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RDS Test 2 > B8-012 Contraception > Flashcards

B8-012 Contraception Flashcards

1
Q

progestin inhibits ovulation by […] suppression

A

LH

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2
Q

[…] thickens the cervical mucus, preventing sperm transport

A

progestin

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3
Q

what type of contraception is contraindicated in patients who experience migraine with aura?

A

combined hormonal contraception (CHC)

(vision changes, numbness, parasthesias)

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4
Q

what schedule of combined oral contraceptive pills have been shown to have improved efficacy?

A

shortened hormone free week
(24 days on 4 days off)

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5
Q

what would an ideal OCP look like?

A

30 mcg EE + levonorgestrel
shortened/erased placebo week
monophasic

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6
Q

CHC patches may have lower efficacy in what patient populations?

A

obese patients

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7
Q

NuvaRing lasts […] month(s)

A

one

*new ring every month

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8
Q

Annovera (contraceptive ring) lasts […] month(s)

A

12

*same ring for 12 months, in for 24 days out for 4

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9
Q

what forms of CHC can be used continuously?

A

ring and pill

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10
Q

what forms of CHC cannot be used continuously?

A

patch

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11
Q

breast cancer in CHC users usually occurs in women in what age range?

A

40s

(RR of breast cancer due to CHC use is very low)

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12
Q

patients who use estrogen containing contraception have lower rates of what cancers? [3]

A

ovarian
colon
endometrial

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13
Q

there is a known causal link between estrogen and what chronic disease?

A

hypertension

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14
Q

CHCs raise systolic BP by […] mmhg and diastolic by […]mmhg

A

CHCs raise systolic BP by [8] mmhg and diastolic by [6]mmhg

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15
Q

what type of contraception is contraindicated in patients with hypertension?

A

CHC

(increased risk of MI, ischemic stroke)

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16
Q

do progestin only contraceptives still carry risk of VTE?

A

no

(suitable option for women with hx/risk factors of VTE)

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17
Q

progestin only pills (POPs) [2]

A

norethindrone (micronor)
drospirenon (slynd)

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18
Q

[norethindrone vs drospirenon]
primary mechanism: cervical mucus thickening

A

norethindrone (POP)

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19
Q

[norethindrone vs drospirenon]
primary mechanism: inhibits ovulation

A

drospirenon (POP)

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20
Q

[norethindrone vs drospirenon]
requires extremely punctual dosing

if the dosing is more than 3 hrs late, need to use a backup for 48 hrs

A

norethindrone (POP)

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21
Q

[norethindrone vs drospirenon]
window for missed pill is 24 hours

A

drospirenon (POP)

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22
Q

how can you be “reasonably sure” a patient is not pregnant?

A

actively menstruating
hasn’t had sex since last period
reliably using a form of birth control
within 7 days of spontaneous or induced abortion
4 weeks postpartum
fully or nearly fully breastfeeding

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23
Q

what are the risks of giving progesterone/estrogen in pregnancy?

A

none

(so can start any form of hormonal contraception and do a pregnancy test in 2-4 weeks if unsure a patient is pregnant; cannot use IUD though)

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24
Q

why are women with obesity are at a higher risk of endometrial cancer? [2]

A

increased peripheral conversion of estrogen
higher rates of anovulation

(contraception offsets risk)

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25
Q

IUDs decrease the risk of […] cancer

A

endometrial

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26
Q

what type of IUD actually reverses 90% of benign endometrial hyperplasia?

A

LNG-IUD

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27
Q

52 mg LNG IUD (mirena) is now approved for […] years of use

A

8

28
Q

20% of patients with the 52 mg LNG IUD (mirena) experience […] at one year

A

amenorrhea

29
Q

recent data supports the copper IUD is effective for […] years

A

12

30
Q

data suggests the copper IUD is effective through menopause if placed after age […]

A

35

31
Q

most common reasons patients stop using progestin implant (Nexplanon)

A

irregular bleeding

32
Q

bleeding with the progestin implant (nexplanon) is highest in the […] months

A

first three

(decreases over the first year, plateaus in year 2/3)

33
Q

most effective form of reversible, prescription contraceptive

A

progestin implant (nexplanon)

34
Q

injection (depo-provera) is administered every […] weeks

A

12-13

grace period up to 15

35
Q

side effect of depo is delayed fertility. it may take […] months for fertility to return

A

9-10

36
Q

patients who use depo-provera experience a bone mineral density loss of 1-2% per year. Because of this, the FDA recommends use is limited to […]

A

2 years

(BUT: ACOG and WHO disagree, no evidence of increased fx risk and reverses within 12 months)

37
Q

MOA spermicidal

A

copper IUD

38
Q

MOA changes cervical mucus [2]

A

LNG IUD
northindrone (POP)

39
Q

MOA inhibits ovulation [4]

A

implant (nexplanon)
DMPA (depo-provera)
drospirenon (POP)
CHC (pill/patch/ring)

40
Q

common side effect is heavier menses

A

copper IUD

41
Q

common side effect is light/rare/absent menses

A

LNG IUD

42
Q

common side effect is light/rare/absent menses/ irregular bleeding

A

progestin implant

nexplanon

43
Q

common side effect is light/rare/absent menses/ irregular bleeding and possible weight gain

A

DMPA (depo-provera)

44
Q

common side effect is lighter menses

A

POP

45
Q

common side effect is lighter menses, HA, nausea, breast tenderness

A

CHC (pill/patch/ring)

46
Q

good up to 10 years (FDA), 12 yrs (evidence)

A

copper IUD

47
Q

good 3-8 years (FDA)

A

LNG IUD

48
Q

good for up to 3 yrs (FDA), 5 yrs (evidence)

A

progestin implant

nexplanon

49
Q

taken every 3 months

A

DMPA (depo-provera)

50
Q

taken daily [2]

A

POPs
CHC pill

51
Q

taken weekly

A

CHC patch

52
Q

taken monthly

A

CHC ring

53
Q

minimum exam requirements for IUD placement

A

pelvic exam, exclude pregnancy

54
Q

minimum exam requirements before prescribing any contraceptive with estrogen

A

blood pressure

55
Q

CHC can be used to treat what medical symptoms/problems? [4]

A

menorrhagia
dysmenorrhea
acne/hirsutism
endometriosis

56
Q

common side effects of estrogen containing contraception [3]

A

headache
nausea
breast tenderness

57
Q

when do the common side effects of estrogen containing contraception typically resolve?

A

after 1-2 cycles

58
Q

[…] will improve acne, decrease menstrual flow, and regulate menstrual cycles

A

CHC

59
Q

CHC […] will result in lighter menses, but continuous use is not recommended so the patient will have a monthly period

A

patch

60
Q

what method of contraception is most consistently associated with weight gain?

A

depot

(5-6 kg over 3-5 years)

61
Q

weight gain within the first […] months of use has been shown to predict future weight gain with depot

A

6 months

62
Q

if the CHC patch falls off, what should the patient do?

A

replace the patch

hormones are delivered through the adhesive

63
Q

the patch is NOT recommended to be placed where on the body?

A

breasts

can be on back, abdomen, buttocks

64
Q

hypertension is a direct contraindication to what types of contraception?

A

estrogen containing

65
Q

associated with delay in return to fertility, 9-10 months after stopping

A

DMPA

(related to IM route of administration)

66
Q

DMPA is administered every […]

A

12-13 weeks

grace period through 15 weeks

67
Q

in evaluating risk of contraceptive methods for a patient, it is important to weight the risks of the method against […]

A

pregnancy

RDS Test 2 (21 decks)

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