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therapeutics > 44-45: Contraception > Flashcards

44-45: Contraception Flashcards

1
Q

Hormonal Contraception forms efficacy

A
  1. implant
  2. IUD
  3. shot
    4-6: pill, ring, patch
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2
Q

Hormones in contraceptives

A

-estrogen
-progestin

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3
Q

Mech of estrogen as contraceptive

A

-suppress FSH production = prevent dominant follicle = no ovulation
-inc sex-hormone binding globulin = inc binding of free androgens (dec acne)

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4
Q

Mech of progestin in contraceptives

A

-prevent LH surge = no ovulation (not most effective mech)
-thicken mucus = inhibit sperm
-change motility of tubes = inhibit sperm/ova transport
-atrophy of endometrium = no implantation

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5
Q

Common estrogens

A

-ethinyl estradiol
-estradiol valerate
-estetrol
-mestranol

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6
Q

Common progestins

A

-northindrone (acetate)
-norgestimate
-drospirenone
-norgestrel
-levonorgestrel
-segesterone acetate
-ethynediol diacetate
-desogestrel
-etonogestrel
-dienogest

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7
Q

Side effects from too much estrogen

A

-bloat
-breast tender
-mood swings
-headache
-nausea
-heavy menses
-fibroid growth
-melasma
-vision changes
-cyclic weight gain

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8
Q

side effects of not enough estrogen

A

-light menses
-vaginal dryness
-spotting
-no withdrawal bleeding

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9
Q

Estrogen dosing

A

-very low: <20 mcg EE
-low: 20-35 mcg
-high: 50 mcg

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10
Q

Progestational side effects of progestin

A

-prevent ovulation
-less bleeding
-desire high selectivity

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11
Q

Progetin activity

A

-progestational
-androgenic
-antiestrogenic

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12
Q

Androgenic side effects of preogestins

A

-acne
-hirsutism
-desire lower activity

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13
Q

Antiestrogenic side effects of progestins

A

-androgenic side effects
-desire lower activity

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14
Q

Progestins with high androgenic activity

A

-levonorgestrel
-norgestrel

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15
Q

Progestins with low androgenic activity

A

-drospirenone
-segesterone

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16
Q

Side effects from too much progestin

A

-acne*
-hirsutism*
-dec sex drive
-depression
-inc appetite
-inc sex drive*
-weight gain
-less energy
-cholestatic jaundice*
-yeast infection
-hair loss*
-arm/leg swelling*

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17
Q

Side effects of not enough progestin

A

-breakthrough bleeding late in cycle
-no withdrawal bleeding
-heavy menses

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18
Q

Non-contraception uses of hormones

A

-androgenic conditions
-regulate cycle
-PMS/PMDD
-menorrhagia
-endometriosis
-dysmenorrhea

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19
Q

Potential health benefits of hormonal contraceptives

A

-dec risk of endometrial and ovarian cancer
-dec risk of pms headaches
-improvement in perimenopausal symptoms

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20
Q

Contraceptive considerations

A

-efficacy
-hormonal content
-route/dosage form
-freq/duration
-side effects
-return of fertility
-potential health benefits

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21
Q

Summary

A

slide 18-19 pls look

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22
Q

Implant (Nexplanon) components

A

-progestin only
-Etonogestrel
-injected in non dominant arm

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23
Q

Implant (Nexplanon) side effects

A

-painful insertion
-irregular bleeding first 6-12 months

-mood
-headaches
-acne

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24
Q

Potential benefits of Implant (Nexplanon)

A

-long term
-up to 3 years
-don’t need to remember to take it

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25
Q

Return of fertility after implant (nexplanon) use

A

-delayed or rapid return
-most likely to be delayed tho
-within 6 weeks

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26
Q

Levonorgestrel IUD side effects

A

-painful insertion
-spotting first 3-6 months
-periods become lighter and less frequent

-uterine perforation
-infection
-expulsion

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27
Q

Potential benefits of LNG IUD

A

-lighter periods, amenorrhea
-safe to breast feed
-lower risk of uterine cancer
-long term

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28
Q

Return of fertility of LNG IUD

A

-immediate

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29
Q

Hormonal IUD brands

A

-Mirena 8
-Skyla 3
-Liletta 8
-Kyleena 5

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30
Q

Shot (depot medroxyprogesterone acetate) admin

A

-150 mg IM
-104mg SC

31
Q

side effects of shot (depot medroxyprogesterone)

A

-weight gain
-spotting between periods/no period
-change in acne, mood, headaches

-lower bone density (supp w calcium)
-heavy bleeding

32
Q

Potential benefits of shot (depot medroxyprogesterone)

A

-low risk of uterine cancer
-safe to breastfeed
-lighter periods/amenorrhea

33
Q

Return of fertility after shot (depot medroxyprogesterone)

A

-possible delayed return

34
Q

Pill COC side effects

A

-nausea, spotting, breast discomfort
-changed mood/headaches

-blood clots (estrogen)
-stroke

35
Q

Potential benefits of the pill

A

-improve acne
-lower risk of ovarian/uterine cancer
-regular, lighter, less painful periods

36
Q

Return of fertility after pill

A

-immediate

37
Q

Monophasic pill

A

-same dose thru cycle
-start patients on this one

38
Q

bi/tri/four phasic pill

A

-2/3/4 strengths of EE or progestin thru cycle

39
Q

Progestin only pill (POP) miniill

A

-mini-pill (norethindrone)
-norgestrel (OTC)

40
Q

POP (mini pill) freq

A

-daily within 3 hours of the same time
-no placebo pills

41
Q

POP (mini pill) side effects

A

-spotting and menses changes more so than in the pill

-headaches
-bleeding
-ectopic preg

42
Q

Potential benefits of POP (mini pill)

A

-safe to breast feed
-lack of estrogen side effects

43
Q

return of fertility after POP (mini pill)

A

-immediate

44
Q

POP- Drosperinone (Slynd) dosing

A

-4mg daily
-no placebo

45
Q

POP (drosperinone) side effects

A

-spotting and menses changes more than COC

-severe headaches
-hyperkalemia

46
Q

potential benefits of POP drospirenone

A

-safe to breast feed
-lack of estrogen effects

47
Q

Return of fertility after POP (drosperinone)

A

-immediate

48
Q

Vaginal Ring (Etonogestrel and EE)

A

-NuvaRing and Eluryng
-leave in place for 3 weeks
-remove for one week
-new ring after 7 days

49
Q

Vaginal ring side effects

A

-nausea, spotting, breast discomfort
-change in mood/headaches

-blood clots
-stroke

50
Q

potential benefits of vaginal ring

A

-improved acne
-more regular, lighter periodsr

51
Q

return of fertility after vaginal ring

A

-immediate

52
Q

Annual vaginal ring (segesterone and EE) Annovera

A

-reused
-no data on continuous use (we dont know how long it is safe to leave in for to skip a period)

53
Q

Patch (norelgestromin and EE)

A

-Xulane, Zamefy
-transdermal patch applied to outer arm, ab, butt, back
-new patch every week for 3 weeks
-patch free for 7 days then new patch

54
Q

Side effects of patch

A

-nausea, spotting, boob hurt
-skin irritation
-change in mood/headaches

-blood clots (more estrogen than pill)

55
Q

potential benefits of the patch

A

-improved acne
-lower risk of ovarian/uterine cancer
-more regular periods
-don’t have to remember daily

56
Q

return of fertility after the patch

A

immediate

57
Q

Patch (Twirla)

A

-Levonorgestrel and EE
-just a little bit bigger but everything else is the same

58
Q

patches and weights

A

-CDC says don’t look at weight
-we dont really have data for ppl over 200lbs but that doesnt mean it wont work

59
Q

General approaches to starting contraception

A

-quick start
-next period start
-sunday start

60
Q

Quick start

A

-start anytime as long as not pregnant
-if more than 1-6 days after period start, use back up protection for 2-7 days

61
Q

Next period start

A

-Start within 1-6 days of period start
-no backup protection needed

62
Q

Sunday start

A

-start on sunday after period starts
-if more than 1-6 days after period start, use backup protection for 2-7 days

63
Q

General approach to starting contraception when changing hormonal methods

A

-switch method at any time or when due for injection
-no back up needed if no gaps in treatment

64
Q

Gen approach to starting emergency contraception

A

-within 5 days of unprotected sex
-levonorgestrel more effective the sooner it is used
-may be less effective if over 165 lbs

65
Q

Gen approach to restarting contraception after emergency contraception

A

-levonorgestrel: start/resume immediately, backup method 7 days
-ulipristal acetate: start/resume method 5 days AFTER use, backup method 7 days

66
Q

If one hormonal pill is late/missed

A

-take as soon as possible
-no additional contraception needed as long as it’s taken by or with the next dose

67
Q

Delayed application of patch

A

-apply new patch asap
-keep the change day the same

68
Q

patches must stick on as

A

self adhesive or it doesnt work

69
Q

Delayed application of over 48 hours

A

-new patch
-reset the change date

70
Q

delayed insertion of vaginal ring

A

-put new one in immediately
-reset the calendar if over 2 days

71
Q

Missed POP drospirenone pill

A

-take asap
-same as COC

72
Q

missed POP minipill

A

-any number of pills taken over 3 hours late
-take asap
-continue daily pills
-backup method 2 days

73
Q

progestin only injection missec dose <2weeks

A

-receive injection
-backup method 7 days and maybe emergency contraception if over 2 weeks late

74
Q

How to clean ring

A

-mild soap

therapeutics (78 decks)

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