contraception

Question 1

latex condoms should not be used w/ ___

Answer 1

oil lubricants

Question 2

do diaphragms and cervical caps req spermicide use?

Answer 2

yes

Question 3

most effective barrier method if used perfectly

Answer 3

condom 2% (13% typical use)

Question 4

estrogens suppress ___

Answer 4

FSH

Question 5

progestins suppress ___

Answer 5

LH mid cycle surge

Question 6

which estrogen is pharmacologically active?

Answer 6

ethinyl estradiol

Question 7

estrogen in OCP should be below ___ to minimise SEs

Answer 7

<35mcg

Question 8

AEs: HA, nausea, breast tenderness

Answer 8

estrogens

Question 9

AEs: Acne, hirsutism, weight gain, fatigue, depression

Answer 9

progestin

Question 10

low androgenic progestins

Answer 10

Ethynodiol, norgestimate, desogestrel, drospirenone, dienogest

Question 11

progestin w/ antiandrogenic and antimineralcorticoid activity

Answer 11

drospirenone

Question 12

progestin that can cause hyperkalemia

Answer 12

drospirenone

Question 13

progestin w/ highest risk of clots

Answer 13

drospirenone

Question 14

OCPs decrease risk for which cancers?

Answer 14

endometrial, ovarian

Question 15

progestin indicated for PMDD

Answer 15

drospirenone

Question 16

OCPs helpful for which conditions?

Answer 16

benign breast dz, ovarian cysts, endometriosis, acne

Question 17

change to make if OCP pt complains of decreased libido

Answer 17

increase estrogen or consider vaginal ring

Question 18

change to make if pt OCP pt complains of weight gain

Answer 18

decrease estrogen, or switch to progestin w/ lower androgenicity

Question 19

change to make if pt OCP pt complains of high triglycerides

Answer 19

switch to progestin w/ lower androgenicity

Question 20

change to make if pt OCP pt complains of spotting

Answer 20

can increase estrogen, wait a few months, counsel to take pill at same time QD

Question 21

main risks of OCPs

Answer 21

CV events, HTN, VTEs, STIs, gallbladder dz, hepatic tumors, cervical CA

Question 22

combined OCP contras

Answer 22

Primarily d/t estrogen component
* Hx of DVT/PE
* CVA/CAD/Ischemic heart dz
* DM w/ vascular dz
* Breast cancer
* Liver adenoma, hepatitis, cirrhosis
* Migraine HA w/ aura - CVA risk is increased and would be difficult to differentiate
* Surgery w/ prolonged immobilization
* >35 years old AND smoking >1-5 cigarettes/day
* BP >160/100

Question 23

warning sign counseling for OCPs

Answer 23

stop med and seek care immediately if: Abdominal pain (severe)
* Chest pain (severe), cough, SOB
* Headache (severe), dizziness, weakness, or numbness
* Eye problems (vision loss or blurriness), speech problems
* Severe leg pain (calf or thigh)

Question 24

stay on OCP for __ months before changing

Answer 24

3

Question 25

missed dose interval for progestin only pills

Answer 25

3 hours

Question 26

Advantages = decreased menstrual blood loss, decreased cramps, decreased risk of VTE, preferable in lactation

Answer 26

progestin only pills

Question 27

higher failure rates: combined or progestin only pills?

Answer 27

progestin only pills

Question 28

only abx w/ a true documented pharmacokinetic interaction

Answer 28

rifampin

Question 29

DI for OCPs

Answer 29

abx Phenobarbital, phenytoin, carbamazepine (induce metabolism) Ritonavir-boosted protease inhibitors (HIV drug) warfarin (increases clotting) st johns wort (induces metabolism) thyroid products

Question 30

is the patch good for obese women?

Answer 30

no

Question 31

if patch comes off for >24 hrs...

Answer 31

use back up method until on skin X 7d

Question 32

vaginal ring decreases which SEs?

Answer 32

less irritability, depression, acne, nausea, and emotional lability

Question 33

Medroxyprogesterone acetate (Depo-Provera) type of BC

Answer 33

IM or SQ injection Q 12-14 wks

Question 34

indications for Medroxyprogesterone acetate (Depo-Provera)

Answer 34

lactating, can't take estrogen, seizures

Question 35

return to fertility after Medroxyprogesterone acetate (Depo-Provera)

Answer 35

18 months

Question 36

BBW: Medroxyprogesterone acetate (Depo-Provera)

Answer 36

significant decrease in BMD, possibly irreversible, increases w/ duration of use * Long term use (>2 years) only recommended if other methods are inadequate or symptoms of endometriosis return after discontinuation * Recommend calcium, vitamin D, and weight bearing exercise

Question 37

which BC can cause decidual cast?

Answer 37

Medroxyprogesterone acetate (Depo-Provera)

Question 38

most effective BC

Answer 38

IUDs, implants

Question 39

CI for hormonal IUD Levonorgestrel (Mirena, Skyla, Liletta)

Answer 39

Undiagnosed uterine bleeding, current or hx of breast carcinoma, acute PID or STI, pregnancy

Question 40

plan B should be taken w/in ___ hrs

Answer 40

72, but can be up to 5 days

Question 41

plan B ASW fental malformations?

Answer 41

no

Question 42

emergency contraceptive ASW fetal malformations

Answer 42

Ulipristal (Ella)

Question 43

Ulipristal (Ella) should be taken w/in ___ days

Answer 43

5

Question 44

most effective form of emergency contraception

Answer 44

copper IUD inserted w/in 5 days

Question 45

best emergency contraception for obese women

Answer 45

copper IUD