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Clin Therapeutics II (Spring 2018) > Exam 2: Contraception > Flashcards

Exam 2: Contraception Flashcards

1
Q

Safety category 1?

A

No restrictions

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2
Q

Safety category 2?

A

Benefits outweigh risk

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3
Q

Safety category 3?

A

Risk usually outweightr benefits- try to avoid

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4
Q

Safety category 4?

A

Don’t prescribe! Not safe!

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5
Q

How many days long is the menstural cycle?

A

28 days

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6
Q

Menstruation is which days of the menstural cycle?

A

1-7

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7
Q

Follicular/Proliferative Phase is which days of the menstural cycle?

A

7-13

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8
Q

Which does is ovulation?

A

14

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9
Q

Luteal/Secretory Phase is which days of the menstural cycle?

A

15-28

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10
Q

Menses is which day of menstural cycle?

A

Day 1 of mensturation

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11
Q

3 strategies to prevent contraception?

A
  1. Prevent ovulation
  2. Prevent fertilization
  3. Prevent implantation
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12
Q

Combined oral contraceptives, nexplanon, nuva ring, and depo-provera are which type of contraception?

A

Prevent Ovulation

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13
Q

Abstinance, pull out, condoms is which type of contraception?

A

Prevent fertilization

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14
Q

IUD and emergency contraception are which type of contraception?

A

Prevent implantation

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15
Q

Urine HCG positive when?

A

After 2 weeks

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17
Q

What ages to ask if she wants to get preggers in next year?

A

18-50

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19
Q

Most effective form of STI prevention?

A

Male condom

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20
Q

What is the least effective contraceptive option?

A

Periodic abstinance

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21
Q

Coitus interruptus, LAM, fertility-awareness based methods are all which type of contraceptive option?

A

Periodic Abstinance. Least effective in preventing contraception.

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22
Q

What is the most effective contraceptive method?

A

Emergency contraception

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23
Q

Does a female diaphragm protect against STIs?

A

Nope

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24
Q

Which 2 agents are in Combined Oral Contraceptives?

A
  1. Progestational agent

2. Estrogenic agent

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25
Q

What do Combined Oral Contraceptives prevent?

A

Prevent ovulation

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26
Q

Combined Oral Contraceptives prevent ovulation by inhibiting what?

A

Inhibiting gonadotropin secretion

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27
Q

Which 2 brain centers are effected by Combined Oral Contraceptives?

A

Pituitary and hypothalamic centers

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28
Q

Which hormone is suppressed by the progestational agent in Combined Oral Contraceptives?

A

LH secretion

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29
Q

Which hormone is suppressed by the estrogenic agent in Combined Oral Contraceptives?

A

FSH

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30
Q

What does FSH cause the development of?

A

Dominant follicle

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31
Q

Estrogenic agents do what to follicles?

A

Suppress development of dominant follicle by suppressing FSH

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32
Q

COCs increased VTE risk by which agent?

A

Estrogen

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33
Q

COCs CI’d to which age and smoker?

A

35+ if smoker

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34
Q

COC CIed at which BP?

A

> 160/100

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35
Q

Which generation COC has highest angrogenic effect? (acne, hirsutism)

A

2nd gen

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36
Q

Which generation COC has lowest angrogenic effect? (acne, hirsutism)

A

3rd

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37
Q

Monthly COCs divided into what types of pills?

A

21 days of hormones, 7 days placebo (menses)

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38
Q

What 2 things to check before prescribing COCs?

A

BP and BMI!

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39
Q

Which method is preferred for starting COCs?

A

Quick Start

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40
Q

When it Quick Start for COCs started?

A

Same day as prescribed

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41
Q

What must be reasonable excluded before doing COC Quick Start?

A

Preggers

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42
Q

If more than 5 days from menses and want to do COC Quick Start what must give? For how long?

A

Backup methods for 7 days (condoms, abstinance, etc)

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43
Q

When is Sunday Start for COCs?

A

Start Sunday after period begins

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44
Q

Backup for Sunday Start COCs?

A

Yes, for 7 days.

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45
Q

When is First Day Start for COCs?

A

Start first day of menses

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46
Q

Backup for First Day Start of COCs?

A

No backup needed! Only one which doesn’t need backup.

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47
Q

What to do if miss one COC pill and within 48h? Backup or emergency needed?

A

Take ASAP, take regular pill, no additional pill or emergency needed.

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48
Q

What to do if miss two COC pills and ≥48h? Backup or emergency needed?

A

Take ASAP, use backup for 7 days (condoms or abstinance)

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49
Q

If miss 2+ COC pills during days 15-21?

A

Omit hormone free days and start new pack

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50
Q

When to use emergency contraception on COCs? (hint: which week? sex?

A

Pills missed during first week and had unprotected sex in previous 5 days

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51
Q

Progestin-only pill suppressed what?

A

Ovulation

52
Q

Progestin-only pill does what to cervical mucuous and endometrium?

A

Thickens mucous, thins endometrium

53
Q

Northindrone has which agent

A

Progestin-only pill

54
Q

Speed of Progestin-only pill act?

A

Rapid acting

55
Q

How long need to use backup for when on Progestin-only pill?

A

2 days only

56
Q

Downside of when to take Progestin-only pill?

A

Take same time each day

57
Q

Bleeding and Progestin-only pill?

A

Irregular bleeding

58
Q

Progestin-only pill and follicular cysts?

A

No estrogen=not effective at suppressing follicular cysts

59
Q

Micronor and Nor-QD are which oral contraceptive?

A

Progestin-only pills

60
Q

Which contraceptive is a vaginal insert

A

Nuvaring

61
Q

Which contraceptive has Estradiol and Etonogestrel

A

Nuvaring

62
Q

Nuvaring in for how long? Out for how long?

A

In 3 weeks, out 1 week (menses)

63
Q

Nuvaring delay <48 hours? Backup or emergency?

A

Insert ASAP. No backup or emergency needed.

64
Q

Nuvaring delay >48 hours? Backup or emergency?

A

Insert ASAP. Backup for 7 days. Emergency is sex within 5 days.

65
Q

Which contraceptive is a transdermal patch?

A

Orthoevra

66
Q

Orthoevra on and off?

A

3 weeks on, 1 week off

67
Q

Blackbox warning for Orthoevra?

A

Increased risk of VTE if smoker d/t estrogen

68
Q

Orthoevra effective in obese?

A

Less effective

69
Q

Need back <48 hour delayed Orthoevra?

A

No backup needed if <48h

70
Q

Need back >48 hour delayed Orthoevra?

A

Need backup

71
Q

Which contraceptive is injected Medroxyprogesterone?

A

Depo-Provera

72
Q

What does Medroxyprogesterone suppress and inhibit?

A

Suppresses gonadotropins to inhibit ovulation

73
Q

Depo-Provera doses when?

A

q90d

74
Q

Depo-Provera does what to weight?

A

Gains

75
Q

Depo-Provera and bone loss?

A

Causes bone loss. Take VitD and Ca.

76
Q

Depo-Provera and regaining fertility?

A

Very delayed return to fertility after stopping

77
Q

When can start Depo-Provera?

A

Any time

78
Q

Need backup if start Depo-Provera >7d after menses?

A

Yes, need backup (condoms, abstinance, etc)

79
Q

Nexplanon and IUDs are examples of what class of contraception?

A

Long Acting Reversible Contraception

80
Q

How long to avoid estrogen when post-partum? Why?

A

4 weeks. Increased risk of VTE.

81
Q

What does estrogen do to breast milk supply?

A

Decreases

82
Q

Which is Progestin rod implanted in upper arm?

A

Nexplanon

83
Q

Nexplanon releases progestin over how many years?

A

3 years. 68mg Progestin.

84
Q

Nexplanon suppressed what and inhibits what?

A

Suppresses ovulation. Inhibits fertilization.

85
Q

Most common LARC?

A

IUDs

86
Q

IUDs have an efficacy similar to what?

A

Sterilization

87
Q

Hormonal IUDs prevent what and inhibit what?

A

Prevent implantation. Inhibit sperm and egg binding.

88
Q

Copper IUDs prevent what and enhance what?

A

Prevent implantaiton. Enhance cytotoxic inflammatory response within endometrium.

89
Q

When is IUD implantation CI’d?

A

Preggers, active infx, disruption of uterine cavity (didelphys), undiagnosed uterine bleeding

90
Q

What does hormonal IUD do to menses? (hint: time and flow)

A

Lighter flow, shorter menses

91
Q

What does Copper IUD do to menses? (hint: time and flow)

A

Heavy menses, dysmenorrhea

92
Q

Which IUD can be used as emergency contraception?

A

Copper IUD (non-hormonal)

93
Q

What 2 things to check/do before implanting hormonal IUD?

A

Bimanual exam, cervical inspection

94
Q

Mirena lasts for how long?

A

5 years

95
Q

Styla lasts for how long?

A

3 years

96
Q

Tubal Ligation is what sort of contraception?

A

Sterilization

97
Q

Tubal Ligation can help protect against which cancer?

A

Ovarian cancer

98
Q

Tubal Ligation can cause what kind of preggers?

A

Ectopic preggers

99
Q

Is Tubal Ligation permanent?

A

Yes

100
Q

Cut vas deferens to keep sperm out of semen called?

A

Vasectomy

101
Q

Can offer emergency contraception up to how many days after unprotected sex?

A

5 days

102
Q

Most effective emergency contraception?

A

Copper IUD- Paragard

103
Q

Most common emergency contraception?

A

Progestin-only pills

104
Q

Are progestin-only pills for emergency contraception OTC?

A

yup

105
Q

Progestin-only emergency contraception up to how many days?

A

3

106
Q

Ulipristal up to how many days for emergency contraception?

A

5 days

107
Q

Copper IUD for emergency contraception up to how many days?

A

5 days

108
Q

Who is the genius behind these flashcards?

A

Brad!

109
Q

Which post-partum contraception if breastfeeding?

A

Progesterone-online (POP, Depo, Nexplanon, IUD)

110
Q

When can start COC for post-partum contraception?

A

5 week after birth d/t VTE risk

111
Q

what is something to counsel patients on when they use combined OCPs?

A

breakthrough bleeding
-this bleeding usually goes away after 90 days, but MUST LET THE 90 DAYS PASS TO SEE AND IF DOESN’T STOP THEN CAN CHANGE MED

112
Q

what meds decrease efficacy of combined OCPs?

A

phenytoin and rifampin

113
Q

if pt is complaining of acne, how can you manage their OCP?

A

increase estrogen or decrease androgen/progestin

114
Q

if pt is complaining of amenorrhea, how can you manage their OCP?

A

increase estrogen

115
Q

if pt is complaining of breast tenderness/swelling, how can you manage their OCP?

A

decrease estrogen

116
Q

if pt is complaining of BTB, spotting (days 1-9), how can you manage their OCP?

A

increase estrogen

117
Q

if pt is complaining of nausea, how can you manage their OCP?

A

take with food at night

decrease estrogen or increase progestin

118
Q

if pt is complaining of androgenic effect (hirsutism, etc), how can you manage their OCP?

A

select 3rd gen progestin, low dose norethindrone or ethynodiol diacetate

119
Q

if pt is complaining of irregular, heavy, painful menses, how can you manage their OCP?

A

increase progestin or decrease estrogen

120
Q

if pt is complaining of BTB, spotting (days 10-28), how can you manage their OCP?

A

increase progestin

121
Q

if pt has high risk of thrombosis, how can you manage their OCP?

A

decrease estrogen (b/c adr of estrogen is clots)

122
Q

at what dose of estrogen in OCPs is there an increase in BTB?

A

dose < 20 mcg (low dose)

123
Q

vasectomy disadvantages? back up method?

A

requires semen analysis at 3 months post procedure

USE BACK UP METHOD FOR 3 MONTHS!!!

Clin Therapeutics II (Spring 2018) (11 decks)

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