Contraception Flashcards
(45 cards)
2 first generation progesterones
megestrol acetate medroxyprogesterone acetate (depo)
2 second generation progesterones
aka estranges
norethindrone
ethynodiol
3rd generation progesterone
norgestrel, levonorgestrel
desogestrel
norgestimate
dienogest
**less androgenic effects
nonsteroidal progesterone
drospirenone
what is drospirenone derived from?
spironolactone
worry about K+ levels with drospirenone
how does progesterin work?
makes secretions viscous - prvt sperm get into uterus
prvts LH surge - no ovum released
decrease tubal motility
thins endometrium - lowers implantation probability
4 progestin metabolic effects
increased insulin secretion + peripheral resistance
increase lipase
increased fat deposition
increased LDL, HDL
when is progesterone indicated?
pregnancy maintance
dysfunctional uterine bleeds
post meno pause HRT
contraception
CI progestin
migrane severe DVT or PE unexplained bleeding breast cancer liver dz that is active
progestin ADR
acne, hirsutism, high LDL, insulin resistance
Vaginal bleed
DVT
Depo - bone loss
estrogen MOA
inhibits FSH release - fertilization does not actually happen
prvts follicle development which = ovulation
enhances LH surge
estrogen helps most with __
cycle control - timing
good for ipt with irregular cycles
10 contraindications OCP
- H/o: stroke, clot, thrombophlebitis, VTE, valvular heart dz
- DM with vascular involvement
- migraine with aura
- uncontrolled HTN
- major surgery with prolonged immobilization
- breast cancer
- liver dz
- age is over 35 - smoking more than half pack
- pregnant (breast feed less than 6 wks post birth)
- thrombogenic mutations
if there is a drug interaction with OCP use __
backup method
drug interactions OCP
- rifampin - lowers OCP efficacy
- phenobarb, phenytoin, carbamazepine (AED)
- use IUD, DMPA, implant instead - ABX? tetracycline, PCN
estrogen contraceptive adr
HA, breast tenderness
DVT clot
N
progesterone adr
acne hirsutism
if too much estrogen
can get dysmenorrhea, menorrhagia or uterine growth
- lower OCP, IUD, IUD, etend cycle
estrogen deficiency
early cycle BTB - increase dose
if see amenorrhea
suggests low estrogen -
check for pregnancy then higher OCP
see high appetite, weight gain, bloating
progestin excess
progestin deficiency =
late cycle BTB
nuvaring is
etonogestrel
insert vaginally leave for 3 weeks
minipill
progestin only pill - norethindrone
