Contraceptives Study Guide

Question 1

Progestin-Releasing IUD (Mirena) MoA

Answer 1

Endometrial atrophy&raquo_space; Inhibit implantation; Cervical mucous thickening

Question 2

Progestin-Releasing IUD (Mirena) Effects

Answer 2

Decreased menstrual blood loss & severity of dysmenorrhea

Question 3

Progestin-Releasing IUD (Mirena) Cautions

Answer 3

Multiple sex partners ^ risk of PID; Copper allergy; Wilson’s disease

Question 4

Progestin-Releasing IUD (Mirena) Disadvantages

Answer 4

Risk of ectopic pregnancy; Rare - Uterine perforation

Question 5

2 Classes of OCPs

Answer 5

Combination (Estrogen & Progestin); Progestin-only

Question 6

Monophasic OCPs

Answer 6

All active pills have identical amts of hormones

Question 7

Biphasic & Triphasic OCPs

Answer 7

Different amts of hormones in active pills to mimic natural cycle and reduce AEs

Question 8

Estrogen MoA

Answer 8

Suppress production of FSH&raquo_space; prevent selection & emergence of dominant follicle

Question 9

Lowest Ethinyl Estradiol Dose

Answer 9

20 mcg

Question 10

Effects of Lower Ethinyl Estradiol Dose

Answer 10

^ risk of spotting; less margin of error for missed tabs; minimizes estrogen related side effects

Question 11

Highest Ethinyl Estradiol Dose

Answer 11

35 mcg

Question 12

Estrogen Side Effects

Answer 12

Spotting; peripheral edema; HTN; Hypertriglyceridemia; THROMBOEMBOLISM

Question 13

Progestin MoA

Answer 13

Inhibits ovulation by suppressing LH surge; Thickens cervical mucous

Question 14

Drug with Most Progestin Activity

Answer 14

Levonorgestrel

Question 15

Progestin with Most ANDROGENIC Activity

Answer 15

Norgestrel/Levonorgestrel

Question 16

OCPs safe during lactation

Answer 16

Progestin-only pills (“minipills”)

Question 17

Progestin Side Effects

Answer 17

Mood changes; Gallbladder dysfunction

Question 18

Androgenic Side Effects of Progestin

Answer 18

Increased appetite/wt gain; Acne; Hirsuitism; ^LDL & Dec HDL

Question 19

Non-contraceptive benefits of most OCPs

Answer 19

Decreased risk of endometrial/ovarian CA; ectopic preg; Iron def anemia; Acne

Question 20

Benefit of Combined OCPs

Answer 20

Prevention of ovarian cysts

Question 21

Risks of Combined OCPs

Answer 21

Increased risk of CV events; HTN; VTE; Breast/Cervical CA; Glucose intolerance; Gallbladder dz; Hepatic tumors

Question 22

OCP contraindications

Answer 22

Thromboembolic dz; Cerebrovascular dz; CV dz; Impaired liver function; Breast CA; Smokers > 35; Personal or Familial Hypertriglyceridemia

Question 23

Adverse effects of Too Much Estrogen

Answer 23

Nausea; Breast tenderness; HTN; Melasma; HA

Question 24

Adverse effects of Too Little Estrogen

Answer 24

Early/mid cycle spotting; Hypomenorrhea

Question 25

Adverse effects of Too Much Progestin

Answer 25

Breast tenderness; HA; Fatigue; Mood changes

Question 26

Adverse effects of Too Little Progestin

Answer 26

Late cycle spotting

Question 27

Adverse effects of Too Much Androgen

Answer 27

Increased appetite; wt gain; Oily skin; Acne; Hirsuitism; ^LDL & Dec HDL

Question 28

Combination OCP MoA

Answer 28

Inhibits ovulation; Reduced penetration of egg by sperm; Reduced implantation; Thickened mucus to prevent sperm penetration; Slowed tubal motility

Question 29

OCP "Starter Set" (EE & Norgestimate)

Answer 29

Ortho-Cyclen; Ortho Tri-Cyclen; Ortho Tri-Cyclen Lo

Question 30

Starting OCPs

Answer 30

Start pills during first five day of cycle; use backup method for one week after starting pills

Question 31

When to use backup birth control

Answer 31

Use for 7 days if more than 2 pills are missed

Question 32

Drugs Decreasing Effectiveness of OCPs

Answer 32

ABX, esp. rifampin; Anticonvulsants

Question 33

Meds affected by OCPs

Answer 33

Anticoagulants; Insulin; Hypoglycemics; TCAs

Question 34

Extended & Continuous OCPs

Answer 34

Seasonale (84 active tabs); Seasonique (84 active tabs); Lybrel (continuous)

Question 35

Seasonale AE

Answer 35

More intercycle spotting

Question 36

Seasonique Advantage

Answer 36

Helps with menstrual symptoms & migraines

Question 37

Disadvantage of Transdermal Patch (Ortho-Evra)

Answer 37

Increased failure rate in pts > 200 lbs; may have more thromboembolic risks

Question 38

Disadvantage of Vaginal Ring (Nuvaring)

Answer 38

^ incidence of vaginitis & vaginal d/c; back up required until ring is in for 7 consecutive days

Question 39

Minipill Disadvantages

Answer 39

Higher rate of unintended preg; Spotting is common; Must take at same time every day; > 3 hrs late requires backup for 48 hr

Question 40

DepoProvera Cautions

Answer 40

Undiagnosed abNL vaginal bleeding; Liver dz; Severe depression; Severe CV disease

Question 41

DepoProvera Advantages

Answer 41

Safe while lactating; Less risk of thromboembolism

Question 42

DepoProvera Disadvantages

Answer 42

Decreased bone density

Question 43

Emergency Contraceptive MoA

Answer 43

Inhibit/delay ovulation; Interferewith fertilization or tubal transport; Prevent implantation by altering endometrial receptivity; ineffective after pregnancy has occurred

Question 44

Best Emergency Contraceptive

Answer 44

High dose progestin = Levonorgestrel

Question 45

Emergency Contraceptive Timing

Answer 45

Best w/in 24 hr of unprotected sex; Labeled for use up to 72 hr after sex