Monday, 2-27-Contraception and sterilization (Wootton) Flashcards Preview

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Flashcards in Monday, 2-27-Contraception and sterilization (Wootton) Deck (29):
1

__ contraceptives provide the most effective reversible contraception

hormona

-includes OCs, injectables, implantables, IUD, patches, rings

2

regarding OCs:

the __ component is the major player-suppresses LH and ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium for implantation

the __ component mainly improves cycle control by stabilizing the endometrium and allows less breaktrhough bleeding

progesterone

estrogen

3

MOA of progestin-only OCs? who uses them?

primarily making cervical mucous thick and impermeable

mainly used in breastfeeding women and women who have contraindication to estrogen

4

benefits of OCs?

-mentrual cycle regularity
-improve dysmenorrhea
-decrease risk of Fe-deficiency anemia
-lower incidence of endometrial and ovarian ca, benign breast and ovarian disease

5

side effects of OCs?

-breakthroug bleeding
-amenorrhea
-mild --> bloating, perceived weight gain, breast tenderness, nausea, fatigue, headache

6

serious side effects of OCs?

Mainly venous thomrbosis and PE

can get cholestasis and GB disease, stroke & MI, hepatic tumors

7

contents of the transdermal patch? side effects? caution in who?

estrogen and progesterone

same effects as OCs except GREATER RISK OF THROMBOSIS

caution with women >198 lbs

8

benefits of vag ring?

greater compliance d/t 1xmonth use

better tolerated since does not go through GI and less breakthrough bleeding

9

who cant use OCs?

-women over 35 who smoke
-women with hx of thromboembolic event
-women with hx of CAD, CVD, CHF, or migraine with aura, uncontrolled HTN
-women with moderate to severe liver disease

10

MOA of IM injx of Depo medroxyprogesterone acetate (Depo provera)? efficacy?

thickens cervical mucous, decidualizes endometrium, blocks LH surge and ovulation

efficacy roughly equivalent to that of sterilization and not altered by weight

11

black box warning of depo provera?

if used for >2 yrs, should consider alternative method d/t bone density issues (particular concern in adolescents)

12

side effects of depo provera?

-irregular bleeding (25% discontinue w/in 1 yr)
-WEIGHT GAIN (makes you hungry)
-EXACERBATION OF DEPRESSION

13

contraindications for depo provera?

-known or suspected pregnancy
-unevaluated vag bleeding
-known or suspected breast malignancy
-active thrombophlebitis
-liver dysfunction

14

MOA of Nexplanon?

-rod-shaped implant used for 3 yrs

MOA: thicken cervical mucous, inhibit ovulation

15

side ffects of nexplanon (implant)?

-irregular vag bleeding
-HEADACHE
-vaginitis
-WEIGHT GAIN
-acne
-BREAST PAIN

16

the ONLY absolute contraindication for the implant?

known or suspected breast cancer

17

complications with insertion of implant?

-INFX
-bruising
-DEEP INSERTION
-migration
-PERSISTENT PAIN OR PARASTHESIA AT INSERTION SITE

18

risks with IUDs?

-increased risk of infx within 1st 20 days post-insertion
-increased risk of ectopic pregnancy if pregnancy does occur
-risk of uterine perforation at time of insertion requiring laparoscopy for removal
-risk of malposition and necessitating hysteroscopy for removal

19

contraindications for IUDS/

-breast CA-levonorgestrel containing only
-recurrent puerperal sepsis
-recent septic abortion
-active cervical infx
-Wilsons disease- Copper T only
-uterine malformations

20

How long does Mirena IUD last? Liletta? Skyla?

how effective are these Levonorgestrel IUDs?

mirena=5 yrs
liletta=3 yrs
skyla=3 yrs

pregnancy rate=0.2%

21

benefits of Levonorgestrel IUDs?

-decrease in menstrual blood loss
-less dysmenorrhea
-protection of endometrial lining from unopposed estrogen
-convenient and long term

22

how long does Copper T last? MOA? contraindications?

10 yrs

Cu interferes with sperm transport or fertilization and prevention of implantation

same contraindications.insertion issues as mirena

23

this emergency contraceptive is progestin only, 2 pills taken 12 hrs apart, OTC for women > 17 yrs old, must be used within 120 hrs after unprotecteed sex, and failure rate is 1.1%

Plan B-Levonorgestrel

24

this emergency contraceptive is indicated for up to 5 days after unprotected sex, postpones follicular rupture/inhibit or delay ovulaton

Ella-Ulipristal acetate

25

vasectomy is occlusion of the __.

benefits of vasectomy?

post-op complications?

immediate effectiveness?

vas deferens

safer, more easily performed, less expensive, easier to reverse

bleeding, hematomas, acute/chronic pain, local skin infx

not immediately effective-compelte azoospermia usually obtained within 10 weeks

26

methods of female sterilization?

laparoscopy, mini-laparotomy, hysteroscopy, and at time of C-section

27

most common female sterilization approach around the world?

mini-laparotomy

28

contraindications for hysteroscopy? who is it good for?

contraindications: nickel or contrast allergies, active pelvic infx, suspected pregnancy

good for obese pts that might not be good candidates for other methods

29

biggest risk for a young pt with respect to permanent sterilization?

regret