Flashcards in Contraception Deck (53):
How are failure rates listed?
From "best/typical" use
Primary MOA of hormonal contraceptives (HC)
Inhibition of ovulation
What are the hormonal components of HC
Estrogen (synthetic -> ethinyl estradiol (E2))
Progestins (synthetic -> levonorgestrel)
What are some common groupings of oral contraceptive (OC) products?
Progestin only (mini pill)
What is a hematologic benefit of HC?
Increased hemoglobin (some OCs contain Fe2+)
What is a fetal benefit of HC?
Reduced risk of neural tube defects (some OCs contain folate)
What are some perimenopausal benefits of HCs?
Decrease vasomotor sx
Increased bone mineral density
Adverse effects of HC
RFs of VTE on HC
When risk of VTE what kind of HC are you supposed to use?
Which HC has the least risk of VTE?
What is cancer associated w/ and how were HC altered to deal with that?
What does decreasing estrogen do to efficacy of HC?
Increased risk of failure -> pregnancy
What are HC users w/ HTN at greater risk of?
MI or stroke
When are HCs not recommended?
Smokers > 35 years
What can we do to deal with less serious SEs of HCs
Adjusting E2 or progestin content
Which transdermal patch is no longer available?
What do transdermal patches do?
Deliver EE and norelgestromin daily
How do you dose the patch?
1 patch weekly for 3 weeks
Then 1 week w/o a patch
When are transdermal patches less effective?
In women > 90 kg
What is the med content of the vaginal ring?
EE and etonogestrel
How do you dose the vaginal ring?
Leave the NuvaRing in place for 3 weeks
Then take out for 1 week
Benefits of vaginal ring/NuvaRing
Rapid return to fertility after removal
Less nausea, acne, irritability, and depression
What is the injectable HC, how is it delivered, and how is it dosed?
DMPA -> progesterone
IM q 3 months
SC q 3 months
What is the benefit of injectable HC?
Improved adherence over OCs
What are some issues with the injectable HC?
Decreased bone density (supposed to DC after 2 years of use)
What are the subtypes of long acting reversible contraception (LARC)?
Intrauterine device (nonhormonal -> copper; hormonal)
How long can you use the nexplanon subdermal implant?
What does nexplanon contain for x ray visualization?
Is Nexplanon affected by BMI?
Is Nexplanon safe immediately postpartum/abortion?
How long can you use a copper IUD?
What is the greatest benefit of copper IUDs?
They are the MOST effective form of emergency contraception
*may be inserted up to 10 days post intercourse*
What is the main SE of copper IUDs?
Increased menstrual bleeding
How long can you use hormonal IUDs?
What is the benefit of hormonal IUDs over copper?
Less menstrual bleeding
What are the two types of emergency contraception pills?
How is Progestin dispensed, what is an example, and how long after sex do you take it?
OCT -> no age restriction
Levonorgestrel (plan b)
How is antiprogestin dispensed, what is an example, and when do you take it after sex?
5 days after sex
Which emergency contraceptive is more effective?
Is it better to wait out the time period after sex or go get the meds sooner?
Get them sooner -> prompt is prudent
What is mifepristone RU-486?
How is mifepristone given?
W/ other prostaglandins
Give an example of a mifepristone agent
What is the success rate of mifepristone?
>90% w/ pregnancies < 49 days
What is E2 mainly metabolized by?
What do 34A inducers do?
Increase HC metabolism -> increasing risk of pregnancy
What are some examples of 34A inducers:
St. John's wort
What is the risk of pregnancy w/ IUD?
What is a risk of IUDs?
What is the risk of expulsion of an IUD immediately after placenta delivery?
What is the risk of expulsion of an IUD 10 min -48 hours after placenta delivery?