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443-SRH and MSK > Contraception L1-2 general and OC > Flashcards

Contraception L1-2 general and OC Flashcards

(68 cards)

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1
Q

LARC include

A

implants, IUDs, injections

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2
Q

what is the PEARL index?

A

comparison of expected rate and typical use

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3
Q

most effective reversible contraceptives

A

implant, IUD

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4
Q

____ stimulates FSH and LH which stimulates ___ and ___ respectively

A

GnRH
E and P

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5
Q

efficacy rate of contraception is compared using the

A

pearl index

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6
Q

estrogen MOA in CHC

A

prevents follicular development and ovulation

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7
Q

progestins MOA in CHC

A

inhibits ovulation, thickens cervical mucus, slows tubal motility

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8
Q

estetrol is a synthetic version of estrogen produced by

A

human fetal liver

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9
Q

estranes include

A

norethindrone, ethynodiol

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10
Q

gonanes include

A

levonogestrel, norgestrel, desogestrel, norgestimate, etonogrestrel, norelgestromin

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11
Q

first generation estranes include

A

norethindrone, ethynodiol

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12
Q

second generation gonanes include

A

levonorgestrel, norgestrel

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13
Q

third generation gonanes include

A

desgrestrel, norgestimate, norelgestromin, etonorgestrel

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14
Q

4th generation is

A

drosperinone

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15
Q

second gen gonanes characteristics

A

higher progesterone selectivity and androgenic activity, with lower estrogen activity

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16
Q

third gen gonanes characteristics

A

higher progesterone selectivity, lower androgenic activity compared to second gen

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17
Q

4th gen spironolactone characteristics

A

antiandrogenic and antimineralocorticoid

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18
Q

cyproterone is used for

A

acne

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19
Q

list some noncontraceptive benefits of CHC

A

improved cycle control (less dysmenorrhea, PMS< blood loss)
inhibits ovulation (lowers incidence of ectopic pregnancy, ovarian cysts), improves acne, lowers risk of ovarian and endometrial cancer
lowers risk of CRC
sx control in perimenopause
positive effect on bone mineral density

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20
Q

medical risks of CHC

A

VTE, MI/stroke

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21
Q

why is there a VTE risk with CHC

A

estrogens have a dose dependent procoagulation effect

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22
Q

VTE risk on CHC is greater in

A

first year, inherited thrombophilia, older age, smoking, obesity, recent surgery
third gen progestins
drospirenone
cyproterone`

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23
Q

CHC may exacerbate

A

BP, glucose control, increase in TG, symptomatic gallbladder disease, migraine headaches

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24
Q

contraindications for drospirenone

A

renal or liver failure, adrenal disease, drugs that increase k+

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25
CHC most common AE
BTB
26
estrogen related AEs
nausea, breast tenderness, fluid retention/ edema, headaches/ migraines, chloasma, poor contact lens fit
27
progestin related AEs
mood, breast tenderness, fluid retention, increased appetite, headache/ migraine
28
why might there be lowered androgen side effects for CHCs
oral estrogens increase sex hormone binding globulin = decreases free testosterone levels = decreased acne and libido
29
E deficiency sx
early or midpoint spotting BTB hypomenorrhea mood menopausal sx
30
P deficiency sx
late BTB/ spotting, heavy period, delayed menses
31
EE and P are both metabolized by
CYP3A4
32
which undergoes enterohepatic recycling, which may be affected by antibiotics? 1. E 2. P
estrogen
33
drug interactions with CHCs
anticonvulsants antiHIV meds rifampin st johns wort
34
EE induces _____ metabolism by 50%
lamotrigine
35
CHC contraindications include (list 3)
CV risk: =>15 cigs/d and >35yrs old, CV disease, HPTN (>140/90), hx stroke, migraines with aura, DM with microvascular complications VTE risk breast cancer liver disease birth in last 3 weeks breast feeding <6wks postpartum rheumatic disease like lupus active cancers/ chemo abnormal uterine bleed
36
what is the cut off BP for CHC
140/90
37
EE dose for teens starting should be around
30-35mcg
38
EE dose for =>35yrs starting CHC should be
<20mcg
39
types of CHC phases
monophasic multiphasic (bi or triphasic): fixed E, changing P
40
why might a 21/7 regimen not be preferred
FSH lvls may come back up, resulting in follicular development and ovulation = not as forgiving as 24/4 or no extended cycle (3mths/7d)
41
when might an extended cycle regimen be preferred
painful periods, endometriosis, headaches/ migraines, PMS, perimenopausal sx, anyone that doesn't want periods
42
the patch __ OC VTE risk
patch is higher
43
the patch may be less effective in those ____
>90kg
44
how long can a vaginal ring be removed for
3hrs, if more = BU f7d
45
vaginal contraceptive rings should not be used with
diaphragm or oil based vaginal products
46
vaginal ring CIs
vaginal stenosis and uterovaginal prolapse
47
how does estetrol work
binds to nucleus estrogen receptor a and b and inhibits membrane ER
48
advantages of estetrol
less effect on markers of homeostasis, lower risk of VTE, weaker estrogen eff on mammary glands compared to estradiol, not metabolized by CYP
49
what kinds of start regimens require 7d BU
quick start sunday start
50
what should you do if you miss 2 pills in the first week
take 1 as soon as you remember use BU f7d
51
what should you do if you miss 2 pills in the last week
take 1 as soon as you remember, BU not required (=>3) start new pack without HFI
52
when do you need BU F7D with the patch
if ≥24hrs late on first week/ patch fell off or ≥72hrs 2nd/3rd wk (+no HFI)
53
how to manage BTB
change to different CHC - if on 10 or 20mcg EE = increase dose - or change to different progestin - ibuprofen 800mg TID F7D - estrogen 1mg daily F7D
54
what to do if BTB is still continuous after increasing dose or changing to different progestin
stop pill for 3-4 days then resume (don't need BU)
55
when to consider progestin only contraceptives
pts that need to avoid estrogen postpartum and breastfeeding
56
progestin only contraceptives CI in
current/ hx breast cancer, liver disease, inducers
57
norethindrone main effect
cervical mucus changes
58
counselling point for norethindrone
must be taken at the same time every day- may not be effective if delayed >3hrs
59
drospirenone main effect
inhibits ovulation and thickens cervical mucus
60
T or F: norethindrone inhibits ovulation as its main contraceptive mechanism
F- thickens mucus ovulation only inhibited in 60%
61
if norethindrone is started any time other than first day of period, BU must be used for
2d
62
if drospirenone is started any time other than first day of period, BU must be used for
7d
63
what is a contraceptive option for those that want to avoid E or are on anticonvulsants
DMPA
64
DMPA MOA
inhibits ovulation, thickens cervial mucus, induces endometrial atrophy
65
DMPA injection regimen
q3mths start in first 5 days of menstrual cycle BU F7D if not started within 5d
66
how long is the delay in return to fertility after DMPA
9mths
67
SEs of DMPA
menstrual cycle disturbances weight gain reduction in bone mineral density
68
what is considered a late injection for DMPA? what should you do
=>14wks BU F7D

443-SRH and MSK (24 decks)

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