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Flashcards in Contraceptives Deck (28):
1

what are the two types of estrogen that are seen in oral contraceptives and mention their activity

-ethinyl estradiol: pharmacologically active
-mestranol: converted by the liver to ethinyl estradiol

2

what are the progestins in oral contraceptives

LMNNNDD

Levonorgestrel
Medroxyprogesterone
Norethindrone
Norgestimate
Norgestrel
Desogestrel
Drospirenone

3

how do the progestins in OC differ

-based on their androgenic activity
-Levonorgestrel and Norgestrel have the highest androgenic activity

-Desogestrel and Norgestimate have lower androgenic activity

-Drospirenone has anti androgenic effect

4

what is the combined oral contraceptive most commonly used today and what does it contain

"low dose" combined oral contraceptive and it contains 35 microgram of ethinyl estradiol or less

5

what do most formulation of OC have

21 hormonally active pills followed by 7 placebo pills to allow for withdrawal bleeding

6

mechanism of combined oral contraceptive

-prevents ovulation by suppressing LH and FSH release
-progestin thickens cervical mucus so sperm cannot penetrate
-induces changes in endometrium so that implantation is unlikely

7

when can women start taking OC and be immediately protected

-anywhere from Day 1 to 5 of her period --> immediate protection unless cycle is less than 23 days

- if that's the case then must be taking pill for at least 7 days for protection to begin

8

non contraceptive benefits of OC

-reduction in endometrial cancer risk
-reduction in ovarian cancer risk
-regulation of menses
-prevent ovarian cysts
-relief of benign breast cancer
-reduced risk for symptomatic PID
-improve acne control

9

AE of OC and how it can be avoided

BHAIM

Breakthrough Bleeding (most common)
Hirsutism
Amenorrhea
Insulin Resistance (progestin competes for its receptors)
Melasma (brown gray patches on face)

adjust estrogen/progestin content of OC

10

the AE hirsutism is associated with which contraceptives

those with androgenic properties so main ones -- Levonorgestrel and Norgestrel

11

most serious AE of OC though very rare

cardiovascular disorders such as thromboembolism, hypertension etc

12

what drugs taken concomitantly with OC can cause OC failure and why

CYP450 inducer such as RIFAMPIN, Carbamazepine, Oxycarbazepine, Phenytoin, Phenobarbitol, Topiramate, and St. John's Wort

-the increase the metabolism of estrogen hence failure of the OC

13

how does Rifampin as an antibiotic affect circulating estrogen (other than being a CYP450 inducer)

decreases intestinal bacteria needed to hydrolyze ethinyl estradiol --> its reabsorption as an active drug

14

absolute contraindications of OC

-Pregnancy
-Thromboembolic or Thrombophlebitis disorder
-Breast Cancer
-Undiagnosed abnormal vaginal bleeding
-Stroke or CAD
-Estrogen Dependent Cancer
-Tumor of liver
-Migraine with aura
-DM with vascular disease
-Uncontrolled hypertension
-Older than 35 and smoke heavily
-Surgery requiring prolonged immobility
-Active hepatitis

15

what is given to women who can't take estrogen containing OC and give example

progestin-only contraceptives called minipills --> norethindrone or norgestrel

16

disadvantage of taking mini pills (name them)

norethindrone or norgestrel

they are less effective and must be taken at same time every day

17

who is most likely to take progestin only OC (name them)

norethindrone or norgestrel

-if increased risk of thromboembolic event
-over 35 and smoke

18

mechanism of progestin only OC (name what they contain)

norethindrone or norgestrel

-thickening of cervical mucus --> sperm cant penetrate
-endometrial alteration --> impair implantatio

19

when can woman take progestin only OC and be immediately protected

Day 1-5 of period unless cycle 23 days or less --> must then take pill for at least two days before protection (compare to estrogen OC where must take 7 days)

20

what does the contraceptive patch and ring contain

ethinyl estradiol and a progestin

21

what is Depo-provera and its main mechanism

progestin only injectable contraceptive that contains depot medroxyprogesterone acetate (DMPA) --> high enough progesterone that it causes negative feedback

22

AE of depo provera

significant loss of bone mineral density

23

what is subdermal progestin implant

implant containing only progestin that is placed just under the skin of upper arm and is effective for 3 years

24

what is intrauterine systems

contraceptive that contains levonorgestrel and lasts for 5 years

25

what can diaphragm and cervical caps lead to if left longer than 24-48 hours

toxic shock syndrome

used together with spermicides to prevent pregnancy

26

what is the name of the spermicide

nonoxynol-9

27

what is Plan B and One choice

used after unprotected sex to prevent pregnancy

-contain levonorgestrel: 1st taken within 72 hours and next 12 hours later

available over the counter for those 17 and older

28

what is Ella

tablet taken within 5 days of unprotected sex to prevent pregnancy

-contains Ulipristal acetate, progesterone antagonist, to inhibit or delay ovulation

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