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Naplex Drug Card > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

(95 cards)

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1
Q

Condom type to protect against STD

A

Latex or Synthetic

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2
Q

Use with condoms would increase irritations and risk of STD/HIV

A

Nonoxynol-9 spermicide

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3
Q

What lubricant type should be avoided with latex or non-latex synthetic condoms

A

Oil-based lubricant

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4
Q

What lubricant type is recommended latex and non-latex synthetic condoms

A

Silicone or Water based lubricants

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5
Q

What is contained in foams, films, creams, suppositories, sponges and jellies

A

Nonoxynol-9 spermicide

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6
Q

Prescription only spermicide that decreases vaginal pH (3.5-4.5)

A

Phexxi
(Vaginal gel)

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7
Q

Phexxi contraindications

A

Vaginal rings

History of UTI

Urinary tract abnormalities

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8
Q

Hormonal contraceptives MOA

A

Inhibits FSH and LH to prevent ovulation

Alter cervical mucus to prevent sperm penetration to egg

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9
Q

Types of hormonal contraceptives

A

Progentin only (pill, injection, implant, IUD)

Estrogen/Progestin combination (pill, patch, ring)

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10
Q

What is required by FDA to be dispensed with oral contraceptives

A

Patient Package Insert

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11
Q

Most common estrogen formulation in hormonal combination contraceptives

A

Ethinyl estadiol

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12
Q

Most common progestin formulation in combination hormonal contraceptives

A

Norethindrone, Levonorgestrel, Drospirenone

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13
Q

Types of combinations hormonal contraceptives

A

Monophasic
Biphasic
Triphasic
Quadriphasic

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14
Q

Progestin with mild potassium sparing diuretic and anti androgenic activity

Associated with less bloating, PMS sx, weight gain and acne

A

Drospirenone

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15
Q

Progestin with low androgenic activity

A

Norgestimate
Desogestrel
Dienogest

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16
Q

Other indications for COC

A

Dysmenorrhea
PMS sx
Acne
Anemia
Menstural associated migraine
Peri-menopausal sx (hot flash, night sweat)

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17
Q

First line to regulate menses in PCOS

A

COC

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18
Q

First line to regulate dysmenorrhea and heavy bleeding in endometriosis

A

COC

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19
Q

FDA approved for endometrial pain

A

Elagolix (Orilissa)

(COC)

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20
Q

COC and Levonorgestrel IUD approved for heavy menstural bleeding

A

Natazia (COC)

Mirena (Levonorgestrel IUD)

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21
Q

Approved for heavy bleeding associated with uterine fibroid but not a contraceptive

A

Oriahnn (estradiol, norethindrone, elagolix)

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22
Q

Nonhormonal oral formulation of TXA for menorrhagia

A

Lysteda
(COC)

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23
Q

aka mini pill

A

Progestin Only Pill (POP)

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24
Q

MOA of action POP

A

Suppresses ovulation
Thickens cervical mucus
Thins endometrium

28 days active pills

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25
Indication of use for POP
Breastfeeding (estrogen reduces milk production) Migraine prophylaxis Migraines with aura (estrogen increases the of stroke) Any contraindication to estrogen
26
How soon can POP be initiated post-partum
3-6 weeks (Estrogen increases risk of thrombosis post-partum)
27
What is the timing of administration for POP
Take within 3hrs of scheduled time
28
How is the patch (CHC) different from COC
Higher systemic estrogen content
29
Avoid with COC patch
Increased clotting risk > 35 y.o and smokes
30
When is patch less effective
Wt > 193 lbs (Xulane) BMI > 30 (Twirla)
31
How often are vaginal rings (CHC) inserted
Once monthly
32
Injectable contraceptive
Depo-Provera Depo-SQ Provera 104
33
Depo-Provera dosing
IM 150mg or SC 104mg every 3 months
34
What is an important counseling point for depot shots for women who wants quick return of fertility following discontinuation
Most females will remain amenorrheic for 12 months (prolonged return of fertility)
35
How are most COC or CHC dosed
28 days supply 3 wks of active drug and 1 wk of inactive drug (placebo, iron, folate) Bleeding will occur during the hormone free week (aka week 4)
36
Extended cycle COC
84 days of active drug and 7 days of inactive drug or low dose estrogen Bleeding occurs every 3 months rather than monthly
37
Clinical pearl of continuous use of COC without placebo
Continous use can suppress menses altogether Difficult to predict if pregnancy has occured Risk of breakthrough bleeding or spotting usually resolves after 3-6 months Less anemia and menstrual migraines
38
Continous COC without placebo week
Amethyst
39
Monophasic COC common brand names (21/7 days)
Junel Fe 1/20 Microgeatin Fe 1/20 Loestrin 1/20 Yasmin 28 Sprintec 28
40
Monophasic COC common brand names (24/4 days)
Loestrin 24 Fe Yaz
41
Monophasic COC common brand names (24/2/2 days)
Lo loestrin Fe
42
Biphasic or Triphasic COC common brand names
Ortho Tricyclen Lo Tri-Sprintec
43
Quadriphasic COC common brand names
Natazia
44
Extended cycle COC common brand names
Seasonique
45
Drospirenone containing COC
Yasmin 28 Yaz Loryna Ocella Zarah
46
Important lab for drospirenone containing COC
Potassium (3.5-5) Scr Contraindicated in renal and hepatic and adrenal impairment Avoid in women with clotting risk
47
CHC vaginal ring brand name
Nuvaring Annovera (reusable for upto 1 year)
48
POP brand name contains norethindrone alone
Errin Camilla Nora-BE Incassia
49
POP brand name contains Drospirenone alone
Slynd
50
Estrogen ADR
Breast tenderness and fullness Increases BP Risk of VTE/PE (caution if HTN, Diabetic, Smoker, Overweight, Bed ridden) Weight gain Melasma
51
Progestin ADR
Breast tenderness Headache Depression
52
Progestin reduces bone mineral density Requires supplementation with calcium and vitamin D
Drospirenone
53
When is breakthrough bleeding resolve
2-3 months
54
Breakthrough bleeding will usually occur due to
Fast drop in estrogen level from missing a pill. Can be used to assess adherence
55
Patients with spotting and estrogens dosed at < 30mcg
Increase estrogen dose
56
Patients with spotting and estrogens dosed at >= 30mcg
Try different progestin
57
Warning and estrogen contraindication
Avoid if >35 and smoker (risk of CVD) Avoid with the following conditions: CAD Hx of thrombosis Hypercoagulopathy Hx of breast, ovarian or liver cancer Liver disease Uncontrolled HTN Severe headache Migraine with Aura Diabetes + Vascular diease Unexplained uterine bleeding
58
Use Depot shot for patient with weight gain
Big NO
59
Drugs that decrease contraceptive efficacy
Antibiotics (Rifampin and co) AED St Johns Wort Smoking Protease inhibitors Bosentan (Trecleer) Mycophenolate (Cellcept, Myfortic) Seperate from colesevelam by 4 hrs Take 1 hr before byetta injection
60
Increased risk of hepatotoxicity in Hep C with EE containing contraceptive and
If administered with: Mavyret Virkira Pak
61
Contraceptive efficacy is achieved when
7 days if initiation
62
Types of COC starts
Start today aka quick start Sunday start
63
Quick start COC counseling
Requires backup for 7 days after starting
64
Time to COC efficacy
7 days
65
Time to POP efficacy
2 days
66
Sunday start COC counseling
Start on the sunday after menses onset Requires 7 days of backup
67
COC started on days 1-5 of menses
Does not require back up
68
POP can be started at anytime. Counseling
Use backup in the first 48h
69
IUD containing progestin LEVONORGESTREL and time to replacement
Mirena- 7 years Liletta- 6 years Kyleena- 5 years Skyla- 3 years
70
IUD used as EC and regularly birth control
Copper IUD last 10 years Associated with heavier bleeding and cramping
71
Etonorgestrol containing implant
Nexplanon last 3 yrs
72
Emergency contraception types
Copper IUD (Paragard) Ullipristal acetate (Ella) Levonorgestrel (Plan-B, Take Action, Aftera, My Way, React)
73
Timing of EC use
Copper IUD inserted within 5 days and last 10yrs Ullipristal ASAP within 5 days (Rx) Levonorgestrel ASAP within 3 days (OTC)
74
Should be taken immediately after any unprotected sex
Ullipristal Levonorgestrel
75
EC least efficient at wt > 193 lbs or BMI > 30
Ullipristal
76
EC least efficient at wt > 165 lbs or BMI > 25
Levonorgestrel
77
Dose of levonorgestrel in EC
1.5mg single dose
78
Levonorgestrel common ADR
N/V
79
Patient throws up within 2hrs of plan B
Repeat dose
80
Why are many hesitant to use Ulipristal
Related to abortion pill mifepristone
81
Dose of EC Ullipristal
30mg. Required Rx
82
Ullipristal ADR
Headache Nausea Abdominal pain
83
How long should diaphragm be left in after intercourse
6 hrs but no more than 24hrs
84
When should spermicide on diaphragms be reapplied
Repeat intercourse Diaphragm placed 2hrs before sex
85
How long can diaphragm be used
2 years
86
Should be placed right before intercourse
Foam Creams Suppositories Jellies Sponge
87
Left in place 6hrs after intercourse and for more than 24h
Sponge
88
Patch is loose or falls off for > 24hrs within the three weeks active period or more than 7 days has passed since week 4
Use back up for 7 days
89
Ring left in place for 4weeks
Make sure not pregnant Insert new ring Use back up for 7 days
90
Inserts ring day 1 of menses
No backup required
91
Inserts ring day 2-5 of menses
Backup required for 7 days
92
Week 1 and 2 and ring falls out > 3hrs
Wash and reinsert Use backup for 7 days
93
Week 3 ring falls out
Discard Insert new ring Backup for 7 days
94
Ring should be refrigerated prior to dispensing
Yes
95
EC and no period for 3 weeks
Pregnancy has occured

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