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NAPLEX > Contraception and Fertility > Flashcards

Contraception and Fertility Flashcards

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1
Q

Normal menstrual cycle day range

A

23 - 35 days

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2
Q

What is day 1 of the cycle?

A

The start of bleeding, menses

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3
Q

Follicular Phase

A

Each follicle in an ovary contains an oocyte (immature egg)

-FSH spurs follicle development and causes estrogen to surge

-estrogen peaks by the end of the phase

-surge in estrogen cause LH and FSH to increase

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4
Q

Ovulatory Phase

A

LH surge from the end of follicular phase triggers ovulation 24 - 36 hours later

-ovulation is the release of the egg (ova) from the ovary

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5
Q

How long does the oocyte liver once released?

A

24 hours (happens mid-cycle)

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6
Q

Luteal Phase

A

Start of ovulation begins the luteal (last) phase which lasts 14 days

-progesterone is dominant in this phase

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7
Q

When should someone trying to conceive have sex?

A

Once LH surge is detected (meaning end of follicular stage and start of ovulatory phase when oocyte is released) for the following 2 days

-sperm can survive for 3 days

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8
Q

Human chorionic gonadotropin (hCG)

A

released when a fertilized egg attaches to this lining of the uterus (implantation)

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9
Q

Key Preconception Tips

A

-increase folate and vitamin B9 (400mcg dietary folate/day then 600mcg during pregnancy)
-stop smoking and drinking
-keep vaccinations current
-avoid toxic chemicals

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10
Q

What is the only reversible contraceptive method that delays the return of fertility?

A

medroxyprogesterone injection

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11
Q

What is the typical temperature prior to ovulation?

A

96 - 98%

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12
Q

What is the typical temperature during ovulation?

A

97 - 99%

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13
Q

Phexxi

A

vaginal gel that maintains an acidic pH ranging from 3.5 - 4.5 which does not allow sperm to live
-do not use with vaginal rings or in those with recurrent infections

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14
Q

How do hormonal contraceptives work?

A

inhibit the production of FSH and LH which prevents ovulation
-alter cervical mucus which inhibit sperm from penetrating the egg

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15
Q

Health benefits provided by hormonal contraception

A

-decrease in menstrual pain/ irregularity
-endometriosis
-acne
-ectopic pregnancy
-noncancerous breast lumps
-decreased risk of endometrial and ovarian cancer

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16
Q

Combination Oral Contraceptives (COCs)

A

ethinyl estradiol (EE) and progestin

progestin can be in the form of:
-norethindrone
-levonorgestrel (LNG)
-drospirenone

Monophasic: same dose throughout pack

Biphasic, triphasic and quadriphasic also available to mimic levels during menstrual cycle

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17
Q

Unique progestin: Drospirenone

A

-used in some COCs to reduce adverse effects
-mild potassium-sparing diuretic
-decreases bloating, PMS symptoms and weight gain
-less acne

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18
Q

products that have anti-androgenic activity

A

-drospirenone
-norgestimate
-desogestrel
-dienogest

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19
Q

First line treatment of polycystic ovary syndrome (PCOS)

A

COCs

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20
Q

“Lo”

A

indicates 35mg or less of estrogen causing less estrongenic side effects

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21
Q

“Fe”

A

iron supplement is included

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22
Q

“24”

A

indicates a shorter placebo time
-24 active pills, 4 placebo to make a 28 day cycle

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23
Q

Monophasic COC formulation

A

Junel Fe 1/20
Microgestin Fe 1/20
Sprintec 28
Loestrin 1/20
Yasmin 28
-21/7 pack
*contains 1mg norethindrone and 20mch EE

Loestrin 24 Fe, Yaz (24/4 pack)

Lo Loestrin Fe (24/2/2 pack)

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24
Q

triphasic formulation (COC)

A

Tri-Sprintec (7/7/7)

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25
Quadiphasic Formulation (COC)
Natazia
26
Extended Cycle COC Formulations
Seasonique 84 days of EE and LNG followed by 7 days of low dose EE
27
Drospirenone containing formulations
Yasmin 28, Yaz -contraindicated in renal or liver disease -monitor potassium and kidney function during use
28
Continuous COC formulations
Amethyst -no inactive pills -28 days of EE and LNG with no placebo
29
patches
Xulane -higher AUC than pills -contains both EE and progestin Xulane and Zafemy less effective in those greater than 198 lbs
30
Rings
Nuva Ring -lower AUC than pills -contains both EE and progestin Annovera: lasts for 1 year
31
Progestin only pills
-Erin -Camila -Nora-BE (nor indicates norethindrone) -incassia -Slynd (drospirenone -only)
32
First line for endometriosis
COCs
33
Products indicated for heavy menstrual bleeding
COC Natazia Mirena IUD
34
Primary uses for POPs (Progestin-Only Pills)
-breast feeding women (EE decreases milk production) -contraindication to estrogen use -can be started 3-6 weeks postpartum (EE this soon after delivery increases risk of thrombosis) -migraine with aura (EE cannot be used because of stroke risk) Downside: -require very good adherence (within 3 hours of scheduled time)
35
Patch considerations
-higher systemic estrogen exposure -not to be used in anyone with high clotting risk
36
High clot risk considerations with estrogen
-greater than 35 -smoker -cerebrovascular disease or previous blood clots -postpartum -BMI greater than 30
37
Side effects of estrogen
-Nausea -breast tenderness -bloating -weight gain -increased blood pressure (fluid retention) -melasma (dark skin patches on the face) (reduced dose helps, but too low will cause breakthrough bleeding)
38
Progestin side effects
breast tenderness, HA, fatigue, depression
39
Drospirenone side effects
slightly higher risk of clotting (avoid in high clot risks) -increased potassium (avoid in kidney, liver, or adrenal gland disease since these can also increase potassium levels)
40
Side effect of Depo-provera shot
-loss in bone mineral density -need to supplement vitamin D and calcium
41
Contraindication with the Estrogen + Progestin patch
-do not use in women with a BMI greater than 30 because of increased risk of thromboembolism (Xulane and Zafemy) -decreased efficacy (Twirla)
42
Contraindications to using estrogen
-history of DVT/PE/stroke, CAD -breast, ovarian or liver cancer -migraines with aura
43
Drug selection of patient with acne or hirsutism
COC with a progestin that has low androgenic activity (norgestimate Sprintec 28) or no androgenic activity like drospirenon (Yaz, Yasmin)
44
Drug selection of patient breastfeeding
-POP -nonhormonal method
45
Drug selection for estrogen contraindication (clot risk)
-POP -non hormonal
46
Drug selection for a patient with heavy menstrual bleeding (menorrhagia)
-COC Natazia -Mirena IUD -COCs with 4 placebos instead of 7
47
Drug selection for those with mood changes or mood disorder
-monophasic COC -extended cycles -continuous drospirenone preferred
48
Drug selection for premenstrual dysphoric disorder
-yaz (just drospirenone) -SSRI may be needed
49
Spotting/ break through bleed dose adjustment
early in cycle: increase estrogen late in cycle: increase progestin
50
Benefit of injection
-less drug interaction since it bypasses first-pass metabolism An
51
Antibiotics that decrease hormonal contraceptive efficacy
-rifampin (back up for 6 weeks after ABX is discontinued) -rifabutin -rifapentine
52
Anticonvulsants that decrease hormonal contraceptive efficacy
-carbamazepine -oxcarbazepine -phenytoin -primidone -topiramate -lamotrigine -barbiturates -perampanel
53
Miscellaneous drugs that interact with birth control
-st. John's wort -smoking tobacco -ritonavir boosted protease inhibitors (Mycophenolate) -colesevelam -Byetta
54
Risks with Hepatitis C treatment
Mavyret cannot be used with any formulation containing EE due to risk of liver toxicity
55
Infertility is defined as how long of actively trying to become pregnant
1 year of unprotected sex
56
Clomiphene
-selective estrogen receptor modulator (SERM) -causes LH and FSH surge to trigger ovulation -surge in LH causes hot flashes
57
SERMs
-act as estrogen agonists in some tissues and antagonists in others -clotting risks
58
Letrozole
-aromatase inhibitor -impacts ovulation through estrogen negative feedback
59
Gonadotropins
-trigger ovulations by acting similar to the endogenous FSH and LH -used after poor response to clomiphene -used to spur egg release during in vitro fertilization
60
Leuprolide
-gonadotropin releasing hormone agonists -used to trigger ovulation
61
Clotting risk with progestin
-drospirenone has a slightly higher risk of clotting compared to other progestins
62
Weeks of first trimester
0 - 12 weeks *organ development, most at risk of teratogens*
63
Gravida (G) Para (P)
G = # of times pregnant P = # of times given birth `
64
Calcium requirements of a pregnant woman
1,000 mg/day calcium 15 mcg/day (600 IU) Vitamin D
65

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