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NAPLEX Prep > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

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1
Q

How long a menstrual cycle?

A

23-35 days

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2
Q

What is the follicular pahse

A

The surge in estrogen causing luteinizing hormone and follicular stimulating hormone to ↑

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3
Q

What is the ovulatory phase

A

LH surge triggers ovulation (the release of the ova)

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4
Q

What is the luteal phase

A

The start of ovulation begins this phase and the corpus lieu develops in the ovaries (14 days)

Progesterone is most dominant

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5
Q

What hormone is an indicator of fertility

A

LH

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6
Q

What hormone is an indicator of pregnancy

A

hCG

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7
Q

What to draw a pregnancy test?

A

First urine in the morning

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8
Q

What is the only way reversible contraceptive that has a delay in return to fertility

A

Medroxyprogestrone injection

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9
Q

What are the most effective forms of contraception

A

Reversible: Implant, IUD
Permanent: Sterilizatn

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10
Q

What is the most effective way to prevent pregnancy?

A

Abstinence

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11
Q

Least effective contraceptives

A

Condoms Withdrawal, Sponge, Fertility awareness, spermicide

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12
Q

Method of contraceptive the can prevent STIs

A

Latex or polyurethane condoms

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13
Q

Active ingredient in spermicides

A

nontoxynol-9

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14
Q

MOA of hormonal contraceptives

A

Inhibits the production of FSH and LH to prevent ovulation

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15
Q

What has to be dispensed with oral contraceptives

A

Patient package insert

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16
Q

Progestin products

A

Norethindrone
Levonorgestrel
Drospirenone

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17
Q

Most COC contain what combination

A

ethinyl estradiol and progestin

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18
Q

What is the difference between monophonic and multi-phasic COCs

A

Monophonic: same dose of estrogen and progestin
Multi-: mimic estrogen and progestrone levels during menstrual cycleI

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19
Q

Indication of COC other than contraception

A

Dysmenorrhea (menstrual cramps)
PMS
Acne
Anemia
Peri-menopausal sx

Regulate menses in PCOS

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20
Q

What is the first line tx for PCOS

A

COCs

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21
Q

What is the first line tx for endometriosis

A

COCs

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22
Q

MOA of progestin only pills

A

Prevent pregnancy by suppressing ovulation, thickening cervical mucus to inhibit sperm penetration and thinning of endometrium

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23
Q

Indications of POPs

A

Lactating → estrogen ↓ milk production

Requires good adherence (3 hrs of scheduled time)

Safe for women with migraines with auras

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24
Q

Risk of contraceptive patches

A

Higher estrogen exposure → risk of thromboembolism and clotting

Avoid in BMI ≥30 (risk of clotting and ineffective)

Xulane and Zafemy → less effective if ≥198 lbs (90kg)

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25
Injectable depot medroxyprogestrone
DepoProvera
26
Administration of DMPA
IM or Sc Q3M
27
How are most COCs formulated
28 days (4 wks) (21-24 active pills) Menses occur in week 4 (3-7 days)
28
How are extended-cycle COCs formulates
84 days of active pills (7 inactive) Menses occure Q3M → continuous contraception can suppress menses altogether
29
Counseling of extended-cycle COCs
Spotting may occur and resolves 3-6 months
30
What does Lo mean
Estrogen ≤35 mcg to reduce ADRs
31
What does Fe mean
Iron supplement is included
32
What does 24 mean
A shorter placebo time (24 active + 4 placebo)
33
What does Pro mean
Contains progestin
34
What are test monophasic formulations
Junel Fe 1/20 Microgestin Fe 1/20 Sprintec 28 Loestrin 1/20 Yasmin 28 Yaz Lo Loestrin Fe
35
What are the multi-phasic fomrulations
Tri-Spintec
36
What are the extended cycle formulations
Seasonique
37
What is the drospirenone formulations
Yasmin 28 and Yaz Slynd (drospirenone only)
38
Patch formulations
Xulane
39
Ring formulation
NuvaRing
40
POP formulation? Active ingredient?
Erin, Camilla, Nora-BE Norethindrone
41
OTC birth control
Opill
42
Ethinyl estrodiol/Drosperidone
Yaz, Yasminq
43
Ethinyl estradiol/etonogestrel
NuvaRing
44
Ethinyl estradiol/Norethindrone
Junel, Microgestin, Loestrin, Lo Loestrin
45
Ethinyl estradiol/Levonorgestrel
Seasonique
46
Ethinyl estradiol/Norgestimate
Tri-Sprintic, Sprintic
47
ADR of estrogen
Nausea Breast tenderness Bloating, weight gain, and ↑ BP Thrombosis
48
Sx of serious ADR high-dose estrogen
ACHES: Abdominal pain Chest pain HA Eye problems Swelling or sudden leg pain
49
ADR of dropsinerone
Slightly higher risk of clotting than other progestin formulations Increased potassium → avoid kidney, liver, or adrenal land disease
50
ADR of medroxyprogestrone
Loss in bone mineral density → take Vit D and calcium supplementation
51
How to resolve breakthrough bleeding?
If persists >3 months: Currently taking <30 mcg estrogen QD: increase dose Currently taking ≥30 mcg estrogen QD: try different progetin
52
BBW of all CHC products
Don't use in women >25 YO who smoke → CV events
53
When to avoid using estrogen rpoducts
Hx of DVT, PE, stroke, or CAD Hx of breast, ovarian, liver, or endometrial cancer Severe HA and migraine with auras
54
Product considerations for acne or hirtuism
Use COC with progestin with lower androgenic activity (Norgestimate-Sprintec 28) or no androgenic (Drospirenone-Yaz, Yasmin)
55
Product considerations for breastfeeding
POP or nonhormonal
56
Product considerations for estrogen CI
POP or nonhormonal
57
Product considerations for migraines
Aura: POP or nonhormonal No aura: any product
58
Product considerations for bloating/fluid retension
Products with drospirenone (Yaz, Yasmin, Slynd)
59
Product considerations for heavy menstration
Natazia (COC) Mirena (Levonorgestrel IUD) COC with 4 palcebo pills or continuous/extended
60
Product considerations for HTN
POP or nonhormonal
61
Product considerations for mood disorder
Monophasic, extended cycle, drospirenone
62
Product considerations for nausea
Take at night with food (consider decreasing estrogen dose)
63
Product considerations for overwight
Avoid patch if ≥30 BMI and DMPA
64
Product considerations for postpartum
Wait 3-6 wks postpartum → POP or nonhormonal
65
Product considerations for premenstrual dysphoric disorder
Drospirenone SSRI
66
Product considerations for avoidance of menses
Extended (91 days) or continuous formulations Alt: Monophasic and skip placebo days
67
Drugs that reduce hormonal contraception efficacy
ABX: rifampin, rifabutin → back up contraception for 6 weeks Anticonvulsants: carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate St John Tobacco Ritonivir Mounjaro (4 weeks backup)
68
Risk of HCs and Hep C
Mavyret combo with >20 mg of EE → liver toxicity
69
Counseling on how to initiate COC
Takes 7 days to achieve contraceptive efficacy (back-up is recommended for 7 days, unless the COC is started within 5 days after the period)
70
Start strategies of COC
Start today: best practice recommendations Sunday start: Start Sunday after mense (but runs out on weekend) First day start: start first day of menses (no backup contraception needed if within 5 day window)
71
Counseling on initiation of POP
Start any time (back-up method for 48 hrs unless started within 5 days of menses)
72
Counseling on missed doses
1. Start as soon as remembered 2. If more than 1 COC pill is missed, back-up contraception is required for 7 days 3. If missed on the 3rd week, omit the placebo week and start new package, (back up contraception for 7 days)
73
Counseling if late or missed one pill (<48hrs)
1. Take as soon as possible and take next as scheduled (if 2 pills in 1 day) 2. No backup contraception is required 3. ED not usually needed
74
Counseling on 2 missed pills (≥48 hrs since last dose
1. Take most recent pill (discard any other missed pills) 2. Omit hormone free week (3 week): start next pack of pills right after finishing current pack 3. Backup contraception x 7 days 4. EC consider iff unprotected sex in last 5 days
75
Counseling on POPs if ≥3hrs past time
1. Take pill ASAP 2. Backup for 48 hrs 3. Consider contraception if unprotected sex in last 5 days
76
Hormonal IUD. Duration
Mirena Skyla Kyleena Liletta 3-8 years
77
Copper IUD. Duration
Paraguard 10 years
78
Implant. Duration
Nexplenon 3 yrs
79
Forms of emergency contraception
Copper IUD: most effective (within 5 days) Ulipristal acetate (Ella): least effective >30 BMI (ASAP, within 5 days) Levonorgestrel (Plan B): least effective >25 BMI (ASAP, within 3 days)
80
Levonorgestrel
Plan B One Step
81
Dosing of plan B
1.5 mg tab once → within 72 hrs (the sooner the more efficacious)
82
ADR of Plan B
Nausea
83
MOA of ulipristal acetate
Similar to the abortion pill (mifepristone, RU-486) that prevents or delays ovulation altering endometrium to impair implantation Indicated for up to 5 days after unprotected intercourse
84
Counseling of patch application
1. Apply to dry, clean skin of buttocks, stomach, upper arm or upper torso once a week for 21 days out of 28 days 2, Start on either day 1 or Sunday (back-up seven days if not day 1)
85
Counseling on NuvaRing
Inserted for 3 weeks and off 1 week If kept >4weeks → recovering, confirm no pregnancy then insert new ring → use back up contraception for 7 days Insert 1st day of menstrual bleeding If ring is out >3hrs rinse and reinsert → Back up for 7 days and consider EC within 5 days (Week 1-2) Discard and insert new ring and use back up for 7 days (Week 3)
86
Define infertility
Unable to get pregnant for 1 yr
87
MOA of fertility agents
↑ LH and FSH → stimulate ovulation Can trigger the release of multiple eggs and ↑ risk of multiple births
88
Fertility agents
1. Clomiphene (SERM, mimics estrogen) 2. Aromatase inhibitors (suppress estrogen to ↑ FSH): letrazole 3. Gonadotropin drugs (mimic LH, FSH, or hCG): Leuprolide
89
Brand names of Gonadotropins
Repro-, foll-, gona-, preg-, ov- Menopur, Follisim AQ, Gonal-f, Pregnyl, Novarel, Ovidrel

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