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Flashcards in contraceptives Deck (28)
1

methods to prevent ovulation

suppress LH and FSH release

prevent fluctuations in estrogen levels

2

method to impair implantation

maintain elevated progesterone by providing elevated progestin

3

combined OCP

estrogen + progestin

only 2 estrogens = ethinyl estradiol or mestranol

4

norethindrone

progestin

5

norgestrel

progestin

6

levonorgestrel

progestin

7

desogestrel

progestin

8

norgestimate

progestin

9

drospirenone

progestin

10

highest androgenic progestin

levonorgestrel
norgestrel

11

lowest androgenic progestin

norethindrone

3rd gen progestins with even less = desogestrel and norgestimate

12

antiandrogenic progestin

drospirenone

13

AE with low dose combined OCP

higher risk of failure with missed dose

nausea, bloating, breakthrough bleeding that improves by 3rd cycle

breakthrough bleeding - bigger problem with lower dose regimens

HA, migraines - should stop if get migraine

insulin resistance - progestin can cause insulin resistance

hirsutism = common with androgen progestins

melasma = estrogen stimulates melanocytes

dyslipidemia

CV risk = more common in women who smoke and >35

14

combined OCP MOA

prevent ovulation = suppress LH and FSH release

progestin = thicken cervical mucus - prevent sperm penetration - impair implantation

15

how does estrogen inc risk of CV risk

estrogen increases production of factor 7, 10, and fibrinogen = inc risk of thromboembolic events

16

OCP interactions

rifampin - P450 inducer = increases metabolism of estrogen

carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate, vigabatrin, St. John's wort

Abx = ethinyl estradiol conjugated in liver and hydrolyzed by intestinal bacteria - some broad spec abx may affect this

17

absolute contraindications of OCP

pregnancy
thrombophlebitis
CVA/CAD
breast CA
undx vaginal bleeding
estrogen dependent CA
liver benign/malignant tumors
uncontrolled HTN
DM with vascular dz
active hepatitis
surgery/prolonged immobilization
migraine with aura

18

relative contraindications of OCP

migraine without aura
HTN
renal dz
DM
gallbladder dz
cholestasis
sickle cell
lactation

19

progestin only pills benefit

*no risk of thromboembolic events*

decreased dysmenorrhea, dcreased blood loss and PMS

20

progestin only MOA

only block ovulation in 60-80% of cycles

mainly works to thicken mucus and impair implantation

21

progestin injection

contains depot medroxyprogesterone acetate

high enough levels of progestin to prevent ovulation and impair plantation

given every 3 months IM

22

depo AE

menstrual irregularities
weight gain
irreversible bone mineral density loss = black box warning

23

progestin implant

major AE = irregular menstrual bleeding

24

IUS

levonorgestrel

work for 5 years

25

emergency postcoital contraception

2 step

2 tablets of levonorgestrel
first tablet taken with 72 hours
second tablet - 12 hours later

PREVENTION OF IMPLANTATION ONLY - (thats why only progestin)

AE: n/v

26

one step plan B

one tablet of levonorgestrel taken within 72 hours

27

Ella

ulipristal acetate
selective progesterone receptor modulator

inhibit/delays ovulation = can be taken within 5 days

available only by prescription

28

non-hormonal emergency postcoital

copper IUD
can be inserted within 5 days of intercourse