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NURP 501 - Ex 1 > 1: General Contraception > Flashcards

1: General Contraception Flashcards

1
Q

What type of pills are usually used for extended / continuous COC regimens?

A

Monophasic are generally preferred.

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2
Q

Which progestin is not testosterone derived?

A

Drospirenone

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3
Q

Who accounts for the least and most unintended pregnancies?

A
  • Women who use contraceptives consistently and correctly account for 5%.
  • Women who do not use contraceptives or have a gap of 1 month or more account for 54% of unintended pregnancies.
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4
Q

What are the two approaches to vasectomies?

A
  1. Conventional vasectomy: One midline or two lateral incisions in the scrotum. The vas is lifted out through the incision and occluded. The opening is then sutured.
  2. “No-scalpel” method: Skin of the scrotum is pierced and the vas exposed and blocked through an opening so small it does not require stitches.
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5
Q

When does the Standard Days method avoid intercourse?

A

Cycle days 8-19.

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6
Q

When should Nexplanon be inserted?

A

During the first 7 days of the menses, postpartum, or post abortion, to avoid pregnancy in the first cycle.

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7
Q

What are the advantages / disadvantages to Sunday start?

A

No bleeding on weekends, but must use backup method for 7 days.

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8
Q

Which patient population would be most likely to have failure with tubal sterilization?

A

Those who are younger at the time of sterilization.

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9
Q

Which methods of birth control have the highest effectiveness and why?

A

LARCs (IUDs and subdermal implants) because it removes user consistency and error.

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10
Q

What are some methods of female sterilization?

A
  • Occluding the fallopian tubes: unipolar or bipolar electrocoagulation; mechanical occlusion; and ligation or salpingectomy.
  • Transcervical sterilization method (Essure) is performed via hysteroscopy and can be done in an office setting.
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11
Q

Which IUD is the smallest?

A

Skyla

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12
Q

How well a method works inherently. This describes the likelihood that an unintended pregnancy will occur even when the method is used consistently and exactly as prescribed. Based on “perfect use.”

A

Efficacy

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13
Q

When is a vasectomy effective?

A

15-20 ejaculations. Current recommendation is to wait 3 months rather than a set number of ejaculations.

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14
Q

How often are DMPA / Depo injections given?

A

Every 13 weeks

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15
Q

How long is each patch used?

A
  • Worn for 1 week at a time.
  • The patch is changed weekly on the same day of the week for 3 weeks.
  • No patch is worn for 1 week to allow for a withdrawal bleed.
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16
Q

What followup is important with transcervical sterilization/Essure?

A

After placement, tissue grows into the insert or matrix, effectively blocking the tubes. A hysterosalpingogram (HSG) must be performed 3 months after the procedure to confirm tubal occlusion, and women must continue to use reliable contraception until sterilization effectiveness is confirmed with HSG.

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17
Q

What should determine whether a particular contraceptive method is inappropriate for a woman?

A

Clinicians should rely only on evidence-based contraindications to avoid unnecessarily restricting contraceptive options when determining whether the woman’s history makes a particular method acceptable.

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18
Q

What is the point of entry for many sexually transmitted pathogens?

A

Cervix

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19
Q

T/F So long as levels are checked frequently, women predisposed to hyperkalemia may use drospirenone-containing COCs.

A

False. They should use other methods.

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20
Q

T/F Overestimation of contraceptive risks and benefits are common and must be addressed.

A

False. Overestimation of contraceptive risks and underestimation of health benefits are common and must be addressed.

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21
Q

How much estrogen is contained in COCs today?

A

Most of the COCs available today contain 10 to 35 mcg of ethinyl estradiol, although a few COCs contain 50 mcg of ethinyl estradiol or mestranol, the methyl ether of ethinyl estradiol.

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22
Q

Is a conventional or no-scalpel method of vasectomy better?

A

A systematic review showed that the no-scalpel approach resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique, with no difference in effectiveness

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23
Q

What are the contraindications for emergency contraception (ECP)?

A
  • Levonorgestrel ECPs, combined ECPs, and ulipristal acetate should not be given to women with a known or suspected pregnancy; there are no other contraindications to their use.
  • The usual contraindications and precautions for ongoing COC and POP use do not apply to ECP.
  • The usual contraindications and precautions to copper IUDs used for ECP.
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24
Q

What patient education should occur for missed COC pills?

A
  • If one pill is missed and is less than 48 hours late, take the late or missed pills as soon as possible and continue taking the remaining pills at the usual time. No backup method or emergency contraception is needed.
  • If two or more consecutive hormonal pills have been missed and it is more 48 hours or more since a pill should have been taken, take the most recent pill as soon as possible (any other missed pills should be discarded). Continue taking the remaining pills at the usual time and use a backup method or avoid sexual intercourse until hormonal pills have been taken for 7 consecutive days.
  • If pills were missed during the last week of hormonal pills, finish the remaining hormonal pills and start new pill pack the following day.
  • Emergency contraception should be considered if pills were missed during the first week and sexual intercourse occurred during last 5 days.
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25
Q

Name the 4 nonhormonal, physiologic methods of birth control.

A
  1. Abstinence
  2. Coitus interruptus
  3. Lactational amenorrhea method (breastfeeding)
  4. Fertility awareness based (FAB) methods
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26
Q

Where can the patch be applied?

A
  • Buttocks
  • Upper arm
  • Abdomen
  • Anywhere on the upper torso except the breasts.
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27
Q

Does laparoscopic or hysteroscopic sterilization have a higher failure rate?

A

Hysteroscopic

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28
Q

What lab test is important with drospirenone?

A
  • K levels.
  • Drospirenone has a mild potassium-sparing diuretic effect, necessitating that potassium levels be checked during the first cycle in women using ACE inhibitors, chronic daily NSAIDs, angiotensin-II receptor antagonists, potassium-sparing diuretics, heparin, or aldosterone antagonists.
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29
Q

What percentage of women using contraception choose reversible?

A

64%

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30
Q

Which meds can affect COC effectiveness?

A

Medications that can reduce the effectiveness of COCs include antiretroviral therapy, rifampin, griseofulvin, and some anticonvulsants (e.g., carbamazepine, phenytoin, barbiturates, primidone, topiramate, oxcarbazepine, lamotrigine), as well as some over-the-counter herbal supplements such as St. John’s wort.

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31
Q

How is the size of a FemCap determined?

A
  1. 22-cm FemCap is for women who have never been pregnant
  2. 26-cm FemCap is for women who have had a miscarriage, abortion, or cesarean birth
  3. 30-cm FemCap is for women who have had a vaginal birth
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32
Q

Why is there little decrease in seminal fluid after a vasectomy?

A

Sperm account for only 5% of the semen that is produced by the prostate and other glands; thus, there is only a minimal decrease in the amount of seminal fluid following male sterilization.

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33
Q

When is a failure most likely to occur with contraceptives?

A

Most failures are concentrated in early usage. More fertile women will have earlier failures, and women who use contraception incorrectly or inconsistently will get pregnant sooner. In addition, older women are less fecund (able to get pregnant) than younger women; thus any method used by younger women will have a higher failure rate than when the same method is used by older women.

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34
Q

What constitutes a low-dose COC?

A

Less than 50 mcg

35
Q

Name the nonhormonal, permanent method of birth control.

A

Sterilization

36
Q

Name the 3 nonhormonal, barrier methods of birth control.

A
  1. Male condoms
  2. Vaginal barriers
  3. Spermicides
37
Q

What are the advantages to nonhormonal methods of birth control?

A

In general, their efficacy is less than that of hormonal methods, but these options do not have systemic side effects. In addition, many barrier methods do not require involvement of a clinician.

38
Q

Because of the MoA of POPs, what should be taught about when to take the pills?

A
  • The onset of cervical mucus thickening occurs 2 to 4 hours after a POP is taken and persists for 22 hours after each dose.
  • For this reason, if intercourse generally occurs in the morning or evening, the POP should be taken at midday.
  • In a woman who ovulates while taking the POP, taking the pill as few as 3 hours late may allow the cervical mucus to return to its fertile state and render the contraceptive effect temporarily void.
39
Q

T/F Use of hormonal contraceptive methods may actually protect future fertility by decreasing the risk of endometriosis, ectopic pregnancy, pelvic inflammatory disease (PID), and abortion-related complications. Hormonal methods also decrease the risk of ovarian, endometrial, and colon cancer.

A

True

40
Q

T/F All unintended pregnancies occur d/t user errors.

A

False

41
Q

Which emergency contraception is available without a prescription?

A

Levonorgestrel ECPs and only to women 17 and older without prescription.

42
Q

T/F IUDs are removed if pelvic infx occurs. They are replaced after treatment.

A

False. Infection can be treated without removing the IUD.

43
Q

Which are the most important pills to take in a COC pack?

A

The first and last active COCs, which ensure that the hormone-free interval does not exceed 7 days.

44
Q

Of the COCs, which formulation is better overall?

A

There is no evidence that either monophasic or multiphasic formulations are a superior choice.

45
Q

Which 2 methods rely solely on evaluation of cervical mucus?

A
  1. Billings ovulation method
  2. Two Day method
46
Q

List the 4 start methods for pills.

A
  1. Sunday start
  2. First-day start
  3. Day 5 start
  4. Quick start
47
Q

T/F Unless a woman is on an extended / continuous cycle of COCs with no placebo pills, she will have a menses.

A

False. During the hormone-free interval, bleeding from the withdrawal of estrogen and progestin occurs. This is technically a withdrawal bleed, rather than menses, and is based primarily on convention rather than on science.

48
Q

Your male patient is concerned about decreased sex drive is he has the vasectomy his wife wants. If this is the only concern, is a vasectomy right for him?

A

Yes. Vasectomies have no effect on sex drive, male hormone production, or sexual function.

49
Q

Why is it so important that women be given a choice in which birth control method they use?

A

A woman who is pressured into choosing a certain method is more likely to feel ambivalent about its use, leading to higher rates of inconsistent use and discontinuation.

50
Q

None of the hormonal methods of birth control provide_____ protection.

A

None of the hormonal methods of birth control provide STI protection. For this reason, it is important to stress the concomitant use of barrier methods in women who are at risk of exposure to STIs.

51
Q

Which 2 methods of birth control are considering long-acting and reversible (LARC)?

A
  1. IUDs
  2. Subdermal Implants
52
Q

How do you calculate fertile window with the calendar method?

A
  • The woman records the length of 6 to 12 menstrual cycles and determines the longest and shortest cycles. She then uses that information to identify the first (days in shortest cycle minus 18) and last (days in longest cycle minus 11) fertile days each month. Calculations must be updated with each cycle.
  • (Shortest cycle - 18) - (Longest cycle - 11)
53
Q

What does the Symptothermal method use?

A

Double-check method based on evaluation of cervical mucus to determine the first fertile day and evaluation of cervical mucus and temperature to determine the last fertile day.

54
Q

What are the advantages / disadvantages to Quick start?

A

Pill use is immediate. Must use backup contraception for 7 days.

55
Q

How do estrogen and progestin work?

A
  • Both progestin and estrogen inhibit the hypothalamic–pituitary–ovarian axis and subsequent steroidogenesis.
  • Progestins have several contraceptive effects, including preventing the luteinizing hormone (LH) surge and thereby inhibiting ovulation; thickening the cervical mucus, which inhibits sperm penetration and transport; changing the motility of the fallopian tubes so that transport of sperm or ova is impaired; and causing the endometrium to become atrophic, although it is unknown whether these changes are sufficient to prevent implantation in the rare event that fertilization occurs.
  • Estrogen suppresses the production of follicle-stimulating hormone (FSH), thereby preventing the selection and emergence of a dominant follicle.
56
Q

Where is estradiol valerate found?

A

New quadphasic COC.

57
Q

What are the advantages / disadvantages to First-day start?

A

No backup contraception is required, but have to wait to start pills and use other methods until then.

58
Q

When is a woman’s fertile window?

A

The “fertile window” or time when intercourse is most likely to result in pregnancy comprises the 5 days before plus the day of ovulation.

59
Q

What is the dosing interval for progestin-only pills (POPs)?

A

Used continuously. There is no hormone-free interval.

60
Q

T/F Women require pelvic exams before hormonal contraceptive use.

A

False. This used to be true. It is no longer true for oral contraceptives.

61
Q

T/F Many uses of contraception for therapeutic reasons are now FDA approved.

A

False. Most therapeutic uses of contraception are not approved by the U.S. Food and Drug Administration (FDA), although many are supported by evidence gathered through research studies. Clinicians frequently prescribe medications for conditions other than those for which they have FDA approval, and this off-label use is within the scope of prescriptive authority when a sound rationale and evidence are used.

62
Q

What is the advantage to the DMPA SQ injection?

A

Can be self-administered

63
Q

How big is the rod and how long does the effectiveness of Nexplanon last?

A

40 mm x 2 mm with 68 mg etonogestrel released over 3 years.

64
Q

What are the 2 types of progestin injections?

A
  1. DMPA 150-mg IM
  2. DMPA 104-mg SQ
65
Q

Which female sterilization methods are effective immediately?

A

Procedures other than transcervical methods are generally effective immediately.

66
Q

Which IUD releases the least progestin?

A
  • Skyla: 14 mcg/day
  • Mirena: 20 mcg/day
  • Liletta: 18-19 mcg/day
  • These decline over time.
67
Q

With the exception of _____, all progestins in COCs available in the United States are derived from C-19 androgens.

A

With the exception of DROSPIRENONE, all progestins in COCs available in the United States are derived from C-19 androgens.

68
Q

What percentage of sexually active women do not want to become pregnant?

A

Approximately 70%

69
Q

What unintended consequences are most common with unintended pregnancies?

A

Increased rates of preterm birth, low-birth-weight infants, and infant mortality. Also, higher rates of maternal anxiety and depression.

70
Q

What are the 2 categories of C-19 androgen derivatives?

A
  1. Estranes, or chemical derivatives of norethindrone (norethindrone, norethindrone acetate, and ethynodiol diacetate).
  2. Gonanes, or chemical derivatives of norgestrel (norgestrel, its active isomer levonorgestrel, desogestrel, and norgestimate).
71
Q

When is unscheduled bleeding most likely to occur with POPs?

A

Typically, during the first 6 months of use, with many becoming amenorrheic by 12 months.

72
Q

Termed “user failure” or “typical use” failure rates, is how well a method works in actual practice. It describes all unintended pregnancies that occur if a method is not used properly, such as in the case of inconsistent or incorrect use.

A

Effectiveness

73
Q

Which IUD is provided at a lower cost to public health clinics?

A

Litetta

74
Q

When can IUDs be placed?

A

Any time during the menstrual cycle. Post-abortion and postplacental (within 10 minutes of expulsion of placenta). Postpartum at least 4 weeks after.

75
Q

The Standard Days Method (SDM) is recommended for who?

A

Women whose cycle lengths are 26-32 days in length.

76
Q

How do you tell if an IUD has been expelled?

A

Though cramping or bleeding may occur, the best way to tell is to feel for the strings.

77
Q

Are IUDs recommended for women with multiple partners?

A

Yes. STI testing should occur, but placement can happen immediately without waiting for results.

78
Q

Which condoms have twice the odds of breakage or slippage during intercourse or withdrawal?

A

Nonlatex condoms appear to have twice the odds of breakage or slippage during intercourse or withdrawal compared to latex condoms.

79
Q

Which 2 ethnic groups report race-based discrimination when they seek family planning services?

A
  1. African American
  2. Latina
80
Q

When is it advised to initially give DMPA / Depo injection?

A

Advised to give during first 5 days of period, but if not pregnant, can be given anytime.

81
Q

How long before the patch reaches therapeutic concentration levels?

A

24-48 hours

82
Q

When does pregnancy occur with IUDs?

A

When complete or partial expulsion occurs, usually within the first 3 months.

83
Q

Which method requires the longest period of abstinence or barrier method in using the fertile window?

A

The postovulation method is another variation on the calendar method. With this method, the woman subtracts 14 days from her average cycle length to predict the day of ovulation. Abstinence or a barrier method is used during the first half of the cycle until the fourth morning after the predicted day of ovulation. This method requires the longest period of abstinence or use of additional contraception.

84
Q

Why is a higher dose of methyl ether used compared to ethinyl estradiol?

A

Approximately 30% of mestranol is lost when it is converted to ethinyl estradiol; thus a 50-mcg mestranol pill is bioequivalent to a 35-mcg ethinyl estradiol pill.

NURP 501 - Ex 1 (63 decks)

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