CONTRACEPTION Flashcards

(61 cards)

1
Q

10 Absolute Contraindications for Combined Hormonal Contraception (Estrogen)

A

• < 4 weeks post partum if breastfeeding
• <21d postpartum (0 breastfeeding)
• Smoker + >35 yo
• HTN (>160/100)
• CVA/CAD
• Valvular disease
• Acute VTE
• Hx of VTE w/ 0 anticoagulants
• Major sx w/ prolonged immobilization
• Thrombophilia
• SLE w/ +/unknown APA
• Current breast CA
• Migraine w/ aura
• DM with retinopathy/neuropathy/nephropathy
• Cirrhosis or liver tumor

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2
Q

4 Absolute Contraindications for Combined Hormonal Contraception (Progestin)

A

• Unexplained vaginal bleeding
• Current breast CA
• Severe cirrhosis
• Pregnant

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3
Q

3 Risks for Combined Hormonal Contraception

A

• VTE (3-4 fold increase in risk; AR 1.5/1000)
• MI / Stroke (greater w/ >50mcg)
• Breast CA (minimal)

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4
Q

5 Benefits for Combined Hormonal Contraception

A

• Menstrual:
o Cycle regulation & ↓ menstrual flow - > ↓Anemia
o ↓Dysmenorrhea / Pelvic Pain
o ↓PMS
o ↓ perimenopausal symptoms
• ↓acne / hirsutism
• ↓risk of ovarian / endometrial CA
• ↓fibroids / benign breast disease / ovarian cysts

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5
Q

5 side effects for Combined Hormonal Contraception

A

• Irregular Bleeding (1st 3 cycles) (12%)
• Nausea (7%)
• Wt gain (5%)
• Mood (5%)
• Breast Tenderness (4%)

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6
Q

Failure rate for Combined Hormonal Contraception (typical vs. perfect use)

A

o Typical: 9%
o Perfect Use: 0.3%

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7
Q

Give 3 delivery methods for Combined Hormonal Contraception

A

Combined oral contraception
Combined patch
Combined Ring

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8
Q

Give 3 examples of combined OCPs and their estrogen levels

A

Very Low: LOLO 10 mcg
Low: Alesse 20 mcg
Standard: Marvelon, 30 mcg

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9
Q

Give 3 examples of classes of medications that decrease the effectiveness of OCP’s

A

Anticonvulsants (phenytoin, phenobarbitol)
Antiretrovirals
Antibiotic (only Rifampin)

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10
Q

What is the mechanism of action for combine hormonal contraception?

A

Prevents ovulation (suppresses gonadotropin secretion)
Prevents implantation (causes endometrial atrophy)
Prevents sperm transportation (causes viscous cervical mucus plug)
Fallopian secretions

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11
Q

List 3 strategies to initiate OCPs

A

R/o Pregnancy
1st Sunday of Period
If started >/5 days from LMP, use backup x 7 days

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12
Q

Do OCPs: cause cancer, need to take pill breaks, affect fertility, cause birth defects, be used over the age of 35, cause acne?

A

Does NOT cause cancer
NO need for pill breaks
Does NOT affect fertility
Does NOT cause birth defects
CAN be used over the age of 35
Does NOT cause acne

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13
Q

Describe 2 strategies for continued combined hormonal contraception use and the benefit

A

Continue combined hormone until breakthrough bleed, then take 4 day break
4 packs (84 days)
Decreases menstrual symptoms

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14
Q

What specific measurement do you take when initiating OCPs?

A

Blood Pressure

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15
Q

Management if delayed taking OCP in < 24 hrs in ANY week

A

Take 1 active pill ASAP
Continue taking 1 pill daily until the end of the pack

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16
Q

Management If 1 or more missed pills in first week:

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack

Back up x 7d*

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17
Q

Management If less than 3 pills missed pills during second or third week

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack

start new cycle of OCP without a hormone-free interval

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18
Q

Management if 3 or more consecutive doses/days of OCP missed during second or third week

A

Take most recent pill ASAP (even if it means two pills the same day) and continue taking remaining pills until end of pack
start new cycle of OCP without a hormone-free interval
Back-up contraception for 7 days
Consider EC

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19
Q

Initiation strategy of Combined Patch (Evra)

A

R/o Pregnancy
1st Sunday of Period
If started >/5 days from LMP, use backup x 7 days

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20
Q

How is the Combined Patched used, where is it placed, how is it stored, is it okay to shower and exercise with?

A

1 patch / w x 3 weeks
1 week off
Place on buttocks / deltoid / lower abdomen / upper torso
DO NOT Keep in fridge
Okay for showering / exercise

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21
Q

What is the failure rate of the combined patch? What decreases the efficacy?

A

Typical: 9%
Perfect Use: 0.3%
Efficacy affected if weight >/ 90 kg

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22
Q

What are 3 side effects of the combined patch (in addition to side effects of combined hormonal contraception)

A

20% mild local rxn
increased breast tenderness
increased n/v
dysmenorrhea

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23
Q

What is an advantage of the combined patch compared to OCPs other than convenience

A

Less breakthrough bleeding

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24
Q

How is the Combined Ring (Nuvaring) used, how is it stored?

A

Insert x 3 weeks
1 week ring free
DONT Store in fridge

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25
What is the failure rate of the combined ring?
Typical: 9% Perfect Use: 0.3%
26
List 3 side effects of the combined ring
Foreign body sensation Leukorrhea Expulsion Coitus issues
27
List 3 advantages of the combined ring compared to OCPs
Decreased N / V Decreased Mood lability No weight gain Decreased acne
28
3 absolute contraindications to progestin only contraception
Unexplained vaginal bleeding Current breast cancer Pregnant
29
Mechanism of action of progestin only contraception
Alters cervical mucus plug Partial ovulation suppression
30
6 Indications for use of progestin only contraception
>35 yo smoker Migraine H/A Breastfeeding Endometriosis Anti-convulsant use Sickle Cell
31
2 risks of progestin only contraception
Delayed fertility by 9 mo Reversible decreased BMD
32
3 side effects of progestin only contraception
Menstrual disturbance Weight gain (4 kg) Mood disturbance
33
benefits of progestin only contraception
Amenorrhea Decreased endometrial cancer Decreased PMS Decreased Pelvic pain Decreased PID Decreased vasomotor symptoms Decreased in myomas
34
Benefits of progestin oral contraception
Amenorrhea (10%)
35
Timing when initiating and use of progestin only oral contraception
1st day of menstrual cycle If stated after >7 days of LMP, use back up x 7 d Take same time daily within 3 hours NO PILL FREE DAYS
36
How to manage irregular bleeding with progestin only oral contraception
r/o other cause of irregular bleeding NSAIDS Change to cOCP Supplement with estrogen
37
Failure rate of progestin only oral contraception
o Typical: 9% o Perfect Use: 0.3%
38
C/i to Progestin Implant
Pregnant Undiagnosed abnormal Vaginal bleed Breast CA Liver disease Liver tumor, cancer VTE
39
Risks / Side Effects of Progestin Implant
Pain Bleeding Hematoma Paresthesia Infection Scaring Migration VTE Irregular bleed Ectopic VTW Liver disease H/A Weight gain Breast / Abdo pain
40
Rx of Progestin Implant
28 d postpartum 5 days after T1 abortion
41
Timing / Use of progestin injection
Q 12 weeks Start within first 5 days of period or rule out pregnancy and use back up
42
Failure rate of progestin injection
<1% 6% with typical use
43
risks / side effects of progestin injection
Wt. Gain Mood changes Irregular bleeding Reversible BMD decrease Delayed return of fertility
44
List 2 types of Intrauterine System
Hormonal - Levonogestrel (LNG-IUS) Non-Hormonal - Copper
45
Absolute c/i of IUS
Pregnancy Puerperal sepsis Immediate Post septic abortion Recent PID Recent STI (w/in 3 mo) Distorted uterine anatomy Unexplained Vaginal Bleeding Ovarian / Cervical Ca Progestin +ve Breast Cancer (LNG-IUS)
46
Benefits of IUS
Decreased menstrual flow (LNG-IUS) Decreased dysmenorrhea (LNG-IUS) Decreased endometrial CA (ALL IUS)
47
Risks of IUS
Pain Perforation (2.6/1000) PID (1st 20 dys) Expulsion Failure -> ectopic
48
Side Effects of IUS
Irregular Bleeding (Copper, decreased with LNG) Pain Progesterone Side Effects: Mood Weight Gain Menstrual Disturbance
49
CPS recommended 1st line contraception for pediatrics
IUS
50
IUS: Can you keep it in while treating PID? Does it cause infertility?
Yes No
51
When can an IUS be inserted. What are the risks of inserting while menstruating? What if inserting > 7 d from LMP? When should follow up be? Should U/S be used?
Anytime Increased risk of infection, expulsion Use backup x 7d F/u 4-12 w post insertion Routine U/S not required
52
Failure rate of IUS
Typical: 0.2-0.8 Perfect: 0.2-0.6
53
Management of lost string w/ IUS
r/o pregnancy. Spec Exam – if 0 string order U/S If negative U/S order pelvic XRAY
54
Management of pregnancy w/ IUS
Removed IUS r/o ectopic
55
Management of amenorrhea w/ IUS
r/o pregnancy Determine position
56
Management of STI / PID w/ IUS
No need to remove while treating unless no improvement after 72 hrs
57
Most effect form of emergency contraception
Copper IUD - almost 100% effectiv
58
how long post coitus can a copper IUD be inserted
Up to 7 days if no c/I, reasonable certainty pt is not pregnant
59
Second line emergency contraception
Hormonal
60
List 3 types of hormonal emergency contraception
Uliprisal acetate (first line) Plan B (levonorgestrel) Yuzpe method
61
S/e of hormonal emergency contraception, treatment of side effects
Nausea Vomiting Dizziness Take an antiemetic