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