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Pharm III > Contraception > Flashcards

Contraception Flashcards

(56 cards)

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1
Q

Unintended pregnancy

A

Mistimed, unplanned or unwanted pregnancy at the time of conception
Typically occurs from inconsistent or incorrect use of effective contraceptives

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2
Q

Non-hormonal contraceptive methods

A 
Periodic abstinence
Barrier methods
-Condom: male and female
-Diaphragm
-Cervical cap
-The last two barrier methods are prescriptions bc they need to be fitted
Spermicide
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3
Q

Combined hormonal contraceptives

A 
Combined oral contraceptives
Patch
-Ortho Evra
-Xulane
Vaginal ring
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4
Q

Progestin only contraceptives

A 
Progestin only pills
Long-acting injectable
-Depo-Provera (DMPA)
Implant
-Nexplanon
IUD 
-Mirena
-Kyleena
-Skyla
-Liletta
-ParaGard
--Copper IUD
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5
Q

Progesterone MOA

A 
Main contraceptive component
Blocks LH surge
Thickens cervical mucus
Slows tubal motility
Induces endometrial atrophy
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6
Q

Estrogen MOA

A

Suppresses FSH release which helps block LH surge
Primary role:
-Stabilizes endometrial lining
-Cycle control

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7
Q

Benefits of CHCs

A 
Pregnancy prevention
Improvement in menstruation-related issues
Reduced risk of:
-Endometrial and ovarian cancer
-Endometriosis
-Ovarian cysts
-Ectopic pregnancy
-PID
Treat acne
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8
Q

Risks of CHCs

A 
Alters lipid metabolism
-Progestin increases LDL, estrogen does opposite, net neutral
Increases BP
-Take baseline and monitor throughout therapy
Increased risk of:
-Breast CA?
-CVD
--MI and CVA
-VTE
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9
Q

Pt interview

A 
Menstrual hx
-Regularity and cycle length
-Light or heavy menses
PE
-Height
-Wt
-BP
Pt preference
-Contraceptive hx
-Planning on conceiving
-Adherence
Monogamous relationship
-No hormonal contraceptive protects against HIV or STDs
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10
Q

R/o pregnancy

A

No s/sx of pregnancy and meets one of the following:
Less than or equal to 7 days after the start of normal menses
Not had sexual intercourse since start of last nl menses
Correctly and consistently using a reliable form of contraception
Less than or equal to 7 days after spontaneous or induced abortion
Within 4 wks postpartum
Fully or nearly fully breastfeeding

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11
Q

Category 4 CIs

A

Unsafe, benefits don’t outweigh risks

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12
Q

Category 3 CIs

A

Risks probably still outweigh benefits

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13
Q

Category 2 CIs

A

Benefits outweigh risk, but there is still risk

A lot of category 2s apply to pt, still may not be the best product for them

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14
Q

Category 1 CIs

A

Go right ahead!!

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15
Q

What is in a category 4?

A

Age >35 yo and currently smoking greater than or equal to 15 cigarettes/day
Complicated solid organ transplant
Complicated valvular heart dz
Current breast CA
Hx of CVA
Hx of VTE with high risk for recurrence
Ischemic heart dz
Known thrombogenic mutations
Major surgery with prolonged immobilization
Malignant hepatoma or hepatocellular adenoma
Migraine HAs with aura
Severe cirrhosis
SLE with pos or unknown antiphospholipid antibodies
Uncontrolled HTN or HTN with vascular dz

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16
Q

What is part of a category 3?

A

Acute viral hepatitis
Age >35 yo and currently smoking <15 cigarettes/day
DM with vascular dz or DM >20 yrs duration
Hx of breast CA, but no evidence of dz for 5 yrs
Hx of cholestasis related to CHC use
Hx of VTE with low risk for recurrence
Hx of malabsorptive bariatric sx (oral therapies only)
Hx of HTN
IBD with increased risk for VTE
Multiple RFs for atherosclerotic CVD
MS with prolonged immobility
Superficial venous thrombosis
Symptomatic or medically treated gallbladder dz
Taking meds that induce liver enzymes and reduce efficacy of CHCs

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17
Q

Drug interactions of CHCs

A 
Increase hepatic metabolism of CHCs:
Carbamazepine, phenytoin, primidone, topiramate, oxcarbazepine
Barbiturates
Protease inhibitors
-Fosamprenavir
Rifampin
Decreased by CHCs: lamotrigine
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18
Q

CHC use postpartum- not breastfeeding

A

Can use progestin only options immediately
Avoid first 3 wks
-Category 4
Avoid first 6 wks if risk factors for VTE
-Category 3

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19
Q

CHC use postpartum- breastfeeding

A 
Can use progestin only options immediately
Avoid first 3 wks
-Category 4
Avoid during days 21-30
-Category 3
Avoid during days 30-42 if RFs for VTE
-Category 3
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20
Q

How do combined oral contraceptives differ from each other?

A

Based on individual hormones and doses of hormones, number of active pills, phases

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21
Q

Estrogens- hormones

A

Ethinyl estradiol (EE)
Mestranol
-Less potent than EE
Estradiol valerate

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22
Q

Progestins 1st gen

A

Ehynodiol diacetate
Norethindrone
Norethindrone acetate

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23
Q

2nd gen progestins

Study These Flashcards
A

Levonorgestrel

Norgestrel

24
Q

3rd gen progestins

Study These Flashcards
A

Desogestrel

Norgestimate

25
4th gen progestins
Dienogest | Drospirenone
26
Drospirenone
Structurally related to sprironolactone -3 mg of drospirenone = 25 mg of spironolactone Antimineralcorticoid and antiandrogen effects -May result in less wt gain
27
AEs of drospirenone
Hyperkalemia | Jury is out on increased VTE risk
28
Usual regimen of combined oral contraceptives
21 active pills | 7 placebo
29
Extended cycle regimens, combined oral contraceptives
24 active pills, 4 placebo 26 active pills, 2 placebo 84 active pills, 7 placebo
30
Continuous cycle regimen, combined oral contraceptives
Always active pills | Skipping placebo pills
31
When would you want to utilize extended or continuous cycle regimens for combined oral contraceptives?
``` Decrease menses Anemia Dysmenorrhea Endometriosis Menstrual migraines Desire for decreased menses ```
32
Monophasic combined oral contraceptives
Same levels throughout cycle | Preferred regimen
33
Biphasic combined oral contraceptives
Hormones change once during cycle
34
Triphasic combined oral contraceptives
Hormones change twice during cycle
35
Four-phasic combined oral contraceptives
Hormones change three times during cycle
36
Initial dosing of combined oral contraceptives
``` Pts without comorbid conditions EE 20-35 mcg Older progestin -Levonorgestrel -Norethindrone ```
37
Counseling for combined oral contraceptives
``` Adherence Adverse effects -Usually improve after first 3 mos D/c therapy if experience ACHES Abdominal pain Chest pain HAs Eye problems Severe leg pain Missed dose management Starting therapy ```
38
Monitoring and f/u
``` No routine f/u required Advise f/u when: -Experiencing adverse effects -Want to change contraceptive method -Need to replace or remove contraceptive method Assess at routine visits -BP -Changes in health status -Pt satisfaction -Wt ```
39
AEs of excess estrogen in CHCs
``` Bloating Breast tenderness HA Nausea Dysmenorrhea Menorrhagia ```
40
AEs of excess progestin in CHCs
``` Acne Bloating Breast tenderness Changes in mood HA Fatigue Hirsutism Increased appetite Oily skin Wt gain ```
41
AEs of estrogen deficiency in CHCs
Amenorrhea Decreased libido Early or mid-cycle breakthrough bleeding Vasomotor sx
42
AEs of progestin deficiency in CHCs
Dysmenorrhea Menorrhagia Late cycle breakthrough bleeding
43
What is the #1 reason pts stop their contraceptives?
Breakthrough bleeding
44
How to manage estrogen excess in combined oral contraceptives
``` Decrease estrogen Consider progestin only methods Avoid patch Consider vaginal ring For dysmenorrhea -Consider extended cycle or continuous cycle -Consider NSAIDs ```
45
How to manage estrogen deficiency in combined oral contraceptives
Increase estrogen
46
How to manage progestin excess in combined oral contraceptives
Decrease progestin For acne, oily skin or hirsutism: -Consider less androgenic progestin
47
How to manage progestin deficiency in combined oral contraceptives
``` Increase progestin Consider progestin only methods For dysmenorrhea: -Consider extended cycle or continuous cycle -Consider NSAIDs ```
48
Patch
Releases EE 35 mcg and norelgestromin 150 mcg per day -Warning regarding increased exposure to estrogen: increased VTE risk? Same CI and precautions as CHCs Avoid in pts weighing >90 kg -Decreased efficacy
49
Counseling for the patch
``` Apply to abdomen, buttocks, upper torso, or upper arm New patch each week for three wks -Patch free 4th wk Adverse effects similar to CHCs -Skin irritation ```
50
Vaginal ring
``` Releases EE 15 mcg and etonogestrel 12 mg per day -Inserted and left in place for 3 wks -Removed for 1 wk Same CIs and precautions as CHCs Adverse effects similar to CHCs -FB sensation -Vaginal sx ```
51
Advantages of CHCs
``` Highly effective Protect against endometrial and ovarian CA Favorable effects on bone mass Fertility returns quickly after stopping -Approximately 1-2 wks Menstrual cycle benefits ```
52
Disadvantages of CHCs
Adverse effects -Breakthrough bleeding: common during first 3-6 mos DO NOT protect against HIV or STDs Efficacy dependent on adherence
53
Role of progestin only therapy
Breastfeeding Pts who do not tolerate estrogen containing contraceptives Pts with medical conditions in which estrogen is not recommended -Category 4 and 3
54
Progestin only pills
No placebo, 28 days of norethindrone 0.35 mg Decreased efficacy compared to CHCs Needs to be taken same time every day -Missed dose >3 hrs, use backup contraception for 2 days
55
When to avoid progestin only pills
Breast CA Hx of malabsorptive bariatric surgery Malignant hepatoma or hepatocellular adenoma Severe cirrhosis SLE with pos or unknown antiphospholipid antibodies
56
DIs- progestin only pills
Increased hepatic metabolism due to: Carbamazepine, phenytoin, primidone, topiramate, oxcarbazepine Barbiturates Rifampin

Pharm III (8 decks)

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