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NAPLEx > contraception & Infertility > Flashcards

contraception & Infertility Flashcards

1
Q

ovulation summary

A
  • The surge in estrogen causes luteinizing hormone (LH) and FSH (follicular stimulating hormone)
  • LH surge triggers ovulation 24 -36 hours
  • Luteal the start of ovulations begins and which lasts till 14 days, progesterone is dominant in this phase
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2
Q

ovulation kits

A

measure LH, first urine, if LH is present, ovulation will occur in 24-36 hers, best time for intercourse to conceive

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3
Q

prego

A

human chorionic gonadotropin (hCG) positive
generally best to measure w/ prego test first urine when levels would be the highest

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4
Q

folic acid

A

400mcg DFE to 600mcg DFE (which is equivilant to 360mcg RDA)

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5
Q

return to fertility

A

most contraceptions you return to fertility immediately, but medroxyprogesterone injection

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6
Q

caya

A

diaphragm, single size and does not require fitting (some do require prescription for fitting)

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7
Q

oil-based lubricants

A

never recommend oil-based lubricant for use w/ a latex or non-latex synthetic condom. ONLY recommend water or silicon-based lubricants

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8
Q

Phexxi

A

prescription-only vaginal gel that maintains an acidic pH (3.5-4.5)
spermicide OTC, but keep in mind, higher risk of STDs, UTIs, not a good option..

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9
Q

hormonal contraceptives

A

inhibit the production of FSH and LH, which prevents ovulation
They also alter cervical mucus, which inhibits the sperm from penetrating the egg

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10
Q

progestin-only options

A

pill, injectable, implantation, and IUD

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11
Q

estrogen/progestin products

A

pill, patch, and vaginal ring
oral products are called COCs- combination oral contractacpetions

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12
Q

progestin is what in most COCs products

A

norethindrone, levonorgestrol, drospirenone

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13
Q

monophasic COCs

A

same dose of estrogen and progestin throughout the pill pack

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14
Q

biphasic, triphasic, and quadriphasic COCs

A

mimic the estrogen and progestin levels during the menstrual cycle

bi, tri, quad- represents the number of times the hormones changes

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15
Q

drospirenone

A

potassium-sparing diuretics

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16
Q

elagolix

A

orilissa- is FDA-approved for moderate to severe pain associated w/ endometriosis

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17
Q

heavy menstrual bleeding

A

menorrhagia
COC Natazia and the levonorgestrel-releasing IUD Mirena are indicated

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18
Q

lysteda

A

an oral formulation of tranexamic acid (antifibrinolytic) is a non-hormonal tx for menorrhagia

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19
Q

POPs- progestin-only pills

A

suppress ovulation
and thicken the cervical mucus to inhibit sperm penetration and thinning the endometrium

primarily used in breastfeeding women cause estrogen decrease milk production, and increase thrombosis risk

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20
Q

POPs adherence

A

must be taken within 3 hours of the scheduled time

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21
Q

migraines w/ aura

A

estrogen CAN NOT be used, increased risk of stroke, POPs are used

22
Q

Depo-prevera, prevera

A

medroxyprogesterone
IM, every 3 months
progesterone only- suppressed ovulation, thickens the cervical mucus and causes thinning of the endometrium
About half of users will be amenorrheic (no menses) after 1 year of use..

23
Q

extended-cycle COCs

A

periods every 3 months

24
Q

“Lo”

A

means <=35mcg of estrogen
ex: Loestrin

25
Q

“Fe”

A

iron supplement included
ex: Loestrin Fe

26
Q

“24”

A

shorter placebo time 24 active, 4 placebo= 28 day cycle

27
Q

monophasic formulations

A

Junel Fe 1/20 (1mg norethindrone, 20mcg EE)
Microgestin Fe 1/20
Sprintec 28
Loestrin 1/20, Loestrin 24 Fe, Lo Leostrin Fe
Yasmin 28, Yaz

28
Q

biphasic, triphasic formulation

A

ortho tri-cyclen lo, tri-sprintec

29
Q

quadriphasic formulation

A

Natazia

30
Q

Extended Cycle Formulation

A

Seasonique

31
Q

drospirenone-containing formulation

A

Yasmin 28, yaz

32
Q

continuous formulation

A

amethyst
no inactive pills

33
Q

patch

A

xulane, twirla

34
Q

progestin-only

A

Errin, Camila, Nora-Be

35
Q

ACHES

A

severe & rare AE of estrogen
A-abdominal (stomach) pain that is severe
C- chest pain
H- headaches
E- eye problems
S- swelling or sudden leg pain

36
Q

box warning
all estrogen-containing products (pills, rings, patch)

A

do not use in women >35 old who smoke due to risk of serious cardiovascular events

37
Q

box warning
estrogen + progestin transdermal patch

A

increased risk of DVT/PE compared to COCs

38
Q

box warning
depo-Provera

A

loss of bone mineral density w/long-term use

39
Q

box warning
do not use estrogen w/ these conditions

A

history of DVT/PE, stroke, CAD… etc
history of breast, ovarian, or liver cancer
severe headaches or migraines w/ aura

40
Q

what decreases hormonal contraception efficacy

A
  • antibiotics (inducers- rifampin, rifabutin…)
  • aniconvulsants (carbamazepine….)
  • st. john’s wort
  • smoking tobacco
  • ritonavir
  • bosentan
  • mycophenolate
41
Q

liver tox

A

mavyret and viekira pack can not be used w/ any ethinyl estradiol due to the risk of liver tox.

42
Q

COCs
1 late or missed pill
<48hrs since the last dose

A
  • take the missed pill as soon as possible and take the next dose on schedule even if its 2 pills in 1 day
43
Q

COCs
2 missed pills (>= 48hrs since last dose)

A
  • take the missed pill as soon as possible and take the next dose on schedule even if its 2 pills in 1 day
    —> Consider emergency contraception if unprotected sex in last 5 days
    if week 3
  • Omit hormone-free week: start the next pack of pills right after finishing current pack
44
Q

POPs
if >3 hrs past scheduled time

A

back up contraception required x 48hrs
—> Consider emergency contraception if unprotected sex in last 5 days

45
Q

IUD

A

Mirena (FDA approved for heavy menstural bleeding)
Skyla
Kyeena
Liletta
this is progestin levonorgestrel

46
Q

copper-T

A

paraguard
EC/ and regular birth control
not hormonal

47
Q

Copper IUD
- EC

A

within 5 days
paragard

48
Q

Ulipristal

A

Ella
ASAP, within 5 days
prescription needed

chemical causing of mifepristone… so there is a controversy but nothing is proven

49
Q

Levonorgestrel

A

Plan B or generic
ASAP, within 3 days
OTC

50
Q

infertility drugs act like

A

try to increase LH/FSH –>ovulation

Clomiphene acts as estrogen to increase LH/FSH

Aromatase inhibitors suppress estrogen to increase FSH

gonadotropin drugs acts as LH, FSH, or hCG

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