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Theraputics Winter > Contraception/Menopause > Flashcards

Contraception/Menopause Flashcards

1
Q

2 forms of emergency contraceptive

A

Pill
IUD if within 5 days

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2
Q

Cycle tracking contraception (name 2)

A

Standard days
Basal method
Mucus methods
Natural cycles (app)
Rhythm method

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3
Q

What method provides STI protection

A

Condoms

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4
Q

What is some issue with no hormonal contraception

A

Can have trick instructions
A lot of room for user error
One of the lower rates for protection

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5
Q

IUD pros

A

10 year replacement
Can be used if obese, SLE and APS

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6
Q

IUD cons/risks

A

Heavier flow
X low platelet counts
X in Wilson disease
Insertion pain
Delay if PID/current or STI

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7
Q

What progestins do we have

A

Norethindrone - oral
Drospirenone - oral
Levonorgestrel - EC
Meroxyprogesterone acetate IM injection

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8
Q

What estrogens do we have

A

Ethinyl estradiol (most popular in BC)
Estradiol valerate
Estetrol

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9
Q

What is monophasic BC

A

21 days of the same active pills and 7 days off

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10
Q

What is multiphasic BC

A

21 of variable estrogen/progestin + 7 days placebo

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11
Q

What is alternative cycle BC

A

84 days + 7 placebo (seasonable, seasonnique)
24 days + 4 placebo (loestrin 24, Yaz)
28 days active no inactive days (lybrel)

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12
Q

What is the benefit for loestrin 24 or yaz

A

Better cycle control
Decrease shedding and premenstrual time

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13
Q

What BC products can you continuously take

A

All

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14
Q

What is the first day method

A

Day 1 of menstral cycle

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15
Q

What is Sunday start

A

1st Sunday after menstral cycle begins

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16
Q

Quick start BC

A

Start on the office visit date

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17
Q

When do you need to use back up method when starting new BC

A

<5 days after menstruation okay to not use back up
> 5 days need to use back up for 7 days

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18
Q

Missed doses <24 and 24-48hrs regiment 21 day regiment (84 see package insert)

A

Late pill less 24hr just take dose asap and continue as Normal

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19
Q

> 48 hrs missed dose

A

Need to use back up method and start pill asap

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20
Q

Pro of oral contraceptives

A

Regulate menstruation
Improve acne and PMDD
Reduce ovarian cancer, endometrial cancer, ectopic pregnancy and PID
Can supply folate, iron or other stuff

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21
Q

When can i not use CHC - combined hormonal contraceptives

A

DVT/PE
DM with any vascular disease
Breast cancer
< 21 days postpartum
Sever decomp cirrhosis or acute hepatitis
Migraines with aura
Uncontrolled HTN
Smoking ≥15 PPD
Complicated organ transplant
Head injury
Ischemic event or valvular heart disease

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22
Q

> 35 of age and >15 cig what BC do we give

A

Only progestin

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23
Q

> 35 age but <15 cigs

A

Monitor but limit estrogen to 20 mcg/day

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24
Q

> 35 age and quit smoking >1yr

A

Lowest effective estrogen dose

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25
Q

< 35 years heavy smoker, light smoker and non smoker

A

Shift >35 table left one

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26
Q

What increase the rate of thromboembolism or BC

A

Estrogen
3x if on COC - combo oral contraceptives

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27
Q

Which BC are highest risk for thromboembolism

A

3rd gen desogestrel, norgestimate
4th gen drospirenone

28
Q

What is ACHES for BC

A

Serious adverse effects for BC
A- severe abdominal pain
C - chest pain, SOB, coughing blood
H - headache severe
E - eye problems, vision loss
S - sever leg/ calf pain

29
Q

Estrogen side effects that would clue in too much

A

Nausea
Bloating
Migraines
Edema

30
Q

Progestin excess side effects

A

Increase appetite
Weight gain
Fatigue
Depression
Androgen effects
Acne, hair loss, hirsutism

31
Q

What reduce effectiveness of OCP

A

Rifampin, phenytoin, carbamazepine, St. John’s wort - increase bleeding
Antibiotics ( ampicillin, penicillin, tetracycline, SMX/TMP ) -reduce effectiveness
P450 block metabolism of estrogen (ritonivir)

32
Q

What to keep in mind with Xulane

A

Noregestromin 150mcg and EE 35mg per day
Increase risk of VTE
High progesterone, slight estrogen and low androgenic

33
Q

what to keep in mind for levonorgestrel

A

Twirls 120mcg + EE 30mcg per day
Reduce efficacy with BMI ≥25
X BMI ≥30

34
Q

How to do use transdermal contraception

A

3 weeks on 1 week off
If miss more then 1 day need to use back up

35
Q

Nuvaring considerations

A

Etonogestrel 120mcg +15 EE
3 weeks on one off
If fell out rinse and reinstall within 3 hrs
Back up if greater then 7 hrs

36
Q

Annovera pros over Nuvaring

A

Use one for the whole year
But needs to be reinstalled within 2 hrs

37
Q

Who benefits form progestin only BC

A

Breastfeeding and estrogen side effects too much

38
Q

Micronor considerations

A

Progestin only
Norethindrone .35mg
28 day cycle no placebo
3 hrs late need back up for 48 hrs

39
Q

Slynd considerations

A

Progestin only
4mg/d
24 days 4 day placebo
24 time window before back up
7 days back up if missed 48+
Less acne but more K, VTE and bone loss

40
Q

What pts Cant use progesterone

A

Breast cancer

41
Q

Pros of Depot medroxuprogesterone acetate

A

Once every 3 week injection
No need body weight adjustment
No androgenic/ estrogen side effects

42
Q

Cons of DMPA

A

Depot medroxyprogesterone acetate - progestin injection
Bleeding irregular
Amenorrhea
Weight gain
Headache
Short term bone loss

43
Q

Progestin implants considerations

A

Etongestrel 68mg
Metabolized by CYP3A4

Increase bleeding problems

44
Q

What are progestin IUD and how long do they last for

A

SKM
Skyla 3 years
Kyleena 5 years
Mirena 5 years

45
Q

What are the risk of progestin IUD

A

Irregular bleeding but this one decreases as time goes on
Uterine perforation, PID, ectopic pregnancy

46
Q

What are the common symptoms of menopause

A

Hot flashes
Chills
Irregular periods
Recurrent UTIS
Mood swings
Decrease energy
Sleep disturbance

47
Q

Treatment overview for menopause (PIC)

A
48
Q

Lifestyle mods for menopause

A

Avoid triggers
Exercise
Calcium and vit D supplements
Smoking censsation

49
Q

What is considered low dose estrogen for menopause

A

.3 mg conjugated estrogen
.5mg micronized
0.014 - 0.0375 trandsdermal patch

50
Q

What do we have for local treatment of menopause

A

Estradiol 10mcg and 4 mcg (vagifem and yuvafem) daily for 14 days then twice weekly
Estradiol cream 2-4 g ( imvexxy) daily for 14 then 1 g biw
CEE (Premarin ) .5-2 g biw
Estradiol (ring) 7.5mcg replace every 90 days

51
Q

What is the problem with oral estrogen in menopause therapy

A

Get metabolized to estrone which 5-7x more potent and causes more side effects

52
Q

What is the benefit of non oral estrogen in menopause

A

More estradiol and mimic body level better
So less side effects (VTE, stroke, CAD )

53
Q

What are some non oral estrogens

A

Patch - Vivelle-Dot; climara (qwK) 25-100 mcg
Spray - Evamist 1-3 sprays/day 1.53
Gel - estrogel - .25- .5mg/ day
IM - E depo-E and delestrogen ( 1-5mg q3-4wk, 10-20 q4wk)
Vaginal ring - not the local one but the systeming one FEMRING 50-100mg QD

54
Q

Pro so progestogen over estradiol menopause

A

Helps vasomotor and no VTE risk
Unknown effects on breast cancer

55
Q

Con of progesterone

A

Irritability, weight gain, bloating, increased appetite, breast tenderness, acne and headaches

56
Q

What is special about the cyclic menopause therapy

A

Combo - Estrogen daily and progesterone 12-14 days
Unexpected bleeding require endometrial biopsy
Withdraw bleeding after progesterone stops

57
Q

When do we use Cyclic therapy in menopause

A

Late menopause
Transition and early post menopause

58
Q

When is continues combo better for menopause

A

2 years post menopausal

59
Q

What is the SERMS we have

A

DAUVEE and OSPEMIFENE

60
Q

Pros of Duavee

A

Server vasomotor symptoms and osteoporosis

61
Q

Duavee ADR

A

Muscle spasms, nausea diarrhea, dyspepsia, upper abdominal pain, oropharyngeal pain, dizziness neck pain

62
Q

What is OSPEMIFINE used for

A

Vaginal dryness, hot flashes, painful sex
Not a combo product

63
Q

What are Absolute X in MHT

A

Genital bleeding
Breast cancer
Neoplasia
DVT,PE or VTE
Stroke or MI
Liver dysfunction

64
Q

Non-normal therapy SSRI pro

A

For reduction of hot flashes

65
Q

Cons of SSRI

A

Loss of libido escitalopram
QTc prolong with citalopram

66
Q

GABA pro for menopause

A

Use for hot flashes

67
Q

Cons for GABA

A

Onset of 4 weeks
Dizziness
Dry mouth
Edema
Weight gain
Blurred vision
SOLOMENCE IS A COMMON ONE

Theraputics Winter (12 decks)

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