Contraception Flashcards Preview

Pharmacology II > Contraception > Flashcards

Flashcards in Contraception Deck (65):
1

List the methods of contraception

1. Periodic Abstinence (rhythm method)
2. Barrier techniques
3. Spermicides (contain nonoxynol-9 chemical surfactants)
4. Spermicides-implanted barrier technique (sponge with spermicide)
5. Hormonal contraception

2

Disadvantages of male condoms

-Efficacy decreased by oil-based lubricants

3

Absolute contraindications for female condoms

-Allergy to polyurethane
-History of toxic shock syndrome

4

What is important to remember about female and male condoms?

not meant to be used together

5

Why are spermicides no longer recommended?

No added benefit against pregnancy and may increase the risk of HIV transmission

6

What is important to remember about Diaphragm with spermicide?

-Insert 6 hours before intercourse

-Leave in place at least 6 hours after intercourse

-DON'T leave in for >24 hours= risk of Toxic shock syndrome

-Subsequent acts of intercourse, condom use recommended for additional protection

7

Diaphragm with spermicide: Absolute contraindications

-allergy to latex, rubber, or spermacide

-Recurrent UTI

-History of TSS

-Abnormal gynecologic anatomy

8

Diaphragm with spermicide: Advantages

-Inexpensive
-Decreased risk of cervical neoplasia
-Some protection against STDs

9

Diaphragm with spermicide: Disadvantages

-High user error/failure rate
-Decreased efficacy with increase intercourse frequency
-Increased vaginal yeast UTIs
-Efficacy decreased by oil-based lubricants

10

What is a unique contraindication for Cervical cap (FemCap)?

Abnormal papanicolaou smear (due to increased risk for cervical dysplasia)***

11

What are 2 disadvantages with the cervical cap?

-decreased efficacy in women who have given birth
-Can't use during menses

12

In combined hormonal contraceptives, what hormone provides the most contraceptive effect?

Progestins

13

Name the effects progestins have to prevent pregnancy

1. Thickening of cervical mucus
2. Slow tubal motility (sperm transport)
3. Induce endometrial atrophy
4. Progestins block LH surge inhibiting ovulation****

14

What effects do estrogens have to prevent conception?

-Stabilize endometrial lining to provide cycle control**
-Suppress FSH release from pituitary, contribute to blocking LH surge

15

Which form of synthetic estrogen is a prodrug?

Mestranol

16

Why would you consider Mestranol?

50% less potent than Ethinyl estradiol
so...

if you want less estrogen this one is good

17

Which is the most common synthetic estrogen?

Ethinyl estradiol (EE)

18

Name a 1st Generation progestin and downside

Ex. Norethindrone

-well tolerated
-Lower doses have more breakthrough bleeding

19

Name a 2nd Generation progestin and pros and cons

Ex. Levonorgestrel

-long half-life (IUD*)
-More androgenic activity - better for libido, worse for hirsutism/acne/lipids

20

Name 3rd Generation progestin and indication for use

Ex. Desogestrel

-Similar to 2nd gen but less androgenic activity--> so think about this in someone with slight libido benefit needed

21

Name 4th Generation progestin and benefit

Ex. Drospirenone (Yasmin)

-anti-androgenic properties**
-Advertised for acne

22

For progestin only, what is importnat to know about the dosing?

-Must take at the same time every day (3 hr window)

-If window missed, need back up contraception for 48 hours

23

What is a main risk factor for progestin only birth control?

Higher risk of ectopic pregnancy

24

When might be a good time to use progestin only birth control?

right after giving birth, because with giving estrogen you would be concerned for increased risk of thrombotic events

25

Progestin only contraindications:

-Gastric bypass
-ischemic heart disease
-Rifampin

26

Which type of populations should we be more cautious of for combined oral contraceptives/combined hormonal contraceptives

1. Women older than 35
2. Smokers*
3. Hypertension
4. Dyslipidemia
5. Diabetes
6. Migraine headaches
7. Breast cancer
8. Thromboembolism
9. Obesity
10. Systemic Lupus Erythematosus

27

What does 1 represent on the CDC contraceptives chart?

No restriction

28

What does 2 represent on the CDC contraceptives chart?

Advantages generally outweight theoretical or proven risks

29

What does 3 represent on the CDC contraceptives chart?

Theoretical or proven risks usually outweight the advantages

30

What does 4 represent on the CDC contraceptives chart?

Unacceptable health risk (method not to be used)

31

What are contraindications for CHC?

-Smoker >35 (>15 cigarettes/day)
-Lupus
-current breast cancer
-Severe liver disesase (cirrhosis)/Liver adenoma
-High risk of DVT/PE
-Migraine headaches with aura
-Hypertension
-Vascular disease
-Post partum <21 days

32

If a patient has no coexisting medical conditions, what oral contraceptive is recommended?

OC containing:

35 mcg or less of EE and less than 0.5mg of norethinodrone (1st gen)

33

How should you alter the OC dose for adolescents, underweight women, women older than 35 and perimenopausal women?

-Lower dose of EE

(fewer side effects with 20-25mcg of EE)

34

If a patient is nonadherent to her OC what should be considered?

increasing the estrogen dose

35

Which type of oral contraceptive is preferred at initiation of therapy?

Monophasic (not multiphasic)

36

If a patient on oral contraception is having weight gain what can you do?

-this typically improves after 2-3 cycles but can change to a lower estrogentic

37

If a patient has breakthrough bleeding what can you do to the oral contraceptive?

Change to higher estrogenic

38

Name the 5 symptoms that should make you immediately discontinue a combined hormonal contraceptive (CHC)?

ACHES

Abdominal pain
Chest pain
Headache
Eye problems
Severe leg pain

39

How long should someone be on OC before changing/making an adjustment?

2-3 months

40

What is the most common adverse effect of oral contraception?

irregular bleeding

(especially first 6 months of extended-cycle regimens)

41

Traditionally, when is it recommended for women to start OC?

"sunday start" - first sunday after menstrual cycle begins

42

With starting new oral contraception, how long do you recommend a second method of contraception?

at least 7 days after initiation

43

How long should breast feeding women avoid CHCs?

42 days (w/ risk factors)

30 days (no risk factors)

44

How long should you avoid giving CHCs to a women you just gave birth?

21 days (higher risk of thrombosis)

45

Mirena IUD: Key points

-good for 5 years
-Reduces bleeding
-99% effective
-Effective 7 days after insertion

46

ParaGard IUD: key points

-copper
-Good for 10 years
-Off label: emergency contraception
-May cause MORE menstrual bleeding**
-99% effective, effective immediately

47

What are the contraindications for ParaGard IUD?

-SLE (with thrombocytopenia)

-Wilson's Disease

48

Nexplanon Implant: key points

-single rod
-good for 3 years
-99% effective

49

Nexplanon IUD: contraindications

-cirrhosis
-ischemic heart disease

50

Depo-Provera (DMPA) indications

-sickle cell
-older women smokers
-seizures

51

Depo-Provera (DMOA) contraindications

currently with breast cancer

52

Depo-Provera: ADE

-Bone loss (should reverse after stoping shots
-Weight gain
-irregular menses (even after stopping)

53

Transdermal patch: OrthoEvra - key points

-don't wear over breasts
-one patch a week for 3 weeks
-one week off

54

Transdermal patch: contraindications

Higher risk for VTE

55

How much overlap between pill brands?

none

56

How much overlap needed between pill and patch?

one day overlap

57

How much overlap between pill and ring?

none

58

How much overlap between pill and shot?

1 week

59

How much overlap between pill to implant?

4 days

60

How much overlap from pill to hormone IUD?

1 week

61

How much time can pass between stopping oral pills and starting copper IUD?

5 days

62

If pregnancy already exists and you take emergency contraception- will it harm the embryo?

No

63

Levonorgestrel containing emergency contraception should be taken within what window after unprotected intercourse?

72 hours (3 days)

64

Levorgestrel emergency contraception: primary mechanism of action?

inhibiting or delaying ovulation (doesn't disrupt implantation)

65

What is the window of use for Ulipristal as an emergency contraceptive?

5 days after unprotected sex

-Rx only