Contraception & Infertility Flashcards

Question 1

Q

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer

A

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Question 2

Q

Childbearing years are from __

Answer

A

between ages 15 to 44 years old

Question 3

Q

Menstrual Cycle Phases:

A normal menstrual cycle ranges from 23-35 days (average = 28 days).

The start of bleeding (menses) is day 1 of the cycle. This indicates that the next cycle has begun. The remnants of the previous cycle (the thick, bloody endometrial lining) are sloughing off.

Menstruation typically lasts a few days (2-5 days). Changes in hormone levels cause the events that characterize the different phases of the menstrual cycle.

Question 4

Q

Menstrual Cycle Phases:

During what phase dose menses occur?

Answer

A

Follicular phase
- when the estrogen and progesterone levels start off low.

Question 5

Q

Menstrual Cycle Phases:

What are the phases of the Menstrual cycle?

1)
2)
3)

Answer

A

1) Follicular phase

2) Ovulatory phase

3) Luteal phase

Question 6

Q

Menstrual Cycle Phases:

The first ~14 days of the menstrual cycle, also called the ____________.

What is happening here is ________

During the end of this phase, what happens?

Answer

A

Follicular phase

that every follicle in a woman’s ovary there is an egg (oocyte - immature)

in this phase FSH is helping to spur on the development of the follicle. Helping it mature and grow.

Approaching the end of the Follicular phase there is this rise in estrogen.
This rise in estrogen leads to a surge in (LH) luteinizing hormone AND (FSH) follicle stimulating hormone.

When we see that LH surge and that FSH that peak, this tells us that it is going to trigger ovulation about 24-36 hours later.

Question 7

Q

Menstrual Cycle Phases:

Ovulation:

Answer

A

the release of the egg (ova) from the ovary.

Question 8

Q

Menstrual Cycle Phases:

The start of ovulation begins the ___________.

____________ is dominant in this phase.

Answer

A

Luteal (last) phase, which lasts ~14 days.

Progesterone.

Question 9

Q

Pregnancy Kits:

_____________ is released when a fertilized egg attaches to the lining of the uterus (called implantation).

A home urine test can detect pregnancy sooner if the women tests the __________________, when it is the highest.

Answer

A

(hCG) Human chorionic gonadotropin -

detecting hCG in the urine or blood indicates pregnancy*
first urine in the morning* when hCG is the highest

(hCG) human chorionic gonadotropin - tells us a woman is pregnant.

Question 10

Q

Fertility Awareness and Test Kits:

Ovulation kits predict the best time for intercourse by detecting LH in the urine. For someone trying to get pregnant and conceive a child.

- LH surge -> release of oocyte (egg) from the ovary into the fallopian tube.
- The egg lives for 24 hours and sperm can survive for ~ 3 days.

A positive ovulation test?

A person wishing to conceive should have intercourse when the LH surge is detected, and for the following 2 days (based on sperm survival of ~3 days).

Answer

A

test will detect if patient has an LH surge
which means, patient is going to have ovulation in the next 24-36 hours
so have intercourse for the next 2 days to give yourself the best chance of becoming pregnant

LH - tells us when we are going to ovulate.

Question 11

Q

Preconception Health:

focuses on steps to take to protect the health of the baby in the future.
any woman planning to conceive (and all women of childbearing age) should:

1)
2)
3)

Answer

A

1) Increase their folic acid (folate, vitamin B9) consumption from a combination of dietary supplements and fortified foods (e.g. dried beans, leafy green vegetables, oranges). Before becoming pregnant.

Folic acid supplementation: Adults are recommended to take 400mcg of dietary folate equivalents (DFE) per day to help prevent neural tube defects.
[During pregnancy this requirement increases to 600mcg DFE/day].

2) Lifestyle changes:
- No alcohol
- No illicit drugs
- Avoid smoking
- Keep vaccinations up to date
- Avoid toxic chemicals (hazardous drugs)

Question 12

Q

Contraception:

Fertility-Awareness Based Methods-

Answer

A

24% failure rate
not very effective
non-pharmacologic option
essentially knowing your cycle, know when you are ovulating and making sure you are not having sex in that window.

Question 13

Q

Contraception:

can be used until ready to conceive.
a prompt return to fertility occurs when most contraceptives are discontinued.
the only reversible contraceptive method that has a delay in return to fertility is the medroxyprogesterone injection.

Answer

A

Nonpharmacologic & OTC contraceptive methods:

Question 14

Q

Contraception:

Male condoms-

Female condoms-

Answer

A

Male condoms:
- 18% failure rate
- a thin latex or plastic sheath worn on the penis.
- OTC

Female condoms:
- 21% failure rate
- has a closed end at the top, which is the part that gets inserted into the vagina.
- OTC

[Never recommend oil-based lubricant for use with latex or non-latex synthetic condom.] Only recommend water or silicone-based lubricants.

Condoms- are the ONLY method that provide some protection with STDs. As long as they are latex or synthetic.

Question 15

Q

Contraception:

Spermicide-

Answer

A

[nonoxynol-9] - spermicide used in this country.

28% failure rate
can be used alone or with other barrier methods
not very effective alone, preferred with other contraceptive methods
Do not use with anal sex, causes irritation
can increase risk of STD/HIV transmission
OTC

Question 16

Q

Contraception:

Phexxi-

Answer

A

(lactic acid, citric acid, and potassium bicarbonate, 1.8%, 1%, 0.4%)
- a prescription option (Rx)
- a vaginal gel that maintains an acidic pH (range 3.5-4.5), which is inhospitable to sperm and reduces their mobility.
- should NOT be used with vaginal rings or in those with a history of UTIs or urinary tract infections.
- comes in a box of #12 (5 gram) pre-filled single dose vaginal applicators.

Question 17

Q

Contraception:

Rx

-Injectable-

Options include:

Answer

A

6% failure rate

Question 18

Q

Contraception:

Rx

-Pill-

Answer

A

9% failure rate

(Natazia) - indicated for heavy menstrual bleeding.

Question 19

Q

Contraception:

Rx

-Patch-

Options include:

Answer

A

9% failure rate

Question 20

Q

Contraception:

Rx

-Ring-

Options include:

Answer

A

9% failure rate

Question 21

Q

Contraception:

Rx

-Diaphragm-

Options include:

Answer

A

12% failure rate

Question 22

Q

Contraception:

Rx

-Implant-

Options include:

Answer

A

0.05% failure rate
is reversible

Question 23

Q

Contraception:

Male sterilization

(Vasectomy)

Answer

A

0.15%
- permanent

Question 24

Q

Contraception:

Rx

-Intrauterine Device (IUD)-

Options include:

Answer

A

LNG 0.2% failure rate
reversible

Copper T 0.8% failure rate
reversible

Question 25

Q

Contraception:

Female sterilization

(Hysterectomy)

Answer

A

0.5%
- permanent

Question 26

Q

Hormonal Contraceptives:

Estrogen and Progestin Combination Oral Contraceptives (COC):

Answer

A

## Most contain Ethinyl Estradiol (EE) AND a progestin [e.g. norethindrone, levonorgestrel (LNG), drospirenone]There are different formulations of COC:

*-Monophasic: COCs have the same dose of estrogen and progestin throughout all the pills in the packet.

-Biphasic, Triphasic, and Quadriphasic pill packs: mimic the estrogen and progesterone levels during a menstrual cycle. The type of formulation (e.g. triphasic) refers to the number of times the amounts of the hormones change (e.g. three times).

Question 27

Q

Hormonal Contraceptives:

How do they work?

What does FDA require with these drug products being dispensed?

Options include:

Answer

A

they work by inhibiting the production of FSH AND LH, which prevents ovulation*
by inhibiting the production of FSH and LH, we don’t get that surge of hormones approaching the end of the Follicular phase signaling ovulation. So no egg is released.
they alter the cervical mucus, which inhibits the sperm from penetrating the egg.

-
-
(CHC) combined hormonal contraceptives (NOT oral)
- patch
- ring
-
-
(POP) Progestin Only Pill options
-
-
-

— a (PPI) Patient Package Insert with all oral contraceptives.

Question 28

Q

Hormonal Contraceptives:

Drospirenone- a unique progestin, it is a mild potassium-sparring diuretic with lower androgenic activity. [so raises potassium]

Less bloating, weight gain, PMS, symptoms, acne
also associated with less acne, as they have anti-androgenic activity

-
-

Answer

A

-
- norgestimate*[
- desogestrel [
- dienogest [

Question 29

Q

Hormonal Contraceptives:

Progestins include:

Answer

A

norethindrone
levonorgestrel (LNG)

## drospirenone-

norgestimate*[
desogestrel [
dienogest [

Question 30

Q

Hormonal Contraceptives:

Treatment of Other Indications- (besides pregnancy prevention)

What are other indications COC’s are used for?

Answer

A

Other uses:

## dysmenorrhea (menstrual cramps, painful)
## premenstrual syndrome (PMS)
## acne (in females)
## anemia (by reducing blood loss)
## polycystic ovary syndrome (COCs are first line to regulate menses in those with PCOS) [PCOS- where infrequent, irregular or prolonged menstrual periods are common].
## endometriosis (when endometrial tissue grows outside of the uterus) - COCs are first line treatment for endometriosis.
## peri-menopausal symptoms (hot flashes, night sweats)
## menstrual-associated migraine prophylaxis
heavy menstrual bleeding (menorrhagia)

Question 31

Q

Hormonal Contraceptives:

Progestin-Only-Pill (Mini-Pills):
- ONLY Progestin
- Contain NO estrogen
- 28-day packs (ALL pills are ACTIVE)
-
What is the MOA?

-

Answer

A

prevent pregnancy by suppressing ovulation, thickening the cervical mucus to inhibit sperm penetration and thinning the endometrium.
require good adherence.
take at the same time everyday
If greater than > or equal to 3 hours have elapsed from the regularly scheduled time, a back-up contraceptive is required for 48 hours.
No placebo week
No placebo days

Question 32

Q

Hormonal Contraceptives:

When would we use a “POP” Progestin Only Pill?

Answer

A

in women who are breastfeeding. (Estrogen causes decreases in milk production)
can be useful for women with a contraindication or intolerance to estrogen/ Can be started soon after delivery (3-6 weeks postpartum). It is not safe to use estrogen this early after delivery because of increased risk of thrombosis.
## women who have migraines with aura (estrogen increases the risk of stroke), progesterone only pills are safe to use in women who have migraines with aura.-
estrogen increases risk of stroke AND migraines with aura are associated with increased stroke risk. So you would be doubling that risk using an estrogen product.

Question 33

Q

Non-Oral Hormonal Contraceptives:

Contraceptive Patch: KEY NOTES TO KNOW

*- the patch has the same side effects, contraindications and drug interactions as (COCs) Combined Oral Contraceptives.

*- the patch causes HIGHER systemic estrogen exposure. It should NOT be used in anyone with clotting risk factors.

*- the patch is less effective in women greater than > 198 lbs or BMI > 30 kg/m2

*- Do NOT use the patch in women greater than > 35 years old who smoke.

Answer

A

(Xulane) norelgestromin & ethinyl estradiol
- - used to be called Orthoevra, no longer on market.
(Twirla) levonorgestrel & ethinyl estradiol

Question 34

Q

Non-Oral Hormonal Contraceptives:

Contraceptive Patch

Key Counseling Points-

Answer

A

Apply patch transdermally for ONE week then remove. Do this for Weeks 1-3. Then no patch on for Week 4.

Question 35

Q

Non-Oral Hormonal Contraceptives:

the exact position of the ring does not matter.
these are small flexible rings that are inserted in the vagina once a month.
the vaginal rings have the same side effects, contraindications and drug interactions as oral contraceptives.

Answer

A

NuvaRing (etonogestrel & ethinyl estradiol)

EluRyng (etonogestrel & ethinyl estradiol)

Annovera (segesterone acetate & ethinyl estradiol)

Question 36

Q

Non-Oral Hormonal Contraceptives:

Vaginal Contraceptive Rings

Key Counseling Points-

Answer

A

NuvaRing (etonogestrel & ethinyl estradiol)
- the ring is to remain in place continuously for 3 weeks, then removed and disposed of. No ring for week 4.
-
-

EluRyng (etonogestrel & ethinyl estradiol)
- the ring is to remain in place continuously for 3 weeks, then removed and disposed of. No ring for week 4.
-
-

Annovera (segesterone acetate & ethinyl estradiol)
- vaginal ring is in for 3 weeks, then is removed for 1 week. Wash and store while it is removed for that one week, then reinsert. Used for one year.
- Is good for 13 cycles!!

Question 37

Q

Non-Oral Hormonal Contraceptives:

Can be given IM or SC every 3 months
## a progestin-
-
What is MOA?

Answer

A

(Depo-Provera) - medroxyprogesterone acetate-DMPA
IM injection is 150mg.

(Depo-subQ Provera 104)
SC is 104mg.

it causes thickening of cervical mucus and thinning of the endometrium

Question 38

Q

Non-Oral Hormonal Contraceptives:

Injectable Contraception

Key Counseling Points-

Question 39

Q

Non-Oral Hormonal Contraceptives:

## Long acting

Answer

A

(Mirena)- levonorgestrel
- 7 years
- approved for heavy menstrual bleeding
-

(Liletta)- levonorgestrel
- 6 years
-
-

(Kyleena)- levonorgestrel
- 5 years
-
-

(Skyla)- levonorgestrel
- 3 years
-
-

Question 40

Q

Non-Oral Hormonal Contraceptives:

(IUDs) Intrauterine Devices

Key Counseling Points-

Question 41

Q

Question 42

Q

Orilissa

Answer

A

elagolix

FDA approved for moderate to severe pain associated with endometriosis.

Question 43

Q

Oriahnn

Answer

A

contains: (estradiol, norethindrone, and elagolix.)
- is indicated for heavy menstrual bleeding associated with uterine fibroids.
- NOT a contraceptive (not intended to prevent pregnancy).

Question 44

Q

Lysteda

Answer

A

tranexamic acid
(antifibrinolytic)
- is a nonhormonal treatment for menorrhagia**
oral formulation

Question 45

Q

Natazia

Answer

A

-
-

Each blister pack contains 28 round, biconvex, film-coated tablets in the following order:

Natazia (estradiol valerate and estradiol valerate/dienogest) tablets provide an oral contraceptive regimen consisting of 26 active film-coated tablets that contain the active ingredients specified for each tablet below, followed by two inert film-coated tablets:

*
2 dark yellow tablets each containing 3 mg estradiol valerate
*
5 medium red tablets each containing 2 mg estradiol valerate and 2 mg dienogest
*
17 light yellow tablets each containing 2 mg estradiol valerate and 3 mg dienogest
*
2 dark red tablets each containing 1 mg estradiol valerate
*
2 white tablets (inert)

Question 46

Q

Contraception and menstrual periods:

*Most (COC) Combined Oral Contraceptives have 28 days (4 weeks) of pills
– 21-24 pills are “ACTIVE” containing hormone
– the remainder are inactive (placebo) pills, or contain iron or folate
– during week 4 (when taking inactive pills) ——–> MENSES occurs

*Extended-cycle COCs have 84 days (12 weeks) of active hormone pills
– Bleeding “MENSES” occurs every 3 months
– Seasonique

*Continuous contraception ————> suppresses menses altogether
– Amethyst

Question 47

Q

**Extended-cycle (COCs) Combined Oral Contraceptives:

have 84 days (12 weeks) of active hormone pills PLUS either
[7 days of very low estrogen pills OR 7 days of placebo pills.]
bleeding “MENSES” occurs every 3 months
a lot of women like this, less bleeding and less frequent periods they have disrupting their lives.

What are examples of extended-cycle COCs?

Answer

A

(Seasonique) - levonorgestrel + ethinyl estradiol
84 light blue-green tablets, each containing 0.15 mg of levonorgestrel and 0.03 mg ethinyl estradiol.
7 yellow tablets each containing 0.01 mg of ethinyl estradiol.
——————————————————————————————————————–
(Jolessa)- levonorgestrel + ethinyl estradiol
is an extended-cycle combination oral contraceptive consisting of 84 pink active tablets each containing 0.15 mg of levonorgestrel, a synthetic progestin and 0.03 mg of ethinyl estradiol, an estrogen, and 7 white inert tablets (without hormones).
——————————————————————————————————————–
(Camrese)-[levonorgestrel/ethinyl estradiol tablets & ethinyl estradiol tablets]
is an extended-cycle oral contraceptive consisting of 84 light blue-green tablets each containing 0.15 mg of levonorgestrel, a synthetic progestogen and 0.03 mg of ethinyl estradiol, and 7 yellow tablets containing 0.01 mg of ethinyl estradiol.
——————————————————————————————————————–
(Camrese Lo)
is an extended-cycle oral contraceptive regimen of 84 orange tablets each containing 0.1 mg levonorgestrel and 0.02 mg ethinyl estradiol, followed by 7 yellow tablets each containing 0.01 mg ethinyl estradiol.
——————————————————————————————————————— (Amethia)
an extended-cycle oral contraceptive consisting of 84 white tablets each containing 0.15 mg of levonorgestrel, a synthetic progestogen and 0.03 mg of ethinyl estradiol, and 7 light blue tablets containing 0.01 mg of ethinyl estradiol.

Question 48

Q

**Continuous contraception:
- suppresses menses altogether

What are examples of Continuous contraception?

Answer

A

Amethyst (levonorgestrel 0.09mg and ethinyl estradiol tablets 0.02mg)
90 mcg levonorgestrel and 20 mcg ethinyl estradiol) is available in a 28-tablet dispenser, arranged in 4 rows of 7 active tablets.
No INACTIVE pills (taken continuously), so NO period occurs.

Question 49

Q

**Select Contraceptive Types: **

if product name contains- “Lo”

like (e.g. Loestrin), this means ________

Answer

A

the product has a low level of estrogen.
less than or equal to 35mcg (0.035mg) of estrogen

other examples include:
Camrese Lo
Loryna
Ortho Tri-Cyclen Lo*
Lo Loestrin Fe

Question 50

Q

**Select Contraceptive Types: **

if product name contains- “Fe”

like (e.g. Loestrin Fe), this means _________

Answer

A

the product includes an iron supplement in the dosing regimen.

other examples include:
Lo Loestrin Fe
Junel Fe
Microgestin Fe
Minastrin 24 Fe

Question 51

Q

**Select Contraceptive Types: **

if product name contains- “24”

like (e.g Loestrin 24 Fe) this means _________

Answer

A

the product has a SHORTER PLACEBO time**
there is 24 active pills of hormone + 4 inactive (or Fe iron) pills

other examples include:
Minastrin 24 Fe
Loestrin 24 Fe

Question 52

Q

**Select Contraceptive Types: **

if product name contains- Tri or 7/7/7/

like (e.g. Tri-Sprintec, Nortrel 7/7/7/) this means _____

Answer

A

the product has 3 DIFFERENT HORMONE STRENGTHS for each “phase” or week

(Trivora)
-Six blue tablets containing 0.05 mg of levonorgestrel and 0.03 mg of ethinyl estradiol.
-Five white tablets containing 0.075 mg of levonorgestrel and 0.04 mg of ethinyl estradiol.
-Ten pink tablets containing 0.125 mg of levonorgestrel and 0.03 mg of ethinyl estradiol.
- (placebo) Seven peach inert tablets. The peach inert tablets are unscored, round in shape with “WATSON” debossed on one side and “P1” on the other side.
——————————————————————————————————————–
(Tri-Sprintec)
7 gray, round, flat-faced, beveled-edge, unscored tablets debossed with stylized b on one side and 985 on the other side contains 0.18 mg norgestimate, USP and 0.035 mg ethinyl estradiol, USP
7 light blue, round, flat-faced, beveled-edge, unscored tablets debossed with stylized b on one side and 986 on the other side contains 0.215 mg norgestimate, USP and 0.035 mg ethinyl estradiol, USP
7 blue, round, flat-faced, beveled-edge, unscored tablets debossed with stylized b on one side and 987 on the other side contains 0.25 mg norgestimate, USP and 0.035 mg ethinyl estradiol, USP
7 white, round, flat-faced, beveled-edge, unscored tablets debossed with stylized b on one side and 143 on the other side contains inert ingredients.

estrogen strength same each week)
——————————————————————————————————————–(Nortrel 7/7/7)
(norethindrone and ethinyl estradiol tablets: 0.5/0.035 mg, 0.75/0.035 mg, and 1/0.035 mg
estrogen strength same each week

Question 53

Q

**Select Contraceptive Types: **

if product name contains- “Nor”

like (eg Nora-BE) this means ______

Answer

A

the product contains the progestin [norethindrone]

other examples include:
Nortrel 7/7/7

Question 54

Q

**Select Contraceptive Types: **

if product name contains- “Pro”

like (eg Depa-Provera) this means ______

Answer

A

the product contains a progestin

other examples include:

Question 55

Q

Adverse Effects of Hormonal Contraceptives: Estrogen

What might a woman expect when starting an oral contraceptive or any hormonal product.

-
-
How can we take care of SE?

Answer

A

side effects of estrogen are very common and non-specific*
These include:
- stomach upset, nausea, breast tenderness/fullness, bloating, weight gain, elevated blood pressure* (not a huge increase maybe ~5-8 mmHg)
——————————————————————————————————————–Reducing the estrogen dose, less side effects but a dose too low can cause breakthrough bleeding (spotting).
- any nobody wants to have random bleeding when they are not expecting it, is bothersome.
- - - Lower estrogen = Less side effects but more breakthrough bleeding (spotting)

Question 56

Q

Adverse Effects of Hormonal Contraceptives: Estrogen

If a woman has spotting early to mid-cycle, then ________________

Answer

A

A higher dose of estrogen is needed in product.

Question 57

Q

Severe and Rare issues associated with Estrogen:
- - (recognizing symptoms of thrombosis):

what might you think of to recognize a clot?
remember; ACHES
A
C
H
E
S

Answer

A

[estrogens are known to cause thrombosis (a clot).]

A- abdominal pain (mesenteric or pelvic thrombosis)
-
C- chest pain (sharp, crushing or heavy pain can indicate a heart attack. Shortness of breath can indicate a PE (a blood clot in the lungs).
-
H- headache (sudden and severe with vomiting or weakness/numbness on one side of the body can indicate stroke)
-
E- eye problems (blurry vision, flashing lights or partial/complete vision loss can indicate a blood clot in the eye)
-
S- swelling or sudden leg pain (can indicate a DVT- a blood clot in the leg)

Question 58

Q

Adverse effects of Hormonal Contraceptives: Progestin

What might a woman expect when starting an oral contraceptive or any hormonal product.

-
-
How can we take care of SE?

Answer

A

progestin can cause breast tenderness, headache, fatigue and depression

Question 59

Q

Adverse effects of Hormonal Contraceptives: Progestin

If a woman is having Late-cycle breakthrough bleeding, then ____

Answer

A

A higher dose of progestin in the product is needed.

Question 60

Q

Adverse effects of Hormonal Contraceptives: Progestin

Which progestin has a slightly higher risk of clotting and should NOT be used in women with clotting risk?

Answer

A

drospirenone

Question 61

Q

Adverse effects of Hormonal Contraceptives: Progestin

which progestin can also increase (K) potassium levels AND should NOT be used in those with kidney, liver or adrenal gland disease?

What is the normal range for potassium (K)?

Answer

A

drospirenone

[3.5-5 mEq/L]

Question 62

Q

Adverse effects of Hormonal Contraceptives: Progestin

Which progestin can cause a loss in bone mineral density?

AND what do teens and young women who are still accumulating bone mass, should they be counseled on with this product?

Answer

A

injectable depot medroxyprogesterone acetate

Patient should take Calcium and Vitamin D

Question 63

Q

Question 64

Q

Risks of Hormonal Contraceptives:

Boxed Warnings: What are the Boxed Warnings for each of the following?

Estrogen + Progestin transdermal patch
-
Depo-Provera
-

Answer

A

ALL estrogen containing products (pills, patch, ring)
- DO NOT USE in women greater than 35 years of age AND smoke due to the risk of serious cardiovascular events.
-
Estrogen + Progestin transdermal patch
- INCREASED risk of VTE (DVT/PE) compared to COCs
-
Depo-Provera
- Loss of bone mineral density with long term use (increased risk of developing osteoporosis) [making sure patient is on enough calcium and vitamin D]

Answer 59

A

## History of DVT/PE, stroke, CAD*, thrombosis of heart valves or acquired hypercoagulopathies.
## History of breast, ovarian or liver cancer*; liver disease; uncontrolled hypertension (e.g. > 160/100 mmHg)
## Severe headaches or migraines with aura* (especially if > 35 years of age); diabetes with vascular disease; unexplained uterine bleeding [ we would want to figure this out first before dispensing product, could be cancer],

Answer 60

A

a progestin that has lower androgenic activity (norgestimate- Sprintec) or a progestin that has NO androgenic activity - [drospirenone-Yaz, Yasmin]

Answer 61

A

a progestin only pill (POPs) or nonhormonal contraception

Answer 62

A

a progestin only pill (POPs) or nonhormonal contraception

Answer 63

A

a progestin only pill (POPs) or nonhormonal contraception method

Answer 64

A

a product containing drospirenone [Yaz, Yasmin]

Answer 65

A

choose any method and counsel patient about the possibility of reduced effectiveness with the contraception patch. Do NOT use DMPA if trying to avoid further weight gain.

Answer 66

A

trialing a COC with only 4 placebo pills (rather than 7 placebo pills) or continuous/extended regimens will minimize bleeding time.

the COC Natazia and the IUD levonorgestrel releasing Mirena are indicated for heavy menstrual bleeding.

Answer 67

A

a progestin only pill (POPs) or nonhormonal contraception.

Answer 68

A

an extended (91-day) or continuous formulations.

an alternative would be to use monophasic 28-day formulation and skip placebo pills.

Answer 69

A

a monophasic COC— extended cycle or continuous with drospirenone is preferred.

Answer 70

A

have patient take at night; consider decreasing estrogen dose (which will have less GI symptoms but may increase spotting around menses) OR switch patient to POP, vaginal ring or nonhormonal method (ideally after 3 month trial)

Answer 71

A

Patient CANNOT use combined hormonal contraception for 3 weeks or 6 weeks if patient has additional risk factors for VTE.

Patient can use POP starting at 6 weeks and nonhormonal method during this time.

Answer 72

A

Use Yaz or antidepressant.

Answer 73

A

breastfeeding
3-6 weeks postpartum
contraindication to estrogen
migraine with aura
uncontrolled BP

Answer 74

A

have acne
fluid retention/bloating
mood changes or disorder
(PMDD) Premenstrual Dysphoric Disorder (Yaz is indicated for PMDD) or [alternative antidepressant]

Answer 75

A

monophasic, extended or continuous-cycle COC

“won’t have those big shifts in hormones, receiving a constant dose or hormone.”

Answer 76

A

Natazia, or Mirena IUD
- both are indicated for this condition.

Could also consider COCs with only 4 placebo pills (rather than 7 placebo pills) or continuous/extended regimens will minimize bleeding time.

Answer 77

A

the inducers help induce the metabolism of substrate drugs. Reducing the level of the drugs.

Viekira, Mavyret, & Tecnive products are contraindicated with ethinyl estradiol containing products. The combination causes liver toxicity.

If patient is on an ace inhibitor, angiotensin receptor blocker, and spironolactone (aldosterone antagonist) then the risk of Hyperkalemia is even greater if being put on drospirenone.

Answer 78

A

2) Sunday start method: This is commonly used if the patient prefers that menstruation occur during the week and is complete before the following weekend.
- this method requires back-up (nonhormonal) contraception for 7 days.

Late or Missed Pills:

Answer 79

A

Late or Missed Pills:
- Start as soon as remembered
- If more than one COC pill is missed, back-up contraception is required.

Answer 80

A

Take miss pill as soon as possible AND take next dose on schedule (even if that makes 2 pills in 1 day*).
Back up contraception is NOT required
Emergency contraception is NOT usually needed if you just missed one pill
BUT if the missed doses are earlier in the same cycle or in Week 3 of the previous cycle. [Then maybe can consider it]

Answer 81

A

Take the most recent missed pill as soon as possible (discard any other missed pills). Take next dose on schedule (even if that makes 2 pills in 1 day).
If you missed 2 pills. YES, back up non-hormonal contraception is required for 7 days.
Can consider (EC) Emergency Contraception if 2 missed pills were during Week 1 AND if had unprotected sex in last 5 days.

Answer 82

A

Take pill as soon as possible and take next dose on schedule.

Back up non-hormonal contraception is required for 48 hours (2 days).

Can consider (EC) Emergency Contraception if unprotected sex in last 5 days.

Answer 83

A

Skip the Hormone Free Week (Week of Placebo Pills) AND Start next pack of pills right after

If you missed 2 pills. YES, back-up nonhormonal contraception for 7 days.
If 2 missed pills during Week 2 or Week 3: Can consider (EC) emergency Contraception

Answer 84

A

If the patch becomes loose or falls off for > 24 hours during the 3 weeks of use, or if > 7 days have passed during the 4th week where NO patch is required, there is a risk of pregnancy. A back-up method should be used for one week after starting a new patch.

Answer 85

A

## The ring is effective for up to 4 weeks and, though not FDA approved, can be kept in place to prevent a period**.
If the ring is kept in place for greater than > 4 weeks, confirm no pregnancy, then insert a new ring and use back up contraception until the new ring has been in place for 7 days.

Answer 86

A

Mirena- 7 years for prevention of pregnancy
- FDA approved for menorrhagia (heavy menstrual bleeding) for ~ 5 years
- about 20% of women will become amenorrheic
-
Liletta- 6 years
-
Kyleena- 5 years
-
Skya- 3 years
-
(all contain levonorgestrel)
—————————————————————————————————————————-

Answer 87

A

1) ParaGard (copper) IUD
- 99.9% effective
- must be placed by a medical provider within 5 days.
- is placed in the uterus by a doctor or nurse
- from a doctor, nurse or at a clinic.
- Do not prevent implantation of a fertilized egg. (So, they do NOT cause an abortion and they do not terminate an established pregnancy).

2) (Ella) ulipristal
- an oral option that requires Rx (prescription)
- less effective in women weighing greater than > 195 lbs (88.6 kg) or if BMI > 30 kg/m2.
- works better the sooner you take. ASAP within 5 days.
- From a doctor, nurse, or at a clinic.
-

3) (Plan B) levonorgestrel
- an oral option that’s OTC
- works better the sooner you take. ASAP within 3 days
- At a pharmacy, no prescription is needed.
-

[These don’t protect against Sexually Transmitted Diseases]

Answer 88

A

packaged as one tablet of 1.5mg levonorgestrel
reduces the risk of pregnancy by up to 89% if started within 72 hours (3days) after unprotected sex.
the sooner you take it the higher the efficacy.
is OTC with no age restrictions.
no requirement to sign a registry, patient can pay for multiple doses.
prevents or delays ovulation and thickens cervical mucus
Nausea/ Vomiting
## so an anti-emetic one hour before use and caution if driving due to sedation.-** If woman vomits with 2 hours of taking the medication, she should consider repeating the dose**

Answer 89

A

a single 30mg oral tablet dose is taken, up to 5 days after unprotected intercourse.
requires a prescription
## ulipristal is used to delay ovulation.
chemical cousin to mifepristone (Mifeprex) also known as “abortion pill” or RU-486
they are not the same drug
- - - used to terminate pregnancy
ulipristal acetate is lower potency.

Answer 90

A

1) clomiphene:
- 1st-line
- a selective estrogen receptor modulator (SERM), an oral tablet used to induce ovulation.
- drug acts like estrogen to increase LH and FSH levels, which triggers ovulation.

2) letrozole:
- an aromatase inhibitor, an oral tablet used to induce ovulation
- drug suppresses estrogen to increase FSH levels causing it to surge and trigger ovulation.

3) gonadotropins:
- 2nd-line
- these are used after a poor response to clomiphene
- are not taken orally but are administered SC or IM injection.
- drugs act as LH, FSH, or hCG (similar to LH) and trigger ovulation.
- trigger ovulation by acting similar to the endogenous (naturally produced) gonadotropins FSH or LH.

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Contraception & Infertility Flashcards

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