros and cons

Recommend most effective method that acceptable to the patient: do they want period or not and route of administration

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6
Q

What is the primary contraceptive agent?

A

Progestin

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7
Q

Mechanism of action for progestin based contraceptive is dependent on what factor?

A

Dose

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8
Q

Low dose progestin mechanism of action

A

Thickens cervical mucus, preventing sperm penetration

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9
Q

Moderate dose progestin mechanism of action

A

Often blocks LH surge = often suppresses ovulation

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10
Q

High dose progestin mechanism of action

A

Block LH surge = suppresses ovulation

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11
Q

What other reproductive system effect can progestin based contraceptive have?

A

Endometrial atrophy

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12
Q

What are the cons of progestin non-contraceptive effects?

A

Irregular bleeding or amenorrhea

Acne, hirsutism ( at high dose)

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13
Q

What are the pros of progestin non-contraceptive effects?

A

Amenorrhea

Reduction in:
Menustral bleeding
Cramping
Endometrial cancer

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14
Q

How is Estrogen used in contraception?

A

Adjunctive to progestin contraceptive

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15
Q

What is the mechanism of action for estrogen based contraception?

A

Suppress FSH

Contribute to blocking LH surge

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16
Q

What other reproductive system effect does estrogen have?

A

Menustral cycle control

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17
Q

Withdrawl of estrogen could lead to what effect?

A

Menustral bleeding

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18
Q

What are the cons of estrogen based contraception?

A 
Increased risk of:
Thrombosis
MI
Hypertension
Hepatic neoplasms
Breast cancer
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19
Q

What are the pros of estrogen based contraception?

A 
Reduces:
Dysmenorrhea or blood loss
PMS or PMDD
Endometriosis
Acne
Hirsutism
Ovarian cyst and cancer
Endometrial and colon cancer
Benign breast condition
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20
Q

Incapacitate sperm

A

Copper IUD

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21
Q

Prevent ovulation

A

Hormonal contraceptives combined:
COCs
Emergency contraceptive pills ( plan B)
Combined hormonal vaginal ring

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22
Q

Prevent ovulation

A 
Hormonal contraceptives (progestin only)
Implants
Injectable
POPs
Progestin only vaginal ring
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23
Q

Prevent ovulation

A

Lactation amenorrhea method (LAM)

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24
Q

Thickens cervical mucus

A 
Hormonal contraceptive (progestin only)
Hormonal IUDs
Implants 
Injectable
POPs
Progestin only vaginal ring
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25
Q

Blocks sperm

A

Male and Female condom

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26
Q

First generation progestin agents

A

Norethindrone

Norethindrone acetate

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27
Q

Second generation progestin only

A

Levonorgestrel

Norgestrel

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28
Q

3rd generation progestin

A

Norgestimate

Desogestrel

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29
Q

Fourth generation progestin

A

Drospirnone

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30
Q

Estrogen agents

A

Mestranol

50mcg

Metabolized EE

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31
Q

Estrogen agents

A

Ethinyl estradiol ( most oral contraceptives)

Low dose: 10,20,25,30,35 mcg

50 mcg rarely used

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32
Q

Estrogen agent

A

Estradiol valerate

Contained in quadriphasic product

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33
Q

Estrogen agent

A

Esterol

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34
Q

How’s the USMEC organized?

A

Contraceptive method
Patient characteristics
Preexisting condition

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35
Q

Intrauterine contraception and can be inserted anytime during the menustral cycle except when pregnant

A

LARC

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36
Q

LARC

A

Copper-T IUD
LNG IUD
Arm implant

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37
Q

Patient wants regular menses and not want to use hormones

A

Copper-T IUD.

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38
Q

No hx of menorrhagia or dysmenorhea

A

Copper-T IUD

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39
Q

Off label EC and last 10 years

A

Copper-T IUD

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40
Q

Acceptable amerrhea and tolerable irregular bleeding

A

LNG IUD

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41
Q

History of dysmenorrhea or menorrhagia

A

LNG IUD

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42
Q

3-5years

A

LNG IUD

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43
Q

Tolerable irregular bleeding and last 3 years

A

Arm implant

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44
Q

Not contraindicated for intrauterine contraception

A 
Multiple partners
STD or PID history
Teens
Nulliparous women
Immediately post partum or post abortion
Ectopic pregnancy history
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45
Q

Actual contradiction for intrauterine contraception

A

Uterine fibrosis or uterus distortion
Active pelvic infection
Sepsis
Active pregnancy

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46
Q

What should a pharmacist do before prescribing: depo shot, pill, patch or ring

A

Review self-screening to evaluate contradictions

Screen for medication interaction

Rule out pregnancy

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47
Q

At what blood pressure should estrogen based depo shot, pill, patch or ring not prescribed

A

BP >140/90

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48
Q

DMPA

A

A dose progestin shot

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49
Q

DMPA dose

A

150 mg IM every 12 weeks

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50
Q

What is the benefit of DMPA

A

Last 3 months

Reduce risk of endometrial, Ovarian cancer or PID

Lacks estrogen

Decrease frequency of sickle cell or seizures

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51
Q

What are the adverse effect of DMPA?

A

Weight gain

Mood changes

Hair loss

Irregular bleeding

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52
Q

What are the disadvantages of using DMPA

A

Amenorrhea

Injection

Decrease HDL

Delayed return of fertility

Does not protect against STD

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53
Q

In patient with low HDL, which contraceptive is probably not appropriate

A

DMPA shots

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54
Q

In Patient who want to get pregnant immediately after the use of contraceptives, which contraception should not be recommended?

A

DMPA shots

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55
Q

According to WHO, which patient population does the benefit of DMPA outweigh its fracture risk

A

Adolescents and women >45 years old

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56
Q

True or false per WHO guideline: there is restriction on the use of DMPA in eligible women 18-45 years old

A

False

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57
Q

Combined contraceptive pills (COCs)

A

Multiphasic vs monophasic

Biphasic vs quadriphasic

21, 24, or 84 day active pills

Placebo vs active placebo

28 day or 84 day cycle

Iron supplementation

Folate supplementation

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58
Q

What is the 91-day extended cycle oral contraceptive( seasonale)

A

84 days of constant pill taking and 7 days of placebo

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59
Q

How is transdermal patch: Ortho Evra or Xulane once weekly used?

A

Apply once weekly for 3 weeks followed by one free week

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60
Q

How is transdermal patch: Ortho Evra or Xulane continuous use administered

A

Once weekly with no free days

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61
Q

What area of the body should transdermal patches be applied

A

Upper outer arm, upper torso, buttock or abdomen

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62
Q

How is vaginal ring (nuvaring) administered

A

Insert for 3 weeks, then removed for a week

Or

For continuous use change once every four weeks

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63
Q

What is Day 1 start of combined hormonal contraceptives

A

CHC use starts on first day of menses regardless what week day

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64
Q

What is quick start of combined hormonal contraceptives

A

Start using CHC on the day it was obtained

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65
Q

What is Sunday start of combined hormonal contraceptives

A

Start using on the Sunday after menses begins

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66
Q

which of the combined hormonal contraceptives do not require backup such as condom

A

Day I start

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67
Q

which of the combined hormonal contraceptives require backup such as condom for one week

A

Quick and Sunday start

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68
Q

What should a pt do if they miss a dose

A

Take ASAP

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69
Q

What should a pt do if they miss one pill

A

Take 2 pill the next day

70
Q

What should a pt do if they miss 2 pills

A

Take 2 tabs per s day for 2 days and use backup for a week

71
Q

How long does the ring have to be out to be considered a missed dose

72
Q

How long does the patch have to be out to be considered a missed dose

A

> 24 hours

73
Q

What is the appropriate way to managing a combination contraceptives with side effects such as: nausea and vomiting, weight gain, and headaches?

A

Reducing estrogen or progestin

74
Q

What is the appropriate way to managing a combination contraceptives with side effects such as: mood changes

A

Reduce progestin

75
Q

What is the appropriate way to managing a combination contraceptives with side effects such as: breast tenderness

A

Reduce estrogen

76
Q

What is the appropriate way to managing a combination contraceptives with side effects such as: break through bleeding

A

Increase estrogen if in early cycle

Or

Increase progestin if late in cycle

77
Q

What is the appropriate way to managing a combination contraceptives with side effects such as: acne

A

Reduce progestin

or

increase estrogen

78
Q

What is the duration for starting IUD postpartum

A

Immediately postpartum or after 6 weeks

79
Q

If the patient is not breast feeding postpartum what contraception methods should be recommended

A

Progestin only to be used anytime

Or

Combination methods at 3 weeks

80
Q

What contraception method is recommended if the pt is breastfeeding postpartum

A

Progestin only method at anytime

Or

Combination when patient starts to wean

Or

Consider combo use as early as 4 weeks

81
Q

Which progestin any pills have no placebo

A

28 days norethindrone

82
Q

If norethindrone progestin only pill dose as missed what should pt do?

A

Use back up for 48 hours

83
Q

What is the dose window for progestin only norethindrone

84
Q

What is the advantage of progestin only pills

A

No estrogen

Decrease risk of endometrial Cancer

Fertility return quickly after stopping

85
Q

What is the disadvantage of progestin only pills

A

Must be taken at the same time everyday

Irregular bleeding or mood changes

Does not protect against STDs

86
Q

By what mechanism does hormonal contraceptives interact with other drug

A

Some drugs can increase the hepatic metabolism of Estrogen or progestin via CYP enzymes

87
Q

What drugs interacts with hormonal contraceptives lowering its efficacy

A

Anticonvulsants

Barbiturates

Protease inhibitor

Antibiotics

88
Q

Which antibiotics are not listed as safe to use with hormonal contraceptives

A

Rifampicin or rifabutin

89
Q

Which emergency contraception is prescription only

A

Ulipristal acetate (Ella)

90
Q

What is the FDA approved timing for the use of UPA EC after sex

A

Take within 5 days

91
Q

What is the FDA approved timing for LNG EC after sex

A

Take within 72 hours

92
Q

When is hormonal contraception resumed after use of UPA EC

A

5 days after use

93
Q

What is the mechanism of action for Emergency contraceptives

A

Release delay of eggs, preventing sperm from reaching the egg

94
Q

LNG mechanism of action

A

Delays ovulation and egg release if LH surge has not started

It does not prevent implantation

95
Q

UPA EC mechanism of action

A

Delays ovulation and egg release sometimes after LH surge

96
Q

Which emergency contraceptive may less effective in obese patient or those weighing over 1651bs

97
Q

What are side effects experienced from EC?

A

Headache ( equal in both)
Nausea ( UPA > LNG)
Dizziness ( equal in both)
Back pain ( UPA > LNG)

98
Q

For which condition should contraception not be recommended?

A

Smoke ≥ 15 cigarettes/day
Multiple risk factors for arterial cardiovascular disease
Systolic ≥ 160 mmH or diastolic ≥ 100 mmHg
Vascular disease
At blood pressure systolic 140-159 or diastolic 90-99 ( risk > benefit)
DVT or PE
Active cancer
Prolonged immobilization
Current or history of Ischemic heart disease (stroke)
Migraine with aura
Do not continue in patient ≥ 35 years with migraine
Diabetes complications (neuropathy, retinopathy, nephropathy)
Acute viral hepatitis and severe cirrhosis
Complicated solid organ transplant

99
Q

Which contraceptive can protect against STI

A

Male condom

100
Q

What is the disadvantage of latex condom

A

Allergy

Degrades with oil based lubricant

101
Q

What is the advantage of latex based condom

A

Includes reservoir tip

102
Q

What is the disadvantage of non-latex condoms

A

Breaks easily

Costly

103
Q

What is the advantage of non-latex condoms

A

Does not degrade with oil based lubricant

104
Q

What is the disadvantage of natural membrane condom

A

Only for pregnancy protection

105
Q

What is the advantage of natural membrane condom

A

Very strong

Does not degrade with oil based lubricant

106
Q

What is the patient education for use of male condom

A 
Only use once
Use with expiration date
Keep with sealed package
Avoid oil base lubricant
Checks for holes and breaks
107
Q

Male condom advantage

A

STD protection

Easily accessible and inexpensive

No system effect or rare ADR

Used when sexually active

Proof of protection

108
Q

Disadvantages of male condom

A

Less effective than systemic

Dull sensation and reduced spontaneity

Must be prepared

109
Q

How long can a female condom be inserted prior to sex

110
Q

What is the advantage of female condoms

A

STD protection

Female controlled

Insert 8 hours prior

Lower risk of breakage

111
Q

What are the disadvantage of female condom

A

Less effective than systemic

Dulled sensation

Can be noisy and expensive

112
Q

Surfactant that destroy sperm cell membrane are called?

A

Spermicides

113
Q

True /False: spermicides should be used alone to increase efficacy

114
Q

Which patient population should not use spermicides

A

HIV infected women or at risk of acquiring HIV

115
Q

True/False: spermicides do not protect against STIs

116
Q

Immediate action and can be combined with condom to provide additional lubrication

117
Q

Immediate action and can adhere to vaginal wall and less lubricating than gel

118
Q

Onset 15 mins and can present with gritty sensation

A

Suppository

119
Q

Onset 15 mins and activated by vaginal secretion and most difficult to use

120
Q

immediate action and provide spermicide and absorb semen

121
Q

Inserted up to 24 hours before sex and leave in ≥ 6 hours after sex

122
Q

How does spermicides increases risk of STI

A

Destroy Vaginal flora

Increase vaginal irritation, ulcers or lesions

123
Q

Effective one hour

A

Foam/Jelly/Gel

124
Q

Wait 15 minutes after insertion and effective for one hour

A

Suppository

125
Q

Wait 15 minutes after insertion and effective for three hours

126
Q

Physical barriers

A

Diaphragm, femcap, sponge

127
Q

Must be fit/sized and prescription only

A

Diaphragm and femcap

128
Q

Diaphragm and femcap proper case

A

Apply OTC spermicidal jelly

Reapply spermicide after 6 hours

Must leave in 6-24hs after sex

Wash with mild soap and water

Replace every year

129
Q

Gives 24hs protection and must be removed within 24 hours

130
Q

Proper sponge use

A

Wet

Fold and insert

Can be use repeated with 24hrs

Effective upon insertion

131
Q

Which Emergency contraceptive is anti-progestin

A

Ulipristal (Ella)

132
Q

Which emergency contraceptive is progestin only and OTC

A

Levonorgestrel (plan B)

133
Q

Can be used upto 120 hours after sex

A

Ulipristal (ELLA)

134
Q

Most effective within 72 hours of sex but can last up to 120 hours

A

Levonorgestrel (plan B)

135
Q

Most expensive Emergency contraceptive ( $ 750 + visit fee )

A

Copper IUD (paragard)

136
Q

Less effective in BMI > 25 and ineffective in BMI >30.

A

Levonorgestrel (plan B)

137
Q

May be less effective with BMI >35

A

Ulipristal (Ella)

138
Q

Efficacy is not dependent on weight

A

Copper IUD

139
Q

30 mg single dose

A

Ulipristal

140
Q

1.5mg single dose

A

Levonorgestrel

141
Q

Single device

A

Copper IUD

142
Q

Must be inserted within 5 days

A

Copper IUD

143
Q

Prevents pregnancy but Not STD if sex was unprotected

A

Emergency contraception

144
Q

What is the timeframe for getting period after EC use?

A

Within 3 weeks

145
Q

What emergency contraception requires prescription for all ages and can get through website

A

Ulipristal

146
Q

Cottage cheese, no odor, erythema and itching

A

Vulvovaginal candidiasis

147
Q

Yellow green frothy discharge, malodorous, erythema and valvular edema

A

Trichomonas vaginalis

148
Q

Thin watery off white or discolored discharge

Strong foul fishy odor (increases after intercourse)

A

Imbalance in normal flora

149
Q

Referral

A

Imbalance in normal flora and trichomonas

150
Q

Anti-fungal or referral

A

Vulvovaginal candidiasis

151
Q

Yeast infection or vaginal thrush

A

Vulvovaginal Candidiasis

152
Q

Oral: metronidazole _ 500 mg x7 days

A

Bacterial vaginosis

153
Q

Topical: metronidazole 0.75% gel _ 1 applicator every night x 5 days

Clindamycin 2% cream _ 1 applicator vaginally at night x 7 day

A

Bacterial vaginosis

154
Q

No partner management

A

Bacterial vaginosis and vulvovaginal candidiasis

155
Q

Oral: metronidazole _ 2 grams once or 500 mg twice daily x7 days

Or

Tinidazole _ 2 grams once

A

Tichromonal vaginitis

156
Q

Partner management: Exam for STI Mgmt

Metronidazole 2g po x 1

A

Trichomonal vaginitis

157
Q

Oral: fluconazole _ 150 mg once

A

Vulvovaginal candidiasis

158
Q

Topical TX: Clotrimazole* Miconazole TioconazoleButoconazole*Terconazole

  • 1, 3, or 7 day internal
    cream or suppository
  • External cream for
    itching
A

Vulvovaginal candidiasis

159
Q

Pregnancy

  • Girls < 12 years
  • Fever or pain in lower abdomen, back or shoulder

• Medications that predispose to VVC
– Steroid or antineoplastic agents

• Medical disorders that predispose to VVC
– DM, HIV infection

• Recurrent VVC
– > 3 infections/year or infection in last 2 months

A

Refer for treatment

160
Q

Limit sucrose and carbohydrates consumption

– Increase consumption of yogurt containing live cultures

– Avoid tight-fitting, nonabsorbent
clothing or underwear

A

Non-pharmacologic therapy for VVC

161
Q

Avoid intercourse after insertion

A

Vaginal treatment products

162
Q

Irritation and burns

A

Vaginal treatment side effect

163
Q

Probiotics
– Lactobacillus preparations – Yogurt with live cultures – Probiotic feminine supplements – RepHresh Pro-B

• Sodium bicarbonate sitz bath
– Relief of vulvar irritation

• Tea tree oil suppository 200mg
– Intravaginally daily x 6 days

• Gentian violet
– Soak tampon in dye and use daily or BID x5 days

• Boric Acid 600mg capsule
– Intravaginally daily or BID x 14 days

A

VVC complimentary therapies

164
Q

In vaginal infections when does relief occur and

When would symptoms be resolved

A

1-2days and one week

165
Q

In vaginal infections, when should patient seek medical evaluation

A

When symptoms persist beyond 48hours

166
Q

How is STI prevented

167
Q

Inflammation of Vagina due to estrogen reduction

A

atrophic vaginitis

168
Q

Menopause
• 10-40% of postmenopausal women have symptoms

– Breastfeeding

– Low estrogen oral contraceptives

– Decreased ovarian estrogen production related to
antiestrogenic drugs
• tamoxifen, clomiphene, raloxifene, danazol

A

Secondary causes atrophic vaginitis

169
Q

Decrease in vaginal lubrication
– Hallmark of hormone insufficiency

• Genital symptoms
– Vaginal irritation, dryness, burning, itching, leukorrhea,
dyspareunia

• Presence of watery, thin malodorous vaginal discharge
or occasional “spotting”

• Symptoms are exacerbated by simultaneous infections

A

Presentation of Atrophic vaginitis

170
Q

Short term improvement for atrophic vaginitis

A

Moisturizers or lubricants

171
Q

Intravaginal cleansing with water or acetic acid solutions

A

Vaginal douching

Pharmacotherapy (12 decks)

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