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OU Module Endo Fall 2018 > Contraception Exam 3 > Flashcards

Contraception Exam 3 Flashcards

1
Q

Nonpharmacologic contraception options

A
  • periodic abstinence

- barrier methods

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2
Q

periodic abstinence

A
  • avoiding intervcourse during ovulation

- FDA approved an app that will track of ovulation

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3
Q

What are the types of barrier methods?

A
  • male condom
  • female condom
  • diaphragm
  • cervical cap (Femcap)
  • sponge (Today)
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4
Q

What is something to consider when a pt is using the barrier method?

A

failure rates are high; counsel pt on emergency contraceptive

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5
Q

Barrier method: male condom

A
  • Single-use, mechanical barrier
  • prevent direct contact -> prevent STDs
  • contraindications: allergy to latex or rubber
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6
Q

Barrier method: female condom

A
  • single use
  • latex free
  • prevent direct contact -> prevent STDs
  • contraindications: allergy to synthetic nitrile, hx of toxic shock syndrome
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7
Q

Barrier method: diaphragm

A
  • reusable
  • use with spermicide
  • has to be fitted: rx
  • decrease incidence of cervical cancer
  • contraindications: allergy to latex or spermicide, recurrent UTI, history of TSS, abnormal gynecologic anatomy
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8
Q

Barrier method: cervical cap

A
  • reusable
  • blocks sperm access to uterus
  • latex free
  • use with spermicide
  • rx
  • contraindications: allergy to spermicide, history of TSS, abnormal gynecologic anatomy, abnormal pap smear
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9
Q

Pharmacologic contraception options

A
  • spermicides

- hormonal contraception

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10
Q

Pharmacologic contraception options: spermicides

A
  • destroy sperm cell walls
  • barrier that prevents sperm from entering the cervix
  • non-rx
  • contraindications: allergy to spermicide, do not use with women who has HIV (or high risk)
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11
Q

Pharmacologic contraception options: spermicide products

A
  • Nonoxynol-9 is the primary ingredient
  • Various formulations: creams, films, foams, gels, suppositories, sponges, and tablets
  • Disadvan: increase risk of UTI
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12
Q

combination hormone contraception contraindications

A
  • H/O thromboembolism or thrombophillia
  • H/O vascular disease (CVA, CAD, PVD)
  • Diabetes with vascular involvement
  • Migraine headaches with focal aura
  • Uncontrolled hypertension (> 160 systolic or > 90 mm Hg diastolic)
  • Breast cancer
  • Acute or chronic hepatocellular disease with abnormal liver function, cirrhosis, hepatic adenomas, or hepatic carcinomas
  • Age > 35 years and currently smoking > 15 cigarettes per day
  • Breastfeeding women < 6 weeks postpartum
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13
Q

combination hormone contraception relative contraindications

A
  • Multiple risk factors for arterial cardiovascular disease
  • Hyperlipidemia (uncontrolled)
  • H/O hypertension (uncontrolled)
  • Migraine headache without aura in women > 35
  • Cirrhosis, mild and compensated
  • Symptomatic gallbladder disease
  • Postpartum < 3 weeks and not breast-feeding
  • Breastfeeding women < 6 months postpartum
  • Commonly use drugs that induce liver enzymes and reduce efficacy
    (i. e. rifampin, phenytoin, carbamazepine, barbiturates, primidone, topiramate)
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14
Q

monophasic oral contraceptives

A
  • Same amount of estrogen and progestin for 21 days followed by 7 days of placebo (21/7 regimen).
  • Selected products: Ovcon, Ovral, Necon, Yasmin, Apri
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15
Q

biphasic and triphasic oral contraceptives

A
  • Contain variable amounts of estrogen and progestin for 21 days followed by 7 days of placebo.
  • Selected products: Ortho Tri-Cyclen, Estrostep Fe
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16
Q

extended cycle regimens

A
  • Designed to reduce menstrual flow intensity & duration to reduce withdrawal symptoms
  • 24/4 regimen: Loestrin-24 FE, YAZ
  • 26/2, 4-phasic regimen: Natazia
  • 84/7 regimen: Seasonale, Seasonique
  • Disadvan: bleeding irregularities
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17
Q

combination oral contraceptives: continuous regimens

A
  • Designed to eliminate menses and reduce withdrawal symptoms
  • equally effective to 21/7 regimen
  • Lybrel
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18
Q

ADE of continuous regimens

A

increase in bleeding irregularities

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19
Q

oral contraceptives: progestin only

A
  • progestin only for all 28 days
  • Must be taken at the same time every day to maintain efficacy
  • If > 3 hours late, use back up contraception for 48 hours
  • Micronor, Ovrette
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20
Q

ADE of progestin only products

A
  • Increased bleeding irregularities

- May not block ovulation, so ectopic pregnancy more likely

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21
Q

choosing oral contraceptives

A
  • consider low androgenic or antiandrogenicOCs in women with acne and hirsutism
  • consider extended or continuous cycle OC in women desiring to reduce or eliminate menstrual cycle and those with menstrual-related symptoms
  • consider progestin-only pills or other progestin only methods in women to contraindications / precautions for estrogen
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22
Q

initiating an oral contraceptive

A
  • First Sunday start method: Take first pill on the first Sunday after menstruation begins. If menses begin on a Sunday, begin on that day.
  • Quick start method: Take first pill on the day of the office visit (given a negative pregnancy test)
  • use second method of contraception for at least 7 days from start date
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23
Q

oral contraceptive adverse effects

A
  • nausea, bloating, breakthrough bleeding should resolve within first 3 months
  • D/C if ACHES are present (Abdominal pain, Chest pain, Headaches, Eye problems, Severe leg pain)
  • metabolized by liver
  • Anticonvulsants and Griseofulvin decrease contraceptive effect
  • Antibiotics (Rifampin, rifapentine, rifabutin)
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24
Q

oral contraceptive patient education

A
  • Give written education and verbally review patient package insert
  • Common and serious adverse effects
  • Management of adverse effects
  • No STI or HIV protection
  • When to start i.e. quick start
  • Importance of routine daily adherence
  • Drug interactions
  • When to expect menses: within 1-3 days after taking the last active pill
  • Start next pack immediately after finishing 28 day pack even if menses is not complete
  • Takes about 1-2 weeks to return back to fertility
  • Could have amenorrhea for 6 months max
25
Q

What should a pt do if she is on oral contraceptives and she misses a dose?

A
  • If 1 active pill < 24 hours late: Take 1 active pill ASAP then continue the remaining pills at the usual time, No additional protection is necessary.
  • If missed 1 or more active pills (> 24 hours late): Take 1 active pill ASAP, throw out any other missed pills, then take remaining pills at the usual time. Skip placebo week and start new pack, Use a 7 day back-up method, Consider emergency contraception ASAP if unprotected intercourse in previous 5 days
26
Q

other forms of hormone contraception

A
  • transdermal patch
  • vaginal contraceptive ring
  • long-acting injectable progestin
  • long-acting implantable progestin
  • intrauterine devices (IUD)
27
Q

other forms of hormone contraception: transdermal patch product

A
  • Ortho Evra®
28
Q

other forms of hormone contraception: transdermal patch

A
  • Not recommended first line if > 90 kg due to higher pregnancy rates
  • Application-site reactions
  • Apply new patch every week for 3 weeks, and then use no patch for week 4
29
Q

other forms of hormone contraception: transdermal patch patient education

A
  • if forgot to change patch within 9 days, use back up method for 7 days
  • can be applied to abd, buttocks, upper torso, or upper arm
  • if patch accidentally taken off for > 24h, restart cycle + back up method for 7 days
  • Takes about 1-2 weeks to return back to fertility
30
Q

other forms of hormone contraception: vaginal contraceptive ring products

A
  • NuvaRing® - releases hormone daily for 3 week period

- Annovera® - reusable rings that works for 1 year duration

31
Q

other forms of hormone contraception: vaginal contraceptive ring

A
  • releases estrogen and progestin
  • insert ring vaginally on or before the 5th day of the menstrual cycle, maintain in place for 3 weeks, then remove for 1 week
  • higher exposure to estrogen
32
Q

other forms of hormone contraception: vaginal contraceptive ring patient education

A
  • May be uncomfortable and cause vaginal discharge in some women
  • If expelled for > 3 hours, use back-up contraception and insert new ring.
  • Takes about 1-2 weeks to return back to fertility
33
Q

other forms of hormone contraception: long-acting injectable progestin

A
  • inhibits ovulation for up to 14 weeks
  • Repeat injection every 3 months
  • can cause menstrual irregularities, weight gain, decrease bone mineral density
  • FDA and ACOG don’t agree on how to use this
34
Q

other forms of hormone contraception: long-acting injectable progestin: products

A
  • Depo-Provera® depo-medroxyprogesterone (DMPA)

- Depo-SubQProvera 104®

35
Q

other forms of hormone contraception: long-acting injectable progestin patient education

A
  • Missed dose: If lapse of > 13 weeks between IM or > 14 weeks between SC, should do pregnancy test before re-dosing and use back-up method for 7 days.
  • Minimize bone loss by taking calcium and vitamin D supplementation and increasing weight-bearing exercise.
  • Return to fertility: usually delayed, mean time to conception from first omitted dose is 10 months, may take up to 18 months.
36
Q

other forms of hormone contraception: long-acting implantable progestin products

A
  • Implanon®

- Nexplanon®

37
Q

other forms of hormone contraception: long-acting implantable progestin

A
  • remove by the end of the 3rd year and replace

- can cause irregular menstrual bleeding

38
Q

other forms of hormone contraception: long-acting implantable progestin patient education

A
  • Feel arm to ensure that you can feel rod to assure proper placement
  • Return to fertility: within 30 days of removal
39
Q

other forms of hormone contraception: intrauterine devices (IUD) products

A
  • Levonorgestrel IUD
  • Mirena® (5 yrs)
  • Skyla® (3 yrs)
  • Liletta® (3 yrs)
  • Kyleena® (5 yrs)
40
Q

other forms of hormone contraception: intrauterine devices (IUD)

A
  • can cause menstrual irregularities

- some can cause pelvic inflammatory disease (PID)

41
Q

other forms of hormone contraception: intrauterine devices (IUD) patient education

A
  • Return to fertility: immediately upon removal
  • Contact physician immediately if s/s of PID including long-lasting heavy bleeding, unusual vaginal discharge, abdominal pain, chills, and fever.
42
Q

considerations for contraception selection

A
  • Weigh benefits and risks & advantages and disadvantages
  • Contraception should fit patient’s lifestyle and suit the patient’s needs
  • If STI protection is needed, a condom should be used and can be combined with another contraceptive
  • If patient has a history of noncompliance, consider long acting options
  • Desire for future fertility/pregnancy
  • Frequency of intercourse
  • Existing medical conditions
  • Smoking status
  • Desired therapeutic outcomes
  • Pharmacoeconomic considerations
43
Q

hormone contraception in diabetes

A
  • patients with diabetes are at increased risk for stroke and MI
  • combined HC should not be used in women with diabetes who smoke, have HTN or vascular disease, or are >= 35
  • All other forms of contraception are acceptable alternatives
44
Q

hormone contraception in thromboembolism

A
  • combined HC should not be used

- All other forms of contraception are acceptable alternatives

45
Q

hormone contraception in migraines

A
  • Acceptable to consider CHC in nonsmoking women who are < 35 with migraines if they do not have focal neurologic signs (i.e. aura), but should be second-line therapy
  • Do not use CHC in women >= 35 years old who have migraines without aura
  • Do not use CHC in women of any age who have migraines with aura
  • Discontinue CHC immediately in women of any age who develop migraines (with or without aura) while on CHC
  • All other forms of contraception are acceptable alternatives
46
Q

hormone contraception in women >= 35 years old

A
  • Must weigh benefit against risk of cardiovascular disease (esp if pt smokes)
  • CHC with < 35 mcg EE acceptable if nonsmoker and no significant risk factors (i.e uncontrolled dyslipidemia or HTN)
  • All other forms of contraception are acceptable alternatives
47
Q

hormone contraception in HTN

A
  • CHC is acceptable if < 35 yo with well-controlled, frequentlymonitored blood pressure in the absence of end-organ vascular disease and smoking
  • All other forms of contraception are acceptable alternatives
48
Q

hormone contraception in smoking

A
  • If < 35 years old, may use CHC with < 35 mcg EE
  • If > 35 years old, do not use CHC
  • All other forms of contraception are acceptable alternatives
49
Q

hormone contraception in dyslipidemia

A
  • Progestins may increase LDL levels
  • Estrogens may increase triglycerides levels
  • Acceptable to use CHC and progestin only methods in women with controlled dyslipidemia with periodic lipid panel monitoring
  • Use alternative non-hormonal contraception in women with uncontrolled dyslipidemia and additional cardiovascular risk factors
50
Q

hormone contraception in breast cancer

A
  • Acceptable to use CHC in patients with benign breast disease or a family history of breast cancer
  • Do not use CHC or progestin-only options in woman with a personal history of breast cancer
  • Acceptable alternatives include copper IUD or barrier methods
51
Q

hormone contraception in postpartum

A
  • Progestin-only methods acceptable to use any time after delivery.
  • CHC may be initiated after 3 wks postpartum. Avoid in first 3 wks.
  • If breastfeeding, wait 6 months
52
Q

hormone contraception in obesity

A
  • Use of HC in obese women is still acceptable given overall pregnancy rates remain low. Avoid using CHC with < 35 mcg EE in obese women
  • In women > 90 kg, may consider alternatives such as DMPA, IUD, or barrier methods
53
Q

emergency contraception: hormone contraception

A
  • High-dose progestin only OR combination OC pills
54
Q

emergency contraception: hormone contraception products

A
  • Plan B One-Step
  • Next Choice One Dose
  • My Way
  • Nordette
  • Levlen
  • Levora
  • Lo/Ovral
  • Triphasil
  • Tri-Levlen
  • Trivora
  • Alesse
  • Levlite
55
Q

emergency contraception: patient education

A
  • If vomiting occurs within 1 hour of taking tablets, recommended to repeat dose
  • If no menstrual cycle within 3 weeks, pregnancy test is recommended
56
Q

emergency contraception: progesterone agonist / antagonist products

A

Ulipristal acetate (Ella One)

57
Q

emergency contraception: progesterone agonist / antagonist

A
  • Selective progesterone receptor modulator that delays or inhibits ovulation, including possibly inhibiting follicular rupture
  • take within 5 days of unprotected intercourse
58
Q

emergency contraception: copper IUD

A
  • copper can prevent sperm from fertilizing an egg and may also prevent implantation of a fertilized egg
  • insertion within 5 days of unprotected intercourse

OU Module Endo Fall 2018 (27 decks)

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