Contraception Flashcards
(132 cards)
1
Q
What are the additional benefits of contraception treatment?
A
- Prevention of STIs (condoms)
- Prevention of ovarian and endometrial cancer (contraception/HT)
- Treatment of acne and hirsutism (HC)
- Treatment of menstruation-related problems (HC)
- Management of perimenopausal symptoms (HC)
2
Q
What are the Non-Hormonal Contraceptive Methods?
A
- Periodic Abstinence
- Condoms
- Diaphragms
- Cervical Caps
- Sponges
- Spermicides
3
Q
What are the Hormonal Contraceptive Methods?
A
- Oral
- Transdermal
- Vaginal Ring
- Injectable/Implantable Progestin
- IUDs
4
Q
How does the pill work?
A
STOPS OVULATION, thins uterine lining, thickens cervical mucus
5
Q
Does the pill stop the ability to get pregnant?
A
No, just decreases the ability
6
Q
How does Estrogen control the cycle?
A
- Stabilizes endometrial lining
- Provides cycle control
- Suppresses FSH release from pituitary
7
Q
What are the two synthetic forms of estrogen?
A
Ethinyl Estradiol and Mestranol
8
Q
How does Progestin provide Contraceptive Effect (ANTI-Ovulary)?
A
- Thickens cervical mucus
- Slows tubal motility of sperm
- Induces endometrial atrophy
- Blocks LH surge and secretion of FSH
9
Q
What occurs with ALL testosterone derived progestins?
A
Bind to the androgen receptor and retain some androgenic activity
10
Q
What are the qualities of first generation oral HC?
A
Norethindrone/Ethynodiol Dictate/Norethindrone Acetate
Estrogenic, Progestational, and Androgenic
11
Q
What are the qualities of second generation oral HC?
A
Levonorgestrel/Norgestrel
Progestational and Androgenic
12
Q
How is second gen different from first gen oral HC?
A
Second is more potent, longer t1/2, and more androgenic
13
Q
What are the qualities of third generation oral HC?
A
Norgestimate/Desogestrel
Progestational and Androgenic
14
Q
How is third gen different from second gen oral HC?
A
Less androgenic, higher risk of VTE, otherwise same
15
Q
What are the qualities of fourth generation oral HC?
A
Drospirenone
Progestational
16
Q
What is special about Drospirenone?
A
Have antimineralocorticoid and antialdosterone activity, higher risk of VTE
17
Q
What are the forms of Non-Oral HC?
A
Transdermal Patch, Vaginal Ring, Depot Injection, Long Acting Implantable Progestin, and Intrauterine Device
18
Q
What are things to know about the Transdermal Patch HC?
A
NONOBESE PATIENTS
>90kg or BMI >30 DO NOT USE
New patch Q3 wks, apply abdomen/butt/upper torso/upper arms
19
Q
What are the concerns with Transdermal Patch HC?
A
Increased risk of VTE, 60% more estrogen
20
Q
What happens if you forget to change the patch after 3 weeks?
A
Patch releases hormone for 9 days, if you change by the 9th day over, NO backup method needed, if NOT backup for 7 DAYS
21
Q
What are the things to know about the Vaginal Ring HC?
A
NuvaRing = 3 week period
Annovera = resusable for 1 yr
Insert before 5th day of menstrual cycle, keep in for 3 wks, then remove for 1 wk
22
Q
What are the concerns with Vaginal Ring HC?
A
Increased VTE Risk
No danger with inserting it too far, cervix will prevent it from traveling up
23
Q
What happens if you the ring falls out for more than 3 hrs?
A
Use Back-Up contraceptive and insert a new ring
24
Q
How long does it take to return to fertility for Oral, Transdermal, and Vaginal HC?
A
2 weeks
25
What are the things to know about the Depot Injection HC?
Inhibits ovulation for 14 weeks
Must be injected within 5 days of onset of menstrual bleeding, repeat injection every 3 months
26
What are the concerns with Depot Injection HC?
Breakthrough bleeding
Weight Gain
Decreased bone mineral density by 3-7%
27
What happens if you miss a dose of depot injection?
Should do pregnancy test before reducing and use back-up method for 7 days
28
How long does it take to return to fertility for Depot Injection HC?
10-18 months
29
How long can you take Depot Injection HC?
2 years due to osteoporosis risk
30
What are the things to know about the Long Acting Implantable Progestin?
Lasts 3 years
100% effective but reduced in women >130% of their IBW
31
What are the concerns with Long Acting Implantable Progestin?
Bleeding, no impact on BMD
32
How long does it take to return to fertility for Long Acting Implantable Progestin?
30 days
33
What are the things to know about Intrauterine Device HC?
Copper Wrapping or Progestin Reservoir
Minimal systemic absorption
34
What are the concerns with Intrauterine Device HC?
Pelvic Inflammatory Disease PID with Paragard Copper IUD
35
How long does it take to return to fertility for Intrauterine Device HC?
Immediate upon removal
36
How long does each IUD Last/
Paraguard (Copper): 10 yrs
Mirena: 8 yrs
Sjyla: 3 yrs
Liletta: 6 yrs
Kyle's: 5 yrs
37
What are the Absolute Contraindications to CHC?
1. H/O thromboembolism or thrombophilia
2. H/O vascular disease
3. Diabetes with vascular involvement (nephro/retino/neuro)
4. Migraine HA with Focal Aura
5. Uncontrolleed HTN >160/90
6. Uncontrolled Dyslipidemia
7. Breast Cancer
8. Acute or Chronic Hepatocelluar Disease
9. Age >36 & Smoking >15 cig/day
10. Breastfeeding Women <6 wks POSTpartum
38
What are the Relative Contraindications to CHC?
1. Multiple risk factors for CVD
2. Migraine HA w/o aura in women >35
3. Cirrhosis, mild
4. Symptomatic gallbladder disease
5. Postpartum <3 wks and NOT breastfeeding
6. Breastfeeding <6 months POSTpartum
7. Commonly used drugs that induce liver enzymes
39
What are the commonly used drugs that induce liver enzymes and reduce efficacy of CHC (relative CI)?
1. Rifampin
2. Phenytoin
3. Carbamazepine
4. Barbiturates
5. Primidone
6. Topiramate
40
What drugs may cause OC Failure?
Anticonvulsants
Antimicrobials
Griseofluvin
NNRTIs
Protease Inhibitors
Rifampin
St. John's Wort
41
What drugs may INCREASE OC Activity?
Acetaminophen
Erythromycin
Fluoxetine
Fluconazole
Fluvoxamine
Grapefruit
Nefazadone
Vitamin C
42
OC can decrease clearance of what drugs?
Amitriptyline
Benzos
Caffeine
Cyclosporine
Imipramine
Phenytoin
Selegiline
Theophylline
Corticosteroids
43
OC can decrease efficacy of what drugs?
Lamotrigine
44
What do Anticonvulsants do to CHC and how to fix it?
Decrease contraceptive effect
At least 50 mcg EE, second method of contraception, or IUD
45
What does Griseofluvin do to CHC and how to fix it?
Decrease effect on contraception
Second method of contraception or IUD
46
What does NNRTI/Protease Inhibitors do to CHC and how to fix it?
Increase/Decrease contraceptive effect
IUD
47
What does Rifampin do to CHC and how to fix it?
Decrease effect of contraception
Second method of contraception or IUD
48
What does Atorvastatin do to CHC and how to fix it?
Increases contraceptive effect
Norgestimate and EE
49
Is estrogen and progesterone affected by Antibiotics?
Progesterone = No
Estrogen = potential
50
How long does Post-OC Amenorrhea last?
No longer than 6 months
51
What should be done if you miss 1 active OC pill LESS than 24 hrs later?
Take 1 active pill ASAP then continue the remaining pills at the usual time
52
What should be done if you miss 1 or MORE active OC pill MORE than 24 hrs later?
Take 1 active pill ASAP, then take remaining pills at the usual time, skip placebo week and start new pack
Use 7-day backup method
Consider emergency contraception if unprotected in last 5 days
53
What is Periodic Abstinence?
Avoidance of intercourse during the days of the menstrual cycle when conception is likely to occur based on fertility awareness methods
54
What are Spermicides and the primary ingredient?
Chemical surfactants that destroy sperm cell walls and acts as a barrier that prevent sperm from entering the cervix
Nonoxynol-9
55
What are the CIs of Spermicides?
Should not be used in women at high risk for HIV or women who are HIV infected (increase transmission)
56
What is a Vaginal pH Regulator and the Product in this category?
Designed to maintain vaginal pH within the range of 3.5-4.5% and impair sperm motility
Phexxi Vaginal Gel
57
What are the concerns with Phexxi Vaginal Gel?
Must be administered up to 1 hr prior to intercourse
A/E: burning, pruritus, discharge, UTI
58
What are the advantages to barrier methods?
Temporary/Intermittent/Long Term Contraception
Provide Immediate Protection
NO systemic AE
NO delay in return to fertility
59
Do you have to reapply spermicides and vaginal pH regulators before each act of intercourse?
YES
60
What is the Male Condom?
Single use, mechanical barrier preventing direct contact of the vagina with semen/infectious secretions
61
What are the advantages of the male condom?
STI protection including HIV and most effective barrier method
62
What is the Female Condom?
Single use, pre lubricated, loose fitting synthetic nitrile sheath, closed at one end, with flexible rings at both ends
63
What are the CI of the female condom?
Allergy to synthetic nitrile
History of Toxic Shock Syndrome
64
What are the advantages of the female condom?
Latex free, inserted before intercourse or ahead of time 8hrs prior max, and STI protection
65
What is the Diaphragm and what is it used with?
Reusable, dome shaped rubber cap with flexible rim to be used with SPERMICIDE
66
What are the CIs of the Diaphragm?
Allergy to latex or spermicide
Recurrent UTIs
History of TSS
Abnormal gynecologic anatomy
67
What is the advantage of the Diaphragm?
Resuable for 2 yrs and DECREASE incidence of cervical cancer
68
What is the Cervical Cap and what is it used with?
Reusable non latex silicone cup that fits over the cervix and blocks sperm to the uterus, use with SPERMICIDE
69
What are the CIs of the Cervical Cap?
Allergy to spermicide
History of TSS
Abnormal anatomy and pap smear
70
What is the Sponge?
Single use, non latex pillow shaped SPERMICIDE imbedded with concave dimple
71
What are the CIs of the Sponge?
Allergy to spermicide
Recurrent UTI
History of TSS
Abnormal anatomy
72
What is the advantage of the Sponge?
When left in place, provides protection for 24 hrs, regardless of the frequency of intercourse
73
What is Monophasic OC?
Same amount of estrogen and progestin for 21 days followed by 7 days of placebo
74
What is Biphasic and Triphasic OC?
Contain variable amounts of estrogen and progestin for 21 days followed by 7 days of placebo
75
Are Multiphasic pills better tolerated than Monophasic?
Not conclusive
76
What are Combination OC extended cycle regimens designed for?
Reduce menstrual flow intensity and duration. Dysmenorrhea, Menorrhagia, and Menstrual HA
77
What is the 24/4 Regimen?
24 days of estrogen/progestin and 4 days placebo
Equal to 21/7
78
What is the 26/2 Regimen?
20 days estrogen/progestin
4 days estradiol only
2 placebo
79
What is the Combination OC extended cycle regimen and the main AE?
84/7
Increase in bleeding irregularities
80
What is the Combination OC Continuous regimen and the main AE?
21/7
Bleeding irregularities in the first 3 months
81
What is the Progestin Only OC regimen and the main concern?
Progestin Only 28/7
Must be taken at the same time every day
82
What happens when you take Norethindrone Progestin Only not at the same time every day?
If shaken >3 hrs late, use backup contraception for 48 hrs
83
What is the EE concentration for Adolescents, Underweight <110 lbs, and Women >35 yrs old?
20-25 mcg
84
What is the EE concentration for >90 kg?
35-50 mcg
85
What is the EE concentration for Acne and Hirsutism?
LOW androgenic or antiandrogenic OC
86
What is the EE for reduced or eliminated menstrual cycle/menstrual related symptoms?
Extended or Continuous Cycle OC
87
What is the EE concentration for CI/precautions of Estrogen?
Progestin ONLY
88
What is the First Sunday Start Method?
Take first pill on the first Sunday after menstruation begins
89
What is the Quick Start Method?
Take first pill on the day of the office visit
90
Which Start Method is more effective?
QUICK Start
91
What A/Es results in Immediate DC of OC?
A: Abdominal Pain
C: Chest Pain
H: Headaches
E: Eye Problems
S: Severe Leg Pain
92
If you have early or mid cycle spotting change to what?
Tricyclic with increased ESTROGEN
93
If you have late cycle spotting change to what?
Tricyclic with increased PROGESTIN
94
What is the recommendation for HC in Thromboembolism?
Do not use CHC in women history of thrombotic event
All other forms or contraception or Progestin ONLY
95
What is the recommendation for HC in Migraines?
1. Consider CHC in NONsmoking <35 urs NO Focal signs (2nd line)
2. AVOID CHC in >35 yrs W/O AURA
3. AVOID CHC in any age with AURA
4. DC CHC IMMEDIATELY who develop margarin (w/ or w/o aura) while on CHC
5. Other forms of contraception are appropriate
96
What is the recommendation for HC in >35 yrs?
1. Benefit vs. Risk
2. CHC <35 mcg EE in NONsmoker and no Significant risk factors
3. Other forms of contraception are appropriate
97
What is the recommendation for HC in Smokers?
1. <35 yrs may use CHC <35 mcg EE
2. >35 yrs NO CHC
3. Other forms of contraception appropriate
98
What is the recommendation for HC in HTN?
1. CHC ok if <35 with well controlled HTN
2. Other forms of contraception appropriate
99
What is the recommendation for HC in Dyslipidemia?
1. CHC and Progestin Only ok with Controlled dyslipidemia
2. Alternative NON-hormonal contraception (barrier or copper IUD) with UNCONTROLLED dyslipidemia and additional risk factors
100
What is the recommendation for HC in Postpartum?
1. Progestin ONLY acceptable any time after delivery
2. CHC may be initiated 3 wks post postpartum, must avoid <3 wks
101
What is the recommendation for HC in Breastfeeding?
1. Progestin ONLY used >3 wks postpartum
2. CHC after >6 months postpartum
102
What is the recommendation for HC in Obesity?
1. HC in obese women still acceptable
2. Avoid using CHC <35 mcg EE
3. >90 kg consider DMPA, IUD, or barrier
103
What forms of contraception have the highest effectiveness with perfect/typical use?
Progestin Implantable, Copper IUD, and Levonorgestrel IUD
104
What form of contraception have the worst effectiveness with perfect/typical use?
Spermicides Alone
105
What is the ranking of cost effectiveness for contraception?
BEST: IUD, progestin implant, and progestin injection
MID: OC, vag ring, patch
WORST: barrier methods
106
What is Emergency Contraception?
Prevent unwanted pregnancy after unprotected intercourse
107
What is the mechanism of Levonorgestrel?
INHIBITION of Ovulation
Thickens cervical mucus, and altering endometrium
108
What are the Progestin ONLY EC Products?
Plan B, Next Choice, and My Way
109
What Combination OC takes 2 tablets/dose as EC?
Ovral
110
What Combination OC takes 4 tables/dose as EC?
Levlen, Levora, Lo/Ovral, Triphasil, Tri-Levlen, and Trivora
111
What Combination OC takes 5 tablets/dose as EC?
Alesse and Levlite
112
What is the recommended dosing/admin for EC?
1 DOSE at once within 72 hrs of unprotected intercourse
113
In women >154 lbs for EC what is the concern?
Progestin Only may be less effective
114
If you vomit within 1 hr of taking EC tablet what must you do?
Repeat EC dose
115
What is the mechanism of Progesterone Agonist/Antagonist?
Prevents progestin from binding, postpone follicular rupture, DELAYS ovulation, alter endometrium
116
What drug is Progesterone Agonist/Antagonist used for EC?
Ulipristal Acetate/Ella One: take 30 mg 1 tablet PO within 5 days of unprotected intercourse
117
How does the Copper IUD serve as an EC?
Copper can prevent sperm from fertilizing an egg and may also prevent implantation of a fertilized egg
118
What forms of contraception are non-prescription?
Male/Female condom, Sponge, Spermicide, Progestin Only EC
119
Brand Name of Cervical Cap?
FemCap
120
Brand Name of Sponge?
Today
121
Brand Name of Monophasic OC 21/7?
Ovcon, Ovral, Necon, Yasmin, and Apri
122
Brand Name of Triphasic OC 21/7?
Estrostep and Ortho Tri-Cyclen
123
Brand Name Extended OC 24/4?
Loestrin-24 FE or YAZ
124
Brand Name Extended OC 84/7?
Seasonale or Seasonique
125
Brand Name Progestin Only OC?
Micronor or Ovrette
126
Brand Name of Transdermal CHC patch?
Ortho Eva
127
Brand Name of Vaginal CHC ring?
NuvaRing or Annovera
128
Brand Name of Long Acting Injectable Progestin?
Depo-Provera
Depo-SQ-Provera
129
Brand Name of Long Acting Implantable Progestin?
Implanon or Nexplanon
130
Brand Name Copper IUD?
ParaGard
131
Brand Name Levongrestrel IUD?
Mirena, Skyla, and Liletta
132
Brand Name Progestin Only EC?
Plan B One Step or Next Choice One Dose
