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Clinical part B > Hormonal Contraception > Flashcards

Hormonal Contraception Flashcards

(68 cards)

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1
Q

define menarche

A

first menstraul cycle

around 12 years

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2
Q

define menses

A

sloughing of endometrial cells - period

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3
Q

define menopause

A

cessation of menstraul cycle
one year with no period
around 50

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4
Q

goals of therapy

A

prevent fertilization in order to prevent pregnancy
tailor method to individual needs
avoid/minimize adverse effects
ensure adherance by providing clear oral and written instructions

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5
Q

4 mechanisms of action

A
  1. estrogen and progesteron provide negative feedback
  2. creates endometrium that is unreceptive to implantation
  3. production of viscous cervical mucus
  4. effect secretion adn peristalisis in fallopian tubes
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6
Q

doses of ethinyl estradiol

A

low - 10mcg
high - 50mcg
most women dont need over 35mcg

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7
Q

diff types of progestins

A

1st gen - bind to estrogen, progesterone, androgen
2nd gen - more potent and better tolerated
3rd gen - fewer androgenic effects
newer - antiandrogens

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8
Q

two different categories of progestins

A

androgenic activity

progestagenic activity

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9
Q

difference between the different phasics

A

monophasic - fixed amount of estrogen and progestin
biphasic - 2 phases of progestin
triphasic - 3 phases of progestin

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10
Q

how do the extended cycles work

A

24/26 days only 4 days hormone free

84 day 7 days hormone free (seaonale) or will little estrogen (seasonique)

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11
Q

what is suggested dose for starting a coc

A

20mcg ethinyl estrodiol and older progestin (levonorgestrel or norethindrone)

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12
Q

which is preferred for doing continuous use with no hormone free period and why

A

monophasic because biphasic will get that drop in progesterone level and may get spotting

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13
Q

why cant the hormone free interval be more than 7 days

A

dominant follicle will form and ovulation will occur

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14
Q

what is recommended for starting coc

A

back up contraception for first 7 days unless its on the first day of your period
to avoid weekend periods start the first sunday after period starts

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15
Q

cautions with COCs

A

people at increased risk of VTE
migraines with an aura higher risk of stroke
hypertension that is uncontrolled or greater then 160/100
smoke more than 15 cigs a day and over 35
21 days post partum, 30 days if breast feeding
current or previous breast cancer
diabetes for 20 yrs
uncontrolled dyslipidemia- may increase LDL and decrease HDL
obesity decreases serum levels
systemic lupus erythmatosus - high risks associated wiht pregnancy so use contraception

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16
Q

benefits of combined oral hormonal contraception

A

relief from menstrual issues such as cramps, ovulatory pain, blood loss
menstrual regularity
decreased acne and hair growth due to antiadrogenic effects
reduced risk of ovarian and endometrial cancer
bone density benefits

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17
Q

risks of coc’s

A

heart attack and stroke due to high doses of estrogen

thromboembolism, but less risk than in pregnancy

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18
Q

who are at high risk of DVT/PE and what should they do

A 
over than 35 adn smoker
history of clots
obesity 
prolonged immobilization 
family history 
use other contraceptive methods
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19
Q

what are some earyl danger signs (ACHES)

A

abdominal pain severe (thrombosis, pancreatitis, gallbladder disease)
chest pain, shortness of breath (pulmonary embolus, MI)
headache (stroke, hypertension)
eye problems (stroke, hypertension, vascular insufficiency)
severes leg pain (DVT)

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20
Q

symptoms of too much estrogen

A 
nausea
bloating
breast tenderness
melasma
irritable 
headache
weight gain
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21
Q

signs of too little estrogen

A 
early spotting
vasomotor symptoms 
headache
depression 
nervous
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22
Q

signs of too much progestin

A 
breast tenderness
headache
fatigue
cahnges in mood
increased appetite
weightgain 
decreased libido
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23
Q

signs of too little progestin

A

late break through bleeding
dysmenorrhea
heavy flow

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24
Q

signs of too much androgen

A 
increased appetite and weight
oily skin and scalp 
acne 
hirsutism 
increased libido 
rash 
increased LDL
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25
what do you do if pt experiences break through bleeding
may occur in first month of use but keep using | after 3-6 months doesnt resolve may need to change to increase estrogen or progestin
26
what to do if pt experiences breast tenderness
if continues after 3 months see doctor | may need less estrogen
27
should you gain weight on the pill
may have increased appetite in first month but overall not associated with weight gain
28
what to do if pt experiences nasuea
should resolve in 3 months take at bedtime or with food may consider less estrogen
29
what to do if pt experiences headaches
if related to treatment avoid oco
30
what to do if pt experiences acne
may worsen initially but general should improve long term | if not change to less androgenic progesterone
31
drug interactions with coc
``` carbamazepine oxcarbazepine phenytoin primidone phenobarb topiramate rifampin griseofulvin ritonavir stjohns wort antibiotics? ```
32
how is ethinyl estradol metabolized
CYP3A4
33
what is contained in the transdermal contraceptive patch evra
norelgestromin 150mcg | ethinyl estradiol 20 mcg
34
how do you use the transdermal patch
apply one patch weely for 3 weeks with 1 week patch free | start first day of menses
35
some of the side effects of transdermal not seen in coc
more spotting and breast tenderness in the first 2 cycles | local skin reaction
36
what is contained in the vaginal contraceptie ring - nuvaring
120mcg etonorgestrel | 15mcg ethinyl estradol - less estrogen so less SE
37
how do you use nuva ring
insert for 3 weeks then remove for 1 week | start day one of mensus no back up method needed
38
disadvantages of the nuva ring
requires self insertion and removal more vaginal symptoms of irritation, discharge, vaginitis concurrent use of tampons not recommended bc absorb some of the progesterone
39
who should you use the progestin only pill in
during lactation | contraindication to estrogen
40
what does the minipill contain
35mcg norethindrone
41
how do you take the minipill
no pill free interval | have to take tablet within 3 hours everyday
42
MAO of the minipill
increases cervical mucus viscosity and endometrial atrophy decreases sperm motility ovulation still occurs
43
adverse effects of minipill
irregular bleeding | hormonal side effects
44
what to do if pill is taken more than 3 hours past
take the pill ASAP and continue taking pack back up must be used for 48 hrs emergency contraception should be considered if unprotected intercourse occurred in the past 5 days
45
how often do you get the medroxyprogesterone acetate injection
every3 months
46
MAO of progestin injection
inhibits secretion of gonadotropins inhibits ovulation increases cervical mucus viscosity and endometrial atrophy resembles menopause bc no GnRH release
47
who should use the progestin injection
women who desire 3 month contraception contraindications to estrogen (over 35 smokers, migraine sufferers, breastfeeding, endometriosis, sickle cell disease, taking anticonvulsants, high risk of stroke)
48
contraindications for the progestin injection
``` pregnancy unexplained vaginal bleeding current breast cancer severe liver disorder - caution between 16-18 bc thats when peak bone mass is being laid fown ```
49
benefits of progestin injectable
no period decreased risk of endometrial cancer decreased symptoms of endometriosis?
50
adverse effects of progestininjectable
menstraul cycle disturbance hormonal weight gain decrease mood decreased bone mineral density (increased with greater duration of use) delayed return of fertility (9-12 months)
51
who cant use an ius
``` current pregnancy pelvic inflammatory disease STI undiagnosed abnormal vaginal bleeding uterine abnormalities ```
52
what are some of the risks associated with ius
uterine perforation with insertion or expulsion
53
MAO copper IUD
creates a hostile environment for sperm through an immune response reduces formation of mature eggs
54
side effects of copper iud
increase in menstrual bleeding and cramping
55
maximum time a copper iud is inserted
30 months | dont need back up contraception as soon as its inserted
56
MAO of levonorgestal ius
creates a hostile environment for sperm trhoguh an immune response reduces formation of mature eggs endometrial suppression and thickening of cervical mucus
57
side effects of levonorgestrel ius
breast tenderness headache acne maybe irregular periods and amenorrhea
58
benefit of levonorgestrel ius
reduced menstrual bleeding and cramping
59
does back up contraception have to be used with levonorgestrel ius
use back up for 7 days if it hasnt been inserted within 7 days of onset of menses
60
duration and strength of mirena ius
``` levonorgestrel 52mcg (20mcg/day of progestin) 5 years ```
61
strength and duration of jaydess
levonorgestrel 13.5mg | 3 years
62
who is jaydess marketted for
adolescent and nulliparous (havent given birth) women
63
strength and duration of kyleena
levonorgestrel 10.5mg | 5 years
64
which progestins have the most progestagenic activity
desogestrel levonorgestrel norgestrel
65
what does yasmin contain as a progestin
drospirenone
66
activity of yasmin and what it is good for
progestagenic antiadrongenic antimineralcorticoid polycystci ovary syndrome, acne, premenstrual dysphoric disorder
67
adverse effects of yasmin
increase potassium
68
what does diane contain and what is it actually used for
cyptoterine which is an antiandrogenic so used as a temporary treatment of severe acne

Clinical part B (15 decks)

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