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Therapeutics - Exam 5 > Lectures 44,45, and 46 > Flashcards

Lectures 44,45, and 46 Flashcards

Contraception and Emergency Contraception This one is going to be a doozy

1
Q

types of hormonal contraceptives

A

implant
levonorgestrel IUD
depot shot
pill (COC/Progestin only)
Vaginal Ring
Patch

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2
Q

implant - hormone, efficacy, duration of actions, and return of fertility

A

progestin
over 99%
3 years
may be delayed or rapid return (within 6 weeks)

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3
Q

implant – SE serious

A

mood changes
headaches
acne

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4
Q

implant – SE common

A

pain with insertion
irregular bleeding for first 6 to 12 months (could lead to no bleeding, regular period, frequent spotting or bleeding)

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5
Q

levonorgestrel (LNG) IUD hormone, efficacy, duration of action, and return of fertility

A

progestin
over 99%
3 to 8 years
immediate

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6
Q

LNG IUD - SE serious

A

uterine perforation
expulsion
infection

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7
Q

LNG IUD - SE common

A

cramping with insertion, spotting for first 3 to 6 months, periods may become lighter or less frequent

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8
Q

Copper IUD hormone, efficacy, duration of action, and return of fertility

A

no hormone
over 99%
10 years
immediate

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9
Q

Copper IUD – SE serious

A

uterine perforation
expulsion
infection

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10
Q

Copper IUD – SE Common

A

cramping with insertion
spotting for first 3 to 6 months
periods may become heavier or stay about the same

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11
Q

DMPA shot – hormone, efficacy, duration of action, and return of fertility

A

progestin
96%
3 months
possible delayed return

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12
Q

DMPA shot – SE serious

A

lower bone density
heavy bleeding

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13
Q

DMPA shot – SE common

A

weight gain
change in acne, mood, or headaches
spotting between periods or no periods

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14
Q

DMPA shot – how to start

A

150 mg IM or SQ injection by PCP

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15
Q

Types of pills

A

combined (COC, CHC)
Norethindrone and Norgestrel
Drospirenone

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16
Q

COC – hormone, efficacy, duration of action, and return of fertility

A

estrogen/progestin
93%
QD
immediate

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17
Q

COC – SE serious

A

blood clots (estrogen related)
stroke

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18
Q

COC – SE common

A

nausea, spotting, and/or breast discomfort
change in mood or headaches

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19
Q

interactions of COCs

A

controversial antibiotic interactions
both increase and decrease

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20
Q

types of COCs

A

monophasic (same dose)
biphasic (varying dose of E/P with two strengths)
triphasic (varying dose of E/P with three strengths)
four phasic (varying dose of E/P with four strengths)

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21
Q

norethindrone (mini-pill) and norgestrel (otc) – hormone, efficacy, duration of action, and return of fertility

A

progestin
93%
QD
immediate

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22
Q

norethindrone (mini-pill) and norgestrel (OTC) – SE serious

A

severe headaches
heavy bleeding
ectopic pregnany

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23
Q

norethindrone (mini-pill), norgestrel (otc), and drospirenone (slynd) – SE common

A

spotting and menstrual changes (more so than COC)

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24
Q

norethindrone (mini-pill) and norgestrel (otc) – how to start

A

take daily within 3 hours of the same time
no placebo pills

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25
Q

drospirenone (slynd) – hormone, efficacy, duration of action, and return of fertility

A

progestin
93%
QD
immediate

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26
Q

drospirenone (slynd) – SE serious

A

severe headaches
hyperkalemia

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27
Q

dropsirenone (slynd) – how to start

A

take daily with no placebo pills

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28
Q

vaginal ring types

A

monthly disposable (nuvaring, eluryng)
annual resuable (annovera)

29
Q

NuvaRing and Annovera – hormone, efficacy, duration of action, and return of fertility

A

estrogen/progestin
93%
in place for 3 weeks then ring free for 1 week
immediate

30
Q

NuvaRing and Annovera – SE serious

A

blood clots
stroke

31
Q

NuvaRing – SE common

A

nausea, spotting, breast discomfort
change in mood or headaches

32
Q

Annovera – SE common

A

headache/migraine
nausea and vomiting
vulvovaginal infection, candidiasis

33
Q

NuvaRing – how to start

A

leave in place for 3 weeks
remove for 1 week
discard ring
insert new ring after 7 days

34
Q

Annovera – how to start

A

leave in place for 3 weeks
remove
wash with mild soap and warm water
pat dry
place in case
leave it out for one week
reinsert into vagina after 7 days

35
Q

patch types

A

norelgestromin and EE (xulane, zefmy)
levonorgestrel and EE (twirla)

36
Q

all patches – hormone, efficacy, duration of action, and return of fertility

A

estrogen/progestin
93%
3 weeks
immediate

37
Q

all patches – SE serious

A

blood clots

38
Q

Xulane, Zefmy – SE common

A

nausea
spotting
breast discomfort
skin irriation
changes in mood or headaches

39
Q

Xulane, Zefmy – how to start

A

transdermal, thin, beige SQUARE patch applied to upper outer arm, abdomen, buttock, or back
keep on for 3 weeks
remove and discard
patch free for 7 days
apply new patch

40
Q

twirla – SE common

A

nausea
spotting
increased weight
skin irriation
changes in mood or headaches

41
Q

twirla – how to start

A

transdermal, thin, beige CIRCLE plastic patch applied to abdomen, buttock, or upper torso (excluding breast)
keep on for 3 weeks
remove and discard
go patch free for 7 days
apply a new patch

42
Q

EC – efficacy, duration of action, and return of fertility

A

more effective the sooner it is used
one insertion per copper iud, one rx per cycle of ulipristal acetate, and one OTC dose of levonorgestrel pill prn
immediate

43
Q

EC – SE

A

nausea
vomiting (if within 2 hours of dose, consider repeating)
headache
dizziness
breast pain
stomach pain
next period may start early or late and may have spotting

44
Q

Too much estrogen – SE

A

bloating
breast tenderness
mood changes
headache
nausea
heavy menses
fibroid growth
melasma
vision changes
cyclic weight gain

45
Q

not enough estrogen SE

A

light mense
vaginal dryness
spotting
no withdrawal bleeding

46
Q

too much progesin SE

A

acne
hirsutism
decreased/increased sex drive (depends on person)
depression
increased appetite
non cyclic weight gain
less energy
cholestatic jaundice
yeast infections
hair loss
swelling in arms/legs

47
Q

not enough progestin SE

A

breakthrough bleeding late in cycle
no withdrawal bleeding
heavy menses

48
Q

combined medications – SE serious

A

abdominal pain
chest pain (SOB, cough)
headache
eye problems (double vision, blurry vision)
severe leg pain

49
Q

combined medications – CI

A

under 21 days postpartum
severe decompensated cirrhosis
VTE, diabetes, vascular disease
migraine with aura
HTN and BP > 160/100
smoking > 15 per day and > 35 yo
History of stroke
current breast cancer
major surgery with prolonged immobilization
IHD
liver tumor
peripartum cardiomyopathy
complicated solid organ transplant
SLE and positive antiphospholipid antibodies

50
Q

General approaches to starting

A

quick
next period
sunday
when changing hormonal methods
EC
restarting after EC

51
Q

quick start

A

anytime is reasonable certain person is not pregnant
if more than 1-6 days after period start, use backup method for 2 to 7 days

52
Q

next period start

A

start within 1-6 days of period start
no backup method required

53
Q

sunday start

A

start on sunday after period starts
if more than 1-6 days after period start, use backup method for 2 to 7 days

54
Q

when changing methods

A

switch method at any time or when due for next injection
no backup needed if no gaps in treatment

55
Q

EC start

A

within five days of unprotected vaginal intercourse
levonorgestrel – more effective the sooner it is used but could be less effective if < 165 pounds

56
Q

Restarting after EC

A

If levonorgestrel, start/resume method immediately and use backup method for 7 days
If ulipristal acetate, start/resume method five days after use and use backup method for 7 days

57
Q

How would you treat SE of irregular bleeding?

A

take pills at same time each day
ibuprofen 800mg tid x5d
may improve with continued use

58
Q

how would you treat SE of headaches?

A

d/c product if headaches get worse
OTC pain relievers
switch to continuous product if occurs during placebo

59
Q

how would you treat SE of nausea?

A

take pills with food or at bedtime
use continuous product if at start of cycle
could improve on own with continued use

60
Q

how would you treat SE of breast tenderness?

A

supportive bra
OTC pain reliever
use product with less estrogen

61
Q

how would you treat SE of acne?

A

topical treatments
different pill formulation (one that is less androgenic)
use combined product if able

62
Q

contraceptive treatment for transgender men

A

progestin-only
CHC
non-hormonal (copper IUD)
irreversible (tubal ligation, excision of fallopian tubes)

63
Q

contraceptive treatment for transgender women

A

condoms
condoms with spermicide
irreversible (orchiectomy, vasectomy)

64
Q

Concerns of patients when bringing up contraceptions

A

feel unable to discuss concerns
insufficient information about options
lack of patient-centeredness
inaccurate knowledge
use of scare tactic and authority

65
Q

approaches to minimize care concerns

A

tiered effectiveness
reproductive life planning
one key question
PATH
shared decision making
others

66
Q

tiered effectiveness approach

A

most effective reversible –> implant and IUD
most effective permanent –> male/female sterilization
second tiered in this order –> injectable, pill, patch, ring, diaphragm

67
Q

one key question approach

A

would you like to become pregnant this year?
yes – assessment and care based on core preconception factors; folic acid supplementation
no - discuss all available options, satisfaction, and accurate use
IDK - pregnancy ambivalence; determine intervention and folic acid supplementation if potential

68
Q

PATH approach

A

PA – parenting attitudes, pregnancy attidues
T – timing
H – how important delay pregnancy is

69
Q

shared decision making approach key steps

A

choice talk and information sharing
option talk and deliberation
decision talk and decision making

Therapeutics - Exam 5 (8 decks)

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