Womens Health Flashcards
Which contraceptive tier is more effective?
Tier 1
Tier 1 contraceptive methods
Implant
Vasectomy
Tubal occlusion
IUD
After procedure require little or nothing to do or remember
Tier 2 contraceptive method
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
Tier 3: least effective
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
What are key points to consider when selecting contraceptives
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
What is the primary contraceptive agent?
Progestin
Mechanism of action for progestin based contraceptive is dependent on what factor?
Dose
Low dose progestin mechanism of action
Thickens cervical mucus, preventing sperm penetration
Moderate dose progestin mechanism of action
Often blocks LH surge = often suppresses ovulation
High dose progestin mechanism of action
Block LH surge = suppresses ovulation
What other reproductive system effect can progestin based contraceptive have?
Endometrial atrophy
What are the cons of progestin non-contraceptive effects?
Irregular bleeding or amenorrhea
Acne, hirsutism ( at high dose)
What are the pros of progestin non-contraceptive effects?
Amenorrhea
Reduction in:
Menustral bleeding
Cramping
Endometrial cancer
How is Estrogen used in contraception?
Adjunctive to progestin contraceptive
What is the mechanism of action for estrogen based contraception?
Suppress FSH
Contribute to blocking LH surge
What other reproductive system effect does estrogen have?
Menustral cycle control
Withdrawl of estrogen could lead to what effect?
Menustral bleeding
What are the cons of estrogen based contraception?
Increased risk of: Thrombosis MI Hypertension Hepatic neoplasms Breast cancer
What are the pros of estrogen based contraception?
Reduces: Dysmenorrhea or blood loss PMS or PMDD Endometriosis Acne Hirsutism Ovarian cyst and cancer Endometrial and colon cancer Benign breast condition
Incapacitate sperm
Copper IUD
Prevent ovulation
Hormonal contraceptives combined:
COCs
Emergency contraceptive pills ( plan B)
Combined hormonal vaginal ring
Prevent ovulation
Hormonal contraceptives (progestin only) Implants Injectable POPs Progestin only vaginal ring
Prevent ovulation
Lactation amenorrhea method (LAM)
Thickens cervical mucus
Hormonal contraceptive (progestin only) Hormonal IUDs Implants Injectable POPs Progestin only vaginal ring
Blocks sperm
Male and Female condom
First generation progestin agents
Norethindrone
Norethindrone acetate
Second generation progestin only
Levonorgestrel
Norgestrel
3rd generation progestin
Norgestimate
Desogestrel
Fourth generation progestin
Drospirnone
Estrogen agents
Mestranol
50mcg
Metabolized EE
Estrogen agents
Ethinyl estradiol ( most oral contraceptives)
Low dose: 10,20,25,30,35 mcg
50 mcg rarely used
Estrogen agent
Estradiol valerate
Contained in quadriphasic product
Estrogen agent
Esterol
How’s the USMEC organized?
Contraceptive method
Patient characteristics
Preexisting condition
Intrauterine contraception and can be inserted anytime during the menustral cycle except when pregnant
LARC
LARC
Copper-T IUD
LNG IUD
Arm implant
Patient wants regular menses and not want to use hormones
Copper-T IUD.
No hx of menorrhagia or dysmenorhea
Copper-T IUD
Off label EC and last 10 years
Copper-T IUD
Acceptable amerrhea and tolerable irregular bleeding
LNG IUD
History of dysmenorrhea or menorrhagia
LNG IUD
3-5years
LNG IUD
Tolerable irregular bleeding and last 3 years
Arm implant
Not contraindicated for intrauterine contraception
Multiple partners STD or PID history Teens Nulliparous women Immediately post partum or post abortion Ectopic pregnancy history
Actual contradiction for intrauterine contraception
Uterine fibrosis or uterus distortion
Active pelvic infection
Sepsis
Active pregnancy
What should a pharmacist do before prescribing: depo shot, pill, patch or ring
Review self-screening to evaluate contradictions
Screen for medication interaction
Rule out pregnancy
At what blood pressure should estrogen based depo shot, pill, patch or ring not prescribed
BP >140/90
DMPA
A dose progestin shot
DMPA dose
150 mg IM every 12 weeks
What is the benefit of DMPA
Last 3 months
Reduce risk of endometrial, Ovarian cancer or PID
Lacks estrogen
Decrease frequency of sickle cell or seizures
What are the adverse effect of DMPA?
Weight gain
Mood changes
Hair loss
Irregular bleeding
What are the disadvantages of using DMPA
Amenorrhea
Injection
Decrease HDL
Delayed return of fertility
Does not protect against STD
In patient with low HDL, which contraceptive is probably not appropriate
DMPA shots
In Patient who want to get pregnant immediately after the use of contraceptives, which contraception should not be recommended?
DMPA shots
According to WHO, which patient population does the benefit of DMPA outweigh its fracture risk
Adolescents and women >45 years old
True or false per WHO guideline: there is restriction on the use of DMPA in eligible women 18-45 years old
False
Combined contraceptive pills (COCs)
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
What is the 91-day extended cycle oral contraceptive( seasonale)
84 days of constant pill taking and 7 days of placebo
How is transdermal patch: Ortho Evra or Xulane once weekly used?
Apply once weekly for 3 weeks followed by one free week
How is transdermal patch: Ortho Evra or Xulane continuous use administered
Once weekly with no free days
What area of the body should transdermal patches be applied
Upper outer arm, upper torso, buttock or abdomen
How is vaginal ring (nuvaring) administered
Insert for 3 weeks, then removed for a week
Or
For continuous use change once every four weeks
What is Day 1 start of combined hormonal contraceptives
CHC use starts on first day of menses regardless what week day
What is quick start of combined hormonal contraceptives
Start using CHC on the day it was obtained
What is Sunday start of combined hormonal contraceptives
Start using on the Sunday after menses begins
which of the combined hormonal contraceptives do not require backup such as condom
Day I start
which of the combined hormonal contraceptives require backup such as condom for one week
Quick and Sunday start
What should a pt do if they miss a dose
Take ASAP