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Flashcards in OCPs Deck (38)
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1

what are the 2 types of OCPs

  1. Combined OCPs
    • estrogen + progestin
  2. Progestin-Only OCPs

2

2 major approaches OCPs prevent pregnancy

1. Prevent ovulation

2. Impair implantation

3

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

4

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

5

Combined OCP
estrogen + progestin agents

  • Estrogen
    • ethinyl estradiol or mestranol (prodrug converted to ethinyl estradiol)
  • Progestin
    • Levonorgestrel
    • Desogestrel
    • Norethindrone
    • Norgestrel
    • Norgestimate
    • Drospirenone

6

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

7

Combined OCPs are available in ___, ____, and ___ preparations - explain these 

Combined OCPs are available in monophasic, biphasic, and triphasic preparations

  • Monophasicfixed estrogen and progestin dose /pill
  • Biphasic/Triphasicvarying proportions of hormones during pill cycle
    • ↓ amount and total monthly dose of progestins
    • mimics normal physiological hormonal changes more closely

8

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

9

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

10

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

11

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

12

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

13

____ 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

14

OCP AE: headache

  • Usually mild and transient
  • migraine may be associated with cerebrovascular accidents
  • Women who develop migraines should stop taking the contraceptive

15

OCP AE: Insulin Resistance

 

  • progestin competes with insulin for insulin receptor → insulin resistance
  • current OCPs have a low progestin content and rarely cause hyperglycemia

16

OCP AE: Hirsutism

  • acne, oily skin and hirsutism from androgenic progestins
  • switch to a less androgenic progestin

17

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

18

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
  • thrombophlebitishypertensionMIcerebral and coronary thrombosis
  • ↑ risk with obesity, smoking, HTN, diabetes

19

OCPs ___ incidence of endometrial and ovarian cancer

 

OCPs decrease incidence of endometrial and ovarian cancer

20

___ 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)

21

Drugs that increase metabolism of OCPs

P450 inducers

  • Carbamazepine
  • Oxcarbazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
  • Topiramate
  • Vigabatrin
  • St John’s Wort

22

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)

23

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

24

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

25

Progestin-only Pills contain ___ or ___ ; not widely used in US

Progestin-only Pills contain norethindrone or norgestrel ; not widely used in US
 

26

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

27

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

28

list non-oral hormonal contraceptives

  • the Patch
  • the Ring
  • the Progestin Injection
  • the Progestin Implant
  • the Intrauterine Systems

29

Transdermal patch & Transvaginal delivery system contain ___ and  ___

 

Transdermal patch & Transvaginal delivery system contain ethinyl estradiol and a progestin

 

30

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