OCPs Flashcards
what are the 2 types of OCPs
-
Combined OCPs
- estrogen + progestin
- Progestin-Only OCPs
2 major approaches OCPs prevent pregnancy
- Prevent ovulation
- Impair implantation
we can prevent ovulation by suppressing __ and __ release by preventing ___ in estrogen levels via giving patient __ __ levels
we can prevent ovulation by suppressing LH and FSH release by preventing fluctuations in estrogen levels via giving patient stable estrogen levels
we can prevent implantation by maintaining elevated __ levels via giving patient ___ elevated __
we can prevent implantation by maintaining elevated progesterone levels via giving patient stable elevated progestin
Combined OCP
estrogen + progestin agents
- Estrogen
- ethinyl estradiol or mestranol (prodrug converted to ethinyl estradiol)
- Progestin
- Levonorgestrel
- Desogestrel
- Norethindrone
- Norgestrel
- Norgestimate
- Drospirenone
Almost all progestins have some ___ activity in varying degrees - explain these
Almost all progestins have some androgenic activity in varying degrees - explain these
- Levonorgestrel, Norgestrel: highest
- Norethindrone: lower
- Desogestrel, Norgestimate (3rd gen): even lower
- Drospirenone: antiandrogenic
Combined OCPs are available in ___, ____, and ___ preparations - explain these
Combined OCPs are available in monophasic, biphasic, and triphasic preparations
- Monophasic: fixed estrogen and progestin dose /pill
-
Biphasic/Triphasic: varying proportions of hormones during pill cycle
- ↓ amount and total monthly dose of progestins
- mimics normal physiological hormonal changes more closely
Combined OCPs most commonly used are called ‘___’ containing ___ of ____ or less
Has decreased adverse effects/risks, but more likely to result in ____ if doses are missed
Combined OCPs most commonly used are called ‘low-dose’ containing 35 μg of ethinyl estradiol or less
Has decreased adverse effects/risks, but more likely to result in contraceptive failure if doses are missed
Types of OCPs
-
21 hormonally active pills
- followed by 7 placebo pills to allow withdrawal from bleeding and facilitates consistent daily pill intake
-
Extended-cycle formulations
- 84 days of hormonal pills, followed by 7-day placebo phase
- 4 periods /year
-
Continuous combination regimens
- hormone-containing pills for 21 days, then very-low-dose estrogen and progestin for an additional 4-7 days
Combination OCPs work primarily to prevent conception by preventing ____
___ LH and FSH release and ovulation does not occur
progestin prevents sperm penetraction by ____, and induces endometrium changes that impair ___
Combination OCPs work primarily to prevent conception by preventing ovulation
suppress LH and FSH release and ovulation does not occur
progestin prevents sperm penetration by thickening cervical mucus and induces endometrium changes that impair implantation
OCP benefits
- ↓ risk of ENDOMETRIAL and OVARIAN cancer
- Improved regulation of menstruation
- RELIEF of benign breast disease
- PREVENTS ovarian cysts
- ↓ risk of symptomatic pelvic inflammatory disease
- acne control
about OCP AEs
- cardiovascular toxicity concerns initially limited long-term use
- adjusting/decreasing estrogen and progestin dose reduces AEs
- many AEs (eg nausea, bloating, breakthrough bleeding) improve spontaneously by third cycle
____ is the most common AE of OCPs → more of a problem with __ doses of estrogen because estrogen ___ the endometrium
Breakthrough bleeding is the most common AE of OCPs → more of a problem with LOWER doses of estrogen because estrogen stabilizes the endometrium
OCP AE: headache
- Usually mild and transient
- migraine may be associated with cerebrovascular accidents
- Women who develop migraines should stop taking the contraceptive
OCP AE: Insulin Resistance
- progestin competes with insulin for insulin receptor → insulin resistance
- current OCPs have a low progestin content and rarely cause hyperglycemia
OCP AE: Hirsutism
- acne, oily skin and hirsutism from androgenic progestins
- switch to a less androgenic progestin
OCP AE: Other
- Melasma - estrogen stimulates melanocyte production
- Amenorrhea - some patients
- Dyslipidemia - most low-dose OCPs have no impact on HDL, LDL, triglycerides or total cholesterol (MYTH)
- Depression (6%) - stop therapy if this occurs
Do NOT give OCPs to women older > 35 AND who smoke
why?
- most at risk for cardiovascular disorders
- rare, but very serious
-
thromboembolism
- estrogen produces ↑ factor VII, factor X, fibrinogen
- thrombophlebitis, hypertension, MI, cerebral and coronary thrombosis
- ↑ risk with obesity, smoking, HTN, diabetes
OCPs ___ incidence of endometrial and ovarian cancer
OCPs decrease incidence of endometrial and ovarian cancer
___ induces CYP450 and increases metabolism of estrogen
Rifampin induces CYP450 and increases metabolism of estrogen
(use a backup nonhormonal contraceptive during course of rifampin therapy)
Drugs that increase metabolism of OCPs
P450 inducers
- Carbamazepine
- Oxcarbazepine
- Phenytoin
- Phenobarbital
- Primidone
- Topiramate
- Vigabatrin
- St John’s Wort
Broad-spectrum antibiotics reduce intestinal bacteria and can ____
(Ethinyl estradiol is hydrolyzed by intestinal bacteria and reabsorbed as active drug)
Broad-spectrum antibiotics reduce intestinal bacteria and can decrease estrogen levels
(Ethinyl estradiol is hydrolyzed by intestinal bacteria and reabsorbed as active drug)
ABSOLUTE contraindications for OCPs
- Pregnancy
- Thrombophlebitis or thromboembolic disorders
- Stroke or coronary artery disease
- Breast cancer
- Undiagnosed abnormal vaginal bleeding
- Estrogen-dependent cancer
- Liver Tumor
- Uncontrolled HTN
- DM w/ vascular disease
- Age >35 and smoking >15 cigarettes daily
- Thrombophilia
- Migraine with aura
- Active hepatitis
- Surgery or orthopedic injury with prolonged immobilization
RELATIVE contraindications for OCPs
- Migraine without aura
- HTN
- Heart, kidney, or gallbladder disease
- DM
- Cholestasis during pregnancy
- Sickle cell disease (S/S or S/C type)
- Lactation
Progestin-only Pills contain ___ or ___ ; not widely used in US
Progestin-only Pills contain norethindrone or norgestrel ; not widely used in US
Progestin-only Pills are slightly __ effective than combined OCPs but have no risk of ____
Progestin-only Pills are slightly less effective than combined OCPs but have no risk of thromboembolic events
- ↓ dysmenorrhea, ↓ menstrual blood loss, ↓ premenstrual syndrome symptoms
- Unscheduled bleeding and spotting are common
Progestin-only pills effectiveness d/t ____ which decreases sperm penetration and endometrial alterations impairing implantation
are highly efficacious but block ovulation in only 60% to 80% of cycles
Progestin-only pills effectiveness d/t thickening cervical mucus which decreases sperm penetration and endometrial alterations impairing implantation
are highly efficacious but block ovulation in only 60% to 80% of cycles
list non-oral hormonal contraceptives
- the Patch
- the Ring
- the Progestin Injection
- the Progestin Implant
- the Intrauterine Systems
Transdermal patch & Transvaginal delivery system contain ___ and ___
Transdermal patch & Transvaginal delivery system contain ethinyl estradiol and a progestin
Depo-Provera is a progestin-only injectable contraceptive
contains ___
given IM every ___ and extremely effective
Depo-Provera is a progestin-only injectable contraceptive
contains depot medroxyprogesterone acetate (DMPA)
given IM every 3 months and extremely effective
Progestin ___ (Depo-Provera) diffuses out ___, providing circulating levels that prevents ovulation through negative feedback
Progestin injection (Depo-Provera) diffuses out over time, providing circulating levels that prevents ovulation through negative feedback
Depo-Provera AE:
high incidence of ___ and ___
significant irreversible ___ with long-term use (black-box warning)
- menstrual irregularities
- weight gain
- significant irreversible loss of bone mineral density with long-term use (black-box warning)
Progestin impants
- 4cm-long implant, containing a progestin
- Placed under skin of upper arm
- Effective for 3 years
- Major AE: irregular menstrual bleeding
Intrauterine systems - contains ____
- contains Levonorgestrel
- has a polyethylene body with a levonorgestrel reservoir
- Effective for 5 years
list non-oral contraceptives
- Barrier contraceptives
- condoms, diaphragms, cervical caps, spermicides
- Intrauterine Devices (IUD)
- Fertility Awareness-Based Methods
- Sterilization
Emergency postcoital contraception
(available without a prescription for consumers ≥17)
-
Plan B & Next Choice
- 2 tablets of levonorgestrel
- first tablet within 72 hrs, second 12 hrs later
-
Plan B One-Step
- 1 tablet of levonorgestrel
- take within 72 hrs
- AE: nausea, vomiting
Emergency postcoital contraception
(prescription only)
-
Ella
- contains ulipristal acetate (selective progesterone receptor modulator (SPRM))
- progesterone antagonist → inhibits/delays ovulation
- 1 tablet taken within 5 days
- AE: nausea, vomiting
- contains ulipristal acetate (selective progesterone receptor modulator (SPRM))
Emergency postcoital contraception (Non-hormonal)
Copper IUD - has to be inserted within 5 days of intercourse
