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Men's and Women's Health > Contraception > Flashcards

Flashcards in Contraception Deck (66):
1

What are the drug types in BC pills?

Estrogen + progestin
Progestin only

2

What drug form is used for estrogen?

Ethinyl estradiol

3

How does ethinyl estradiol prevent ovulation?

Suppresses the hypothalamic gonadotropin-releasing facors
Prevents FSH and LH secretion

4

How is ethinyl estradiol metabolized?

Hepatically

5

What is progestin?

Synthetic progesterone-like compound (levonorgestrel, norethindrone, norgestrel, etc)

6

How does progestin prevent ovulation?

Suppresses LH
Thicken cervical mucus
Endomtrium incapable of implantation

7

How is progestin metabolized?

Some hepatic metabolism

8

What is drosperinone?

Progestin

9

What class is drosperinone?

Aldosterone antagonism analog

10

What are the AE's of 25mg spironolactone

Hyperkalemia, gynecomastia

11

Why does drosperinone not affect BP?

The estrogen offsets the BP effects from aldosterone antagonists

12

What drugs do we use caution with when taking drosperinone?

ACE/ARBs

13

Why do we put iron in BC?

For iron deficiency anemia

14

Why is folate added to BC?

In case of failed contraception to prevent neural tube defects

15

What are the types of four-phasic BC?

Initial high estrogen (dose reduction during proliferative/follicular phase)
Initial low progestin (Dose increase during secretory/luteal phase)

16

What antituberculosis agent interacts with BC?

Rifampin

17

What antifungal interferes with BC?

Griseofulvin

18

Which anticonvulsants interact with BC?

Most

19

Which abx interact with BC?

Tetracycline
Doxycyline
Penicillins
Cipro
Ofloxacin

20

Which HIV meds interact with BC?

Telaprevir
Tipranavir
Elvitegravir

21

What are the "good" AEs for BC?

Increased bone density
Reduced menstrual blood
Less pre-menstrual problems
Acne improvement
Improved pre-menstrual mood (Yaz)

22

What are the "bad" AEs for BC?

VTE, MI, Stroke (from estrogen)

23

When are oral contraceptives not recommended?

Women > 35 w/:
Uncontrolled HTN
DM + vascular disease
Smoking

24

When is thromboembolism risk increased when taking BC?

Protein C and S deficiency
HTN, obesity, DM, smoker, sedentary lifestyle

25

How does obesity effect BC effectiveness?

Mixed evidence/safety

26

Where is the patch applied?

Buttocks
Upper outer arm
Lower abdomen
Upper torso

27

Which hormones are in the patch?

Estrogen and progestin

28

How is the patch dosed?

1qweek x 3 weeks + 1 patch-free week

29

Who is the patch good for?

Non-adherent patients

30

Above what weight is the patch's efficacy potentially reduced?

90kg

31

How long is the patch effective for?

9 days
If wearing the patch for > 9 days, must use additional contraception for 7 days

32

What are the rules if the patch becomes detached?

< 24 hours apply new patch
> 24 hours apply new patch + additional contraception for 7 days

33

What drugs are in NuvaRing?

Estrogen and progestin

34

How is NuvaRing absorbed?

Through vaginal epithelium

35

How is NuvaRing used?

1qweek + ring free week

36

If a patient is using NuvaRing, what additional barrier contraception should not be used?

Diaphragm
Sponge
FemCap

37

What is an AE of NuvaRing?

Vaginitis

38

How long is NuvaRing good for outside of the fridge?

4 months

39

What are contraindications to not having estrogen in BC?

>35 yo + Smoker/DM + vascular disease
H/o VTE, major surgery with prolonged immobilization
CV dz, SBP > 160 mmHg or DBP > 100 mmHg, IHD, valvular heart disease
Breastfeeding/< 21 day postpartum
Breast cancer (excludes FH)
Severe cirrhosis, benign hepatocellular adenoma or malignant liver tumor
Migraines with aura

40

What does the effectiveness of the POP depend on?

Cervical mucus thickened
Endometrial atrophy
Does not completely prevent ovulation

41

How should a POP be taken?

Same time daily

42

How long is the cervical mucus change maintained while on a POP?

<24 hours

43

What do you do if you missed your POP dose by 3+ hours?

Use additional form of contraception x48 hours

44

What are the positives of POPs?

Minimal effect on coagulation
Do not worsen BP
Does not impair milk production during lactation

45

What are the negatives of POPs?

Take at the same time daily
Irregular bleeding

46

What are the formulations of progestin injections?

Depo-Provera q3months IM
Depo-SubQ Provera q3months SQ

47

When is progestin injected?

Within 5 days of period onset

48

How soon is progestin injection effective?

Within 24 hours

49

What are the positives for progestin injections?

Minimal to no milk production impairment in lactation
Convenient schedule

50

What are the negatives for progestin injections?

Irregular bleeding
Delayed ovulation after discontinuation
Weight gain****
Loss of BMD (2 yr limit of therapy)

51

When are progestin implants placed?

In upper arm within 5 days of menses

52

How long are progestin implants effective?

3 years

53

How long should additional contraception be used upon placing the progestin implants?

7 days

54

What is a caution for progestin implants?

ABW > 30% greater than IBW

55

What are the AEs of progestin implants?

Irregular menstrual bleeding
Weight gain (less than injections)
Acne

56

What are the two types of IUDs?

Mirena, Liletta, Skyla (Levonogestrel IUD)
ParaGard (Copper IUD)

57

How long are liletta and skyla effective for?

3 years

58

How long is mirena effective for?

5 years

59

How long is ParaGard effective?

10 years

60

How does ParaGard work?

Copper has a spermicidal effect
Thickens cervical mucus (similar to progestin)
Prompts release of leukotrienes and and prostaglandins by enometrium

61

How long after unprotected sex is ParaGard good for?

Effective up to 5 days

62

When is ParaGard inserted?

At end of period (cervix is softer and dilated)

63

When is ParaGard inserted after childbirth?

6-8 weeks

64

How long should additional contraception be used after insertion of ParaGard?

1 month

65

When is the risk of ParaGard expulsion most likely to expel?

1st month

66

What are the positives of ParaGard?

Long term use
No weight gain
No decreased