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Flashcards in Contraception Deck (53):
1

How are failure rates listed?

From "best/typical" use

2

Primary MOA of hormonal contraceptives (HC)

Inhibition of ovulation

3

What are the hormonal components of HC

Estrogen (synthetic -> ethinyl estradiol (E2))
Progestins (synthetic -> levonorgestrel)

4

What are some common groupings of oral contraceptive (OC) products?

Monophasic
Biphasic
Triphasic
Quadriphasic
Progestin only (mini pill)

5

What is a hematologic benefit of HC?

Increased hemoglobin (some OCs contain Fe2+)

6

What is a fetal benefit of HC?

Reduced risk of neural tube defects (some OCs contain folate)

7

What are some perimenopausal benefits of HCs?

Decrease vasomotor sx
Increased bone mineral density

8

Adverse effects of HC

VTE

9

RFs of VTE on HC

Obesity
Smoker
HTN
DM
Surgery
Previous DVT

10

When risk of VTE what kind of HC are you supposed to use?

Progestin only

11

Which HC has the least risk of VTE?

Levonorgestrel

12

What is cancer associated w/ and how were HC altered to deal with that?

Unopposed estrogen
Decreased estrogen

13

What does decreasing estrogen do to efficacy of HC?

Increased risk of failure -> pregnancy

14

What are HC users w/ HTN at greater risk of?

MI or stroke

15

When are HCs not recommended?

Smokers > 35 years
HTN
Migraines

16

What can we do to deal with less serious SEs of HCs

Adjusting E2 or progestin content

17

Which transdermal patch is no longer available?

Evra

18

What do transdermal patches do?

Deliver EE and norelgestromin daily

19

How do you dose the patch?

1 patch weekly for 3 weeks
Then 1 week w/o a patch

20

When are transdermal patches less effective?

In women > 90 kg

21

What is the med content of the vaginal ring?

EE and etonogestrel

22

How do you dose the vaginal ring?

Leave the NuvaRing in place for 3 weeks
Then take out for 1 week

23

Benefits of vaginal ring/NuvaRing

Rapid return to fertility after removal
Less nausea, acne, irritability, and depression

24

What is the injectable HC, how is it delivered, and how is it dosed?

DMPA -> progesterone
IM q 3 months
SC q 3 months

25

What is the benefit of injectable HC?

Improved adherence over OCs

26

What are some issues with the injectable HC?

Decreased bone density (supposed to DC after 2 years of use)
Delayed fertility

27

What are the subtypes of long acting reversible contraception (LARC)?

Subdermal implant
Intrauterine device (nonhormonal -> copper; hormonal)

28

How long can you use the nexplanon subdermal implant?

3 years

29

What does nexplanon contain for x ray visualization?

Barium

30

Is Nexplanon affected by BMI?

Nope

31

Is Nexplanon safe immediately postpartum/abortion?

Yes :D

32

How long can you use a copper IUD?

10 years

33

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*

34

What is the main SE of copper IUDs?

Increased menstrual bleeding

35

How long can you use hormonal IUDs?

3-5 years

36

What is the benefit of hormonal IUDs over copper?

Less menstrual bleeding

37

What are the two types of emergency contraception pills?

Progestin ECPs
Antiprogestin ECPs

38

How is Progestin dispensed, what is an example, and how long after sex do you take it?

OCT -> no age restriction
Levonorgestrel (plan b)
72 hours

39

How is antiprogestin dispensed, what is an example, and when do you take it after sex?

Rx only
Uliprostal acetate
5 days after sex

40

Which emergency contraceptive is more effective?

Antiprogestin

41

Is it better to wait out the time period after sex or go get the meds sooner?

Get them sooner -> prompt is prudent

42

What is mifepristone RU-486?

An abortifacient

43

How is mifepristone given?

W/ other prostaglandins

44

Give an example of a mifepristone agent

PO misoprostol

45

What is the success rate of mifepristone?

>90% w/ pregnancies < 49 days

46

What is E2 mainly metabolized by?

CYP3A4

47

What do 34A inducers do?

Increase HC metabolism -> increasing risk of pregnancy

48

What are some examples of 34A inducers:

Anticonvulsants
Antiretrovirals (HIV)
St. John's wort

49

What is the risk of pregnancy w/ IUD?

18%

50

What is a risk of IUDs?

Uterine perforation

51

What is the risk of expulsion of an IUD immediately after placenta delivery?

3-27%

52

What is the risk of expulsion of an IUD 10 min -48 hours after placenta delivery?

11-27%

53

What is the risk of expulsion of an IUD 4-8 weeks post partum?

0-6%