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Pharm Spring 2023 > Womens Health Part 2 > Flashcards

Womens Health Part 2 Flashcards

1
Q

What condoms protect against STD

A
  1. Latex or synthetic
    *do not use sheepskin
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2
Q

How does lactational amenorrhea work (contraceptive)

A
  1. Must breastfeed on demand at least 5 to 6 days a week with 10 min or longer per session or >65 min per day without supplementation from other sources
  2. <2% change within first 6 months after birth
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3
Q

What is the paragard / copper IUD (non-hormonal contraception)

A
  1. Copper is spermicidal
    *prevention of implantation
  2. Effective immediately for up to 10 years
  3. Emergency contraceptions
    *insert within 5 days of unprotected intercourse
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4
Q

What are the ADEs of ParaGard / copper IUD

A

Heavy bleeding
Spotting
Cramping

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5
Q

How does estrogen + progestin products work for contraception

A
  1. Inhibit the LH and FSH hormone surges that normally lead to ovulation and change cervical mucus, preventing sperm from reaching the egg
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6
Q

How do progestin only contraceptive products work

A
  1. Makes endometrial less suitable for implantation
    *long term cyclic or daily exposure of progestin leads to endometrial atrophy
    *thickens cervical mucus
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7
Q

What are the combined hormonal contraceptives

A
  1. One synthetic estrogen (ethinyl estradiol + one progestin)
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8
Q

What are monophasic combination oral contraceptives

A
  1. Same dose of estrogen and progestin throughout the pack
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9
Q

What are biphasic, triphasic, and quadriphasic combination oral contraceptives

A
  1. Mimic estrogen and progesterone levels during menstrual cycle
    *differ based upon the number of times the hormone amount changes
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10
Q

What are extended cycle combination oral contraceptives

A
  1. > 21 days of active hormone (monophasic only)
    *period every 3 months
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11
Q

What is a “menstrual start” for combined oral contraceptives

A
  1. Start within the first 5 days of menstruation
    *effective immediately
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12
Q

What is a “random start” when starting combined al contraceptives

A
  1. Randomly start on any day
    *takes 7 days to work
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13
Q

What are the progestin only oral contraceptives

A

Mini pills
1. Nora
2. Camila
3. Errin
Norethindrone 35mcg
*taken daily with no placebo or pill free interval
*can start on any day

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14
Q

How long does it take for progestin only oral contraceptives to work and is it okay to miss a dose

A
  1. Works within 48 hours
  2. If >3 hours late, use alternative contraception for next 48 hours
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15
Q

What are the non oral contraceptives (injectable progestins)

A
  1. Depo-provera 150 mg IM every 13 wk
  2. Depo-subQ Provera 104 mg sc every 12-14 wk
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16
Q

What are the fertility problems with injectable progestins and BBW

A
  1. Return to fertility may be delayed 10 to 12 months
    BBW: longer term use >2 years May cause bone mineral density loss that may not be reversible upon stopping
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17
Q

What is the transdermal patch

A
  1. 20mg EE and 0.15mg norelgestromin
  2. One patch weekly for 3 weeks then one week patch free
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18
Q

What are the efficacy problems with the transdermal patch and risk problems

A
  1. Efficacy may be compromised in women >90kg (198lb)
  2. Increased risk of VTE vs COC w/35 mcg EE
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19
Q

What is the contraceptive ring

A

Vaginal ring, one size fits all
*left in for 3 weeks, one week ring-free
1. 15 mcg EE and 0.12 mg etonogestrel
*least estrogen available in CHC

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20
Q

What are the levonorgestrel IUDs (effective for 3 years)

A
  1. Liletta
    *15.6 mcg
  2. Skyla
    *6mcg
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21
Q

What are the levonorgestrel IUDs (effective for 5 years)

A
  1. Kyleena (19.5mcg)
  2. Mirena (20 mcg)
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22
Q

What are some things to keep in mind with levonorgestrel IUD

A
  1. Use backup protection for 7 days post insertion (if inserted > 7 days post menstruation)
  2. Does not protect against STI
  3. Fertility returns almost immediately
23
Q

What are some warning signs of IUD

A
  1. Period late
  2. Abdominal pain or pain with intercourse
  3. Infection
  4. Not feel well, fever chills
  5. String (missing, shorter, longer)
    PAINS
24
Q

What are the ADEs of IUD

A
  1. Irregular bleeding (first 3 to 6 months)
  2. Infective (PID post insertion)
  3. Uterine perforation
25
What are the components of Nexplanon (implant)
1. Single rod system *68 etonogestrel 2. Effective for 3 years 3. Fertility rapid returns after removal
26
What are the duration of effectiveness and time until fertility returns with combined oral, progestin only oral, and injectable progestins
COC 1. As long as taken regularly 2. Within 1 to 2 months Progestin only 1. As Lon as taken regularly 2. Within 1 to 2 months Injectable progestin 1. 1/3 months 2. 10 to 12 months
27
What are the duration of effectiveness and time until fertility returns with Transdermal patch, contraceptive ring, liletta
Transdermal patch 1. Applied weekly X3 was 2. Within 1 to 2 months Contraceptive ring 1. Replaced every 3 weeks 2. Within 1 to 2 months Liletta 1. 3 years 2. Immediate
28
What are the duration of effectiveness and time until fertility returns with nexplanon, kyleena / mirena (levonorgestrel), copper IUD
Nexplanon 1. 3 years 2. Immediate kyleena / mirena (levonorgestrel) 1. 5 years 2. Immediate copper IUD 1. Up to 10 years 2. Immediate
29
What are the ADRs of estrogen
1. Nausea 2. Breast tenderness/fullness 3. Bloating 4. Weight gain 5. Elevated BP 6. Thrombosis
30
What are the ADRs of progestin
1. Drospirenone *slightly higher clotting risk b/c of increased potassium *avoid in kidney, liver, or adrenal gland disease
31
What are the BBW of hormonal contraceptives
1. All estrogen containing products *do not use in women >35 who smoke (risks of cardiovascular events) 3. Transdermal patch *increased risk of VTE/DVT/PE compared to COC 3, Depo-provera *loss of bone mineral density with long term use
32
When should you not use estrogen containing products
History of 1. DVT/PE 2. Stroke 3. CAD 4. Breast/ovarian/liver cancer 5. Uncontrolled HTN 6. Migraine with aura
33
If someone has no risk factors what contraception should they chose
1. Long term = IUD or implant 2. Short term = start with COC 20mg EE and older progestin
34
If someone if taking a CYP3A4 inducer what contraception should they use
1. Injectable medroxyprogesterone or IUD 2. If COC use product with EE >30mcg
35
If someone is obese what contraception should they choose
1. Formulation ups to 35mcg EE 2. Extended cycle may improve efficacy 3. Patch may not be as effective is >90kg
36
For women over 40 what contraception method should they choose
1. No more than 20 mcg EE 2. Avoid COC, patch, ring in women >35 w/ risk factors
37
If a women smokes what contraception should they chose
1. >35 years avoid COC due to increased risk of VTE 2. If <35 years use COC is no other factors for thrombosis
38
If the patient has migraines what type of contraception should they choose
1. No aura *can use COC <20mg EE *copper IUD *progestin only preferred
39
What is the safest contraceptive method for a patient with +/- aura
1. Progestin only or paragard 2. Aura = copper IUD of progestin only
40
If a patient has HTN what contraceptive can they use
1. If well controlled *okay to consider COC 2. Not well controlled or if SBP>140mmHg *avoid COC *consider progestin only 3. If SBP >160 or DBP >100 *use non hormonal contraception
41
If a patient has acne what type of contraceptive should they use
1. Use COC with lower androgenic activity (Sprintec) or no androgenic activity (Yaz)
42
If someone has an increased risk of VTE what should they avoid
1. Estrogen-containing contraceptive (COC, vaginal ring, patch) 2. Avoid desogesrel and dropsperinone
43
What are the signs and symptoms of a clot
ACHES 1. Abdominal severe pain 2. Chest pain 3. Headaches 4. Eye problems 5. Swelling or sudden leg pain
44
If someone missed their COC pill (<48 hours since last dose) what should they do
1. Take missed ASAP and next on schedule (even if 2 in 1 day) *no back up protection needed
45
If someone missed 2 of their COC pill (>48 hours since last dose) what should they do
1. Take most recent ASAP (discard other missed pills) 2. Take next dose on schedule (even if 2 pills in 1 day) *back up method needed *consider if unprotected sex in last 5 days
46
If someone missed their POP pill >3 hrs past the scheduled time what should they do
1. Take ASAP and next on schedule *back up is needed for 48 hrs *consider EC if unprotected sex in the last 5 days
47
What are the different type of emergency contraceptions
1. ParaGard IUD (cooper IUD) 2. Ella (ullipristal Acetate) 3. Levonorgestrel (plan B one step)
48
What are the components of ParaGard IUD (cooper IUD)
1. 99.9% effective within 5 days (most effective EC) *doctor / nurse placement *cramping and N/V common SEs
49
What are the components of Ella (ullipristal acetate)
Use within 5 days 1. 30mg requires prescription 2. MOA = delays ovulation and may also prevent implantation 3. Less effective if >195lb
50
What are the components of levonorgestrel (plan B one step)
Use within 3 days 1. MOA = prevents / delays ovulation and thickens cervical mucus 2. Less effective if 195lbs 3. Over the counter
51
If someone if postpartum and breast feeding what type of contraceptives should they use
1. Progestin only pills *avoid estrogen containing COC, patch, ring 2. Progestin only pills and copper IUD can start immediately postpartum 3. Medroxyprogesterone may be administered within first 5 days postpartum if NOT breast-feeding / pumping or at 6 weeks if breast feeding
52
What contraceptive should postpartum women avoid
NO COC for at least 6 weeks postpartum due to increase risk of thrombi’s
53
If someone if planing to get pregnant what should they consume or avoid
Consume *iron *folic acid Avoid conception *within 4 weeks of MMR and varicella vaccine

Pharm Spring 2023 (27 decks)

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