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Exam 9 > Contraception > Flashcards

Contraception Flashcards

1
Q

Estrogen and progesterone ____ feedback to anterior pituitary to prevent___

A

negative

ovulation

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2
Q

What is the difference between endogenous estrogen vs what is in the pill

A

exogenous is more potent

the pill has ethinyl estradiol

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3
Q

What are qualities of the 4 different generations of progesterone

A

1st: potent, well tolerated
2nd: longer half life, more androgenic
3rd: work on minerocorticoids too, fewer androgenic side effects. risk of thromboembolism
4th: increased thromboembolism, antimineralcorticoid and antiandrogen

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4
Q

What are 1st gen progesterone? 2nd? 3rd? 4th?

A

1st: morethinddrone, ethylnodiol
2nd: levonorgestrel, norgestrel
3rd: norgestimate, desogestrel
4th: drospirenone, dienogest, segesterone

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5
Q

estrogen suppresses ___ which causes what

A

FSH-> no follicles grow, no LH surge so no ovulation

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6
Q

Progesterone acts at the ______

A

cervical mucus and thickens it. less lush endometrium, impaired tubal motility

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7
Q

Endogenous hormones have ___ oral absorption

A

poor

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8
Q

extensive first pass metabolism with estrogen at _____

A

CYP3A4

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9
Q

Proposed male contraception is proposed to work to reduce ___

A

GnRH. need to have androgen as well so body doesn’t rev up (?)

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10
Q

What are the risks of OCP

A

VTE! (varies by estrogen, age, BMI, smoking)

Stroke: be careful in individuals with HTN, DM, obesity, migraines with aura, cirrhosis

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11
Q

What are the risk profiles with using OCP and cancer

A

ovarian and endometrial: decreased risk
cervical: maybe increased
breast cancer: mixed

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12
Q

What are side effects of cOCPs

A

mood changes, libido changes, nausea, breast tender, HA, breakthrough bleeding, amenorrhea

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13
Q

The patch gives you (increased/decreased) systemic exposure to estrogen becasue____

A

increased, bypass the first pass metabolism

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14
Q

What do you do if the patch falls off

A

if it falls off >24 hours, or if interval lasts longer than 9 days, use backup method

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15
Q

The patch is not indicated for _____

A

individuals BMI>30, >200lb

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16
Q

What are the differences between NuvaRing vs Annovera. Similarities?

A

Nuva-> every 4 weeks insert new ring
Annovera: you can insert same ring after removal for 1 week
keep in for 3 weeks, remove for 1

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17
Q

There is ____ variability in level of hormones for the ring and patch

A

less. the level of hormone is sustained more.

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18
Q

What are some of the risks for the patch and ring

A

VTE, CV, cancer risk (maybe)

overall same as OCPs

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19
Q

For the patch there is a relative contraindication for people will

A

morbid obesity. There is not the same contraindication with the ring

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20
Q

What is lactation amenorrhea?

A

nursing-> hypothalamus-> decreased GnRH pulse frequency-> hormones disrupted-> no egg, no pregnancy

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21
Q

Estrogen inhibits ___ more than progesterone

A

lactation

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22
Q

Norethindrone has a _____ half life, so if you miss a dose >/= 3 hrs, you need to ___

A

short

backup method for 48 hours

23
Q

Drospirenone is the new progesterone containing tablet and could cause an increased in ___ and if you miss a dose >24 hours, use______

A

potassium

use backup method for 7 days

24
Q

What is the risks for drospirenone?

A

higher increase for VTEs, be VERY careful in individuals who were just pregnant

25
Q

POPs MOA?

A

thicken cerical mucus, endometrial decidualization and atrophy, impaired tubal motility

26
Q

With progesterone only pills, they may not______

A

prevent ovulation. Not predicable for cycle control

27
Q

POPs side effects

A

irregular bleeding, increased acne, no impact on weight gain

28
Q

POP contraindications

A

Pregnancy, breast cancer, uterine bleeding, liver disease

29
Q

Women who have undergone________ or taking ______ are not advised to use POPs

A

malabsoptive bariatric surgeries, certain anticonvulsants

30
Q

Even with perfect use, POPs have a __% failure rate

A

5

31
Q

What molecule is in depo

A

medroxyprogesterone

32
Q

There are two versions of depo. There are:

A

IM and SQ

33
Q

How does depo work for 3 months?

A

acetate group added that keeps the molecule there for longer

34
Q

Depo should be administered by the ___ day of menses

A

5th

35
Q

Depo inhibits ____, produces shallow endometrium, and thickens ___

A

FSH and LH

cervical mucus

36
Q

There is erratic absorption of depo when given ___

A

IM. The SC formula is less eratic

37
Q

Return to ovulation after depo could take up to

A

10 months

38
Q

Are the worries with bone mineral density with depo

A

Not really. physiologically yes but not seen clinically

39
Q

Depo is ok in women with history of __

A

VTE

40
Q

What are common side effects of depo

A

irregular periods, no periods, bone density loss, weight gain, delayed return to fertility, injection reactions

41
Q

Depo contraindications

A

pregnancy, breast cancer, uterine bleeding, liver disease, long term risk of corticosteroid therapy

42
Q

nexplanon is a single rod implant of _____ and it releases 60mcg/day for ___ years

A

etonogestrel

3 years

43
Q

Implant Nexplanon during days ___ of the cycle

A

1-5

44
Q

MOA of Nexplanon

A

inhibits gonadotropins (FSH, estrogen), produce shallow and atrophic endometrium and produces vertical mucus

45
Q

Nexplanon return to ovulation within ____ after removal

A

7-14 days

46
Q

What are the 4 commonly used progestin-based IUDs

A

Mirena (7 years)
Liletta (6 years)
Kyleena (5 years)
Skyla (3 years)

47
Q

MOA of IUDs

A

low grade intrauterine inflammation, increased prostaglandin formation primarily spermicidal, interfere with implantation
endometrial suppression

48
Q

Nexplanon risk and side effects

A

no VTE, CV risk, no impact on breast cancer

irregular bleeding, increased acne, HA, local inflammation or bruising on placement

49
Q

Hormonal IUD risks and side effects?

A

no VTE, CV, breast cancer risk. perforation with placement/expulsion. ectopic pregnancy
irregular bleeding, cramping

50
Q

Hormonal IUD contraindications that are not the standard contraindications

A

severely distorted uterine cavity

active PID

51
Q

Copper IUD can be used as _____

A

emergency contraception

52
Q

What is the MOA of copper IUD

A

?????
(intrauterine inflammation-> increased prostaglandin formation -> spermicidal/impaired sperm transport. Also interferes with implantation)

53
Q

Risks of copper IUD? Side effects?

A

expulsion/perforation, ectopic pregnancy

continued cyclic bleeding (heavier), cycles may be longer and crampier

54
Q

What is a contraindication for copper IUD that is different from the usual contraceptives?

A

Wilson’s disease/copper allergy
(Relative: heavy periods, anticoagulation use, coagulopathy)
And strike liver disease from the typical list

Exam 9 (8 decks)

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