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Pharm- Exam 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

List the barrier techniques

A
  1. Condoms
  2. Diaphragms
  3. Cervical Caps
  4. Sponges
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2
Q

Define Spermicides

A

Contain Nonxynol-8:

  • Chemical surfactants that destroy sperm cells walls
  • Act as barriers that prevent sperm from entering cervical os
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3
Q

What type of lubricant in condoms is preferred? Why?

A

Water soluble lubricants: KY Jelly, Astroglide

Mineral-oil based, lotions, lubricants can decrease barreri strength of latex

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4
Q

How long prior to and after sex do you need to insert/keep in diaphragms, cervical caps and sponges?

A

6 hrs prior

6 hrs after

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5
Q

What is the maximum time a diaphragm can be left in place?

A

24 hrs

>24 hrs increases potential for toxic shock syndrome

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6
Q

What must you use if you have subsequent sex when using a diaphragm

A

Condom for additional protection

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7
Q

What is the maximum time a cervical cap can be left in place?

A

48 hrs

>48 hrs increases potential for toxic shock syndrome

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8
Q

What is a benefit of using a cervical cap?

A

Can be left in place for multiple x of sex without needing to add more spermicide

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9
Q

What is the maximum time a cervical cap can be left in place?

A

24-30 hrs

>24-30 hrs increases potential for toxic shock syndrome

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10
Q

What must you have in order for ovulation to occur?

A

LH surge

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11
Q

What hormone is responsible for the follicular phase/early phase of the cycle?

A

Estrogen

STABILIZES the endometrium

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12
Q

What hormone is responsible for the proliferative phase/late phase of the cycle?

A

Progesterone

MAINTAINS THE endometrium for implantation

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13
Q

What precursor is required to make testosterone?

A

Cholesterol

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14
Q

What does the presence of Aromatase allows the conversion of?

A

Different forms of estrogen:

  1. Estradiol
  2. Estriol
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15
Q

Which type of estrogen is predominant?

A

Estradiol

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16
Q

What type of estrogen do we monitor for in pregnancy?

A

Estriol

Produced in large amounts by the placenta

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17
Q

What do we Aromatase Inhibitors in the treatment of?

A

Estrogen Dependent CA’s

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18
Q

Progestin MOA

A

Blocks the LH surge, therefor inhibiting ovulation

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19
Q

Combined Hormonal Contraceptives MOA

A

work BEFORE fertilization to prevent contraception

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20
Q

Estrogen MOA

A

Suppress FSH release from pituitary

May contribute to blocking LH surge and preventing ovulation

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21
Q

List the Estrogen available

A
  1. Ethinyl Estradiol (EE)
  2. Mestranol
  3. Estradiol Valerate
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22
Q

What estrogen would be a good option if you wanted lower levels of hormones?

A

Ethinyl Estradiol (EE): Pro drug that gets activated by the liver, loses 50% of potency

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23
Q

What hormone do we choose the products based off?

A

Progestins=MAJOR contraceptive PREVENTING ovulation

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24
Q

List the 3 types of Progestins

A
  1. Estrogenic
  2. Antiestrogenic
  3. Androgenic Activity
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25
Q

What two variables is androgenic activity based on?

A
  1. Presence of sex hormone binding globulin (SHBG-TBG)

2. Androgen: Progesterone activity ratio

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26
Q

SHBG-TBG and Testosterone relationship

A

Decreased SHBG-TBG= Increased Free Testosterone levels= Increased Androgenic S/E’s

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27
Q

List a 1st generation Progestin

A

Norethindrone

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28
Q

Norethindrone ADE

A

Breakthrough bleeding @ lower doses

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29
Q

List 2nd generation Progestin

A

Levonorgestrel

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30
Q

Levonorgestrel activity

A

Increase Androgenic Activity

31
Q

Levonorgestrel ADE’s

A

Worse for:

  1. Hirsutism
  2. Acne
  3. Lipids
32
Q

List 3rd generation Progestin

A

Desogestrel

33
Q

Desogestrel activity

A

Decreased androgenic activity

34
Q

Who should you consider using Desogestrel in?

A

Libido issues

35
Q

List 4th generation Progestin

A

Drospirenone

36
Q

Drospirenone activity

A

Anti-Androgenic

37
Q

Who should you consider using Drospirenone in?

A

Treatment of Acne

38
Q

Progestin administration directions

A
  1. Take @ same time every day
  2. 3 hr window
  3. if you miss 3 hr window, use backup method contraception
39
Q

Progestin CI

A
  1. Gastric Bypass surgery
  2. Ischemic heart dz
  3. Rifampin therapy
40
Q

What do you need to know about minipills?

A

May NOT block ovulation
40% of women continue to ovulate normally
Risk of ectopic pregnancy

41
Q

Progestin indications

A

Post-partum

42
Q

At what age should you NOT prescribe CHC to women?

A

> 35= RED!

43
Q

What is the MC type of Estrogen?

A

Ethinyl Estradiol

44
Q

What is the MC ADE of CHC?

A

Excessive or deficient amounts of estrogen and progestin

45
Q

What is the OC dose in women with NO coexisting medical conditions?

A

EE=35 mcg

Norethindrone=0.5 mg

46
Q

Who do we prescribe only 20-25 mcg of EE to?

A
  1. Adolescents
  2. Underweight: <50 kg, <110 lbs
  3. > 35 y.o.
  4. Perimenopausal
47
Q

What do we prescribe women with oily skin, acne or hirsutism with?

A

Low androgenic OC’s: Yaz

48
Q

Who would benefit from extended-cycle OC regimens? Why?

A
  1. Dysmenorrhea
  2. Severe premenstrual syndrome
  3. Menstrual Migraines

*Reduces or eliminates # of cycles/yr

49
Q

How long should you wait before making a change to OC’s d/t SE’s?

A

2-3 months
Extended-cycle regimens=6 months
Sx’s usually improve by the 3rd cycle

50
Q

How long should women who are breastfeeding avoid CHC’s for?

A

With RF’s for VTE=42 days

Without RF’s=30 days

51
Q

What is the time period for the highest risk of thrombosis following pregnancy? What do you use to avoid this?

A

Frist 21 days postpartum

Use Progestin only

52
Q

If you want to reduce the risk of thrombosis and reduce nausea, breast tenderness or vascular HA’s…what should you prescribe?

A

Product with lower dose estrogen

53
Q

If you want to minimize spotting or breakthrough bleeding, what should you prescribe?

A

Pill with higher dosage of estrogen OR

progestin w/ greater potency

54
Q

If you want to minimize androgenic effects and avoid dyslipidemia, what should you prescribe?

A

3rd generation progestin

low-dose norethidnrone

55
Q

What is a possible benefit of Mirena IUD (levonorgestrel)?

A
  1. Shrink Fibroids

2. Reduce Endometriosis

56
Q

What is an ADE of ParaGard IUD (Copper)?

A

May cause more menstrual bleeding

57
Q

ParaGard IUD (Copper) CI

A
  1. SLE

2. Wilson’s disease

58
Q

Mirena IUD (levonorgestrel) and ParaGard IUD ADE’s

A
  1. Menstrual irregularities: Amenorrhea
  2. Expulsion
  3. PID
  4. Insertion-related complications (cramping, pain)
59
Q

Nexplanon CI

A
  1. Cirrhosis

2. Ischemia heart dz

60
Q

Depo-Provera (DMPA) ADE’s

A
  1. Weight gain: even after stopping
  2. Irregular menses: even after stopping
  3. Decreased BMD: Reverse after stopping, limit use to 2 yrs.
  4. Acne and hirsutism
  5. Depression: Depression screening
61
Q

What do you need to educate your patient about with the use of Depo-Provera (DMPA)?

A

May take up to 12 months to return to fertility

62
Q

Depo-Provera (DMPA) Indications

A
  1. Sickle cell
  2. Older smokers
  3. Seizures
63
Q

Depo-Provera (DMPA) CI

A

CURRENT breast CA

64
Q

Transdermal Patch CI

A
  1. Higher risk for VTE
  2. Skin conditions
  3. Obesity (less effective)
65
Q

What can the Vaginal Ring (NuvaRing) help decrease the frequency of?

A

BV

66
Q

How long of overlap do you need when switching from pill to pill and pill to ring?

A

No change

67
Q

How long of overlap do you need when switching from pill to patch?

A

1 day

68
Q

How long of overlap do you need when switching from pill to implant?

A

4 days

69
Q

How long of overlap do you need when switching from pill to copper IUD

A

up to 5 days

70
Q

How long of overlap do you need when switching from pill to shot and hormone IUD?

A

7 days/1 week

71
Q

What is the MOA of Progestin-only Emergency Contraceptive?

A

Inhibits or Delays Ovulation

No effect on implantation or disruption of fertilized egg after implantation has occurred

72
Q

How many days after an Emergency Contraceptive should non hormonal contraceptives be used for?

A

7 days

73
Q

What is Ulipristal (Ella)?

A

Selective Progesterone Receptor Modulator w/ mixed progesterone agonist and antagonist properties

74
Q

How many hours after unprotected sex is Ulipristal (Ella) effective for?

A

120 hrs=5 days

*Prescription only

Pharm- Exam 2 (5 decks)

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