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Repro > Contraception Pharm > Flashcards

Contraception Pharm Flashcards

1
Q

Mechanism of progesterones

A

Increases cervical mucus viscosity which inhibits sperm penetration
Decreases motility of ovum
Increases atrophy of endometrium

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2
Q

Secondary mechanisms of 2nd generation progesterones

A

Decrease HDL

Increase LDL, glucose tolerance, incidence of acne

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3
Q

Secondary mechanisms of 3rd generation progesterones

A

Less acne than 2nd gen

May increase risk of thrombosis

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4
Q

POPs

A

Taken everyday within 3 hour window

Not affected by gut flora (antibiotics don’t affect absorption)

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5
Q

High dose progesterone

A

Currently available in injectable form only

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6
Q

Pt populations that can use POPs

A

Pts with sickle cell anemia
Nursing mothers
In women who smoke or are over 35
In women with HTN or migraines

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7
Q

Common AEs of POPs

A

Spotting
Worsening depression in those already depressed
Reduced libido

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8
Q

Mechanism of estrogens

A

Inhibits follicular development preventing ovulation
Reduce implantation
Potentiates progesterone mechanisms
Increase uterine edema decreasing likelihood of implantation

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9
Q

Form of estrogen in COCPs

A

Ethinyl estradiol

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10
Q

Contraceptive effectiveness of COCPs

A

Effective if first pill is started within 5 days of first day of menstruation otherwise does not begin until 7 consecutive days of active pills have been taken

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11
Q

Affect of obesity on COCPs

A

Decreased effectiveness with BMI >30
COCPs created for average hormone lvls
Most effective contraception is progesterone IUS instead

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12
Q

COCP drug interaction

A

High doses of vitamin C will increase side effects of estrogen

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13
Q

Benefits of COCPs

A

Reduced symptoms of endometriosis, PCOD, anemia

Reduced risk of PID, dysmenorrhea, PMS, acne

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14
Q

Depression and COCPs

A

No evidence of increased depression

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15
Q

COCPs risks

A

May increase HTN
Mastalgia, amenorrhea, N/V, melasma, gallstones, decreased ability to build muscle mass
Women > 40 y/o are at greater risk of these SEs

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16
Q

Greatest COCPs risk occurs in women with what comorbid risk factors?

A

Smoking
> 35 yrs
Long continued use of COCPs

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17
Q

What pt has an increased risk for cardiovascular SEs with COCPs?

A

Smokers, especially smokers over 35 y/o

Lowest dose of estrogen or POPs recommended

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18
Q

Tri-cycling

A

3 or 4 packs of active monophasic pills in a row

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19
Q

Triphasic

A

3 doses of hormones in one pack

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20
Q

Monophasic

A

Single doses - all active pills alike

21
Q

Multiphasic/estrophasic

A

Single doses of progestin with varying doses of estrogen until just before break week then estrogen only for few days then placebo

22
Q

Biphasic

A

Two different active pills

23
Q

Four-phase

A

4 different active pills (both hormones change)

24
Q

Which pill is FDA approved for PMDD and moderate acne in females age 14 or older?

A

EE+drospirenone+placebo (Yaz)

25
Q

Which pill is designed to prevent neural tube defects in fetuses conceived shortly after stopping the COCP?

A

EE+drospirenone+levomefolate (Beyaz, Safyral)

26
Q

Which pill has a spearmint flavor?

A

EE+norethindrone+ferrous fumarate

27
Q

What should be considered if acne is exacerbated after COCP use?

A

Change to EE+drospirenone (Yaz)

28
Q

Which form of BC is best for a pt with seizure disorder using valproic acid, clonazepam, vigabatrin, or lamotrigine?

A

Progesterone injection

29
Q

If 3 or more COCPs were missed

A

Pills from day 1-7 and intercourse occurred during days 1-7 consider emergency contraception

30
Q

How long is Plan B effective?

A

Up to 72 hours

31
Q

When should ulipristal be taken?

A

WIthin 5 days of unprotected sex

32
Q

Benefits and risks of transdermal contraceptive patch

A

Good for non compliant pill users
May have topical reaction to adhesive
Less effective in obese women

33
Q

When does protection begin after a contraceptive injection?

A

1 week after first injection

34
Q

Benefits of contraceptive injection

A

FDA approved for endometriosis related pain
Good for non complaint contraceptive users
Good in special needs women - physically, mentally disabled, very young girls
Effectiveness not decreased by anti epileptic drugs
Decreased incidence of sickle cell crisis

35
Q

What is the vaginal insert ring not approved for?

A

Tricycling

36
Q

How long do copper IUDs last?

A

5 year and 10 year options

37
Q

How long does levonorgestrel IUS (Mirena) last?

A

5 years

38
Q

Risks and common AEs of IUD/IUS

A

Expulsion rate of 4%

AE - lighter menses, amenorrhea or irregular bleeding

39
Q

What test must be done prior to insertion of IUD/IUS?

A

STD testing

40
Q

Sponges

A

May be inserted up to 24 hours before intercourse
Must be left in place for at least 6 hours after intercourse
Should not be worn for more than 30 hours at a time

41
Q

Common AE of sponges

A

Use of multiple sponges in 24 hours increases risk of tissue irritation

42
Q

When is mifepristone effective?

A

Two pill regimen and only effective after 2nd pill

43
Q

Off label use of mifepristone

A

Cushing syndrome

Off label as glucocorticoid receptor antagonist for 10 years with no noticeable AEs

44
Q

Clomifene citrate

A

Improves sperm penetration and survival by changing cervical mucus and uterine mucosa
Induces ovulation about 67% of time, but pregnancy success only about 37%

45
Q

hMG

A

Stimulates follicles

Risk of multiple fetus pregnancy

46
Q

Bromocriptine

A

Reduce production of prolactin by the pituitary

47
Q

When can corticosteroids be used to tx infertility?

A

When dx is related to overproduction of testosterone by female

48
Q

What medication is DOC when the pt is at risk of pre-eclampsia but not yet dx?

A

Methyldopa

49
Q

What is approved for tx menopause but not contraception?

A

Drospirenone+estradiol (angeliq)

Repro (14 decks)

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