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Flashcards in Contraception Deck (25):
1

fertile days of cycle 

8-19

2

two types of IUD

Copper

progestin levonorgestrel (3 and 5 year(

3

LH surge ___ days before ovulation

 

dominant follicle develops on day ___

Lh surge 2 days before ovulation (tiggers meiosis)

 

dominant follicle on 5-7days

3

Depot Caveats and side effects

unscheduled bleeding and ammenorrhea with continued use

reversible decrease in bone density (no fracture risk)

unaffected by hepatic enzyme inducing drugs

decreases siezure threshold and sickle cell crisis

4

trasndermal patch caveats

less effective in body weight >90kgs

higher rate of VTE

5

enzyme inducing anti-epileptics

phenytoin

carbamazepine

phenobarbital

primodone

topiramate (>200mg)

felbamate

vigabatron

6

after ovulation oocyte retains potential for fertilization for

 

spem viable in tract for 

12-24 hours

 

sperm viable for 120 hours

6

hormonal emergency contraceptives + mechanistic requirements

Levonorgestrel - 72-120hours, effective only if 2-3d prior to LH peak

Ulipristal acetate - 120hrs - preventsfolciular rupture if before LH surge, delays follicular rupture for 24-48hr if taken on day of LH peak 

Copper IUD

 

7

mechanism of action for combined hormonal methods (estrogen + progestin)

prevent ovulaiton

thicken cervical mucus

7

mechanism progestin only methods

ovulation suppressed in 50% of cycles

thickening of cervical mucus

possilbe prevention of implantation via thinning of endometrium

9

enzyme inducing general medications (p450 3A4)

rifampin

griseofulvin

St johns wort

modafinil

some HIV protease inhibitors

Nevirapine (non-nucleoside reverse transcriptase inhibitor)

10

caveats, progestin only pills

time dependent - daily dose consitency needed

unscheduled bleeding or spotting 

12

hematologic effets combined hormonal contraceptives

Increase 2 7 8 10 fibrinogen

decrease anticoag Protein S, anti-thrombin, tissue factor pathway inhibitor

induce resistance to activated protein C

14

most reliable predictor of ovulation

LH surge

15

Progestin mechanism of ovulation prevention

 

estrogen mechanism

progesstin: diminishs frequency of hypothalamic GnRH pulse frequency

inibits estrogen induced LH surge

 

estrogen supresses FSH preventing selection and emergence of dominant follicle

 

16

transdermal patch mechanism

combined hormonal BC

ethinyl estradiol

norelegesstromin (active metabolite of norgestimate)

17

Combined oral contraception formulations

estranes (norethinidrone-1stgen) (Norgestimate, Nesogestrel 2nd gen)

Gonanes - borgestrel, levonorgestrel (2nd gen)

sprironolactone analogue - drosprienone

18

LH surge causes lutenization of ___ cells resulting in 

luteinization of granulosa cells with increased progesterone and slowed estrogen synthesis

19

LH promotes androgen production in the ___ cells

theca cells

19

copper IUD mechanism

Cu ions reduce motility and viability of sperm

toxic to oocyte

prevent implantation (useful for emergency contraception)

21

progestin only methods

Pills

Injection

implant

22

androgens converted to estrogen by aromatase in _____ cells

granulosa cells

23

vaginal ring mechanism

combined hormonal contraception

estradiol and etonogestrel (active metabolite of desogestrel)

24

contradictions to IUD

pregnancy

PID within past 3 months

peurperal or post-partum sepsis within 3 months

Purulent cervicitis

undx abnormal bleeding

malignacy

Known uterine morphologic abnls

25

contraindications to CHC

Hx of VTE, inherited or acquired thrombophilia
postpartum - 3-6wks
Hx of MI or CAD
Hx of cerebrovacular accident
smokers > 35
complicated diabetes or vascular disesase
severe HTN BP >160/100
MIgrane with aura
Liver disease
Hx 
breast or endometrial cancer