Contraception Flashcards
(57 cards)
1
Q
Role of Estrogen in Contraception
- Suppress ___ production
- prevent ___ follicle
- increase sex hormone ___ globulin (SHBG)
- increase binding of free ___
A
- FSH
- dominant
- binding
- androgens
2
Q
Role of Progestin in Contraception
- Prevent ___ surge
- inhibit ___
- Thicken cervical ___
- atrophy of ___
- lessen ___
A
- LH
- ovulation
- mucus
- endometrium
- bleeding
inhibits sperm’s swimming ability and implantation
3
Q
Not enough estrogen
- Breakthrough bleeding ___ in the cycle
- ___ menses
- vaginal ___
- spotting
- no ___ bleeding
A
- early
- light
- dryness
- withdrawal
4
Q
not enough progestin
- breakthrough bleeding ___ in cycle
- no ___bleeding
- ___ menses
A
- late
- withdrawal
- heavy
5
Q
Levonorgestrel has high progestational activity and high ___ activity
A
androgenic
6
Q
Implant - Etonogestrel (Nexplanon)
- more than ___ effective
- left in place for up to ___ years
- if inserted > 5 days after start of period, use backup method for ___ days
- Return of fertility: may be delayed or rapid return within ___ weeks
A
- 99%
- 3 years
- 7 days
- 6 weeks
7
Q
Implant - Etonogestrel (Nexplanon)
Serious SE:
* ___ changes
* headaches
* acne
Common SE:
irregular bleeding for ___ months
A
- mood
- 6-12
8
Q
Levonorgestrel IUD
- more than ___ effective
- left in place for ___ years (based on each IUD)
- use back up method for ___ days after insertion
- Benefits: ___or lighter periods, safe to ___, lower risk of ___ cancer
- Return of fertility: ___
A
- 99%
- 3-7 years
- 7
- amenorrhea, breastfeed, uterine
- immediate
9
Q
Levonorgestrel IUD
Serious SE: (all about insertion)
* uterine ___
* expulsion
* infection
Common SE:
* spotting for first ___ months
* periods may become ___ or less ___
* cramping with insertion
A
- perforation
- 3-6
- lighter or less frequent
10
Q
Copper IUD (Paragard)
- More than ___ effective
- left in place for ___ years
- no backup method needed, effective ___
- Benefits: lower risk of __ cancer, safe to ___
A
- 99%
- 10+
- immediately
- uterine, breastfeed
11
Q
Copper IUD (Paragard)
Serious SE:
* uterine ___
* expulsion
* infection
Common SE:
* cramping with insertion
* spotting for the first ___ months
* periods may become ___
A
- perforation
- 3-6 months
- heavier
12
Q
Levonorgestrel Brands/Strengths/Duration
Mirena; ___ mg; ___ years
Skyla; ___ mg; ___ years
Liletta; ___ mg; ___ years
Kyleena; ___ mg; ___ years
A
- 52 mg, 7 years
- 13.5 mg, 3 years
- 52 mg, 6 years
- 19.5 mg, 5 years
13
Q
Depo Shot
- ___% effective
- ___ mg IM or ___ mg SC
- every __ months
- Quick Start: start today and use backup for __ days
- Next Period: start within ___ days of period
- Benefits: lower risk of ___ cancer, safe to ___, lighter and less ___ periods
Late dose: - > 15 weeks + unprotected sex, use ___
A
- 94%
- 150 mg; 104 mg
- 7 days
- 7 days
- uterine, breastfeed, painful
- Emergency contraception
14
Q
Depo Shot
Serious SE:
* ___ bone density
* ___ bleeding
Common SE:
* ___ gain
* changes in ___, mood, or headaches
* spotting or ___
Return of fertility: possible ___ of return
A
- lower
- heavier
- weight
- acne
- amenorrhea
- delay
15
Q
COC
- ___% effective
- E + P
- Quick Start: start today, if 5 days after ___ use backup for 7 days
- Next period: start within ___ days of period
- wait 5 days to start is ___ is used
- Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods
Late dose:
* 1 pill: take ASAP and take next pill at usual time
* 2 or more pills: take 1 ASAP, take next pill ay usual time, use backup for ___ days
A
- 91%
- period
- 5 days
- Ella
- acne, ovarian/uterine, regular
- 7 days
16
Q
COC
Serious SE:
* Blood ___
* stroke
Common SE:
* nausea
* spotting
* ___ discomfort
* Change in __
* headaches
Return of fertility: ____
A
- clots
- breast
- mood
- immediate
17
Q
Very low dose EE range
A
20-25 mcg
18
Q
Low dose EE range
A
30-35 mcg
19
Q
High dose EE range
A
50 mcg
20
Q
Mini-Pill (POP-Norethindrone)
- ___% effective
- must be taken with ___ hours of the same time every day
- no ___ in the pack
- same starting methods as COC
- Benefits: Safe to ___, lack of ___ related SE
- Return of Fertility: ___
A
- 91%
- 3 hours
- placebo
- breastfeed
- estrogen
- immediate
21
Q
Mini-Pill (POP-Norethindrone)
Late Dose
* if more than 3 hours late: take pill ASAP and use backup for ___ days
* miss 1 or more pills, take 1 ASAP, take next pill at usual time, and use backup for ___ days
A
2 days
22
Q
Mini-Pill (POP-Norethindrone)
Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy
Common SE:
* spotting and menstrual changes more common than ___
A
- headaches
- heavy
- ectopic
23
Q
POP-Drospirenone 4mg (Slynd)
- ___% effective
- ___ placebos in the pack
- same starting info as COC
- same late dosing info as COC
- Benefits: safe to ___, lack of __ related side effects
- return of fertility: ___
A
- 91%
- 4
- breastfeed, estrogen
- immediate
24
Q
POP-Drospirenone 4mg (Slynd)
Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy
* ___kalemia
Common SE:
* spotting and menstrual changes more common than ___
A
- headaches
- heavy
- ectopic
- hyperkalemia
- COC
25
# Ring - EE and Etonogestrel (Nuvaring, Eluryng)
* ___% effective
* E + P (releases ___ mcg of ___ per day)
* left in place for 3 weeks and removed for ___ week
* new ring inserted after ___ days
* Quick Start: Start today, if more than ___ day after period, use backup for 7 days
* Next Period: start ___ day of period
* wait ___ days if Ella is used
* Benefits: improved ___, lower risk for ___ cancer, more ___, light, less painful periods
* return of fertility: ____
* 91%
* 15 mcg, EE
* 1 week
* 7 days
* 1 day
* first
* 5 days
* acne, ovarian/uterine, regular
* immediate
26
# Ring - EE and Etonogestrel (Nuvaring, Eluryng)
Serious SE:
* Blood ___
* stroke
Common SE:
* nausea
* spotting
* ___ discomfort
* chanhes in ___
* headaches
* clots
* breast
* mood
27
# Ring - EE and Etonogestrel (Nuvaring, Eluryng)
Late Dose:
* out for over 3 hours; reinsert and use backup for ___ days
* in for over ___ weeks; remove ring, put in new ring and use back up for 7 days
* 7 days
* 4 weeks
28
# Reusable Ring - Segestrone and EE (Annovera)
* ___% effective
* E + P (releases ___ mcg of ___ per day)
* left in place for ___ weeks, removed for 1 week
* wash with mild ___ and warm water
* Quick Start: start today, if more than 5 days after period, used backup for 7 days
* Next period: start on days ___ of period
* Wait 5 days if ___ is used
* Benefits: Improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods, can use one device up to ___ times
* Return of fertility: ___
* 97%
* 13 mcg, EE
* soap
* 2-5
* Ella
* acne, ovarian/uterine, regular, 13x
* immediate
29
# Reusable Ring - Segestrone and EE (Annovera)
Late Dose:
* out for more than 2 hours: reinsert and use backup for ___ days
7 days
30
# Reusable Ring - Segestrone and EE (Annovera)
Serious SE:
* blood ___
* stroke
Common SE:
* headache/___
* infection/___
* N/V
* clots
* migraine
* candidiasis
31
# Patch - Norelgestromin and EE (Xulane, Zafemy)
* ___% effective
* may be less effective if over ___ lbs
* caution with BMI over ___ (still used clinically)
* E +P (releases ___ mcg of ___ per day)
* patches can be applied to arm, ___ , back , or ___
* new patch every __ weeks, patch free for ___ days
* same starting info as COC
* Benefit: improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods
* Return of fertility: ___
* 91%
* 198 lbs
* 30
* 35 mcg, EE
* butt, abdomen
* 3 weeks, 7 days
* acne, ovarian/uterine, regular
* immediate
32
# Patch - Norelgestromin and EE (Xulane, Zafemy)
Late Dose:
* off over ___hours: apply new patch, backup for 7 days
* On over ___ days: apply new patch; backup for 7 days
* 24 hours
* 9 days
33
# Patch - Norelgestromin and EE (Xulane, Zafemy)
Serious SE:
* blood ___ (more estrogen than most COC)
Common SE:
* nausea
* spotting
* ___ discomfot
* ___ irritation
* change in ___
* headaches
* clots
* breast
* skin
* mood
34
# Patch - Levonorgestrel and EE (Twirla)
* ___% effective
* less effective as ___ increases
* E + P (releases ___ mcg of ___ daily)
* same administartion location as other patches
* new patch every __ weeks, patch free for ___ days
* Next Period: start on ___ day of period, use back up for the first 7 days of first cycle
* wait ___ days is Ella is used
* Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods, ___ risk of blood clots
* Return of Fertility: ___
* 91-96%
* BMI
* 30 mcg, EE
* first
* 5 days
* acne, ovarian/uterine, regular, lower
* immediate
35
# Patch - Levonorgestrel and EE (Twirla)
Late Dose:
* off less than __ hours: apply new patch, no backup needed
* off greater than ___ hours: apply new patch and start and use backup for 7 days
24 hours
36
# Patch - Levonorgestrel and EE (Twirla)
Serious SE:
* Blood ___
Common SE:
* nausea
* spotting
* increased ___
* ___ irritation
* changes in ___
* headaches
* clots
* weight
* skin
* mood
37
# Some Contraindications of COC
* < ___ days postpartum
* Venous ___
* ___ and vascular disease
* migraine ___ aura
* ___ cancer
* BP > ___
* smoking over ___ cigs over the age of ___
* stroke
* 21 days
* thromboembolism
* diabetes
* with
* breast
* 160/100 mmHg
* 15 cigs, 35 years old
38
T or F: antibiotics and COC is controversial, and backup should be recommended
Truw
39
T or F: Amethyst is the only pack with no placebo pills that is FDA approved
True
| skipping the placebo pills of other COCs is off label
40
# POP contraindication
current ___ cancer
breast
41
T or F: For transgender men, testosterone treatment alone is enough to prevent pregnancy
FALSE; Testosterone use may decrease fertility but, can still lead to pregnancy
| use contraceptives and estradiol to stop menses altogether
42
T or F: CHC is controversial for use in transgender men due to the presence of estrogen
True; progestin only would be a better option
43
T or F: Ella can only be used once per cycle
True
44
emergency contraception types (3)
* PlanB
* Ella
* Copper IUD
45
# Emergency Contraception
Copper IUD
* interferes with ___ viability and function
* Most effective EC across all ___
* sperm
* BMIs/weight
46
# Emergency Contraception
Ulipristal Acetate
* inhibits ___ and leads to follicular ___
* effective up to ___ days; better efficacy than LNG up to ___ lbs
* effective after ___ surge has begun
* interaction with ___ contraception
* ___ only
* ovulation, rupture
* 5 days, 194 lbs
* LH
* hormonal
* rx
47
# Emergency Contraception
Levonorgestrel
* inhibits ___
* available ___ (not interaction with other methods)
* may be less effective over ___ lbs (BMI of ___)
* labled for ___ hours
* ovulation
* OTC
* 165 lbs, 25
* 72 hours
48
# Mifepristone (Mifeprex)
* Selective ___ receptor modulator (SPRM)
* Anti___
* decidual ___
* cervical __
* increased uterine ___
* prostaglandin ___
* progesterone
* progesterone
* necrosis
* softening
* contractility
* sensitivity
49
# Misoprostol (Cytotec)
* Prostaglandin ___ analogue
* cervical ___
* uterine ___
* E1
* softening
* contractions
50
# Medication abortion dosing
Mifepristone: ___ mg po for 1 dose
Misoprostol: ___ mcg buccally 24-48 hours later. (2x ___ mcg tablets in each cheek for 30 mins)
* 200 mg
* 800 mcg, 200 mcg
51
# Medicaltion abortion counseling points
bleeding and cramping is to be expected but contact your doctor if:
* more than ___ pads/ hour for 2 consecutive hours
* blood clots larger than a ___
* chills and fever greater than ___ or ___ for over 4 hours
* most severe pain is ___ after misoprostol
* 2 pads
* lemon
* 101 degrees, 100.4 degrees
* 2.5-4 hours
52
# Irregular Bleeding - Pills
1. take pill at the same time each day
2. ibuprofen ___ mg po ___ for 5 days
3. ___ acid 500 mg po TID for 5 days
4. change pill formulation
* 800 mg, TID
* Mefenamic
53
# Irregular Bleeding - Implant/IUD
1. ibuprofen ___ mg po ___ for 5 days
2. ___ acid 500 mg po TID for 5 days
3. Combined pill with ___ for 1 cycle
4. EE ___ mcg daily for ___ days
* 800 mg, TID
* Mefenamic
* levonorgestrel
* 50 mcg, 21 days
54
# Heavy/Prolonged Bleeding
1. ibuprofen ___ mg po ___ for 5 days when bleeding starts
2. EE ___ mcg daily for ___ days (or ___ pills)
3. ___ acid 1500 mg po TID for 3 days, then ___. mg po daily for 2 days when bleeding starts
* 800 mg, TID
* 50 mcg, 21, combined
* Tranexamic, 1000 mg
55
# Headaches and Nausea
Headaches
* pain relievers
* if during hormone free week, consider __ use
* if headaches get worse or are more often, seek evaluation
Nausea
* take pill at ___ or with ___
* if beginning of cycle, consider ___ use or ___ cycle
* extended
* bedtime, food
*continuous, extended
56
# breast tenderness and acne
Breast Tenderness
* wear supportive bra
* hot/col compress
* pain relievers
* consider product with lower dose of ___
acne
* topical
* try different formulation of pills
* switch from implant/IUD to ___
* estrogen
* COC
57
# Mood changes
* ___ cycle if changes during hormone free week
* refer if major ___
* continuous
* depression
