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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
Q

What are the components of Nexplanon (implant)

A
  1. Single rod system
    *68 etonogestrel
  2. Effective for 3 years
  3. Fertility rapid returns after removal
26
Q

What are the duration of effectiveness and time until fertility returns with combined oral, progestin only oral, and injectable progestins

A

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
Q

What are the duration of effectiveness and time until fertility returns with Transdermal patch, contraceptive ring, liletta

A

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
Q

What are the duration of effectiveness and time until fertility returns with nexplanon, kyleena / mirena (levonorgestrel), copper IUD

A

Nexplanon
1. 3 years
2. Immediate
kyleena / mirena (levonorgestrel)
1. 5 years
2. Immediate
copper IUD
1. Up to 10 years
2. Immediate

29
Q

What are the ADRs of estrogen

A
  1. Nausea
  2. Breast tenderness/fullness
  3. Bloating
  4. Weight gain
  5. Elevated BP
  6. Thrombosis
30
Q

What are the ADRs of progestin

A
  1. Drospirenone
    *slightly higher clotting risk b/c of increased potassium
    *avoid in kidney, liver, or adrenal gland disease
31
Q

What are the BBW of hormonal contraceptives

A
  1. All estrogen containing products
    *do not use in women >35 who smoke (risks of cardiovascular events)
  2. Transdermal patch
    *increased risk of VTE/DVT/PE compared to COC
    3, Depo-provera
    *loss of bone mineral density with long term use
32
Q

When should you not use estrogen containing products

A

History of
1. DVT/PE
2. Stroke
3. CAD
4. Breast/ovarian/liver cancer
5. Uncontrolled HTN
6. Migraine with aura

33
Q

If someone has no risk factors what contraception should they chose

A
  1. Long term = IUD or implant
  2. Short term = start with COC 20mg EE and older progestin
34
Q

If someone if taking a CYP3A4 inducer what contraception should they use

A
  1. Injectable medroxyprogesterone or IUD
  2. If COC use product with EE >30mcg
35
Q

If someone is obese what contraception should they choose

A
  1. Formulation ups to 35mcg EE
  2. Extended cycle may improve efficacy
  3. Patch may not be as effective is >90kg
36
Q

For women over 40 what contraception method should they choose

A
  1. No more than 20 mcg EE
  2. Avoid COC, patch, ring in women >35 w/ risk factors
37
Q

If a women smokes what contraception should they chose

A
  1. > 35 years avoid COC due to increased risk of VTE
  2. If <35 years use COC is no other factors for thrombosis
38
Q

If the patient has migraines what type of contraception should they choose

A
  1. No aura
    *can use COC <20mg EE
    *copper IUD
    *progestin only preferred
39
Q

What is the safest contraceptive method for a patient with +/- aura

A
  1. Progestin only or paragard
  2. Aura = copper IUD of progestin only
40
Q

If a patient has HTN what contraceptive can they use

A
  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
Q

If a patient has acne what type of contraceptive should they use

A
  1. Use COC with lower androgenic activity (Sprintec) or no androgenic activity (Yaz)
42
Q

If someone has an increased risk of VTE what should they avoid

A
  1. Estrogen-containing contraceptive (COC, vaginal ring, patch)
  2. Avoid desogesrel and dropsperinone
43
Q

What are the signs and symptoms of a clot

A

ACHES
1. Abdominal severe pain
2. Chest pain
3. Headaches
4. Eye problems
5. Swelling or sudden leg pain

44
Q

If someone missed their COC pill (<48 hours since last dose) what should they do

A
  1. Take missed ASAP and next on schedule (even if 2 in 1 day)
    *no back up protection needed
45
Q

If someone missed 2 of their COC pill (>48 hours since last dose) what should they do

A
  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
Q

If someone missed their POP pill >3 hrs past the scheduled time what should they do

A
  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
Q

What are the different type of emergency contraceptions

A
  1. ParaGard IUD (cooper IUD)
  2. Ella (ullipristal Acetate)
  3. Levonorgestrel (plan B one step)
48
Q

What are the components of ParaGard IUD (cooper IUD)

A
  1. 99.9% effective within 5 days (most effective EC)
    *doctor / nurse placement
    *cramping and N/V common SEs
49
Q

What are the components of Ella (ullipristal acetate)

A

Use within 5 days
1. 30mg requires prescription
2. MOA = delays ovulation and may also prevent implantation
3. Less effective if >195lb

50
Q

What are the components of levonorgestrel (plan B one step)

A

Use within 3 days
1. MOA = prevents / delays ovulation and thickens cervical mucus
2. Less effective if 195lbs
3. Over the counter

51
Q

If someone if postpartum and breast feeding what type of contraceptives should they use

A
  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
Q

What contraceptive should postpartum women avoid

A

NO COC for at least 6 weeks postpartum due to increase risk of thrombi’s

53
Q

If someone if planing to get pregnant what should they consume or avoid

A

Consume
*iron
*folic acid
Avoid conception
*within 4 weeks of MMR and varicella vaccine

Pharm Spring 2023 (27 decks)

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