Test 2 Flashcards
(176 cards)
1
Q
Three locations of UTIs
A
urethra- urethritis
bladder- cystitis
upper urinary tract- pyelonephritis
2
Q
Symptoms of an acute simple cystitis lack what symptoms?
A
fever >99.9
systemic symptoms- chills or body aches
flank pain
costovertebral angle tenderness (CVA)
3
Q
Microbiology of UTIs
A
75-95% of cases are E.Coli
Other organisms: enterobacteriaceae, klebsiella pneumoniae, proteus mirabilis, and staphlococcus saprophytcus
4
Q
Clinical manifestations of UTI
A
urinary frequency, urgency, hesitancy, dysuria, suprapubic pain, hematuria
5
Q
Specific manifestation of UTI in older adults
A
new onset nocturia, incontinence, forgetfulness, new or worsening urinary symptoms
6
Q
Physical exam for UTI
A
not necessary but if performed should include CVAT, abdominal, fever assessment
Pelvic exam if vaginal complaints
7
Q
Lab results positive for UTI
A
leukocytosis >10 microL
nitrates and + leaks on dipstick or UA
Urine culture if resistant organisms or all cases of upper UTI
8
Q
What do you do for a negative urine dipstick test?
A
urine culture and/or UA due to high rate of false negatives
9
Q
Multiple organisms on urine culture indicates…
A
suspected contamination
10
Q
Treatment of UTI
A
first line: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin
11
Q
OTC treatment for urinary discomfort
A
phenazopyridine
12
Q
When should you expect symptom relief for a properly treated UTI
A
48-72 hours
13
Q
Nonpharmacological treatment of UTI
A
liberal fluid intake (2-3L per day)
behavior modification- contraception modification, postcoital voiding, good hygiene
cranberry juice/pills (limited studies)
14
Q
Etiologies for volvovaginitis
A
infection
reactions to allergens or irritants
estrogen deficiency
systemic disease (RARE)
15
Q
Normal vaginal discharge physiology
A
white or transparent, thick, mostly odorless
formed by mucoid endocervical secretions with sloughing epithelial cells, normal bacteria, and vaginal transudate
16
Q
Normal pH of vaginal secretions
A
4.0-4.5 (acidic)
In premenarchal and postmenopausal women: 4.7 or greater
17
Q
Normal isolates of vagina
A
most abundant is lactobacillus
18
Q
Bacterial Vaginosis (BV) findings
A
thin, off white discharge with fishy odor
no vaginal inflammation
pH >4.5
clue cells present
positive whiff test
19
Q
Candidiasis findings
A
itching, soreness, change in discharge, “cottage cheese” discharge
vaginal inflammation
normal pH
pseudohyphae
budding yeast
negative whiff test
20
Q
Trichomoniasis findings
A
malodorous, thin, yellow-green, frothy purulent discharge
vaginal inflammation
pH >4.5 motile trichomonads
often positive whiff test
21
Q
Symptoms of vaginitis
A
change in volume, color, or odor of vaginal discharge
pruritus
irritation
burning
soreness
erythema
dyspareunia
spotting
dysuria (less common)
22
Q
Rare findings of vaginitis
A
abdominal pain (think PID)
suprapubic pain (think cystitis)
23
Q
Common diagnosis based on menses cycle
A
candida vulvovaginitis often in premenstrual period
trichomoniasis and BV often during or immediately after menstrual period
24
Q
Pelvic exam should include…
A
degree of vulvovaginal inflammation
characteristics of vaginal discharge
presence of cervical inflammation
abdominal or cervical motion tenderness
25
Can appearance of vaginal discharge be used for diagnosis
NO.. extremely unreliable
26
What is the most important finding for diagnostic process of vulvovaginitis
pH... should always be determined
27
Cervical inflammation is suggestive of...
cervicitis
28
In cervicitis the cervix will be
erythematous and friable with a mucopurulent discharge
29
Ectropion
represents normal physiologic presence of endocervical glandular tissue in the exocervix. not friable
30
Lab tests to diagnose vulvovaginitis
narrow range pH paper or broad range paper
saline microscopy- performed 10-20 minutes from obtaining sample
31
Technique of saline microscopy
vaginal discharge sampled with cotton-tipped swab
sample is mixed with one to two drops of 0.9% NS on a glass slide
cover slips placed on slides which are examined under a microscope at 10x and 40x
32
KOH preparation for microscopy
addition of 10% potassium hydroxide (KOH) destroys cellular elements and can be helpful in diagnosis (especially candida vaginitis)
whiff test is used with KOH
excessive WBCs without evidence of yeast, trichomonads, or clue cells suggests cervicitis
33
Most common cause of vaginitis in women of childbearing age
Bacterial vaginosis
34
Diagnosis of bacterial vaginosis is made when 3 of the following are present
abnormal grayish discharge
pH greater than 4.5
+whiff test
presence of clue cells
35
Treatment of Bacterial Vaginosis
Metronidazole oral x 7 days
metronidazole gel intravaginally x 5 days
clindamycin gel intravaginally x 7 days
Alternatives: clindamycin oral x 7 days
clindamycin ovules intravaginally x 3 days
36
Most common cause of vulvovaginal itching
candida vulvovaginitis
90% are Candida albicans
37
Diagnosis and treatment of uncomplicated candida vulvovaginitis
sporadic, infrequent episodes
mild to moderate signs/symptoms
probable infection with candida albicans
healthy, non pregnant women
variety of OTC oral and vaginal regimens
oral prescription fluconazole may be less expensive than OTC options
38
Diagnosis and treatment of complicated candida vulvovaginitis
poorly controlled diabetes, immunosuppression, debilitation
severe signs/symptoms
candida species other than C. albicans (c. glabrata)
pregnancy
history of recurrent vulvovaginal candidiasis
oral fluconazole (150mg orally) for two to three doses 72 hours apart
eliminate risk factors
39
Organism responsible for trichomonas vaginalis
flagellated protozoan trichomonas vaginalis
40
Signs/Symptoms of Trichomonas Vaginalis
always sexually transmitted
purulent, malodorous, thin, frothy discharge, with associated burning, pruritus, dysuria, frequency, and vaginal inflammation
41
Diagnosis of trichomonas
presence of motile trichomonads on wet mount is diagnostic but only occurs in 50-70% of culture-confirmed cases
CULTURE is diagnostic
42
Treatment of Trichomonas vaginalis
Metronidazole or Tinidazole BID x 7 days
Also treat sexual partners
43
Etiology of genital ulcers
herpes simplex virus (MOST COMMON)
treponema pallidum
haemophilus ducreyi
klebsiella granulomatis (Rare in US)
lymphogranuloma venererum (unknown in US)
44
Painful ulcers, multiple lesions
think HSV, chancroid
45
Painless, single lesions
think syphillis, LGV, and granuloma inguinale
46
S/S of genital ulcers
dysuria
fever
malaise
body aches
lymphadenopathy
47
Diagnosis of genital ulcers
evaluate for herpes, GC, CT, screen for symphilis and HIV
viral culture (HSV)
serologic screening (syphillis)
48
Follow up of initial syphillis serology is negative
repeat 1-3 months later
49
Primary HSV infection
patient HSV-seronegative for both HSV-1 and HSV-2 prior to this episode
associated with multiple constitutional S/S
dysuria
sx can last 2-4 weeks if untreated
50
Non-primary HSV infection
in an area not previously infected
ex: oral then genital infection
51
Recurrent HSV
over time recurrence generally decrease and recurrence lower in HSV-1 vs HSV-2
recurrence may be asymptomatic, shorter in duration
52
Treatment of HSV (Primary infection)
Acyclovir
Famciclovir
Valacyclovir
53
Treatment of HSV (recurrent infection)
chronic suppressive therapy
episodic therapy
or nothing!
Acyclovir
Famciclovir
Valacyclovir
54
Organism responsible for syphilis
spirochete bacterium treponema pallidum
seen on dark field microscopy
corkscrew-shaped organism
55
Primary syphilis infection
chancre at site of entry approximately 10-60 days after infection
heals spontaneously in 3-6 weeks
56
Secondary syphilis infection
4-8 weeks after primary chancre appears, skin rash of rough red or brown lesions on trunk, palms, or soles
other symptoms: fever, lymphadenopathy, headache, weight loss, muscle aches, patchy hair loss
HIGHLY infective
if untreated resolves in 2-6 weeks and then enters latent phase (no symptoms but tests positive)
57
Tertiary stage of syphilis
1/3 of patients
transmission unlikely
mainly through transfusions or placental transfer
severe CNS and cardiovascular damage
ophthalmic and auditory abnormalities
gummas- 1-10 years
58
Diagnosis of Syphilis
Non-treponemal tests
VDRL
RPR
Treponemal tests
fluorescent treponema antibody absorption
microhemaglutination test for antibodies to T. pallidum
T. pallidum particle agglutination assay
T. pallidum enzyme immunoassay
Chemiluminescence immunoassay
USE of only ONE test is insufficient
Positive treponema test is positive for life
59
Treatment of syphilis
Early: benzathine Penicillin G IM once
Unknown duration: benzathine penicillin IM weekly for 3 weeks
Alternatives: Doxycycline 100mg PO BID for 4 weeks
60
Chancroid
starts as erythematous papule, evolves into pustule, erodes into a deep ulcer
almost always confined to genital area and draining lymph nodes
painful
base is usually covered with gray or yellow purulent exudate that bleeds when scraped
61
Diagnosis of Chancroid
definite- isolation of H.ducreyi bacteria from the lesion
probable- painful genital ulcer and tender suppurative inguinal adenopathy, plus negative dark field microscopic exam for T. pallidum, negative serum test for syphilis, negative culture for HSV, clinical presentation not typical for herpes
62
Treatment of chancroid
Azithromycin PO once OR ceftriaxone IM once
Alternatives: Ciprofloxacin or Erythromycin
63
Condyloma Acuminate
Genital warts
HPV manifestations
can be found on genitals, tongue, lips, oral cavity
spread through skin to skin contact
64
Patient applied treatments for condyloma acuminate
podofilox
imiquimod
sinecatechin
65
Healthcare applied treatments for condyloma acuminate
cryosurgery
trichloracetic acid
laser
intralesional interferon injections
66
Cervicitis
inflammation of uterine cervix
67
most common causes of Cervicitis
Chlamydia trachomatis and neisseria gonorrhoeae
68
Other causes of cervicitis
local trauma from foreign object
malignancy
radiation therapy
sensitivity to chemical irritation
systemic inflammatory disease
69
Clinical manifestations of cervicitis
may be asymptomatic
all sexually active women age 25 years or younger should be screened
cervix may be tender to motion
When present manifestations are:
purulent or mucopurulent discharge from the endocervix
intermenstrual or postcoital bleeding
dysuria, urinary frequency
dyspareunia
vulvovagnial irritation
70
Cardinal signs of cervicitis
purulent or mucopurulent discharge on the surface and/or exuding from the OS
friability (bleeding)
erythema and edema
71
Diagnosis of cervicitis
Nucleic acid amplification testing (NAAT) for N. gonorrhoeae and C. trachomatis
performed with endocervical sample
could use vaginal swab or urine sample
72
treatment of cervicitis
empiric antibiotic therapy
treatment of sex partners
ceftriaxone IM once (gonorrhea)
add azithromycin for concerns about resistance
Doxycycline (100mg PO BID 7 days) (chlamydia)
Alternatives for chlamydia azithromycin, ofloxacin, levofloxacin
73
Test of cure for gonorrhea
not recommended if received treatment for uncomplicated infection
recommended for oropharyngeal infections
74
Treatment of chlamydia
Doxycycline (100mg PO BID 7 days)
Alternatives for chlamydia azithromycin, ofloxacin, levofloxacin
75
Treatment of gonorrhea
ceftriaxone IM once
add azithromycin for concerns about resistance
76
Test of Cure for chlamydia
retesting: done on all patients 3 months after treatment
Test of cure:
for persistant symptoms
suspected compliance issues with regimen
pregnant females
treatment with erythromycin and amoxicillin
77
Pelvic Inflammatory Disease (PID)
most serious form of STD
involves upper genital tract- endometrium, Fallopian tubes, ovaries, and pelvic peritoneum
caused by chlamydia trachomatis or neisseria gonorrhea
78
Greatest risk for PID is...
previous PID
79
Other risks for PID
adolescents
multiple sex partners
not using condoms
GC or CT infection
80
Why is it important to diagnose PID early?
to prevent infertility and/or ectopic pregnancy
infertility occurs in 15% after one episode of PID and up to 75% after 3 episodes
81
S/S of PID
lower abdominal pain
guarding
CMT, uterine tenderness
rebound tenderness
purulent cervical discharge
tender/painful adnexa, palpable
fever
serum WBCs elevated
abnormal uterine bleeding
82
Tubovarian abscess
in severe cases of PID
acutely ill with high fever, tachycardia, severe pelvic/abdominal pain, nausea vomiting
83
Diagnostic labs for PID
pregnancy test
microscopic exam of vaginal discharge
CBC
NAAT
Urinalysis
C-reactive protein
HIV
Hep B
Syphilis testing
84
Treatment for PID
empiric treatment essential for sexually active women ill appearing with CMT, cervical or ovarian tenderness on pelvic exam
Severe cases or pregnant = hospitlization
Outpatient oral therapy- ceftriaxone IM + doxycycline 100mg PO BID + metronidazole 500mg PO BID x14 days
85
Follow up for PID
in 48-72 hours to ensure clinical improvement
consider hospitalization and further eval if no improvement in 72 hours
male partners should be evaluated if sexual contact with patient within 60 days of symptom onset
86
Cardiovascular Risk of combined oral contraceptives
Hypertension- frequently cause mild elevation, but can cause overt hypertension as well (not common)
These users are at increased risk of myocardial infarction and stroke compared to nonusers
87
Strokes with hormonal contraceptives
rare due to population who take the medication but still a risk
if pt experiences a stroke pill should be discontinued and not resumed
88
VTE risk of hormonal contraception
increase risk in both high and low dose estrogen OC but also may exist with progestin
smoking increases the risk
obesity further increases risk
89
Who are good candidates for POPs?
older women
breast feeding women
post-delivery
over 35 and smoker
severe breast tenderness or other estrogen related symptoms
sickle-cell anemia
epileptics
90
Down sides of POPs
associated with more breakthrough bleeding and slightly higher failure rates than combined OCs
91
Main progestin formulation
Norethindrone 0.35mg tablets
28 active pills taken continuously
92
Do POPs have to be taken at the same time every day?
YES; has a dose of progestin that is close to the threshold of efficacy, so needs to be taken at the same time every day
variation of only a few hours in administration can reduce effectiveness
However, highly effective when taken as directed
93
Side effects of POPs
menstrual changes
unscheduled bleeding, spotting, amenorrhea
follicular cysts
acne flare-up
weight gain or loss
headache
94
When is a pregnancy test appropriate in POP users
if experiencing nausea, breast tenderness, a change in menstrual pattern or lower abdominal pain.
95
POP effects on cardiovascular system
little effect on coagulation factors, blood pressure, or lipid levels
96
Cancer risks vs benefits of POPs
protects against the development of endometrial cancer
breast cancer risk not significantly different
97
Missed POP pills
back. up contraception needed for at least two days if pill is taken more than 3 hours late on any given day
or started more than five days from the onset of menses
98
Only injectable contraceptive available in US
depot medroxyprogesterone acetate (DMPA)
highly effective, reversible, avoids the need for compliance daily or near the time of sexual intercourse
reduces risk of endometrial cancer and volume of menstrual bleeding
99
Route of DMPA
deep IM injection
lower dose can be administered subQ every 3 months as well
100
effectiveness of DMPA
99.7%
effective for 3 months
101
Migraines with injectable contraceptive
women who have migraines with combination OC typically do not have a problem with injectable contraceptives
102
Who can safely use DMPA (injectable contraceptives)
women taking enzyme inducing anticonvulsant drugs can use DMPA
also those with sickle cell anemia, fibroids, and older women who smoke
103
Decreased risk of PID in those using injectable or oral contraceptives
due to changes in cervical mucus, decreased menstrual blood flow, and a reduction in retrograde menstruation
104
Efficacy of injectable contraceptives
probability of pregnancy is only 0.2%
failure rate is 5/100 in first year (possibly due to users not returning for injections as scheduled)
105
Initial injection of DMPA
within 7 days of the onset of menses
ensures that patient is not pregnant and that it prevents ovulation during the first month
back-up contraception is unnecessary
can be initiated any day if pregnancy is ruled out (back up contraception should be used for 7 days)
106
Accidental administration of DMPA during pregnancy
no increased risk of congenital anomalies
107
Repeat injections of DMPA
every 12 weeks; but no one turned away based on time
two week "grace period" is appropriate
108
Switching from injectable contraceptives to another method
should be started no later than 15 weeks after previous injection
109
With long term use of DMPA, most users become __________
amenorrheic
110
Side effects injectable contraceptives
menstrual irregularities (most common)
weight changes (possibly 3-6 kg)
headache
abdominal pain or discomfort
nervousness & depression (in those with PMS or mood disorders)- not contraindication to use of DMPA
111
Menstrual irregularities with injectable contraceptives
if spotting or unscheduled bleeding persists after several injections of DMPA evaluate for other causes such as uterine fibroids, adenomyosis, or endometrial polyps
111
Menstrual irregularities with injectable contraceptives
if spotting or unscheduled bleeding persists after several injections of DMPA evaluate for other causes such as uterine fibroids, adenomyosis, or endometrial polyps
112
Major benefit of DMPA
causes amenorrhea- appropriate contraceptive choice for women with prolonged, heavy menstrual bleeding, dysmenorrhea, or iron-deficiency anemia
113
Other benefits of DMPA
protects against the development of endometrial hyperplasia
decreased risk of PID
low risk of conceiving ectopic and intrauterine pregnancies
inhibit pituitary gonadotropin secretion and ovarian estrogen production
treatment of pain associated with endometriosis
fewer painful crises in women with sickle cell disease
great for those with special needs (cognitive impairment, military personnel)
114
Cardiovascular risk of DMPA
may be a good option for those with history of blood clots
115
Bone mineral density of injectable contraceptives
primary concern in long-term safety of DMPA
due to suppression of ovarian estradiol production
BMD of hip and spine decreases 0.5-3.5% after one year and 5.7% to 7.5% after two years of use
116
DMPA return to fertility
return to fertility may be delayed
within 10 months of last injection- 50% of women who discontinue DMPA will conceive
some women fertility is not reestablished until 18 months after the last injection
117
Nexplanon
contraceptive implant
single-rod progestin
slow release of 68mg of progestin etonogestrel
good for 3 years
irregular bleeding primary reason for discontinuation
118
Adverse effects of Nexplanon
Headache, weight gain, acne, breast tenderness, emotional lability, and abdominal pain
migration of implant
unpredictable bleeding
119
Insertion of contraceptive implants
Office procedure with or without local anesthesia
takes less than two to three minutes
can only be distributed to clinicians who have received 3 hours of training in patient selection, counseling, insertion, and removal
120
Contraindications of Nexplanon
known or suspected pregancy
current DVT or PE (suggest getting medical clearance)
SLE
severe liver cirrhosis
undiagnosed abnormal genital bleeding
breast cancer in the last 5 years
hypersensitivity to any components of Nexplanon
121
Nexplanon timing
if no hormonal contraception in the past month- insert anytime during first 5 days of menstrual period
if using COC- insert 4 days before stopping the pill
Can be inserted post abortion, postpartum, or during breastfeeding
If insertion occurs at any other time, back-up contraception advised for first seven days after insertion
122
Advantages of transdermal hormonal contraceptive systems
therapeutic effects are achieved at lower peak doses
plasma hormone levels remain constant
improved patient compliance due to infrequent self-administration- no swelling pills
immediate cessation of drug administration possible with removal of transdermal patch
123
Side effects of transdermal contraceptive patch
breast symptoms
headache
application site reactions
nausea
124
Contraindications to transdermal contraceptive patch
same as those for other estrogen-progestin contraceptives
history of thromboembolism
estrogen-dependent tumor
abnormal liver function
skin hypersensitivity to any component of transdermal system
obese women may have potential for reduced contraceptive efficacy
125
Initiation of transdermal contraceptive patch
either first day of menses or Sunday following the start of menses
if >5 days from menses, back-up contraception should be used for the first 7 days of use
alternatively women can start patch at anytime if pregnancy is excluded
126
Two types of transdermal contraceptive patch
Ethinyl estradiol-norelgestronmin (EE/N) (Tulane and zafemy)
Ethinyl estradiol-levonorgestrel (EE/LNG) (Twirla)
127
Vaginal Contraceptive Ring
delivers 15mcg ethinyl estradiol and 120mcg of etonogestrel daily
worn intravaginally for three weeks of each four week cycle
128
Advantages of NuvaRing
rapid return to ovulation after discontinuation
lower doses of hormones
ease and convenience
improved cycle control
comes in one size and does not need to be fitted
129
Administration of vaginal ring
in recently pregnant women, the ring may be started within five days of a first pregnancy loss or four weeks after a second or third trimester delivery
not removed during intercourse
can be removed for 2-3 hours without altering effectiveness
130
Intrauterine Contraceptives or Devices
Safe and effective method of contraception
currently available IUDs release either copper or synthetic progestin
One copper IUD remains effective for at least 10 years
131
Intrauterine contraceptives
Skyla, Kyleena, Liletta, and Mirena
Progestin-releasing IUDs inhibit sperm transport and fertilization of ova, and partially inhibit ovulation
remain effective for at least 3-8 years
amenorrhea is common and relief of dysmenorrhea
membrane regulates release of progestin
132
Adverse effects upon fertility with IUD
none after removal
decreased risk of ectopic pregnancy once removed but increased while in place
133
Emergency Contraception- Plan B
Progestin only (levonorgestrel)
One 0.75mg tablet within 72 hours, other 0.75mg tablet in 12 hours OR one 1.5mg tablet once
Failure rate is approximately 1.1%
will not terminate existing pregnancy or harm fetus if woman is already pregnant
taken within 72 hours of UPI
no prescription or age required to purchase
134
Ella Emergency Contraception
Ulipristal Acetate (UPA)- selective progestin receptor modulator (I.e. antiprogestin)
one 30mg tablet once as soon as possible
well not terminate existing pregnancy or harm fetus if woman is already pregnant
taken within 120 hours of UPI
do not use progestin containing contraceptives within 5 days of its use
135
Emergency Contraception- IUD
Copper IUD or LNG 52mg can now be used as EC
insert within 5 days of UPI, some sources say up to 10 days
136
Contraceptive choices during lactation
POPs, implants, and Depo appropraite
delayed COCs until at least 4 weeks postpartum and then only if lactation is well-established
137
Permanent contraception
vasectomy as effective but less morbid and costly than tubal occlusion
hysteroscopic tubal occlusion does not require an incision and is usually performed using a local anesthetic
138
Best options for long-term but reversible contraception
intrauterine contraception, DMPA injections, or nexplanon
139
How to minimize discomfort during GYN procedure
reassure the woman
explain each step before doing it
avoid the use of a tenaculum when possible
gently dilate the cervical canal if needed
NSAID 30-60 minutes prior to the procedure to decrease cramping
140
Indications for endometrial cramping include
abnormal uterine bleeding
pelvic pain
infertility
may be better to refer to OBGYN
141
Major contraindication to endometrial sampling
viable and desired intrauterine pregnancy
142
Endometrial suction curette
most popular method for sampling endometrial lining
flexibility of curette minimizes cramping
143
Side effects and complications
cramping, subsides rapidly
vasovagal reactions
rare complications- excessive uterine bleeding, uterine perforation, pelvic infection, bacteremia
144
Absolute contraindications to IUD insertion
possible or confirmed pregnancy
severe distortion of uterine cavity
acute, recent,, or recurrent uterine infection
untreated cervicitis
active genital actinomycoses
145
contraindication to use of Cu T IUD
Wilson's disease
known copper allergy
Relative contraindication- anemia
146
Contraindications to use of the LNg 20 IUD
known allergy to levonorgestrel
acute liver disease or liver tumor
known or suspected carcinoma of the breast
147
Relative contraindications for IUD insertion
Risk factors for STDs
history of a previous IUD problem
unresolved abnormal uterine bleeding
known immunocompromise
past history of severe vasovagal reactivity
148
IUD counseling
counsel prior to visit
for patient dissatisfaction with heavy bleeding and cramping
give patient a copy of the manufacturers patient information brochure
get signature to declaration of understanding of materials and written IUD consent
149
Timing of IUD insertion
any time during menstrual cycle if using reliable contraceptive method or has bene abstinent since last menses
documentation of a negative pregnancy test for others
150
Routine antibiotic propylaxis is...
not recommended with IUD insertion
151
Explanation for apparent failure of contraception
nonadherence
inappropriate use
failure to continue use of the method
failure of the method
cost and drug coverage issues
152
Factors to consider with choosing a method of BC
efficacy
convenience
duration of action
reversibility and time to return to fertility
effect on uterine bleeding
frequency of side effects and adverse events
153
Top 10 questions to ask
What are your contraceptive goals? Do you ever want to get pregnant? When?
Are you currently having sex with a male partner?
Have you tried any contraceptive methods? If so, which one?
What did you like/dislike about the method?
Are you a good pill taker?
How often did you forget to use the method?
Are there any methods you have heard about and would like to try?
How important is the spontaneity of use?
Is protection from STIs important considering your life situation?
Is cost an issue? Does your insurance cover any contraceptive method?
154
Strategies for enhancing compliance and continuation
provide ongoing support for contraceptive use based on regular assessment of clients sexual activity, relationships, attitudes about pregnancy, and life events
improve clients knowledge
anticipate and manage AEs
address cost and access barriers
provide clear information about ways to remember to take pills, what to do if one or more pills are missed, back-up contraception, and emergency contraception
155
"most effective" contraceptive
intrauterine contraception (IUD)
contraceptive implants
sterilization
156
"Lest effective" contraceptives
diaphragm
condoms
spermicides
withdrawal
periodic abstinence
various coital positions
157
Tubal obstruction/ligation
any procedure that prevents pregnancy by occluding or disrupting tubal latency
often performed under local anesthesia
can undergo surgical sterilization shortly after birth
ligation of Fallopian tubes
laparoscopic is most common
158
non contraceptive benefit of sterilizaiton
reduction of ovarian cancer
159
Advantages of oral contraceptives
high effectiveness
does not increase risk of death among non-smoking, no birth defects
used through reproductive years
rapid reversibility (2 week delay)
160
Menstrual related health benefits to hormonal contraceptives
decreased dysmenorrhea- reduction by 60%
decreased menstrual blood loss
regulation of menses
reduction in PMS symptoms
reduction of PMDD
decreased anovulatory bleeding
Mittelschmerz relief
reducted risk of post-ovulatory ovarian cysts
improvement of menstrual migraines
161
General health benefits to hormonal contracepiton
endometrial cancer risk reduction
decreased risk of benign breast conditions
improvement of acne and hirsutism
reduced risk of hospitalization for gonorrheal PID
reduction of endometriosis symptoms
decreased risk of iron deficiency anemia
treatment of hot flashes
reduced risk of uterine fibroids
162
Disadvantages to hormonal contraception
daily administraiton
expense and access
need for storage and ready access
no protection against STIs
163
Lowest estrogen formulations
10mcg
164
Most combined OCs contain
20-35mcg of ethinyl estradiol
165
Contraindications to COCs
previous thromboembolic event or stroke
history of an estrogen-dependent tumor, breast CA
liver disease, severe cirrhosis
severe vascular headache- migraine with aura
pregnancy/postpartum <21 days
undiagnosed abnormal uterine bleeding
congenital hyperlipidemia
cerebral vascular or coronary artery disease
complicated valvular heart disease
women over 35 who smoke
DM with end organ failure
HTN
obese women over the age of 35
166
MOA of hormonal contraception
estrogen inhibits FSH and LH seretion thereby inhibiting follicular maturation and ovulation and potentiates progesterone effects and thickens cervical mucus
167
Progestin contraceptive effect
suppressing the release of GnRH and LH preventing ovulation
also thickens cervical mucus
168
ACHES acronym
Abdominal pain
Chest pain
Headaches
Eye Problems
Severe leg pain
169
Assessments required prior to hormonal contraception prescription
careful medical history and blood pressure measurement
170
Assessments not required prior to hormonal contraception prescription
breast exams
cervical cancer screening
screening for STIs
171
Instructions for missed COCs
If one missed pill- take as soon as possible, then take pills as scheduled (may take 2 at one time)
If two missed pills- take one pill as soon as possible, then take as scheduled
use back-up contraception until 7 days of active pills taken
172
side effects of OCs
bloating
nausea
breast tenderness
mood changes
breakthrough bleeding
amenorrhea
173
treatment of breakthrough bleeding
add extra estrogen for 1-2 cycles to stabilize endometrium
174
assessment for post-pill amenorrhea
women who do not menstruate for 3 months after d/c an OC should undergo amenorrhea eval
175
Only antibiotic that requires a back-up method
rifampin
