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Flashcards in Contraceptives Deck (56)
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1
Q

What does FSH do?

A

Promotes growth of follicle to prepare for ovulation

2
Q

What does LH do?

A

Promotes ovulation & oocyte maturation

3
Q

What are the phases?

A

Follicular (1-13)
Ovulation (day 14)
Luteal

4
Q

How does estrogen work?

A

Suppress FSH release from the pituitary and maintains stability of endometrium

5
Q

What are the 2 forms of estrogen?

A
  • Ethinyl estradiol (almost all)

- Mestranol (rare, prodrug)

6
Q

What are the MOA of estrogens?

A
  • Inhibit ovulation
  • Inhibit implantation
  • Accelerated ovum transport
  • Induction of luteolysis
7
Q

A/E of estrogens

A
  • VTE
  • Mi
  • Stroke
  • HTN
  • Migraine
8
Q

Why use progestin?

A

Provides majority of contraceptive effects

9
Q

How does progestin work?

A
  • inhibits ovulation by mod of FSH & LH
  • inhibit implantation, suppress endometrium
  • produces thick cervical mucus
  • slows ovum transport
10
Q

Adverse effects of progestin?

A
  • Androgenic a/e (acne, hirtuism, weight gain)
  • Potential VTE risk with 4th generation
  • worsening of lipid profile
  • diuretic effect, may increase K
11
Q

What do you start your patient on for OCP?

A

Monophasic, 21 days of the same dose

12
Q

Why use multiphasic OCP?

A

Minimizes adverse effects

13
Q

Contraindications of OCP for patients with migraines?

A
  • migraines with aura (any age)

- migraines >35

14
Q

Smoking and OCP contraindications?

A

No if >35 and heavy smoker

15
Q

Precaution with pregnancy and OCP?

A

Breast feeding women 6weeks – 6 months postpartum

16
Q

Who should get progestin-only ?

A

Does NOT contain active pills

Give to lactating women or if they have contraindication to combined OCP

17
Q

Progestin only is great for who?

A

Patient with light menses

18
Q

Progestin only disadvantages?

A
  • Must take at same time every day
  • Weight gain
  • More breakthrough bleeding
  • Increased risk of ectopic pregnancy
19
Q

Disadvantages of OCP?

A
  • Depend on user consistency

- No protection against STI

20
Q

Continue OCP for how long before adjusting based on adverse effects?

A

3 months

21
Q

Symptoms of serious a/e of OCP?

A
  • Abdominal pain
  • Chest pain
  • Headache
  • Eye problems
  • Severe leg pain
22
Q

Use back up for how long after starting OCP

A

One month

23
Q

What is a transdermal contraceptive?

A

Combined estrogen and progestin (so same CI as before)

24
Q

How is transdermal different?

A

60% more estrogen due to eliminating first pass metabolism (liver processing)

25
Q

How often do you change the patch? What if you forget to take off your patch?

A

Repleace every 3 weeks (leave off for a week) with 48 hour forgivness

26
Q

What if patch detaches?

A

For more than 24 hours, restart new cycle. If not, just reapply

27
Q

A/E of patch?

A

Application site reactions

28
Q

BBW of patch?

A

Possible increase in thromboembolism due to increased estrogen exposure

29
Q

Who can NOT use the patch?

A

Women > 198 pounds (90 kg)

30
Q

What Is the nuva ring?

A

Estrogen and progestin in a flexible Rx ring

31
Q

How do you use the ring?

A

Insert on or before 5th day of first cycle of use. Leave in 3 weeks, take out for 1 week

32
Q

When do you use backup with the ring?

A

If expelled for > 3 hours, use for a week

33
Q

Advantage of ring?

A
  • Increased compliance
  • Improved cycle control (less breakthrough bleeding)
  • Precise placement not necessary
34
Q

A/E unique to the ring?

A
  • Vaginal irritation
  • Leukorrhea
  • Increased wetness
  • Foreign body sensation
35
Q

What is in the injectable form of BC?

A

Progestin only (Depo-provera)

36
Q

When do you use injectable?

A

Give within 5 days of onset of bleeding

37
Q

How long does injectable work?

A

Inhibits ovulation for 3 months

38
Q

What about injectable with post partum women?

A

Not until 6 weeks postpartum if breast feeding

39
Q

Non-contraceptive benefits of injectable?

A
  • Decreased sickle cell pain crises
  • Fewer seizures in women with history
  • Approved for endometriosis associated pain
40
Q

Disadvantages of injectable?

A
  • Not readily reversible
  • 10-18 months until return to fertility
  • Ammenorhea & breakthrough bleeding
41
Q

BBW of injectable?

A

Decreased bone marrow density

42
Q

How does the subdermal contraceptive work?

A

Progestin only implant (implanon)

43
Q

How long does subdermal work?

A

3 years

44
Q

Subdermal decreased efficacy in whom?

A

> 130% of ideal body weight

45
Q

When does fertility return with subdermal?

A

30 days after removal

46
Q

No subdermal in who?

A
  • Pregnant
  • History of active liver disease
  • History of thromboembolic events
  • History breast cancer
47
Q

What are the types of IUD?

A
  • Paragard (copper only)

- Mirena (5 years) or Skyla (3 yrs) (progestin only)

48
Q

How do IUDs work?

A
  • Low grade intrauterine inflammation
  • Increased prostaglandin formation
  • Endometrial suppression
  • Interference with egg implantation
49
Q

Return to fertility with IUD?

A

IMMEDIATE

50
Q

Who is great candidate for IUD

A

Heavy menstrual bleeding

51
Q

Disadvantages of IUD?

A

Increased risk of infection
Uterine perforation
Spotting
NO for uterine fibroids and PID

52
Q

How does emergency contraceptives work?

A

Levonorgestrel (plan B)

  • Inhibits / delays ovulation
  • May interfere with sperm transport
  • May interfere with corupus luteum function
53
Q

How long do you have to take emergency contraceptive?

A

5 days after

54
Q

What happens to your period if you take emergency contraceptive?

A
  • 1 week late or early, so take pregnancy test if period doesn’t begin within 3 weeks
55
Q

What is ulipristal?

A
  • 1 week late or early, so take pregnancy test if period doesn’t begin within 3 weeks
56
Q

OCP and antibiotics?

A

RX emergency contraception

Selective progesterone receptor modulator (agonist & antagonist) that delays ovulation