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naplex > contraception and infertility > Flashcards

contraception and infertility Flashcards

1
Q

phases in the menstrual cycle

A

follicular
ovulatory
luteal

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2
Q

follicular phase is when

A

FSH causes follicle development creating a surge in estrogen
estrogen–>LH and FSH stimulation

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3
Q

Ovulatory phase is

A

the LH surge –> ovulation 24-36 hours later, release of egg

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4
Q

luteal phase is

A

lasts 14 days
progesterone is dominant

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5
Q

when is a good time to get pregnant

A

when LH is present in urine following 2 days
cervical mucus and body temperature

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6
Q

what indicates pregnancy

A

human chorionic gonadotropin in the first urine

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7
Q

preconception health

A

folate 400mcg during pregnancy 600mcg
vit B9
stop smoking and drinking keep vaccines current
avoid toxic drugs

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8
Q

which contraception has a delay in fertility

A

medroxyprogesterone injection

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9
Q

what is the most effective contaceptive

A

Implants and intrauterine devices
vasectomy, hysterectomy

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10
Q

lleast effective contraception

A

male condom, female condom, withdrawal, sponge,
fertility awareness, spermicide

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11
Q

does condoms help against STDs

A

yes only if latex or synthetic not natural sheepskin
- use with nonoxynol-9 spermicide can cause irritation and increased risk of STD/HIV
- lubricants reduce breakage of condoms (water or silicon based lubricants preffered

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12
Q

should spermicide be used in anal

A

no

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13
Q

phexxi

A

vaginal cream that keeps acidic and reduces sperm motility

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14
Q

hormonal contraception MOA

A

inhibits production of FSH and LH and prevents ovulation
progestin only
estrogen/progestin combination or COCs= combination oral contraceptives
noon oral contraceptives= CHC= combined hormonal contraceptives

*** PPI must be dispensed with oral contraceptives

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15
Q

what are the diff progestins in COCs

A

norethindrone
levonorgestrel
drospirenone

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16
Q

what is monophasic COCs

A

equal dose of estrogen and progestin throughout the pack

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17
Q

what are biphasic, triphasic and quadraphasic COCs

A

mimics the E and P levels of menstrual cycle

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18
Q

advantage of drospirenone

A

decrease AE such as bloating , PMS and weight gain
less acne (antiandrogenic acitivtiy )

  • other progestins include norgestimate, desogestrel and dienogest
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19
Q

what are some other use of COCs

A

PMS
Acne
dysmenorrhea- menstrual cramps
pCOS- polycystic ovary syndrome- 1st line
endometriosis

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20
Q

elagolix or Orlissa is indicated

A

for treating pain associated with endometriosis

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21
Q

Natazia / mirena are indicated for

A

heavy mentrual bleeding

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22
Q

Oriahnn= estradiol, norethindrone and elagolix

A

indicated for heavy menstrual bleeding with uterine fibroids but not a contraceptive

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23
Q

progestin only pills POPS

A

28days active pills in each packs
supresses ovulation
thickens mucus and thins endometrium= prevents sperm penetration
needs to be taken within 3 hours of schedule

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24
Q

what are some benefits of POPs over estrogen products

A

can be used in lactating pts
can be started as early as 3-6 weeks after delivery
doesnot have risk of thrombosis after delivery
migrane prophylaxis= estrogen can cause stroke

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25
Q

notes on contraceptive patchs

A

should not be used in >35 years old who smokes
is not effective in >198lbs oor BMI >30

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26
Q

injectable depo provera

A

every 3 months delay in fertility

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27
Q

menstrual period affected by use of contraception

A

medroxy users= 1 year of use can cause no menses to 50% of pts
extended cycle COCs involve 84 days active and 7 days low estrogen causing menses every 3 months
benefits of taking continuous contraception= less migrane and anemia

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28
Q

what does lo mean in contraception

A

<35mcg of estrogen

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29
Q

what does Fe indicate in contraception

A

iron supplement is included

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30
Q

what does 24 indicate in contraception

A

24 active and 4 placebo
shorter placebo time

31
Q

which contraception is contraindicated in renal or liver disease

A

Drospirenone containing
Yasmin 28

32
Q

what is a conctinuos formuation

A

Amethyst
no inactive pills

33
Q

does patches have more AUC than pills

A

YES

34
Q

do rings have more AUC than pills

A

no
every 3 weeks and off for 1 week

35
Q

how long does Depo provera last

A

3 months

36
Q

which ring is yearly

A

Annovera

37
Q

what are some AE of hormonal contraceptives

A

Nausea
breast tenderness
bloating
weight gain
HBP
spotting

38
Q

what are some serious AE of estrogen

A

ACHES
Abdominal pain
chestpain
headache
eye problems
swelling or leg pain

39
Q

what are some effects of progestin

A

HA, fatigue depression
drospironone can cause clotting risk adn increased potassium

injectable medroxy can cause loss in bone density

40
Q

spotting cause and how to prevent

A

check adherence
increase dose if taking <30mcg estrogen
if taking >30 takke a different progestin

41
Q

if acne what type of contraception

A

COC with a progestin that has lower or androgenic activity
norgestimate or drospirenone

42
Q

If breastfeeding

A

POPs or non hormonal

43
Q

if estrogen containdication

A

POPS or nonhormonal

44
Q

if Migraine

A

if with auro POPs
if no aura chose any method

45
Q

If fluid retention/bloating

A

Drospirenone

46
Q

heavy menses use

A

COC- Natazia and IUD Mirena

47
Q

Hypertension

A

POPS or non hormonal

48
Q

mood changes

A

use mono phasic or extendted cycle/continuous cycle with drospirenone

49
Q

nausea

A

take at night consider decreasing estrogen or swithcing to POP

50
Q

Overweight

A

chose any method

51
Q

postpartum

A

can use POP or non hormonal

52
Q

premenstrual dysphoric disorder

A

Yaz or antidepressant

53
Q

monthly cycles

A

use extended or continuous fomrulation

54
Q

drug interaction with hormonal contraceptive

A

decrease in efficacys-
abx rifampin, rifabutin and rifapentine (use backup)
anticonvulsants- carbamazepine, oxcarbamazepine phenytoin topiramate lamotrigine
st johns wort
tobacco
PI- ritonavir
colesevelam
byetta
drospirenone with ace arbs heparin sglt2 calcineurin

55
Q

when is a backup method needed with COC inititation

A

upto 5 days after beginning of menses

56
Q

COC initiation

A

start today with backup for 7 days
sunday start after menses backup for 7 days

57
Q

POPs initiatiton

A

start anytime use another method for the first 48 hours
all 28 pills are active

58
Q

long acting contraceptives not dispensed in community pharmacies

A

IUDs like mirena skyla kyleena liletta = cause lighter bleeds 3-6 years use
copper-T IUD= paragard= emmergency contraceptio and/or regular birth control upto 10 years can cause heavy mense
Nexplanon plastic rod placed in the arm releases etonogestrel for 3 years

59
Q

emmergency contraceptions

A

Copper IUDs within 5 days
Ella Ulipristal within 5 days and asap (more effective than plan B and less effective in 195lbs or BMI>30
PLan B levonorgesterel less effective in 165lbs or BMI > 25 asap within 3 days

60
Q

what is levonorgestrel

A

1.5mg tab within 3 days the sooner the better
89% efffective
works by thickening cervical mucus
AE- nausea if puked within 2hours retake the dose

61
Q

What is Ella

A

ulipristal acetate (relative to mifepristone Mifeprex) abortion pill
30mg - RX

62
Q

COCS missed 1 pill

A

take missed pills asap and if it makes it 2 a day take 2
no backup needed

63
Q

COCs missed 2 pills

A

take asap take next dose even if it makes 2 at same day
omit hotmone free week- start next pack of pills
back up contraception required for 7 days

64
Q

POPs missed pill

A

if >3 hours past schedule
take as soon as remembered and take next dose in schedule
back up contraception 48 hours

65
Q

key counselling points for diaphram

A

one teaspoon of spermicide
leave in for 6 hours after intercourse
do not keep wearing for 24 hours
reapply spermicide in intercourse is repeated
can be used for upto 2 years

66
Q

foams creams suppository jellyies

A

place deep innto the vagina before intercourse

67
Q

sponge

A

leave in for 6 hours after intercourse not more than 24 hours

68
Q

COCs

A

risk of clots
nausea weight gain breast tenderness
take pill same time of day
drug interactions

69
Q

drospirenone

A

increases potassium

70
Q

patches

A

but stomach, upper arm
once a week for 21 days do not apply to breasts
start on day1 or sunday (back up for 7 days )

71
Q

nuva ring

A

3 weeks taken out 1 week

72
Q

injectable medoxyprogesterone

A

decrease bone density take with calcium or vit D
menstruation cycle may change

73
Q

infertility

A

> 1 year unable to get pregnant
clomiphene
letrozole
gonadotropins
hCG

naplex (78 decks)

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