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From Flashcardlet > hormonal contraceptives > Flashcards

hormonal contraceptives Flashcards

0
Q

Name 4 progesterone only contraceptives

A

Progesterone only contraceptives (mini-pill)

Depo shot (depo-probers)

Implants (implanton)

IUd (Mirena)

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1
Q

Name 3 combined estrogen and progesterone hormone contraceptives

A

Pills, patch (ortho-evra), and ring (Nuva ring)

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2
Q

How do combination contraceptives work? (6)

A

Suppress FSH/LH inhibiting ovulation

Endometrial atrophy- no implantation

Viscous cervical mucous

Secretion and paristalsis of Fallopian tube-sperm and egg can’t meet

Seven day off period- sloughing of endometrium (menses)

Progestin inhibits endometrial growth-lighter menses

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3
Q

What are the 3 ways combination oral contraceptives work?

A

Monophasic, biphasic, and triphasic

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4
Q

Monophonic- is what?

A

Fixed amount of estrogen and progesterone throughout cycle

Some have less SE

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5
Q

What is biphasic oral contraceptives?

A

Progestin/estrogen ratio is lower in 1st half of cycle then increased estrogen

Some contain no progestin during the 2nd half

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6
Q

What are the triphasic oral contraceptives?

A

Estrogen/progestin ratio varies throughout the cycle

Can mimic natural cycle

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7
Q

What is the name of the group added to estriodol that is a highly potent OC

A

Ethinyl estradiol

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8
Q

What is a prodrug of ethinyl estradiol

A

Mestranol

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9
Q

Low dose birth control (20mcg) has these 2 problems

A
  1. It can cause breakthrough bleeding

2. Obese patients may be unaffected due to a high Vd

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10
Q

Why must you always use estrogen with progesterone?

A

Because unopposed estrogen promotes endometrial growth: early studies showed increased risk for endometrial cancers

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11
Q

If a women wants birth control but has a history of DVT. What are your options?

A

No estrogen birth control can be used. Use progesterone only

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12
Q

Androgen activities of progesterone can cause what AE

A

Acne

Hursutism

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13
Q

What are antiandrogenic Progestins?

A

Drospirenone

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14
Q

Progesterone also has antimineralcorricoid properties which can cause what?

A

Hyperkalemia

Less water retention

Acne

Breast tenderness

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15
Q

Your patient placed on a birth control has developed nausea, breast tenderness, breakthrough bleeding, edema. And headache. What should you do?

A

No need to discontinue. May subside in a few weeks

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16
Q

Your patient newly placed on birth control develops breakthrough bleeding, weight gain, increased skin pigmentation, acne hursitism amenorrhea. What do you do?

A

This needs attention. May need to stop

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17
Q

Your patient on new birth control develops vascular disorder, gallstone, a Gi infection, depression, or cancer. What do you do.

A

Stop the medication

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18
Q

What are the 4 reasons to decrease estrogen dose

A

1breast tenderness
2weightgain
3nausea
4headache

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19
Q

What are the 3 reasons to increase estrogen dose?

A

1breakrheough bleeding
2acne (also decrease androgen)
3absent menstrual flow

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20
Q

What are the 5 reasons to switch to a less potent progesterone?

A 
1.breast tenderness
2weight gain
3.depression
4.moodineas/irritability
5. Headaches
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21
Q

What 2 reasons do you switch to a more potent progestin?

A
  1. breakthrough bleeding

2. Severe menstrual cramps

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22
Q

The Progestins with the least androgenic activity

A

Drospirenone and ethynodiol diacetate

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23
Q

What are the combination contraceptives benefits?

A

All decreased: (8)

Ovarian cancer.         Ectopic preg
Endometrial cancer.    Dysmenhhorea
Benign breast disease   no babies
PID.   Menorrhagia
Iron deficient anemia
24
Q

What are the potential harm of birth control (AE)

A

DVT

Over 35 and smoke= increased thrombotic CV events

Increased risk of breast cancer-slightly

25
Q

What are the 5 reasons oral contraceptives are used?

A
  1. Contraception
  2. Regulation of menses
  3. Dysmenorrhea
  4. Emergency contraception
  5. Transition to menopause
26
Q

These meds cause a decrease effectiveness of birth control. You must use another bC method.

A

Rifampin, phenytoin, Dilantin, tegretol, phenobarbital greseofulvin

27
Q

The engancemt of these drugs occurs when given with OC. You may need less of these medications

A

Valium, Librium, theophylline, TCAs, corticosteroids,

28
Q

Name some reasons progesterone is given alone as birth control?

A 
Breast feeding
sLE
Sickle cell
CV disease
VTE
Migraines
29
Q

What are some downside to treating with progestin only

A

More breakthrough bleeding

Less effective alone

Acne

30
Q

A 21yo 225 lb female reports new onset breakthrough bleeding during her initial visit with you. She has been taking the same OCP for 2 years. What should you ask? Why might this be occurring? What should you do?

She later comes back after 6 months on the new pill complaining of Ha and irritability. What might be the problem now?

A
  1. Find out if she has recently gained weight. Make sure she isn’t on any new meds that could interfere with the OC. Increase her OC.
  2. Lower the progestin
31
Q

How long is breakthrough bleeding likely to occur and it be normal on the new pill?

A

The first 3 months

32
Q

How long does it take oral contraceptives to work?

A

1 month

33
Q

An 18 year patient would like to start OCPs. She also had acne. What component is largely responsible for the androgenic effect of the combination pill?

Specifically which formulation of this pill might benefit her? Had no adrenergic effects? What should you monitor?

A
  1. Progestin
  2. Drospirenone or increased estrogen

AE hyper kalemia, breast tenderness, acne

34
Q

A women who can’t remember to take the pill every day may do well with what?

A

The patch or ring

35
Q

What Contraceptives have no peak and trough

A

Patch and ring

36
Q

Ortho evra- the patch- lasts how long? What is the AE?

A

Each patch lasts 7 days. One week off for period.

AE- skin irritation

37
Q

Drop provera is a IM or subq injection. How often do you give it. What are the SE

A

3 month dosing, good choice if need to avoid estrogen.

AE increased bleeding. Weight gain

38
Q

Implanon (implant) how long is it good for. What are the benefits and AE?

A

Good for 3 years.

Immediately reversible; no opportunity for user error

Irregular bleeding

39
Q

Mirena works how? What are its AE? How long is it good for? How long does it take to work?

A

Inhibits fertilization and implantation

Good for 5 years and works immediately

AE- ectopic pregnancy, intrauterine pregnancy, sepsis, irregular bleeding, amenorrhea

40
Q

Taking into account user error. Which 2 forms of birth control are most effective?

A

Implanon and Mirena

41
Q

You prescribe a oral steroid to a patient on OC who has a rashz what should you consider?

It’s actually fungal and you need to give griseofulvin. Now what do you consider?

A
  1. Give a lower dose steroid. It will potentiate the effects

2. Use a back up method. OC will not be affective with this med

42
Q

What type of hormonal contraceptives would be useful for a breastfeeding mother?

A

Progesterone- mini pill, implanon, Mirena, depo shot

43
Q

A patient comes into your office requesting the morning after pill. She took a home pregnancy test that was positive this morning. It is the second day after her missed period. What do you say?

A

It is 72 hours after only.

44
Q

How does Plan B work?

A

Interferes with ovulation, fertilization, transport of egg, or implantation.

45
Q

What are the AE of plan B

A

N/V

46
Q

How old is a person before the can get plan B

A

17

47
Q

What are the other post-coital contraceptives?

A

Copper IUD or levonorgestel

48
Q

What is HRT estrogen/progestin therapy used for?

A

Moderate/severe menopausal symptoms

49
Q

Howdo you prescribe HRT

A

The shortest dose for the shortest time. No more than 5 years

50
Q

What must you add in with HRT therapy to all women with a uterus?

A

Progestin

51
Q

Oral estrogen for HRT is not recommended over transdermal due to what?

A

Higher hepatic concentrations- increased hepatic production of thyroxine, HDL, clotting factors

So increased risk of VTE, stroke, high lipids,

52
Q

Transdermal HRT (patch) estrogen aids in preventing what 2 problems?

A

Post menopausal symptoms and preserving bone density

53
Q

Why do we prescribe HRT therapy?

A

For quality of life improvement only

54
Q

Vaginal estrogen for HRT can treat what symptoms of menopause?

A

Vaginal atrophy and GU symptoms of menopause

55
Q

Which 2 routes of HRT are for treatment of bone density?

Note: all 4 routes treat vasomotor sx of menopause

A

Oral and transdermal

56
Q

What is important teaching for topical estriodol for HRT?

A

Risk to pets and children

57
Q

What are phytoestrogens?

A

Occur naturally in plants fruit and vegetables

58
Q

Where are phytoestrogens?

A

Soy, chickpeas, lentils, flax, grains, fruits and veggies

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