Contraceptives II

Question 1

Contraception Options

Answer 1

Postcoital
Transdermal
Intravaginal
Injectable
Implantable
Oral

Question 2

Injectable example

Answer 2

Depro-Provera and Depo-SubQ Provera

Progestin only

Question 3

Depo-Provera Info

Answer 3

Inject IM or SQ every 3 months
Good for pt who can’t use estrogen
Can cause amenorrhea

Question 4

Depo-Provera special property

Answer 4

Fertility doesn’t return for 10-12 months after discontinuation

Question 5

Intrauterine contraceptives

Answer 5

Mirena

ParaGard

Question 6

Implantable devices

Answer 6

Implanon

Nexplanon

Question 7

Progesterone implantables

Answer 7

Mirena
Implanon
Nexplanon

Question 8

Abnormal implantable?

Answer 8

ParaGard; releases copper

Question 9

Implantable Contraceptive Info

Answer 9

Long Acting Reversible Contraceptives

Up to 5-10 years

Question 10

Progestin does what?

Answer 10

Prevents ovulation and thickens cervical mucus

Question 11

Copper does what?

Answer 11

Interfere with sperm transport and prevent implantation

Question 12

Good candidate for intrauterine devices

Answer 12

At least one child
Monogamous relationship
No PID
No etopic pregnancy

Question 13

Intrauterine devices AE

Answer 13

Ab cramping
Bleeding
Expulsion

Question 14

Transdermal Contraception Drug

Answer 14

Ortho Evra

Question 15

Transdermal Info

Answer 15

Apply new patch once weekly for 3 weeks

Obesity issue

Question 16

Intravaginal Contraception drug

Answer 16

Nuvaring

Question 17

Intravaginal info

Answer 17

Insert and remove 3 weeks later

If the ring dislodges for more than 3 hours use back up for 7 days and a new ring

Question 18

Emergency contraception that is progestin only drugs?

Answer 18

Plan B
Levonorgestrel
Ella (RX only)

Question 19

YuzpE Method

Answer 19

200 micrograms of EE + 1 mg of levonorgestrel OR 2 mg of norgestrel
Divided into 2 doses

Question 20

Ovral Emergency Contraception

Answer 20

2 tablets STAT, repeat in 12 hours

Question 21

Levora, Lo/Ovral, Levlen, Nordette, Seasonale Emergency Contraception

Answer 21

4 tablets STAT, repeat in 12 hours

Question 22

Trivora, Tri-Levlen, Triphasil Emergency Contraception

Answer 22

Yellow pills only

4 tablets STAT repeat in 12 hours

Question 23

Alesse, Levlite Emergency Contraception

Answer 23

5 tablets STAT, repeat in 12 hours

Question 24

What has a higher failure rate?

Answer 24

YuzpE is worse than Levo

Question 25

Counseling Tips for Emergency Contraception

Answer 25

``` N/V Headache Vomit within 1 hr = repeat dose Late period = pregnancy Take more does not increase efficacy ```

Question 26

Women >35 + OC

Answer 26

CV disease, cancer risk reduce, bone mineral density benefits Should use <50 mcg EE if nonsmoker

Question 27

Smokers + OC

Answer 27

>15 cigs/day = NO OCs >50 mcg = MI Progestin only

Question 28

HTN + COCs

Answer 28

Increased angiotensinogen levels Cause Na/H20 retention More prevalent with higher dose, prolonged use, age >35

Question 29

Progestin only + HTN

Answer 29

Does not increase BP | Caution with drospirenone

Question 30

Estrogen + HTN

Answer 30

Increase BP 6-8 Return to normal in 3-6 months Increase risk stroke and MI

Question 31

Dyslipidemia + COC

Answer 31

E: remove LDL and increase HDL, increase TGs Levonorgestrel: decreases HDL Could increase CV risk

Question 32

Diabetes + OC is okay IF

Answer 32

Nonsmoker <35 you No vascular disease

Question 33

Diabetes + progestins

Answer 33

Alter carb metabolism Alter insulin, glucose, and glucagon release Newer and low dose: little to no affect (except levonorgestrel)

Question 34

Migraines and OCs?

Answer 34

Progestin only, IUD or barrier method

Question 35

Migraine + aura

Answer 35

NO COCs | Higher risk of stroke

Question 36

Breast Cancer + OC??

Answer 36

Small increased risk No association with low-dose WHO says do NOT use

Question 37

History of Thromboembolism

Answer 37

DMPA and levonorgestrel IUD (first line)

Question 38

Contraindicated in a history of thromboembolism

Answer 38

Estrogens Increased clotting factures Greatest risk with transdermal contraception

Question 39

SLE + antiphospholipid antibodies, you would use?

Answer 39

Progestin only

Question 40

SLE without antibodies

Answer 40

COCs do not increase flare risk

Question 41

Sickle Cell

Answer 41

``` DMPA (1st line) Avoid CHCs (platelet activaiton, RBC deformity) ```