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ENRP II > contraception and sterilization > Flashcards

contraception and sterilization Flashcards

(74 cards)

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1
Q

what is the method failure rate vs the typical failure rate surrounding contraceptives

A
  1. method failure- the rate that the method is going to fail when used correctly
  2. typical failure - the rate the method is going to fail when it is used by the patient
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2
Q

what ar the two general mechanisms of contraception?

A

inhibit formation and release of the egg

create a berrier between the sperm and the egg

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3
Q

what goes into choosing a birth control

A

efficacy
safety
availability
cost
accebtility

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4
Q

_ contraceptives provide the most reversible contraception

A

hormonal

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5
Q

oral contraceptives: the combination pill- what is the role of estrogen and progesterone

A

estrogen: improves cycle control by stabilizing the endometrium and decreases breakthrough bleeding

progesterone: the major player in suppressing LH (which stops ovulation and increases cervical mucuous thickening) which inhbitis sperm migration nad creates an unfavorable atropic endometrium for implantation

suppresses FH and LSH

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6
Q

oral contraceptive: combination pill are phasic formulas meaning they can ?

A

monophasic or triphasic (mimic the natural cycle)

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7
Q

class combinatino pills is _ days of active hormones and _ days of placebo

A

21 days

7 days

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8
Q

oral contraceptives: progestin only (mini pill) MOA

A

makes cervical mucus thick and impermeable

ovulation continues in 40% of users

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9
Q

the mini pill is mainly used in _ women who have contraindication to _

A

breastfeeding

estrogen

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10
Q

because of the mini pill ow does they must?

A

be taken at the same time every day

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11
Q

what are some benefits of oral contraceptives

A

mestrual cycle regularity

stop painful periods

decrease risk of anemia

lowe incidence of endometrial/ ovarian cancers/benign breast/ovarian diseases

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12
Q

what are some side effects of oral contraceptives

A

breakthrough bleeding, amenorrhea, bloating, breast tenderness, fatigue.

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13
Q

what are some SERIOUS side effects of oral contraceptives?

A

venous thrombosis
pulmonary embolism
cholestasis anf gall bladder disease
hepatic tumors
stroke/MI

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14
Q

the transdermal patch has _ and _

A

estrogen and progesterone

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15
Q

how does the transdermal patch work

A

apply one patch weekly for 3 weeks at a time to dry skin (just not on breast)

is it cautioned in people greater than 198 pounds

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16
Q

transdermal patch has the same side effects as oral contraceptives expect they are at a greater risk for?

A

thrombosis

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17
Q

brand names for transdermal patches

A

twirla

ortho evra

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18
Q

the vaginal ring is a combination of _ and _

A

estrogen and progesterone

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19
Q

the vaginal ring is associated with greater _ becuase of its once a month use- insert into the vagina for up to 3 weeks

A

compliance

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20
Q

the vaginal ring can be removed for up to _ hours without affecting efficay

A

3

better tolerated because there is not first pass through the liver

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21
Q

what is the annovera vaginal ring

A

it is a newer vaginal ring that is has a prescription for 13 months

you use the same ring, place in vagina for 21 days, take out for 7, wash and put back inside

combination product

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22
Q

who cant use combination contraceptives?

A

women over 35 who smoke cigarettes

people with a history of thromboembolic event/DVT/PE

migranine with auras, uncontrolled hypertension, CAD

liver disease or liver tumors

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23
Q

what is the depot medoxyprogesterone acetate (DEPO Provera)

A

this is a progesterone only intramusclar shot that is given every 11-13 weeks

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24
Q

depo prevera shot maintains contraceptive level of progestin for about _ weeks

A

14

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25
what is the MOA of depo provera
thickens cervical mucus, decidualization of the endometrium and blacks LH surge/ovulation
26
depo provera efficacy is roughly equivalent to that of _ steralization and is not altered by _
sterilization weight
27
what is the concern behind bone density and depo provera
it alters bone metabolism because of decreased estrogen this is concerning in adolescents who are still growing if you discontinue depot provera the bone symptoms will improve BBW that you should use for only 2 years
28
side effects of Depo provera
irregular bleeding (can become amenorrheic after 2 years) - this can improve if you have estrogen addback menses will take up to a year to regulate after discontinuation of the medication weight gain- progesterone makes you hungry depression exacerbation
29
what are some reasons why people get on depo provera
contraception method with good compliance breastfeeding when estrogen is contraindicateed seizures, sickle sell anemia, endometriosis, decrease risk of endometrial hyperplasia
30
when should you not use depo provera
if there is suspected/known pregnancy unevaluated vaginal bleeding (dont want to mask the effects of something else) breast malignancy current rhomboembolic/cerbral vascular disease liver dysfunction
31
what are the long acting reversible contraceptives (LARCs)
implants and IUDs
32
what is nexplanon
a progesterone only radiopaque injectable implant that is used for contraception it can be used for 3 yeats then needs to be taken out and a new one in
33
MOA of nexplanon
progesterone only so it inhibits ovulation and thickens cervical mucus
34
side effects of implant/nexplanon
irregular bleeding headache weight increase vaginitis acne tender breasts
35
indications for implant - nexplanon
convient and effective can be used in breast feeding
36
contraindications of the implant
BREAST CANCER (absolute contraindication) current/history of thrombosis liver tumors undiagnosed uterine bleeding
37
complications with insertion of an implant
infection bruising migration deep insertion persistant pain/tingling at insertion site
38
what IUD is nonhormonal what IUDs are progesterone releasing
nonhormonal- paragaurd levonorgesterl releasing- mirena/sklya
39
insertion of IUD is done in _
office
40
risks of IUD
increased risk of infection in the first 20 days post insertion increased risk of ectopic pregnancy if pregnancy did occur uterine perforation at time of insetoin risk of malposition
41
if someone becomes pregnant with an IUD in they should be offered removal if the strings are visible this decreases the risk of
spontaneous abortion
42
malposition of IUD necessitates _ for removal
hysteroscopy
43
contranindications to IUDs
breast cancer- progesterone containing ones puerperal sepsis/chorioamnionitis recent septic abortion cervical infection wilsons disease (in paragaurd) uterine malformations like septums, fobroids etc- cant get food placement
44
the levonogesterl IUDS are mirena/kyleena, liletta, skyla what are the differences
skyla- is smalled and is used for 3 years in nulliparous women liletta- used for 7 years mirea- used for 7.5 years ## Footnote all are highly effective
45
what are the benefits of levonogesterel IUDS
decrease mentrual blood loss, less painful periods, protection of endometrial lining from unapposed estrogen convient and longterm
46
Copper T/Paragaurd IUD is used for 10 years, what is the MOA
copper will interefere with sperm transport or fertilization and prevention of implantation
47
barrier methods have a _ failure rate
high ## Footnote they are inexpensive, no medical consultation
48
_ provide the only method with protection against sexually tramitted infections
condoms
49
_ _ condoms may decrease condom breakage
resivoir tip
50
female condoms are a vaginal liner and recommend to be left in _ hours after intercourse
6 hours
51
what are diaphragms
latex covered dome shaped devices that must be used with a spermicide must be inserted 6 hours before inercours and left in for 6 hours aftr intercourse: they must be fitted by health care professional and fit may change
52
women who use diaphragms are more likely to get?
urinary tract infections due to urinary stasis from repssure on the urethra + spermicides alter the vaginal flora
53
what is a cervical cap
a smaller version of a diapraghm that is applied to the cervic use it with a spermicide and has high risk of TSS and displacement leave in for 6 hours after intercourse
54
what is a sponge
a pillow chaped sponge that contains spermicide that fits of the cervix with a hoop on the other side to make removal easier must be left in 6 hours after intercourse, increase risk of TSS
55
what is phexxi
a hormone free gel that raises the pH of the vagina and lowers sperm motility it is available by prescription lasts 4 hours contains lactic acid/citic acid/and postattium bitartrate
56
side effects of phexxi
vaginal burning, itching , infections, bV, UTI, vaginal burning in male partner
57
what is the calendar method
this is calculation of fertile period and avoiding sex during that time (cycle beads)
58
what is the basal body temperature method
checking temperature daily in the monring and noting a change in temperature at the time of ovulation, avoiding sex during this time avoid for 3 days
59
what is the cervical mucus method
examining cervical mucus and notes changes around ovulation and avoid sec for 4 days after peak
60
what is the symptothermal method
combinding cervical mucus and basal body temperature with awareness of any other symptom of ovulation
61
what are the symptoms of ovulation
cramping, breast tenderness, change in position/firmness of cervix
62
emergency contraception acts by preventing _ and _
ovulation and fertilization
63
are there medical contraindications for emergency contraception
no
64
plan B is _ only and works in women older than 17, it should be used within 72 hours of unprotected sex
progestin
65
ella is an emergency contraception that is _ acetate and postpones _
ulipristil postpones follicular rupture / delay ovulation
66
what is most frequently used contraception method in the united states
sterilization
67
steralization methods prevent?
the sperm and the egg from meeting ***permanent
68
how do you decide if someone should consider sterilization?
tell them its permenant explore other options like LARCS what is their reasoning procedure risks/benefits screen for REGRET (in young patient) possibility of failure and ectopic risk condoms for STD prevention
69
what is male sterilization
a vasectomy that is occlusion of the vas deferens - not immediately effective
70
what is female steralization
permenant steralization that is low cost and can be done by laparoscopy, mini-laparotomy at the time of c-section
71
what is laparoscopy sterilization
samll incusions to occlude the fallopian tube
72
how can you occlude the fallopian tube
electrocautery- greatest risk for ecctopic pregnancy clips (hulka - most reversible) and filshie bands salpingectomy- removal of whole tube (decreases ovarian cancer risk)
73
what is a mini laparotomy for sterilizaition
infra umbilica incision postpartum to take a portion or all of the fallopian tube
74
what is hysteroscopy sterilization
transcervical approach to tubal ligation (enssure system )

ENRP II (25 decks)

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