OCSH1 Flashcards

Question

Alternative progestin forms

Answer 1

Medroxyprogesterone acetate -Depo-provera ( 150 mg IM ) q 3 months - Depo SubQ provera 104 q3 months - Provera ( 2. 5 mg, 5 mg , 10 mg ) Candidates for use : Can’t tolerate estrogen Does patient have seizures ( estrogen is a more excitatory hormone and progesterone is more calming hormone) Avoid in patients with depression and migraine headaches

Answer 2

Irregular bleeding and spotting for up to 7 days during 1st few months of therapy Amenorrhea - no period at all Weight gain Delayed fertility upon D/C ( 9 months to 1 year ) Headache, nervousness, depression Risk of bone loss with prolonged administration, may be irreversible

Answer 3

Deep IM injection Q3 months 150 mg ( given day 1-5 of cycle or after ruling out pregnancy ) -depoSubQ provera 104: SubQ 104 mg every 3 months ( every 12 to 14 weeks Advantages : No estrogen side effects ( no increased risk of blood clots) Decrease seizure frequency - ok with anticonvulsants Increase quantity of protein content in breast milk Low failure rate 0.3%

Answer 4

Implanted by physician ( inserted / removed minor procedure ) Subdermal ethonogestrel rod implant ( Released over 3 years -great long term option Effect reduced by inducers SE: Risk of clots Implantation site tenderness

Answer 5

Apply to butt, ab, or upper outer arm or back Change once a week, last week is placebo Never put on breast area. Releases about 60% more estrogen than oral OC Xulane has less EE than orthoevra Start on 1st day of menstrual cycle or 1st Sunday after patients period starts If patch off for <24 hours- put patch back on If patch off for > 24 hours - apply new patch asap, start, use back up for 7 days

Answer 6

Used for 21 days q month ( 3 weeks ) Very low daily dose of EE and ethonogestrel Refrigerate - can store at room temp for up to 4 months - if you refrigerate can be used until exp date on box

Answer 7

Copper ( paragrad) - ( good for 10 years ) - cannot give if patient has Wilson’s disease or copper allergy - sometimes used as emergency contraception. ( not FDA approved ) used with 5 days of UPI Levonorgestrel - Mirena 5 years ( Skyla ) 3 years ( liletta ) - 3 years Watching out for PID for first 20 days then after that it is rare. If period is late make sure youre not pregnant Benefit: highly efficacious, long acting, safe , rapidly reversible, avoidance of exogenous estrogen

Answer 8

Caya ( no size ) Miles wide seal arching All diaphragm are to be used with spermicide : ( nonoxynol 9) Leave in 6 hours after sex but take out afterward ( dont want infection/ toxic shock syndrome ) Washing with mild soap and water Dont use oil based products ( like petroleum jelly can break condom and thing out silicone gel ) Replace every 2 years. If you gain or lose weight need to resize

Answer 9

Nonoxynol- 9 MOA: immolizes sperm

Answer 10

Acne: ortho tri-cyclen, estrostep, and YAZ are all approved for acne. Most COC are helpful bc estrogen decreases testosterone levels -YAZ = 25 mg spironolacone which is an androgen receptor blocker Weight gain: estrogen initially cause weight gain due to water and sodium retention but long term weight not likely Pill with androgenic activity stimulate appetite, if this is suspected suggest less androgenic pill PMS or dysmenorrhea: sx may improve with extended or continuous cycle pills : seasonique, Lybrel Bloating: Yasmin or yaz Menstrual migraine: if migraine from drop of estrogen then recommend something continuous ( seasonique etc) If patient has migraine with auras - avoid EE bc increased risk of stroke. Now if migraine & >35 years old -with or without aura we don’t recommended combined oral contraception bc fear of stroke

Answer 11

If patient <35 y/o and controlled HTN can start COC with low estrogen ( <35 mcg ) Mircette, Loestrin, If not controlled HTN then no EE Diabetes : if non smoker, <35 y/o, without HTN, rentinopathy, or other vascular dz then you may be give COC, if diabetes plus one condition then no COC Women with Hx of DVT, PE, CAD, CHF, or CVA : NO Estrogen products -use mini pill Women w/migraines & depression: no Depo provera ( it stays in for 3 months ) -

Answer 12

- if bleeding early in cycle then maybe not enough EE ( now this is after patient on contraception for a couple of months ) If bleeding later in cycle it could be progesterone so ∆ progesterone

OCSH1 Flashcards

(36 cards)