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1. Pharm II > Contraception > Flashcards

Contraception Flashcards

1
Q

What are goals of contraception?

A
  • Prevent pregnancy
  • Prevent STDs (condoms)
  • Improve menstrual cycle
  • Improve health conditions
  • Manage perimenopause
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2
Q

What are methods of contraception?

A
  • Periodic abstinence
  • Barrier techniques
  • Spermicides
  • Spermicides-implanted barrier
  • Hormonal
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3
Q

What are 2 contraindications for female condoms?

A
  • Allergy to polyurethane

- Hx of TSS

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4
Q

What are contraindications of using a diaphragm w/ spermicide?

A
  • Allergy to latex, rubber, or spermicide
  • Recurrent UTIs
  • Hx of TSS
  • Abnormal anatomy
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5
Q

What are contraindications of using a cervical cap?

A
  • Allergy to spermicide
  • Hx of TSS
  • Abnormal anatomy
  • Abnormal pap
  • Menses
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6
Q

How do you use a cervical cap?

A

Insert 6 hrs prior to intercourse

Do not remove for at least 6 hrs after intercourse

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7
Q

Can a cervical cap remain in place for multiple episodes of intercourse?

A

Yes, but not for longer than 48hrs at a time

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8
Q

What are contraindications to using a sponge?

A
  • Allergy to spermicide
  • Recurrent UTIs
  • Hx of TSS
  • Abnormal anatomy
  • Menses
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9
Q

What form of contraception can increase the transmission of HIV?

A

Spermicides

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10
Q

How do you use a sponge?

A

Moisten w/ water & insert up to 6hrs prior to intercourse

Do not remove for at least 6hrs after intercourse

Do not leave in for longer than 24-36hrs

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11
Q

Describe the hierarchy of contraception methods.

A

Implant > LNG > Copper T > injectable > pill, patch, ring > diaphragm, sponge (nullparous) > male condom > female condom > withdrawal > sponge (parous), fertility awareness > spermicide

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12
Q

What s/s are seen EARLY in the menstrual cycle?

A 
Irritability, anxiety, depression
Bleeding 
Lower abd, back, & leg pain  
HA, dizziness
N/D
Changes in libido 
Infection
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13
Q

What s/s are seen LATE in the menstrual cycle?

A 
Anxiety, depression
Wt gain, bloating, constipation 
Swollen eyes, ankles 
Breast fullness, tenderness 
HA
Nausea 
Acne 
Spotting, discharge
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14
Q

In combined hormonal contraceptives (CHCs), what provides the majority of the contraceptive effect?

A

Progestin

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15
Q

What is the MOA of progestins?

A

Thicken mucus
Slow motility & delay sperm transport
Induce endometrial atrophy
Block LH surge –> inhibits ovulation

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16
Q

What is the MOA of estrogens?

A

Suppress FSH release –> prevents ovulation
Stabilize endometrial lining & control cycle
Thicken mucus

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17
Q

What are the 3 synthetic estrogens?

A

Ethinyl estradiol (EE)
Mestranol (liver converts to EE)
Estradiol valerate

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18
Q

Progestins differ w/ respect to….

A

inherent estrogenic, antiestrogenic, & androgenic effects

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19
Q

What 2 variables are androgenic effects dependent upon?

A

presence of sex hormone binding globulin

androgen:progesterone activity ratio

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20
Q

What happens if SHBG decreases?

A

Free testosterone increases

Androgenic side effects become more prominent

21
Q

Describe 1st gen progestins. Give an example of one.

A

Well tolerated, but lower doses have breakthrough bleeding

Norethindrone

22
Q

Describe 2nd gen progestins. Give an example of one.

A

long half life (in implant/IUD), more androgenic activity- better for libido, worse for hirsutism/acne/lipids

Levonorgestrel

23
Q

Describe 3rd gen progestins. Give an example of one.

A

Same progestational activity w/ decreased androgenic activity

Desogestrel

24
Q

Describe 4th gen progestins. Give an example of one.

A

Anti-androgenic

Drospirenone

25
What are special considerations of oral contraceptives?
``` Women > 35 Smoking HTN HLD DM Migraines Breast CA Thromboembolism Obesity SLE ```
26
What are the risks associated with Minipills (progestin only)?
40% of women continue to ovulate | Increased risk of ectopic pregnancy
27
What are contraindications of progestin only?
Gastric bypass Ischemic heart disease Rifampin
28
What are ADEs of CHCs?
``` N/V Breast tenderness Wt gain Acne, oily skin Depression, fatigue Breakthrough bleeding/spotting Site reaction Vaginal irritation ```
29
What s/s warrant discontinuation of CHCs?
"ACHES" - Abd pain - Chest pain, SOB - HAs - Eye problems - Severe leg pain
30
Women breastfeeding w/ RFs of VTE should avoid CHCs for how long? What about those w/out RFs?
42 days postpartum If no RFs --> avoid CHCs for 30 days postpartum
31
What type of contraception should be offered if trying to minimize androgen effects or avoid HLD?
3rd gen progestin, low dose
32
What is 1st line for contraception in adolescents?
LARC - Nexplanon - Mirena, Kyleena, Skyla - Copper ParaGard
33
What are contraindications to IUDs?
``` Unexplained vaginal bleeding STDs PID Hx of breast CA or endometrial CA Post abortion Pregnancy Pelvic TB Anatomic abnormalities ```
34
Describe the mirena
Lasts 5 years Reduces bleeding Shrinks fibroids, reduces endometriosis Effective 7 days after insertion
35
Describe the ParaGard
Lasts 10 years Can be used for emergency conception May cause more menstrual bleeding
36
What are contraindications of ParaGard?
Wilsons disease | SLE
37
Describe Nexplanon
Lasts 3 years | Irregular bleeding
38
What are contraindications for Nexplanon?
Cirrhosis | Ischemic heart disease
39
What are ADEs of levonorgestrel & copper IUDs?
Menstrual irregularities Expulsion Insertion complications PID
40
What are ADEs of progestin only implants?
Menstrual irregularities | Insertion site reactions
41
Describe ADEs of Depo Provera (DMPA)
``` Wt gain Irregular menses Bone loss Acne, hirsutism Depression ```
42
Who is the Depo Provera shot good for?
Sickle cell anemia Older smokers Seizures
43
What is a contraindication of Depo Provera?
Breast CA
44
What are considerations of Depo Provera?
``` Cirrhosis DM w/ microvascular disease CVD Uncontrolled HTN SLE Unexplained vaginal bleeding Women close to menopause (risk of osteoporosis) ```
45
What are contraindications for the transdermal patch (OrthoEvra)
Higher risk of VTE Skin conditions Obesity
46
If switching pill to patch, what should be the overlap?
1 day
47
If switching pill to shot or pill to hormone IUD, what should be the overlap?
1 wk
48
If switching pill to implant, what should be the overlap?
4 days
49
If switching pill to copper IUD, how long do you have to wait?
5 days after stopping pill

1. Pharm II (11 decks)

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