Contraception Pharm

Question 1

Mechanism of progesterones

Answer 1

Increases cervical mucus viscosity which inhibits sperm penetration
Decreases motility of ovum
Increases atrophy of endometrium

Question 2

Secondary mechanisms of 2nd generation progesterones

Answer 2

Decrease HDL

Increase LDL, glucose tolerance, incidence of acne

Question 3

Secondary mechanisms of 3rd generation progesterones

Answer 3

Less acne than 2nd gen

May increase risk of thrombosis

Question 4

POPs

Answer 4

Taken everyday within 3 hour window

Not affected by gut flora (antibiotics don’t affect absorption)

Question 5

High dose progesterone

Answer 5

Currently available in injectable form only

Question 6

Pt populations that can use POPs

Answer 6

Pts with sickle cell anemia
Nursing mothers
In women who smoke or are over 35
In women with HTN or migraines

Question 7

Common AEs of POPs

Answer 7

Spotting
Worsening depression in those already depressed
Reduced libido

Question 8

Mechanism of estrogens

Answer 8

Inhibits follicular development preventing ovulation
Reduce implantation
Potentiates progesterone mechanisms
Increase uterine edema decreasing likelihood of implantation

Question 9

Form of estrogen in COCPs

Answer 9

Ethinyl estradiol

Question 10

Contraceptive effectiveness of COCPs

Answer 10

Effective if first pill is started within 5 days of first day of menstruation otherwise does not begin until 7 consecutive days of active pills have been taken

Question 11

Affect of obesity on COCPs

Answer 11

Decreased effectiveness with BMI >30
COCPs created for average hormone lvls
Most effective contraception is progesterone IUS instead

Question 12

COCP drug interaction

Answer 12

High doses of vitamin C will increase side effects of estrogen

Question 13

Benefits of COCPs

Answer 13

Reduced symptoms of endometriosis, PCOD, anemia

Reduced risk of PID, dysmenorrhea, PMS, acne

Question 14

Depression and COCPs

Answer 14

No evidence of increased depression

Question 15

COCPs risks

Answer 15

May increase HTN
Mastalgia, amenorrhea, N/V, melasma, gallstones, decreased ability to build muscle mass
Women > 40 y/o are at greater risk of these SEs

Question 16

Greatest COCPs risk occurs in women with what comorbid risk factors?

Answer 16

Smoking
> 35 yrs
Long continued use of COCPs

Question 17

What pt has an increased risk for cardiovascular SEs with COCPs?

Answer 17

Smokers, especially smokers over 35 y/o

Lowest dose of estrogen or POPs recommended

Question 18

Tri-cycling

Answer 18

3 or 4 packs of active monophasic pills in a row

Question 19

Triphasic

Answer 19

3 doses of hormones in one pack

Question 20

Monophasic

Answer 20

Single doses - all active pills alike

Question 21

Multiphasic/estrophasic

Answer 21

Single doses of progestin with varying doses of estrogen until just before break week then estrogen only for few days then placebo

Question 22

Biphasic

Answer 22

Two different active pills

Question 23

Four-phase

Answer 23

4 different active pills (both hormones change)

Question 24

Which pill is FDA approved for PMDD and moderate acne in females age 14 or older?

Answer 24

EE+drospirenone+placebo (Yaz)

Question 25

Which pill is designed to prevent neural tube defects in fetuses conceived shortly after stopping the COCP?

Answer 25

EE+drospirenone+levomefolate (Beyaz, Safyral)

Question 26

Which pill has a spearmint flavor?

Answer 26

EE+norethindrone+ferrous fumarate

Question 27

What should be considered if acne is exacerbated after COCP use?

Answer 27

Change to EE+drospirenone (Yaz)

Question 28

Which form of BC is best for a pt with seizure disorder using valproic acid, clonazepam, vigabatrin, or lamotrigine?

Answer 28

Progesterone injection

Question 29

If 3 or more COCPs were missed

Answer 29

Pills from day 1-7 and intercourse occurred during days 1-7 consider emergency contraception

Question 30

How long is Plan B effective?

Answer 30

Up to 72 hours

Question 31

When should ulipristal be taken?

Answer 31

WIthin 5 days of unprotected sex

Question 32

Benefits and risks of transdermal contraceptive patch

Answer 32

Good for non compliant pill users May have topical reaction to adhesive Less effective in obese women

Question 33

When does protection begin after a contraceptive injection?

Answer 33

1 week after first injection

Question 34

Benefits of contraceptive injection

Answer 34

FDA approved for endometriosis related pain Good for non complaint contraceptive users Good in special needs women - physically, mentally disabled, very young girls Effectiveness not decreased by anti epileptic drugs Decreased incidence of sickle cell crisis

Question 35

What is the vaginal insert ring not approved for?

Answer 35

Tricycling

Question 36

How long do copper IUDs last?

Answer 36

5 year and 10 year options

Question 37

How long does levonorgestrel IUS (Mirena) last?

Answer 37

5 years

Question 38

Risks and common AEs of IUD/IUS

Answer 38

Expulsion rate of 4% | AE - lighter menses, amenorrhea or irregular bleeding

Question 39

What test must be done prior to insertion of IUD/IUS?

Answer 39

STD testing

Question 40

Sponges

Answer 40

May be inserted up to 24 hours before intercourse Must be left in place for at least 6 hours after intercourse Should not be worn for more than 30 hours at a time

Question 41

Common AE of sponges

Answer 41

Use of multiple sponges in 24 hours increases risk of tissue irritation

Question 42

When is mifepristone effective?

Answer 42

Two pill regimen and only effective after 2nd pill

Question 43

Off label use of mifepristone

Answer 43

Cushing syndrome | Off label as glucocorticoid receptor antagonist for 10 years with no noticeable AEs

Question 44

Clomifene citrate

Answer 44

Improves sperm penetration and survival by changing cervical mucus and uterine mucosa Induces ovulation about 67% of time, but pregnancy success only about 37%

Question 45

hMG

Answer 45

Stimulates follicles | Risk of multiple fetus pregnancy

Question 46

Bromocriptine

Answer 46

Reduce production of prolactin by the pituitary

Question 47

When can corticosteroids be used to tx infertility?

Answer 47

When dx is related to overproduction of testosterone by female

Question 48

What medication is DOC when the pt is at risk of pre-eclampsia but not yet dx?

Answer 48

Methyldopa

Question 49

What is approved for tx menopause but not contraception?

Answer 49

Drospirenone+estradiol (angeliq)