11. Contraception Flashcards Preview

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Flashcards in 11. Contraception Deck (81):
1

Informed Consent Acronym

BRAIDED

Benefits
Risks
Alternatives
Inquiries
Decision
Explanation
Documentation

2

Natural Family Planning Methods (4)

• Coitus interuptus (Withdrawal)
• Periodic abstinence (NFP)
• Cervical mucus method
• Symptothermal method (Combo of all)

3

Two methods of periodic abstinence (NFP)

• Rhythm method (Calendar method)
• Basal body temperature method

4

What is the rhythm method?
• Type
• Must have what?

• Form of periodic abstinence
• Must have regular, predictable cycles

5

Basal body temperature method (3)

• Taken immediately after waking and before getting out of bed.
• Temps recorded on the graph to document trend
• Observe for Thermal shift
o Abstinence from day of temp drop x3days

6

Thermal shift with BBT (2)

• Right before ovulation: Slight drop in temp
• With ovulation the temp rises 0.2-0.4*C

7

Outside factors that affect BBT

• Alcohol
• # of hours of sleep
• Infection

8

When do you start observation for cervical mucus method?

Last day of the menstrual flow

9

Cervical mucus method: What are you looking for?

Spinnbarkheit

(mucus thin and watery like egg whites prior to ovulation)

10

What is the most effective method of NFP?

Symptothermal -- a combo of all methods

11

Standard days method: Def

Standardized version of calendar method

12

Requirement for standardized days method

Must have a cycle of 26-32 days

13

When are the fertile days for the standardized days method

8-19 -- avoid unprotected intercourse

14

Predictor test for ovulation: What is it testing for?

Detects LH surge prior to ovulation

15

Predictor Test for ovulation: Benefit

Not affected by illlness, emotional upset or physical activity

16

Pre-ovulation mucus characteristics (4)

• Thick
• Cloudy
• Sticky
• Slippery

17

Ovulation mucus characteristics (4)

• Clear
• Wet
• Sticky
• Slippery

18

Types of barrier methods (4)

• Condoms (male and female)
• Diaphragm
• Cervical cap
• Lea's Shield / Fem Cap

19

Patient teaching: Male condom (3)

• Must counsel about proper use / application
• Apply the condom on the penis after it is erect and before intimate contact
• Lubricants: Do not use petroleum-based products because they cause the condom to break

20

Male Condom side effects (2)


• Irritation
• Allergy (latex)

21

Female condom patient teaching (3)

• Female controlled
• Can insert 8 hours prior
• Must remove after

22

Female condom side effects (2)

• Irritation
• Polyurethane

23

When would a patient need a new diaphragm (2)

o Requires fitting and refitting if excessive weight gain or loss (20%)
o Replace every 2 years

**By Rx only**

24

Diaphragm: Method

o Works by covering the cervix to prevent sperm from entering and killing sperm with spermicide application

25

Diaphragm insertion and removal (3)

• Diaphragm is used every time you have intercourse
• Must be left in place for six hours after intercourse
• Check device for integrity

26

Diaphragm patient teaching

o Efficacy diminishes with increased frequency of intercourse

27

Cervical cap characteristics (4)

o No longer in US
o Fitting, use and efficacy similar to diaphragm
o Must use with spermicide
o Efficacy decreases with parity

28

• Other Cervical Barriers: Lea’s Shield, Fem Cap (6 characteristics)

o Use is similar to diaphragm, cap
o Requires prescription
o Femcap requires fitting
o Reusable
o Silicone
o Use with spermicide

29

Contraceptive sponge (3 characteristics)

o Female controlled
o Available OTC
o Insertion and removal

30

Types of intravaginal spermicides (6 - don't memorize)

o Foams
o Tablets
o Suppositories
o Creams
o Films
o Gel

31

Spermicides -- side effects (3)

o Irritations
o Rash
o Microlacerations

32

What is the most commonly used spermicidal chemical in the US?

N-9

33

Mechanism of N-9

o Surfactant that destroys the sperm cell membrane on the surface

34

When must spermicide be used?

Just before intercourse

35

How many different contraceptive formulations are available in the US?

More than 30

36

What do hormonal contraceptives consist of?

Estrogen-progesterone or just progesterone

37

Hormonal contraceptives: Mechanism of action (3)

o Estrogen suppresses production of FSH and LH, suppressing ovulation
o Endometrium remains thin
o Cervical mucus is thick

38

Hormonal contraceptive contraindications: Cardiovascular / blood (4)

o Thromboembolitic Disorders
o Coronary artery or cerebral vascular disease
o Severe diabetes (with vascular involvement)
o Uncontrolled HTN

39

Hormonal contraceptive contraindications: Hormonal (3)

o Breast cancer (estrogen positive tumors)
o Estrogen dependent tumors


40

Hormonal contraceptive contraindications: Other things (3)

o Currently impaired liver function or liver tumor
o Smoking (>35 y/o)
o Migraines with neurologic symptoms

41

Hormonal contraceptive contraindications: Related to childbearing

o Lactation (no combined contraceptive pills)
o Pregnancy

42

Possible side effects of Hormonal Contraceptives

• Estrogen excess

43

What are the symptoms of estrogen excess? (8)

• N/V
• Dizziness
• Edema
• Increased breast size
• chloasma
• Visual changes
• Hypertension
• Vascular HA

44

Sxs of estrogen deficiency (7)

• Early spotting (days 1-14)
• Hypomenorrhea
• Nervousness
• Vaginal dryness
• Breast tenderness
• Oily skin and scalp
• Hiritruism

45

Sxs of progesterone deficiency (3)

• Late spotting (days 15-21)
• Heavy flow with clots
• Increased breast size

46

Hormonal contraception warning signs (5)

A - Abdominal Pains

C - Chest pain

H - Headache

E - Eye changes

S - Severe leg pain

47

Contraceptive warning signs: Abdominal pain

May indicate a problem with the liver or gall bladder

48

Contraceptive warning signs: Chest pain

Chest pain or shortness of breath may indicate possible clot problems within the lung or heart

49

Contraceptive warning signs: Headache (2)

• May be sudden or persistent
• May be caused by CVA or HTN

50

Contraceptive warning signs: Severe leg pain

May indicate a thromboembolitic process

51

How are combined oral contraceptives packaged?

21 or 28 days

52

When should you start taking oral contraceptives?

The first sunday after menses starts

53

What causes failures with oral contraceptives?

Missed pills

54

Side effects from oral bc (5)

• Nausea
• Breast tenderness
• Fluid retention
• Chloasma
• Early spotting (lo estrogen)

55

What is OrthoEvra

A transdermal contraceptive patch

56

Transdermal Contraceptive patch - what is it?

Delivers continuous levels of hormones

57

What is lunelle?

A combined monthly injection (IM)

58

Lunelle - mechanism (2)

• Works the same way as other combination hormonal contraceptives (pill, patch, ring)
• Prevents ovulation so that no sperm can fertilize an egg

59

Vaginal / nuva ring - patient counseling (3 components)

o The ring is thought to be as effective as oral contraceptives
o The first time the vaginal ring is used, it is inserted during the first five days of menstruation
o Effectiveness of a vaginal ring is lowered when taken with certain medications

60

Extended use regimens
• When approved
• Contents
• Time frame
• Brand name

• Approved by the FDA in 2003
• Contains both estrogen and progestin and is taken in 3-month cycles
• 12 weeks of active pills followed by 1 week of inactive pills
• Brand name: “Seasonale”

61

Progestin only contraceptives - benefit

• Eliminates side-effects of estrogen

62

Progestin only contraceptives: Mechanism of action (3)

o Inhibits ovulation
o Thickens and decreases the amount of cervical mucus
o Thinning endometrium

63

What is Depo-Provera?

Injectable Progestin

64

Emergency Contraception: Def

High doses of oral contraception taken to prevent ovulation or implantation

65

Emergency Contraception: Effectiveness

75-89% effective

66

2 protocols of emergency contraception

- Split or single dose
- 72 or 120 hours

67

Emergency contraception: Mechanism

High hormonal levels prevent or delay ovulation, thicken the cervical mucus and later the sperm transport in order to prevent fertilization.

68

Emergency contraception -- must be used before...

IMPLANTATION

69

Intrauterine contraception -- mechanism of action (3)

o Damages sperm in transit to tubes
o Uterine lining inhospitable
o Effect mucus and endometrial maturation

70

Two types of IUDs

o Copper T: Approved for 10 years
o Progesterone based: Approved for 5 years

71

Contraindications of IUDs (8)

o Not monogamous
o Pregnant
o HIV +
o Undiagnosed vaginal bleeding
o Pelvic infections
o Recent endometritis
o Uterine / cervical cancer
o Allergy to copper

72

What is Mirena?

A Type of IUD

73

Mechanism of Mirena (4)

• Thickens cervical mucus
• Impairs sperm migration
• Alters the endometrium to prevent implantation
• Inhibits ovulation

74

Mirena -- Contraindications (3)

• Breast cancer
• Undiagnosed vaginal bleeding
• Liver disease

75

IUD Warning Signs

P - Period Late
A - Abdominal Pain
I - Infection Exposure
N - Not feeling well
S - String missing / changes in length

76

Male / Female sterilization:

Female: Tubal Ligation
Male: Vasectomy

77

Induced abortion - types

Elective or therapeutic,

Medical or surgical

78

Medical abortion: Timing

7-9 weeks or earlier

79

Surgical abortion: Types and Timing (3)

• Manual Vacuum Aspiration (MVA) <14 weeks
• Dilation and evacuation (D+E) up to 20 weeks

80


• Method (2 components)




o Complete abstinence during fertile period
o To determine fertile period, must record menses for 6 mo

81

Rhythm method:
• How to calculate

How to calculate:
• Length of shortest cycle minus 18 days (start of fertile period)
• Length of longest cycle minus 11 days (end of fertile period)