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Flashcards in Contraception Deck (90):
0

How long is the normal menstrual cycle?

23 - 35 days (average 28 days)

1

What do ovulation kits test for?

LH and are positive if LH is present

2

What happens pre-ovulation (before day 14)?

FSH is dominant

3

What happens post-ovulation (after day 14)?

Theres a LH surge from day 14

4

What indicates a positive pregnancy test?

If hCG (human chorionic gonadotropin) is present in urine

5

What supplement should all women of child-bearing age be on?

Folic acid supplement 400-800 mcg/day

6

What's the purpose of taking Folic acid supplement (400-800 mcg/day)?

To help prevent birth defects of the brain and spinal cord (neural tube defects)

7

At least how long should a woman be on Folic acid before she conceives? Why?

At least 1 month before pregnancy

Bcuz it takes time to build up adequate body stores

8

Name the main types of hormonal contraceptive

Progestins-only pills (POPs) - pill or injectable

Estrogen and progestin combinations oral contraceptives (COCs) - pills or patch or ring

9

Which contraceptive is recommended for breast-feeding mothers? Why?

POPs

Estrogen reduces milk production

10

List the various indications of COCs

Pregnancy prevention
Dysmenorrhea
PMS
Perimenopausal sx (hot flashes, night sweat)
Anemia due to excessive period-related blood loss
Acne (in females)
Premenstrual migraine

11

In what type of migraine is POPs preferred over COCs? Why?

In migraines with aura

Estrogen increases the risk of stroke, t4 POPs is preferred

12

SEs due to estrogen (COCs issue only)?

Nausea

Breast tenderness/fullness

Bloating

Weight gain

Elevated BP

13

Which SE due to estrogen is most bothersome? What can be done to alleviate it?

Nausea

They may take pill in the evening or at bedtime

14

Severe SEs of estrogen?

Thrombogenic disorders, including heart attack, stroke, DVT/PE

15

What other factors, other than estrogen increases a woman's risk for clotting disorders?

Age

Smoking

Diabetes / HTN

Prolonged bed rest

Overweight

16

What should be avoided in at-risk women?

Progestin drospirenone (present in
YAZ
YASMIN
Gianvi
Ocellated
Safyral
Syeda
Zarah
Beyaz
as well as Ortho Evra patch)

17

List the conditions that u should not use any form of estrogen in?

Hx of blood clot disorder (DVT/PE)
Hx of stroke or heart attack
Heart valve dx with complications
Severe HTN
Diabetes that causes blood vessel problems
Poorly controlled diabetes
Severe headaches
Recent major surgery with prolonged bed rest
Breast cancer
Liver cancer or dx
Uterine cancer /other known /suspected estrogen-dependent cancers
Unexplained abnormal bleeding from the uterus
Jaundice during pregnancy or jaundice with prior hormonal contra use
Known or possible pregnancy
If older than 35 yrs + smoke > 15 cigarette/day

18

SEs of POPs?

Breast tenderness

Fatigue

Changes in mood

19

What other factors do u consider for clotting risk?

Higher estrogen dose, higher clotting risk

Drospirenone-containing birth control pills may be ass with a higher risk for blood clots than other progestin-containing pills

Ortho Evra patch: higher systemic estrogen exposure than most COC pills

20

If a woman is breastfeeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)

POPs

21

If a woman has elevated clotting risk, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Lower dose estrogen content

Progestin-only pill

22

If a woman has estrogen CI, include clotting risk, what type of hormonal contraceptive would u recommend? (Formulation considerations)

POPs

23

If a woman experiences Estrogenic side effects, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Low estrogen formulation

24

If a woman is Spotting/Breakthrough Bleeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Wait 3 cycles before switching (bleeding more common with Seasonale, Seasonique and Lybrel)

Use higher estrogen and progestin if mid-cycle bleeding persist

25

If a woman is Avoiding Monthly Cycle, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Longer formulation - Seasonale or Seasonique (Q3 months)

Continuous - Lybrel

26

If a woman has fluid retention/bloating, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Product containing Drospirenone (if low clotting risk)

Progestine is a mild diuretic (retains K)

27

If a woman has Premenstrual Dysphoric Disorder, what type of hormonal contraceptive would u recommend? (Formulation considerations)

YAZ

Sertraline

Fluoxetine (Sarafem)

28

If a woman has acne, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Ortho Tri-Cyclen

Estrostep

Yaz

29

If a woman has Heavy Mentsrual Bleeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)

Any OCP would do

Mirena - preferred
Natazia - is indicated for menorrhagia
Tranexamic acid (Lysteda)

30

List drugs that reduce efficacy of hormonal contraceptive (use back-up while on these meds)

Antibiotics especially, Rifampin. Others are rifapentine, Rifabutin

Anticonvulsants - barbiturates, CBZ, oxcarbazepine, phenytoin, topiramate and felbamate

St. John's wort

Protease Inhibitors (PIs) and non-nucleoside reverse transcriptase inh (NNRTIs) - increase or decrease OCPs

Bosentan (Tracleer), Mycophenolate (CellCept)

Smoking

31

How do u make changes to OCPs while on Rifampin?

Use other form of birth control

If switching back to OCPs after rifampin use, use back up for 11/2 months after stopping rifampin

32

Advantage of depo-provera inj? Disadvantage of depo-provera inj?

Doesn't have drug interactions

Lowers bone density (should be avoided in women at risk for osteoporosis)

33

List oral contraceptive types (representative list)

High dose Monophasic COCs: all active pills contain the same level of hormone throughout the 3 active weeks

Biphasic or Triphasic (multiphasic): the dose of hormones changes over the course of 21 days

Low estrogen COCs

Extended cycle COCs

Progestin only mini-pills (POPs)

34

Which OCPs is approved for PMDD?

Seasonique

35

List agents in high dose Monophasic COCs (all active pills contain the same level of the hormones throughout the 3 active weeks)

50mcg Ethinyl estradiol, with various progestins

Ogestrel 0.5/50-28

Ovcon-50

Zovia 1/50-28

36

List agents in Biphasic or Triphasic (also called Multiphasic): dose of hormones changes over the course of 21 days

Cyclessa
Estrostep FE
Kariva
Mircette
Nortrel 7/7/7
Necon 7/7/7
Ortho-Novum 7/7/7,
Tri-Cyclen Lo
Tri Lo Sprintec

37

Which multiphasic OCPs has 4 phases?

Natazia

38

Uses of low estrogen COCs (20-30 mcg estrogen, compared to 35mcg)?

Used to lower withdrawal sx (emotional/physical) and bleeding

39

Difference btw Seasonique and Seasonale? (Extended Cycle COCs)

Seasonique has shorter placebo periods (7 days of low dose estrogen) than Seasonale (7 days of placebo)

40

Which OCPs contain Folic acid?

Extended cycle COCs

Beyaz

Safyral

41

What's unique about Lybrel?

12 months continuous OCP

42

What's unique about Ethinyl estradiol/levonorgestrel (Amethyst)?

Continuous (no placebo or stop)

43

What's LoSeasonique?

3 months, with 20mcg EE

44

List progestin only mini pills agents

Norethindrone 35 mcg (Camila, Errin, Heather, Jolivette, Micronor, Nor-QD, Nora-BE)

Some names include "nor"

45

POP start day option?

Start any time

Use another method of birth control for first 48 hrs (protection begins after 2 days)

46

How to use POPs?

Need to take exactly around same time of day everyday

47

What happens if 3 hrs have elapsed from regular schedule time?

Back up is needed for 48 hrs after taking the late pill

48

COC start day?

Sunday (menstruate during the week)

OR

1st day of menses (or within 5 days of start of period)

49

When should u use back up during the start of COC? For how long?

If not starting within 5 days after start of period, use back-up for 1st week of use

50

How do u deal with a single COC pill missed?

Take single pill when noticed, and take next pill at scheduled time (u may nene to take 2 pills on the same day)

No additional contraceptive is req

51

How do u deal with a 2+ COC pill missed?

Back up contraception is needed if >= 2 pills are missed

U may need to take 2 pills on the same day

52

How do u deal if 2 or more pills are missed in the first week of cycle?

Emergency contraception should be used

53

How do u deal if 2 or more pills are missed in the last week of hormone pills (day 15-21 of a 28-day pack)?

Omit hormone-free week, by finishing the hormone pills in current pack and start a new pack the next day

54

How long does it take for protection to occur in Seasonale and Seasonique?

7 days

Use back-up for first 7 days

55

Which OCPs are continuous pills with no monthly cycle?

Lybrel

Amethyst (generic)

56

How do u deal with a 1 tab of Lybrel/Amethyst pill missed?

Take as soon as remembered and take next pill at regular time (u may need to take 2 pills in a day)

Use back-up for7 days

57

How do u deal with a 2 tabs of Lybrel/Amethyst pill missed?

Take the. 2 tabs asap. Take next one at regular schedule time.

Use back-up for 7 days

58

How do u deal with a 3 tabs of Lybrel/Amethyst pill missed?

Continue to take 1 tab daily

Don't take missed pills

EC may be req

Use back-up for 7 days

59

List brands that contain Drospirenone

YAZ

Gianvi

Yasmin

Ocella

Syeda

Zarah

Beyaz

Vestura

Safyral

Loryna

60

Why are Drospirenone-containing pills imp?

They decrease bloating, PMS sx and Wt gain

61

What's the caution with Drospirenone-containing pills?

Have a risk of increased K and caution must be used with K-sparing agents including:

Aldosterone antagonist
K supplements
Salt substitutes (KCl)
ACE-I
ARBs
Heparin
Canaglifozin
Calcineurin inhibitors

62

What must be checked b4 starting Drospirenone-formulations?

Check potassium level

Safe range = 3.5-5 mEq/L

63

In what disease states are Drospirenone-formulations avoided?

Kidney, Liver or Adrenal gland dx

In women with clotting risk (bcuz they have a slightly higher risk of clotting)

64

Howz Ortho Evra COC patch used?

Once a week for 21 out of 28 days

Apply on clean, dry skin of buttocks, stomach, upper arm or upper torso

65

Do u need backup when staring Ortho patch?

No backup needed

66

When should backup be needed for Ortho patch?

If patch falls > 24hrs

67

Unique SE of Ortho patch?

Higher systemic estrogen exposure (60% more than a 35mcg pill)

Other SE same as PI,,

68

When is Ortho patch less effective?

In women > 198 pounds

69

How often is NuvaRing used?

Inserted into the vagina once a month

Kept in place for 3 weeks

70

What do u do if ring is out > 3 hrs during week 2 or 3?

Rinse and re-insert ring and use backup for 7 days

71

T/F? NuvaRing has same SE, CI and drug interactions as the pills?

True

72

Howz NuvaRing stored? Duration?

Up to 4 months at room temperature

73

What's the only 100% way to prevent pregnancy?

Abstinence

74

What's used to increase birth control effectiveness of condoms?

Nonoxynol-9 spermicide

75

What do OTC contraceptive methods (and some condoms) all contain?

Nonoxynol-9

76

List the 3 options made of soft latex or silicone barriers that cover the cervix is and prevent sperm passage

Shield

Cap

Diaphragm

77

List other forms of contraception

IUD - Mirena, Skyla

Copper-T IUD - Paraguard

Subdermal rod - Implanon, Nexplanon

Injection - Depo-Provera, Depo-subQ Provera

78

What's emergency contraception (EC)?

The morning after pill is a form of contraception that prevents pregnancy up to 72hrs (3days) for levonorgestrel EC

120 hrs (5 days) for Ella

79

What can also be used as EC?

Higher than normal doses of regular OCPs can be used e.g.

5 tabs of Aviane

Alesse x 2 doses, taken 12 hrs apart

80

If a pt vomits within 2 hrs of taking pills, what should be done?

They should consider repeating the dose

81

Which EC is OTC?

Levonorgestrel EC (Plan B One-Step) is OTC with no age or other restrictions

82

MOA of levonorgestrel (primarily)?

Prevent or delay ovulation

83

What do ovulation kits test for?

Luteinizing hormone (LH)

84

When is the highest chance for pregnancy when using ovulation kits?

3 days immediately from the positive result

85

What agent is oral fertility med?

Clomiphene (Clomid, Serophene)

86

What's the brand name of Clomiphene?

Clomid

Serophene

87

MOA of Clomiphene (Clomid, Serophene)?

Selective Estrogen Receptor Modulator (SERM)

88

SE of Clomiphene (Clomid; Serophene)?

Hot flash

Ovarian enlargement

Abdominal bloating/discomfort

Thrombosis risk

89

List injectable fertility meds

Human Chorionic Gonadotropin (hCG)

Gonadotropins

Urofollitropin

Follitropin

Gonadotropin Releasing Hormone Agonist (GnRH agonist)

Gonadotropin Releasing Hormone Antagonist (GnRH antagonist)

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