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Endocrinology > Hormonal Contraception > Flashcards

Hormonal Contraception Flashcards

1
Q

T/F: Condoms and Hormonal contraceptives can prevent STIs?

A

F; ONLY condoms (ONLY latex and synthetic)

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2
Q

What is the MOA of condoms?

A

Mechanical barrier between vagina and semen/genital lesions/infectious secretions

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3
Q

What are some counseling points for condoms?

A
  • Do NOT combine vaginal and penile condoms
  • Penile condoms sold with pre-lubricated spermicide is NOT recommended
  • AVOID mineral oil and latex: medications (Monistat, Premarin, Cleocin), lubricants, and lotions
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4
Q

What is the preferred lubricant?

A

Water soluble lubricant
* Astroglide and K-Y jelly

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5
Q

What is the MOA of Spermicides and Spermicide-implanted barrier techniques?

A

Chemical surfactant
* Destroy sperm cell wall
* Barrier–> prevents sperm accessing cervix

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6
Q

What are some counseling factors for Spermicides and Spermicide-implanted barrier techniques?

A
  • Most products contain **Nonoxynol-9 **which can increase the risk of transmission of HIV if used more than 2/day
  • Does NOT protect against STIs
  • Can improve efficacy of barrier methods
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7
Q

What is the MOA of Nonoxynol-9?

A

Small disruptions of the vaginal epitheliu

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8
Q

What activity types does progestin have?

A
  • Progestin activity
  • Estrogenic and antiestrogenic activity (dependent on extent of progestins’ metabolism to estrogenic substances)
  • Androgenic effects (dependent on presence of SHBG and androgen-to-progesterone activity ratio)
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9
Q

What are the MOA of progestins?

A
  • Sustained progestin exposure blocks LH surge–inhibiting ovulation
  • Decrease ovum motility in fallopian tubes
  • Thins endometrium, reducing chance of implantation
  • Thickens cervical mucus, producing barrier to sperm
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10
Q

What are some counseling points for Oral Progestin only “mini pills”?

A
  • Irregular periods and unpredictable periods
  • Strict adherence is necessary for efficacy
  • Do NOT block ovulation (risk for ectopic pregnancy)
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11
Q

What happens if you take your oral progestin only “mini pills” late?

A

If taken more than 3 hrs late, then need backup contraception for 48 hrs

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12
Q

When do you administer DMPA?

A

Administered every 3 months within 5 days onset of menstrual bleeding

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13
Q

Where do you administer DMPA?

A
  • Deep IM injection to gluteal/deltoid muscle
  • SubQ in abdomen/thigh
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14
Q

What are some counseling points for DMPA?

A
  • Requires medical visit
  • In ABSENCE of pregnancy
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15
Q

What happens if you miss a dose of DMPA?

A
  • No backup need if administered between day 1-7 of menstrual cycle in patients who have NOT used CHC
  • If given any other time of the menstrual cycle, 7 day backup contraception needed
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16
Q

What are some contraindications of DMPA?

A

Current breast cancer diagnosis

17
Q

Which patients should DMPA used in caution for?

A
  • Breast cancer
  • Vascular/cardiovascular/cerebrovascular disease
18
Q

In which patient does injected progestins benefit?

A
  • Breastfeeding
  • Estrogen intolerance (estrogen-related headache, breast tenderness, nausea)
  • Sickle cell disease (reduction in sickle cell pain crises)
  • Seizure disorders (reduction in seizures)
  • Return to feritlity may be delayed
19
Q

What are some adverse effects of injected progestins?

A
  • Menstrual irregularities (most common in first year of use)
    * Spotting
    * Prolonged bleeding
    * Can take NSAID for 5-7 days
    * Short course of estrogens (10-20 days) if not contraindicated
    * Amenorrhea
  • Breas tenderness
  • Depression
  • Weight gain-wide variability
  • Short term bone loss
20
Q

Nexplanon

A
  • Subdermal progestin implant
  • Taper down until end of 3 year use (FDA recommends 3 year use but can be up to 5 for off-label use)
  • Possible decreased efficacy if 130% of ideal body weight
  • Placed under the skin in the upper arm
21
Q

When can Nexplanon be administered and do we need backup?

A
  • Reasonable absence of pregnancy
  • Can be inserted any time
  • No back up needed if inserted day 1-5 of menstrual cycle
  • Backup for 7 days if inserted at any other time
22
Q

What are the adverse effects of subdermal progestin implant?

A
  • Irregular menstrual bleeding
  • Amenorrhea with continued use
  • Prolonged bleeding (short course of NSAIDs/estrogens)
  • Prolonged spotting
  • Frequent bleeding
23
Q

What is a potential drug interaction of Nexplanon?

A

CYP450 inducers

24
Q

What is the MOA of IUD?

A
  • Progestin containing (endometrial suppression, thickening cervical mucus)
  • Inhibition of sperm migration
  • Damaging ovum/disruption transport
  • Damaging fertilized ovum
25
Q

What patients should NOT have an IUD?

A
  • Pregnancy
  • PID
  • Current STI
  • Puerperal/post-abortion sepsis
  • Purulent cervicitis
  • Undiagnosed abnormal vaginal bleeding
  • Malignancy of genital tract
  • Uterine anomalies/fibroids distorting uterine activity
  • Allery to components
26
Q

What are some patient counseling points for Copper IUD (ParaGard)

A
  • Highly effective, can be left in place for 10 years
  • Increases menstrual blood flow/dysmenorrhea
27
Q

When do you administer IUD?

A
  • Days 1-7 menstrual period–> no backup needed
  • Any other day backup is needed for 7 days
28
Q

What are the adverse effect of each IUD?

A
  • Irregular effects
  • Copper IUD: heavy bleeding
  • Levonorgestrel: Spotting for first 6 months
  • Amonorrhea
  • Prolonged bleeding (Short course of NSAID/estrogen)
29
Q

What is the first line emergency contraception?

A
  • Progestin only products
  • Progestin receptor modulatory products
30
Q

What is the MOA of progestin-only formulations (levonorgestrel 1.5 mg)?

A

Inhibiting or delaying ovulation

31
Q

Ulipristal acetate

A

Selective progesterone receptor modulator with mixed progesterone agonist and antagonist properties

32
Q

What are some counseling points for ulipristal acetate?

A
  • Take within 5 days
  • NOT recommended in breastfeeding
  • AVOID using hormonal contraception method and avoid initiating new hormonal contraception for at least 5 days after administration
33
Q

What are some adverse effects of emergency of emergency contraception?

A
  • Nausea/vomiting (occur less with progestin only and progesterone receptor modulator EC)
  • Irregular bleeding (menstrual period occurring 1 week before or after expected time)
34
Q

Compare the efficacy of emergency contraception

A

Copper IUD > Ulipristal acetate > levonorgestrel

35
Q

What is the MOA of estrogen?

A

Bind to the nuclear receptors in estrogen responsive tissue, impacts secretions of:
- Gonadotropins
- LH
- FSH

Endocrinology (10 decks)

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