Flashcards in Contraception Deck (66):
What are the drug types in BC pills?
Estrogen + progestin
What drug form is used for estrogen?
How does ethinyl estradiol prevent ovulation?
Suppresses the hypothalamic gonadotropin-releasing facors
Prevents FSH and LH secretion
How is ethinyl estradiol metabolized?
What is progestin?
Synthetic progesterone-like compound (levonorgestrel, norethindrone, norgestrel, etc)
How does progestin prevent ovulation?
Thicken cervical mucus
Endomtrium incapable of implantation
How is progestin metabolized?
Some hepatic metabolism
What is drosperinone?
What class is drosperinone?
Aldosterone antagonism analog
What are the AE's of 25mg spironolactone
Why does drosperinone not affect BP?
The estrogen offsets the BP effects from aldosterone antagonists
What drugs do we use caution with when taking drosperinone?
Why do we put iron in BC?
For iron deficiency anemia
Why is folate added to BC?
In case of failed contraception to prevent neural tube defects
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)
What antituberculosis agent interacts with BC?
What antifungal interferes with BC?
Which anticonvulsants interact with BC?
Which abx interact with BC?
Which HIV meds interact with BC?
What are the "good" AEs for BC?
Increased bone density
Reduced menstrual blood
Less pre-menstrual problems
Improved pre-menstrual mood (Yaz)
What are the "bad" AEs for BC?
VTE, MI, Stroke (from estrogen)
When are oral contraceptives not recommended?
Women > 35 w/:
DM + vascular disease
When is thromboembolism risk increased when taking BC?
Protein C and S deficiency
HTN, obesity, DM, smoker, sedentary lifestyle
How does obesity effect BC effectiveness?
Where is the patch applied?
Upper outer arm
Which hormones are in the patch?
Estrogen and progestin
How is the patch dosed?
1qweek x 3 weeks + 1 patch-free week
Who is the patch good for?
Above what weight is the patch's efficacy potentially reduced?
How long is the patch effective for?
If wearing the patch for > 9 days, must use additional contraception for 7 days
What are the rules if the patch becomes detached?
< 24 hours apply new patch
> 24 hours apply new patch + additional contraception for 7 days
What drugs are in NuvaRing?
Estrogen and progestin
How is NuvaRing absorbed?
Through vaginal epithelium
How is NuvaRing used?
1qweek + ring free week
If a patient is using NuvaRing, what additional barrier contraception should not be used?
What is an AE of NuvaRing?
How long is NuvaRing good for outside of the fridge?
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
What does the effectiveness of the POP depend on?
Cervical mucus thickened
Does not completely prevent ovulation
How should a POP be taken?
Same time daily
How long is the cervical mucus change maintained while on a POP?
What do you do if you missed your POP dose by 3+ hours?
Use additional form of contraception x48 hours
What are the positives of POPs?
Minimal effect on coagulation
Do not worsen BP
Does not impair milk production during lactation
What are the negatives of POPs?
Take at the same time daily
What are the formulations of progestin injections?
Depo-Provera q3months IM
Depo-SubQ Provera q3months SQ
When is progestin injected?
Within 5 days of period onset
How soon is progestin injection effective?
Within 24 hours
What are the positives for progestin injections?
Minimal to no milk production impairment in lactation
What are the negatives for progestin injections?
Delayed ovulation after discontinuation
Loss of BMD (2 yr limit of therapy)
When are progestin implants placed?
In upper arm within 5 days of menses
How long are progestin implants effective?
How long should additional contraception be used upon placing the progestin implants?
What is a caution for progestin implants?
ABW > 30% greater than IBW
What are the AEs of progestin implants?
Irregular menstrual bleeding
Weight gain (less than injections)
What are the two types of IUDs?
Mirena, Liletta, Skyla (Levonogestrel IUD)
ParaGard (Copper IUD)
How long are liletta and skyla effective for?
How long is mirena effective for?
How long is ParaGard effective?
How does ParaGard work?
Copper has a spermicidal effect
Thickens cervical mucus (similar to progestin)
Prompts release of leukotrienes and and prostaglandins by enometrium
How long after unprotected sex is ParaGard good for?
Effective up to 5 days
When is ParaGard inserted?
At end of period (cervix is softer and dilated)
When is ParaGard inserted after childbirth?
How long should additional contraception be used after insertion of ParaGard?
When is the risk of ParaGard expulsion most likely to expel?