contraception and infertility

Question 1

phases in the menstrual cycle

Answer 1

follicular
ovulatory
luteal

Question 2

follicular phase is when

Answer 2

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

Question 3

Ovulatory phase is

Answer 3

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

Question 4

luteal phase is

Answer 4

lasts 14 days
progesterone is dominant

Question 5

when is a good time to get pregnant

Answer 5

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

Question 6

what indicates pregnancy

Answer 6

human chorionic gonadotropin in the first urine

Question 7

preconception health

Answer 7

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

Question 8

which contraception has a delay in fertility

Answer 8

medroxyprogesterone injection

Question 9

what is the most effective contaceptive

Answer 9

Implants and intrauterine devices
vasectomy, hysterectomy

Question 10

lleast effective contraception

Answer 10

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

Question 11

does condoms help against STDs

Answer 11

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

Question 12

should spermicide be used in anal

Answer 12

no

Question 13

phexxi

Answer 13

vaginal cream that keeps acidic and reduces sperm motility

Question 14

hormonal contraception MOA

Answer 14

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

Question 15

what are the diff progestins in COCs

Answer 15

norethindrone
levonorgestrel
drospirenone

Question 16

what is monophasic COCs

Answer 16

equal dose of estrogen and progestin throughout the pack

Question 17

what are biphasic, triphasic and quadraphasic COCs

Answer 17

mimics the E and P levels of menstrual cycle

Question 18

advantage of drospirenone

Answer 18

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

• other progestins include norgestimate, desogestrel and dienogest

Question 19

what are some other use of COCs

Answer 19

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

Question 20

elagolix or Orlissa is indicated

Answer 20

for treating pain associated with endometriosis

Question 21

Natazia / mirena are indicated for

Answer 21

heavy mentrual bleeding

Question 22

Oriahnn= estradiol, norethindrone and elagolix

Answer 22

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

Question 23

progestin only pills POPS

Answer 23

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

Question 24

what are some benefits of POPs over estrogen products

Answer 24

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

Question 25

notes on contraceptive patchs

Answer 25

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

Question 26

injectable depo provera

Answer 26

every 3 months delay in fertility

Question 27

menstrual period affected by use of contraception

Answer 27

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

Question 28

what does lo mean in contraception

Answer 28

<35mcg of estrogen

Question 29

what does Fe indicate in contraception

Answer 29

iron supplement is included

Question 30

what does 24 indicate in contraception

Answer 30

24 active and 4 placebo shorter placebo time

Question 31

which contraception is contraindicated in renal or liver disease

Answer 31

Drospirenone containing Yasmin 28

Question 32

what is a conctinuos formuation

Answer 32

Amethyst no inactive pills

Question 33

does patches have more AUC than pills

Answer 33

YES

Question 34

do rings have more AUC than pills

Answer 34

no every 3 weeks and off for 1 week

Question 35

how long does Depo provera last

Answer 35

3 months

Question 36

which ring is yearly

Answer 36

Annovera

Question 37

what are some AE of hormonal contraceptives

Answer 37

Nausea breast tenderness bloating weight gain HBP spotting

Question 38

what are some serious AE of estrogen

Answer 38

ACHES Abdominal pain chestpain headache eye problems swelling or leg pain

Question 39

what are some effects of progestin

Answer 39

HA, fatigue depression drospironone can cause clotting risk adn increased potassium injectable medroxy can cause loss in bone density

Question 40

spotting cause and how to prevent

Answer 40

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

Question 41

if acne what type of contraception

Answer 41

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

Question 42

If breastfeeding

Answer 42

POPs or non hormonal

Question 43

if estrogen containdication

Answer 43

POPS or nonhormonal

Question 44

if Migraine

Answer 44

if with auro POPs if no aura chose any method

Question 45

If fluid retention/bloating

Answer 45

Drospirenone

Question 46

heavy menses use

Answer 46

COC- Natazia and IUD Mirena

Question 47

Hypertension

Answer 47

POPS or non hormonal

Question 48

mood changes

Answer 48

use mono phasic or extendted cycle/continuous cycle with drospirenone

Question 49

nausea

Answer 49

take at night consider decreasing estrogen or swithcing to POP

Question 50

Overweight

Answer 50

chose any method

Question 51

postpartum

Answer 51

can use POP or non hormonal

Question 52

premenstrual dysphoric disorder

Answer 52

Yaz or antidepressant

Question 53

monthly cycles

Answer 53

use extended or continuous fomrulation

Question 54

drug interaction with hormonal contraceptive

Answer 54

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

Question 55

when is a backup method needed with COC inititation

Answer 55

upto 5 days after beginning of menses

Question 56

COC initiation

Answer 56

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

Question 57

POPs initiatiton

Answer 57

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

Question 58

long acting contraceptives not dispensed in community pharmacies

Answer 58

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

Question 59

emmergency contraceptions

Answer 59

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

Question 60

what is levonorgestrel

Answer 60

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

Question 61

What is Ella

Answer 61

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

Question 62

COCS missed 1 pill

Answer 62

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

Question 63

COCs missed 2 pills

Answer 63

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

Question 64

POPs missed pill

Answer 64

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

Question 65

key counselling points for diaphram

Answer 65

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

Question 66

foams creams suppository jellyies

Answer 66

place deep innto the vagina before intercourse

Question 67

sponge

Answer 67

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

Question 68

COCs

Answer 68

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

Question 69

drospirenone

Answer 69

increases potassium

Question 70

patches

Answer 70

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 )

Question 71

nuva ring

Answer 71

3 weeks taken out 1 week

Question 72

injectable medoxyprogesterone

Answer 72

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

Question 73

infertility

Answer 73

>1 year unable to get pregnant clomiphene letrozole gonadotropins hCG