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Ahmed Repro 1 Sadness > Lecture 3: Contraception and Sterilization > Flashcards

Lecture 3: Contraception and Sterilization Flashcards

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1
Q

Caution should be used when using the transdermal OC, orthoevra, in whom?

A

Women >198 lbs.

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2
Q

What are the contraindications for use of the long acting reversible contraceptive (LARCS), Nexplanon?

A
  • Known or suspected pregnancy
  • Current (yes) or past hx of thrombosis or thromboembolic disorders (consideration)
  • Liver tumors or active liver disease (poorly metabolized)
  • Undiagnosd abnormal uterine bleeding
  • Known or suspected breast cancer (only absolute)
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3
Q

Side effects associated w/ injectable, DepoProvera?

A
  • Alterationsinbone metabolism
  • Irregular bleeding –> ↓ with use, but 25% will discontinue within one year
  • Weight gain
  • Exacerbation of depression
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4
Q

What are some of the risks associated with IUDS?

A
  • ↑ risk of infection within first 20 days post-insertion
  • ↑ risk of ectopic pregnancy if pregnancy would occur
  • Risk of uterine perforation at time of insertion requiring laparoscopy for removal
  • Risk of malposition and necessitating hysterscopy for removal
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5
Q

What are the contraindications to using emergency contraception?

A

NO medical contraindication to use

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6
Q

What are 5 serious AE’s associated with hormonal oral contraceptives?

A
  • Venous thrombosis
  • Pulmonary embolism
  • Cholestasis and GB disease
  • Stroke and MI
  • Hepatic tumors
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7
Q

Why is the use of salpingectomy as a means of female sterilizaton increasing in use?

A

Due to recent literature regarding decrease in ovarian cancer risk

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8
Q

What is the MOA of the long acting reversible contraceptive (LARCS), Nexplanon?

A
  • Thickens cervical mucous
  • Inhibits ovulation
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9
Q

How long does injectable, DepoProvera, maintain contraceptive level of progestin; when is it preferred to be given?

A
  • Maintains contraceptive level of progestin for about 14 weeks
  • IM injection every 11-13 wks, preferred to be given within first 5 days of menses and if not, use a back up method for 2 weeks
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10
Q

What are the benefits and risks to using electrocautery for female sterilization?

A
  • Fast!
  • ↑ risk of thermal injury to surrounding tissue
  • Poor reversibility
  • Greater risk of ectopic pregnancy
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11
Q

What is a strategy for improving the bleeding profile in someone suffering from irregular bleeding while on DepoProvera?

A

Short term use of estrogen add back (usually wait till after receiving 2nd dose)

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12
Q

What is the name of the injectable hormonal contraceptive?

A

Depo medroxyprogesterone acetate (DepoProvera)

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13
Q

What is the implantable hormonal contraceptive called?

A

Etonogestrel rod implant (Nexplanon)

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14
Q

Female sterilization is done using which methods?

A
  • Laparoscopy
  • Mini-laparotomy
  • Hysteroscopy
  • At time of C-section
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15
Q

How long after unprotected sex can you take the emergency contraceptive, Ella; what is it’s MOA?

A
  • Indicated for up to 5 days after unprotected sex
  • Postpones follicular rupture / inhibit or delay ovulation
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16
Q

Who can’t use combination contraceptives?

A
  • Women over 35 who smoke cigs
  • Women w/ personal hx of thromboembolic event
  • Women w/ hx of CAD, cerebral vascular disease, CHF or migraine w/ aura, uncontrolled HTN
  • Women w/ moderate to severe liver disease or liver tumors
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17
Q

How long is the long acting reversible contraceptive (LARCS), Nexplanon good for?

A

Used for 3 years

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18
Q

Caution should be used in women with which underlying conditions when considering combination contraceptives?

A
  • Diabetes
  • Chronic HTN
  • SLE
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19
Q

What are the differences between hulka anf filshie clips used for female sterilization?

Study These Flashcards
A
  • Hulka = MOST reversible method, but greatest failure rate >1%
  • Filshie = lower rate of failure because of larger diameter
20
Q

Which AE associated with DepoProvera caused the FDA to issue a black box warning; what is this warning?

Study These Flashcards
A
  • Alterations of bone metabolism assoc. w/ ↓ estrogen levels
  • Particular concern in adolescents
  • Reversible after discontinuation
  • BLACK BOX = if used for more than 2 years should consider alternative method
21
Q

What is the name of the hormonal contraceptive transdermal patch; how often is it applied?

Study These Flashcards
A
  • OrthoEvra
  • Apply one patch weekly for 3 weeks
22
Q

How does the progestin-only oral contraceptive (mini-pill) work; chance of ovulation; and who is it mainly used in?

Study These Flashcards
A
  • MOA is primarily making cervical mucous thick and impermeable
  • Ovulation continues in about 40% of users
  • Mainly used in breastfeeding women and women who have contraindication to estrogen
23
Q

Women who use diaphragms as a method of contraception are more likely to get what?

24
Q

What hormones are contained in the combo oral contraceptives; describe how each hormone contributes to its function?

Study These Flashcards
A
  • Progesterone = major player –> suppresses LH and therefore ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium
  • Estrogen: mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
25
What are the benefits of the hormonal contraceptive ring, NuvaRing?
- **Combo** of **progesterone** and **estrogen** - Associated w/ **greater compliance** due to once a month use - Can be **removed** for **up to 3 hours** without affecting efficacy - **Better tolerated** since not going thru GI tract and **less breakthrough bleeding**
26
List 6 contraindications to using IUDS; which are specific to levonorgestrel containing and which to Copper T?
- **Breast cancer** - **levonorgestrel** containing **only** - Recent **puerperal sepsis** - Recent **septic abortion** - **Active cervical infection** - **Wilson disease** - **Copper T only** - **Uterine malformations** (uterine septums/fibroids/enlarged \>10cm)
27
What is the efficacy of the injectable contraceptive, DepoProvera?
**Roughly** equivalent to **sterilization** and is **not** altered by weight
28
List 4 benefits to using the levonorgestrel containing IUDS.
- ↓ in **menstrual blood loss** (up to **50%**) - **Less dysmenorrhea** (painful periods) - **Protection** of **endometrial lining** from **unopposed estrogen** - **Convenient** and **long term**
29
What are 4 benefits to using hormonal oral contraceptives?
- **Menstrual** cycle **regularity** - **Improve dysmenorrhea** (painful periods) - ↓ **risk** of **iron deficiency** **anemia** (shorter and less heavy cycles) - **Lower incidence** of **endometrial** and **ovarian** cancer, benign breast and ovarian disease (**cysts**)
30
What is a contraindication for using hormonal oral contraceptives?
**Migraine WITH aura**
31
Which general class of contraceptives provide the most effective **reversible** contraception?
**Hormonal** contraceptived
32
List 5 contraindications for the use of the contraceptive DepoProvera?
- Known or suspected **pregnancy** - **Unevaluated vaginal bleeding** - Known or suspected **malignancy** of the **breast** - **Active thrombophlebitis** or **current/past hx** of **thromboembolic events** or **cerebral vascular disease** - **Liver dysfunction/disease**
33
What are some of the side effects associated with oral contraceptives?
- **Breakthrough bleding**: 10-30% experience during first 3 months of use (**make sure to counsel** **it will improve!**) - **Amenorrhea** - **Mild AE's**: bloating, weight gain (perceived), breast tenderness, nausea, fatigue, and HA
34
What are the names of the 5 hormone containing IUD's?
**-** Copper T (**Paragard**) - **Levonorgestrel releasing** = Mirena and Skyla + Liletta and Kyleena
35
Which IUDS are used for 5 years and which are used for 3 years?
- **Mirena/Kyleena** are used for **5 years** - **Liletta/Skyla** used for **3 years**
36
List 4 indications for choosing the contraceptive DepoProvera?
- Desire for **effective** contraception - Need a method w/ **better compliance** - **Breastfeeding** - Can be used when **estrogen** is **contraindicated**
37
How long is the Copper T IUD, Paragard, used for and what is it's MOA?
- Used for **10 years** - **Copper** interferes w/ **sperm transport** or **fertilization** and **prevention** of **implantation**
38
What is the MOA of the injectable contraceptive, DepoProvera?
- **Thickens** cervical mucous - **Decidualization** of the **endometrium** - **Blocks** the **LH surge** and **ovulation**
39
Which hormone is found in Plan B and how quickly must use take it?
- **Progestin** only (levonorgestrel) **2 pills** taken **12 hrs apart** - Must be used within **120 hrs** after unprotected intercourse
40
There is a greater risk of what AE associated with the transdermal patch, Orthoevra?
**Greater risk** of **thrombosis**
41
What are some of the underlying conditions where the contraceptive DepoProvera can still be used?
- Women w/ **seizure disorders** - **Sickl cell anemia** - **Anemia** secondary to **menorrhagia** - **Endometriosis** - ↓ risk of **endometrial hyperplasia**
42
How long after vasectomy does it take for complete azoospermia?
Takes about **10 weeks**
43
List 6 side effects associated with the long acting reversible contraceptive (LARCS), Nexplanon?
- Irregularly irregular vaginal bleeding - **HA** - Vaginitis - **Weight increase** (mild) - Acne - **Breast pain**
44
When using a progestin-only OC (mini-pill) when must the patient take the pill and what if they mistime a dose?
- Because of **low dose**, they **MUST** be taken at **same time everyday** starting on **first day of menses** - If pt is **\>3 hours late** taking pill should use **backup method** for **48 hours**
45
What is the most common method of female sterilization throughout the world and how is it done?
- **Mini-laparotomy** - Use **small infra-umbilical** incisions in postpartum period or suprapubic incisions as an interval procedure

Ahmed Repro 1 Sadness (20 decks)

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