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Flashcards in Contraception Deck (45):
1

What are the estrogenic effects of birth control

Ovulation is inhibited by suppression of FSH/LH
Implantation is inhibited by alteration of the endometrium
Ovum transport is accelerated
Luteolysis may occur as estrogen causes progesterone levels to fall

2

What are the pro gestational effects of birth control?

Hypothalmis-pituitary- ovarian disturbances
Thick cervical mucus interferes with sperm transport
Capacitation (sperms ability to fertilize the egg) may be inhibited
Ovam transport may be slowed
implantation is hampered by the suppression of endometrium

3

What are the 3 non-contraceptive benefits of oral contraceptives

Decreased mental cramps and pain
Less menstrual blood flow
Improvement of facial acne

4

What are the absolute contraindications for oral contraceptives?

History of thromboembolic disorders
CVA (hx)
Coronary artery disease
Known or suspected breast carcinoma
Known or suspected estrogen-dependent neoplasia (breast, cervical, stomach, brain)
Pregnancy
Benign or malignant tumor or impaired liver function
Previous cholelithiasis during pregnancy
Undiagnosed abnormal uterine bleeding (r/o pathology)

5

When should progestin only pills be used?

hx migraine headaches
breast feeding
contraindication to combination pills

6

What drugs decrease effectiveness of oral contraceptives?

antibiotics and anticonvulsants

7

What drugs do oral contraceptives decrease the effectiveness of?

warfarin, insulin, certain hypoglycemics

8

What are the excessive estrogenic effects

dysmenorrhea, nausea, cholasma, CVA, DVT, PE, thromboembolic disease, telangiectasias (spider vein around the face), hepatic adenoma/adenocarcinoma, cervial changes, breast tenderness (secondary to increased size)

9

Deficiencies in estrogen effects

menopausal like
no withdrawal bleeding
decreased duration in menstrual bleeding
Continuous spotting/bleeding
break through bleeding on DOC 1-9
atrophic vaginitis

10

Excessive pro gestational effects

breast tenderness, HTN, depression, fatigue, decreased libido, decreased duration in menstrual bleeding, increased appetite, weight gain and acne

11

deficiencies in progesterone

breakthrough bleeding DOC 10 to 21
delayed menses

12

How would you begin oral contraceptives?

Begin with low dose combined or multi phasic pill (35mcg or less)

13

Contraindications of the contraceptive ring

Age >35
Smoking
uncontrolled HTN
Controlled BP but smokes >15 cigarettes/day
Hx of blood clots or any cardioembolic disorder

14

How long do you have after a ring falls out to replace it?

3 hours
use back up method of contraceptive must be used if left out for more than 3 hours

15

How often do you change the patch?

once per week

16

At what weight does the patch have reduced effectiveness

>90kg

17

What medications reduced the effectiveness of the patch

Antibiotics, antifungals, anticonvulsants, st johns wart

18

What does the patch increase the risk for?

serious cardioembolic events (bc 60% more estrogen than oral contraceptives)

19

What are the contraindications for the patch?

age >35
Smoking
high BPHx of blood clots or any cardioembolic disorder

20

When should the first patch be applied

on the first day of menstrual cycle (day 1) or the sunday following

21

What do you advise if the patch has been off for >24 hours?

restart a new 4 week cycle along with backup method

22

with is depo-provera's MOA?

suppresses FSH and LH, thus blocking the LH surge which will inhibit ovulation

23

what are the disadvantages of depo-provera?

menstrual irregularities: Usually amenorrhea
Delayed return of fertility up to 1 year
Injection every 3 months
Lipid changes (decreases in HDL)
Possible reduction in bone density with long-term use

24

When do you test for pregnancy in a depo patient?

if greater than 2 weeks since 3 month period ended

25

What do you include in patient education in starting depo?

BAck up method should be used during the first 2 weeks after the injection, unless administered b yDOC 5

26

What are the kinds of IUDs?

Copper-releasing para-gaurd (10 years) and Progestin-releasing MIrene (5 years)

27

What are the advantages of IUDs

Progestin releasing IUDs may decrease menstrual loss and dysmenorrhea
Can prevent Asherman's syndrome (making adhesions during bleeding)

28

What are the IUDs MOA

1) Immobilizes sperm and interferes with migration of sperm from the vagina into the fallopian tubes
2) Speeds transport of the ovum through the fallopian tube
3) inhibits fertilization
4) causes lysis of the blastocyst and/or prevents implantation due to local forge in body inflammatory responses

29

How long after post partum can you insert IUD

4-8 weeks

30

When should a woman have her diaphragm refitted?

Weight gain or loss of 20lbs or more

31

How long do diaphragms need to stay in after intercourse?

6 hours

32

What is the sponge made out of

polyurethane

33

How long can you leave the sponge in for?

30 hours or less, provides protection for 12 hours

34

How much space should you leave on the end of a condom?

1/2 inch

35

What is the morning after pill?

levonorgesterel, plan B, high dose progestin

36

Within how long should the morning after pill be taken?

within 72 hours

37

What is the "abortion pill"?

mifepristone

38

How is the copper IUD used for emergency contraception?

inserted within 5-6 days after intercourse

39

What is the effectiveness of Plan b vs copper releasing IUD

Plan B: 85%
IUD: 99%

40

What are the possible undesired effects of Plan B?

N/V- may want to consider antiemetic
fatigue
HA
dizziness
Diarrhea
breast tenderness
fluid retention
Changing in timing or flow of next menses, may increase length of period

41

MOA of sterilization

Female: tubal ligation
Male: Male vasectomy

42

How do you: calendar method

Record cycles, fertile phase is -18 days from the shortest cycle and -11 days from the longest cycle (last day of fertility)

43

How does the basal body temperature graph work

A.m. Body temp for 3-4 months. Temp drops 12-24 hours prior to ovulation, rises following ovulation due to production of progesterone and avoid sex 2-3 days prior to expected drop to 3 days following the rise

44

What cervical mucus changes do you look for in the billings test/ cervical mucus test?

Mucus changes from scant and thick to thin with increasing Spinnbarkeit

45

What is the symptom herbal method?

Uses both basal body temp and cervical mucus thechniques