Lecture 9, part 1 (GYN)- Exam 5 Flashcards

Question

Female Condom * What do you need to educate on? (4)

Answer 1

* Proper use * Recommend lubrication * Do not use with male condom-causes tearing * Do not reuse

Answer 2

Effectiveness: * Failure rate 6-16% Benefits: * No systemic side effects * Significant protection from pelvic infection * Protection from cervical dysplasia

Answer 3

* Must be inserted near the time of coitus (when about to have sex) * Pressure from the rim predisposes some women to cystitis after intercourse

Answer 4

Efficacy: * Failure in nulliparous female: 9% perfect use and 16% typical use * Failure in parous female: 26% perfect use and 32% typical use Benefits: * Can be used in women that cannot be properly fitted for diaphragm or with recurrent bladder infections from diaphragm

Answer 5

* Should not be left in the vagina for over 12-18 hours, risk of toxic shock syndrome. * Should not be used during menstrual cycle * Does not protect from STD

Answer 6

* MC oral contraception * Contain synthetic versions of estrogen and progesterone * Provide steady levels of exogenous estrogens and/or progesterone

Answer 7

* Trick the pituitary gland into thinking woman is pregnant * Stops hormone release that triggers ovulation

Answer 8

Administration of exogenous estrogen and progesterone results in: * Inhibition of ovulation * Thickens cervical mucus

Answer 9

Discontinuation during 7 days of placebo cause rapid decline in estrogen and progesterone levels – withdrawal bleeding May choose no withdrawal bleeding Effectiveness: * Perfect use failure rate 0.3% * Typical use failure rate 8%

Answer 10

Suppresses FSH/follicular development * Less in low doses Stabilizes endometrium and controls bleeding Potentiates the action of progestins

Answer 11

Suppresses LH/ovulation * Dose-dependent Atrophies endometrium Thickens cervical mucous Disrupts fallopian tube secretion and peristalsis

Answer 12

* One pill once a day round the same time each day * Initial therapy with monophasic recommended * Specific combination dependent on concomitant disease states and symptoms

Answer 13

Least androgenic progestins recommended: * Desogestrel * Drospirenone * Norgestimate Some pills contain iron * Decrease anemia for heavy menses / prolonged duration

Answer 14

MC twenty-one days of active pills followed by 7 days of placebo * Monophasic - provide a continuous concentration of estrogen and progesterone * Multiphasic - provide varying levels of estrogen and progesterone * Attempt to mimic normal hormone fluctuation * Decrease overall exogenous hormone dose per cycle

Answer 15

* Highly effective * Rapid reversibility * Regulation of menstrual bleeding * Decreased menstrual blood loss/lighter menses * Improved dysmenorrhea symptoms

Answer 16

Decreased risk ovarian and endometrial cancer * Reduces risk of endometrial CA by 40% after 2 years of use and 60% after 4 or more years of use * Reduces risk of ovarian CA by 30% if used for <4 years, by 60% if used 5-11 years, by 80% if used >12 years

Answer 17

* Improvement in acne and hirsutism * Decrease functional ovarian cysts * Decreased risk developing uterine myomas if taken for >4 years * Beneficial effect on bone mass/improved bone density

Answer 18

Provides guidance for safe use of contraception * 1 - No restriction * 2 - Advantages generally outweigh risks * 3 - Theoretical or proven risks usually outweigh advantages * 4 - Unacceptable health risk

Answer 19

Increased risk of MI Thromboembolic Disease Strokes Liver tumors

Answer 20

* Age ≥35 and smoking (can be older if no smoking) * Multiple risk factors for CV disease (advanced age, smoking, DM, HTN) * HTN (Systolic ≥140 mmHg or Diastolic ≥ 90 mmHg) * History of venous thromboembolism * History of breast cancer * Systemic lupus erythematous * Migraine with aura * Known ischemic heart dx, hx CVA, complicated valvular dx * History of stroke * Severe liver cirrhosis or liver cancer

Answer 21

* Nausea * Breast tenderness * Bloating * Mood changes * Headaches * Irregular vaginal bleeding * ± weight gain * May take QHS if symptoms

Answer 22

Take everyday around the same time of day * Start on the first day of the menstrual cycle OR the first Sunday after the onset of the cycle OR any day of the cycle * If started >5 days after the first day, use backup method for the first 7 days

Answer 23

* No intercourse in the past 5 days, take two pills immediately and backup method for 7 days * (+) intercourse last 5 days, offer emergency contraception and restart pills the following day, backup method for 5 days

Answer 24

* Call office immediately for ACHES * Does not protect from STDs * DO NOT SMOKE * Most adrs improve in 2 to 3 months * Bleeding – must take for 3 months before changing

Answer 25

CYP450 inducers * Antiretrovirals * Antieplielptics (phenytoin, carb, phenobarbital, topiramate, lamotrigine) * Rifampin and rifabutin

Answer 26

* 150mcg norelgestromin /35 mcg ethinyl estradiol per day (Xulane) * 120 mcg levonorgestrel / 30 mcg ethinyl estradiol per day (Twirla)

Answer 27

* Apply one patch once per week for 3 consecutive weeks; one patch-free week * Can apply continuously to avoid withdrawal bleeding * **Additional contraindication: BMI ≥ 30 kg/m2** * Apply to abdomen, upper torso, upper arm or buttock

Answer 28

* **DO NOT apply to breasts, chest, and ovaries (cancer risk)** * Apply to clean, dry skin; rotate sites * Improved compliance over oral hormonal pills

Answer 29

Etonogestrel 120mcg/ethinyl estradiol 15mg per day (NuvaRing, et al) * NuvaRing reports 98% effective Ring placed in in the upper vagina for 3 weeks, removed and replaced 1 week later May replace immediately to avoid withdrawal bleeding

Answer 30

* May increase vaginal discharge * May move into different positions is vagina, does not need to be in exact position to work. * Ok to use with tampons

Answer 31

Progestin only pill: 0.35 mg norethindrone or 4 mg drospirenone (Slynd) or 0.075mg nogestrel PO daily Efficacy similar to CHC but MUST be taken within same 3-hour window daily * Back up contraception needed for 48 hours if > 3 hours late * Start 1st day of menses and take continuously, no placebo week

Answer 32

* Thickening of the cervical mucus / endometrial atrophy * Ovulation inhibition (inconsistent)

Answer 33

* Safe during lactation * Preferred for minimal doses of hormones * Alternative for women with contraindications to estrogen-containing birth control

Answer 34

* Inconsistent ovulation inhibition * Bleeding irregularities—prolonged, spotting, or amenorrhea * May require regular pregnancy tests if bleeding irregularities and concern for effectiveness

Answer 35

Depot-medroxyprogesterone acetate [DMPA (Depo Provera)] * Long-acting progestin * Intramuscular or subcutaneous

Answer 36

* ONLY started in the first 5 days of normal menstrual cycle, then every 10-15 weeks * If time between injections >15weeks, MUST have pregnancy test before injection ## Footnote Effectiveness: 99.7%

Answer 37

Benefits: * Effective for 10-15 weeks * Increased compliance Risks: * Irregular bleeding, amenorrhea * Ovulation may be delayed after cessation (6 to 12 months) * Decreased bone mineral density * Weight gain (> 2kg) common

Answer 38

* Irregular bleeding, unpredictable bleeding or spotting, usually decreases to amenorrhea * Should not use for more than 2 years unless other contraception methods inadequate * VitD and Ca++ supplements for bone density prevention

Answer 39

* LARC = Long-acting Reversible Contraception --progestin implant, etonogestrel (Nexplanon) * Five-year contraception protection (previously 3yrs)

Answer 40

* MUST Have negative pregnancy test prior to implantation (No UPIC since last menstrual period or EC candidate) * Implanted inner aspect of nondominant arm (about the size of matchstick)

Answer 41

* Implant within first 5 days of cycle if not on combination hormonal contraception; OR any time during cycle after confirmation not pregnant and use alternate form contraception for 7 days * Implant on the day after the last active pill if on oral hormonal contraception (combo or progestin only) * Implant day next IM progestin shot due * Implant day of removal of IUD * Removal in office procedure

Answer 42

Effectiveness: * Over 99% effective * Pregnancy rate 0.0% with 3 years of use Benefits: * 5 years continuous contraception (used to be 3yrs) * No delay in return of fertility after removal

Answer 43

* Contact provider if unable to palpate implant at any time (potential of migration, moving) * If implanted after fifth day of menses, use backup contraceptive method for first 7 days after implant * May have change in normal menstrual bleeding patterns

Answer 44

* Inhibitory effects of sperm migration and viability * Sperm cannot get to egg * Sperm do not like copper * Levonorgestrel – thickens uterine mucosa, sometimes stop ovulation

Answer 45

## Footnote Skyla: 5 years now

Answer 46

* Highly effective * Compliance high * Do not need partner compliance * May be used in nulliparous patient * May be used in adolescent * No estrogen

Answer 47

Increased risk of PID High risk of spontaneous abortion with failure; 50% if left in place, 25% if removed * Spontaneous abortion with IUD high risk severe sepsis Spontaneous expulsion * 10-20% of cases during the first year Perforation of the uterus with abdominal migration of the IUD

Answer 48

* Does not protect from STDs * Copper IUD increased risk of menorrhagia or severe dysmenorrhea * Self check for strings not recommended anymore; String check with provider – if not visible, use Back Up method, RTC or diagnostic imaging * IUD IS NOT AN ABORTIFACIENT

Answer 49

Effectiveness: * Failure rate 10-22% Mechanism of action * Immobilize/inactivate/damage and/or kill sperm

Answer 50

* Available without prescription * No hormonal effect. * Increases lubrication during intercourse

Answer 51

* **Does not protect** from HIV or other STD; vaginal and rectum irritation can cause epithelia disruption and increased risk of HIV transmission * Some formulations may contain base ingredients that can interact and break down latex and the barrier device (latex) * Increased risk of UTI and vaginal irritation

Answer 52

Recognizing fertile time in cycle Avoid intercourse or use barrier method during fertile times ACOG general effectiveness data for all types: * 1-5 pregnancies/100 first year perfect use * 12-24/100 typical use

Answer 53

Calendar Method: Avoid intercourse during fertile period * Track cycle for 8 months * First fertile day= subtract 18 days from the shortest cycle * Last fertile day=subtract 11 days from the longest cycle * Efficacy is 91% with perfect use

Answer 54

* Slight drop in temp 12-24 hours before ovulation; raises 1-2 days after * Pregnancy risk starts 5 days before, highest day of ovulation, sharply drops 1 day after

Answer 55

* Can only use if menses regular, never shorter than 26 days or longer than 32 days. * Avoid unprotected coitus days 8-19 * Use an App or color-coded circle of beads, called CycleBeads, to remind couple when to avoid intercourse or use barrier method. * Effectiveness:Failure 5% perfect; 12% typical

Answer 56

Not to be confused with medical abortion * Emergency contraception prevents pregnancy and only effective before pregnancy established * Medical abortion used to terminate an existing pregnancy

Answer 57

* No clinical examination or pregnancy testing is necessary before prescribing * Plan B available OTC without age restrictions in the US * MC adverse reactions of hormonal agents includes headaches, nausea, vomiting

Answer 58

* Oral medication most effective when taken as soon as possible after unprotected or contraception failure * Other forms of contraception recommended for regular use * May be taken more than once within same menstrual cycle; should not be used for long term contraception

Answer 59

* All victims of sexual violence should be offered emergency contraception * May need antinausea medicine; more so with combination pills * Irregular bleeding may occur in one week to one month after treatment; most have next menstrual period within 1 week of expected time. * Does not need follow-up

Answer 60

Benefits: * Highly efficient * Excellent for those with medical contraindications to reversible methods Efficacy: * Female sterilization failure <1% first year; 10-year failure 1.85%; 0.75% for postpartum partial salpingectomy and laparoscopic unipolar coagulation to 3.65% for spring clips * Male sterilization slightly more effective than female sterilization at 1 year mark;

Answer 61

* Does not protect against STDs * Back up method required for 3-months post vasectomy * May be reversible in some cases

Answer 62

Surgical, medical or combination may be used In US: * 60% performed before 9 weeks * 90% performed before 13 weeks * 1.2% are performed after 20 weeks

Answer 63

*Mifepristone – blocks progesterone and stops pregnancy * Misoprostol – cramping and uterine bleeding (48 hours later-> day 3) * Up to 11 weeks gestation | Two part method-> TAKE BOTH

Answer 64

* Open cervix and expel pregnancy tissue * Exact procedure depends on gestation * **Up to 23 weeks gestation**

Lecture 9, part 1 (GYN)- Exam 5 Flashcards

(92 cards)