Week 2 Reproductive Health and Contraception Flashcards
(104 cards)
1
Q
Which medication in combination with oxytocin and misoprostol is used to induce labor after the first trimester?
A
Methotrexate
2
Q
Which of these is the active chemical agent in spermicidal gels, foams, suppositories, etc?
A
Nonoxynil-9 (N-9)
3
Q
Define Efficacy
A
Efficacy: Likelihood conception occurs when evaluation birth control methods with 100% accurate use
4
Q
Define Effectiveness
A
Success of a method preventing pregnancy use typically
5
Q
Pregnancy Termination: Manual Vacuum Aspiration Up to how long? length of procedure
A
Up to 12 weeks Procedure 15. mins
6
Q
Pregnancy Termination: Dilaton & Curettage (DNC) Up to how long? What are the complications?
A
Up to 13 weeks
Complications:
- Heavy bleeding,
- cervical laceration,
- infection,
- continued intrauterine pregnancy;
- uterine perforation,
- injury to surrounding organs,
- risk of retained conception productions
7
Q
Explain a medical abortion
A
- Mifepristine prevents fertilization
- Endometrium sheds
- 2 days later…Misoprostol is taken to soften cervix and expel pregnancy
4.
8
Q
What is Mifepristine and how does it work?
A
Progesterone receptor antagonist
9
Q
What is Misoprostol (Cytotec)
A
Prostaglandin
Softens cervix and expels conception
10
Q
What is Methotrexate?
A
Immunosuppressive/chemotherapeutic drug; inhibits enzyme for DNA synthesis and stops mitosis of rapidly dividing cells
11
Q
How effective is the withdrawal method for contraception?
A
20-60%
12
Q
How does lacational amenorrhea work for contraception?
What is the criteria to use this as a birth control method?
Effectiveness?
A
MOA:
High levels of prolactin inhibits GnRH secretion
Criteria:
- Exclusive Breastfeeding (no more than 4 hours between feeds or 6 hours at night)
- Infant Less than 6 months
- Menses have not resumed
99.5% effective
13
Q
What is the effectiveness of the fertility awareness method?
What are its contraindications?
A
Effectiveness: 24/100 unintended pregnancy in first year use
Contraindication:
- Irregular menstrual cycles,
- recent child birth,
- menarche,
- perimenopause,
- breast feeding,
- anovulatory menstrual cycle,
- recent discontinuation of hormonal therapies
14
Q
What rise in temperature means ovulation has occurred?
A
rise 0.4F above previous 6 days
15
Q
What does cervix look like before ovulation? Post ovulation?
A
Pre-ovulation: Cervix dilated slightly, softer, and positioned higher in vagina.
Post ovulation: Cervix firm and lower in vagina.
16
Q
What is the symptothermal method?
A
combines basal body temp with cervical mucus and cervical observations.
17
Q
Benefits/Disadvantages of Polyurethane condoms
A
latex free option;
more expensive;
effective against STI;
less vaginal irritation
18
Q
Benefits of latex condoms
A
cheaper; effective against STI & HIV
19
Q
How long can a female condom be left in before intercourse?
How effective is it?
A
8 hours prior
79% effective
20
Q
What is the Calendar or Rhythm Method for contraception?
A
Counting days in menstrual cycle
21
Q
What is the standard day method contraception?
Who can use it?
A
Abstain/Barrier BC days 8-19 of cycle (12 days/1month)
Women with 26-32 day cycle length
Dot Fertility or Natural cycles app
22
Q
A
23
Q
What 3 questions do you ask when discussing a client’s reproductive plan?
A
- Do you think you might like to have (more) children at some point?
- When do you think that might be?
- How important is it to you to prevent pregnancy until then?
24
Q
What is the failure rate of coitus interruptus?
A
22% with typical use
25
What is the fertility awareness based method?
Determining when a women is most fertile and using abstinence during this time
26
what are the 3 criteria form Lactation Amenorrhea Method for birth control?
1. Exclusively breastfeeding
2. Amenorrhea 56 days postpartum
3. Infant younger than 6 months
27
How does LAM work for birth control?
Breastfeeding increases prolactin levels which inhibits ovulation
28
How do you use the calendar or Rhythm method?
Records length of 6-12 cycles and determines longest and shortest cycles and uses it to calculate fertile days each month
Can be confusion
29
What is the standard day method of birth control?
How do you use it?
Who is this for?
simpler calendar method
## Footnote
Abstain/barrier 8-19 days of the cycle (12 days/month)
"Cyclebeads"
Dot Fertility & Natural cycles
Only for women 26-32 day cycle length
30
What is the post ovulation method of birth control?
How do you use it?
Variation of calendar method
Instructions
1. Subtract 14 days from average cycle length to predict day of ovulation
2. Abstain during 1st half of cycle and until 4th day after predicted ovulation
REQUIRES LONGEST PERIOD OF ABSTINENCE
31
A ____ % increase in temperature risk means ovulation as occured
A **0.4 %** increase in temperature risk means ovulation as occurred
32
How does the basal body temperature method work?
0.4 % increase in temp after ovulation
Abstain 5+ days after
also may use cervical mucus changes
33
What is the Billings Ovulation method?
When is the fertile time?
Assessment of cervical mucus to determine fertile window.
## Footnote
Fertile:
Egg white 1st observed & 4 days after they are last observed
34
What is the 2 day method?
How to use it?
Simpler than the ovulation method
Check secretions daily and fertile if any present
Had secretions day or yesterday = fertile
35
What is the symptothermal method?
Uses multiple indicators of fertility window: BBT & Cervical mucus
Cervical mucus checks beginning ovulation and BBT detects end
36
What is the most common spermicide?
N-9
37
How does spermicide work?
surfactant and disrupts cell membranes
38
What is Caya
One size fits all diaphragm
39
What are diaphragms made of?
Most made of silicone
40
41
How do you use a diaphragm?
Leave in place for 6 hours after intercourse
Do not leave in place \>24hours risk of TSS
42
How many weeks post partum can you be fitted for a diaphragm?
6 weeks PP
43
How. long can a cervical cap be worn?
When does the spermicide need to be reapplied?
How long does a FemCap last for?
up to 48 hours
Every 24 hours
2 years
44
What is the Sponge?
How does it work?
How do you get it?
Polyurethane with spermicide
When moistened it releases 125mg N-9 over 24 hours. Enough spermicide for multiple acts of intercourse over 24 hours
Available OTC/one size fits all/no prescription
45
What are risks and side effects of the Sponge?
TSS risk if left over 24 hours
Irritation more common than diaphragm r/t higher amounts N-9
46
How long do you leave the sponge in after intercourse?
6 hours
47
What does tubal ligation put a women at high risk for?
Ectopic pregnancy
Post tubal syndrome
Less likely return for GYN exams
Less likely to use STI prevention
48
What is post tubal syndrome?
After tubal sterilization
Increased dysmenorrhea
Abnormal menses
49
Tubal Sterilization
Advantages:
Disadvantages
**Advantage:**
* Decreased risk ovarian cancer
* Lower risk PID
**Disadvantage**
* Low risk surgical procedure
* Waiting period after signing consent
* Less likely to return for GYN exams
* Less likely STI prevention
50
How long until a vasectomy is effective?
What's the failure rate of Vasectomy
3 months
## Footnote
**Failure rate**: \<1%
51
True or false?
1. All condoms are equally effective in preventing pregnancy prevention?
2. All barrier methods can be used together?
1. False
2. False; can't use M/F condoms together
52
True or false
1. You should encourage women to leave the diaphragm in over 24 hours for better protection?
1. False
Only 6 hours; \>24 hours = TSS
53
True or false
you have to have a prescription to get the diaphragm?
True
54
N-9 spermicide is safe to use for rectal intercourse?
N-9 should be used to encourage prevention of STIs?
true or false
false
False
55
Fertility awareness option (SDM) is most effective to use if a person has regular menstrual cycles (28 day cycles)?
True or false?
True
Between 26 - 32 days
56
The standard day method only requires abstinence or backup BC for 5-7 days a month if a woman has regular menstrual cycles?
True or false?
False
Sometimes require 2 weeks of abstinence
Usually days 8 -19 of the cycle
57
tubal ligations decrease the risk of ovarian cancer
True or false?
true
58
When using the BBT method fertile days start when BBT declines
True or false
false
Rise is a result of progesterone release by corpus luteum signaling ovulation has occurred and rise comes down after 5 days
59
What is the role of estrogen in combined hormonal contraception?
Predictable bleeding patterns by stabilizing the endometrium
60
What is the role of Progestin in CHC?
Suppress ovulation
61
What are contraindications to estrogen? #12
1. Pregnancy
2. Estrogen dependent cancers: Breast/Endometrial
3. Undiagnosed Dysfunctional Uterine Bleeding
4. Clotting disorder/ Factor 5
5. Stroke/MI/CAD/DVT/PE
6. Major surgery with prolonged immobilization
7. Severe Hepatic disease
8. Uncontrolled HTN
9. 35+ years & smoking
10. Active gall bladder disease
11. migraine with aura
12. \<21 days post partum
62
What is ACHES and what does it stand for?
**Abdominal pain** (mass)
**Chest pain** (cough or SOB)
**Headache** (severe or new onset)
**Eye Problems** (Visual change/loss/speech change)
**Severe leg pain** (or hot leg edema)
63
What does progesterone inhibit?
LH
64
What does estrogen inhibit?
FSH
65
What would be reasons to stop CHC?
1. New onset of severe HA
2. worsening history of migraines
3. Aura with migraine
66
What are noncontraceptive benefits of CHC? #6
1. Reduce endometrial/ovarian/colon cancer risk
2. Reduce anemia w/menses
3. Reduce PMS/PMDD
4. Reduce PID
5. Fewer ectopic pregnancies
6. Reduce fibrocystic breasts
67
How is the effectiveness of COC?
91%
68
What antibiotic lowers the efficacy of COC?
rifampin
69
What drugs decrease the effectiveness of COC?
Anticonvulsants (except valproate or gabapentin)
HIV meds
Tb meds
Griseofulvin
St. Johns wort
Rifampin
70
What would be a good contraception option for people on anticonvulsants
Depo because it is progestin only
71
What is the most common cause of allergic reaction in COC?
Additives and fillers
usually LACTOSE
72
What is the range of low dose estrogen?
What is the low dose range of progestin?
EE: 10-30mch
Progestin: 0.1 - 1.5mg
73
What is a worry with the newer progesterone? Drospirenone
Hyperkalemia, especially if they take alot of NSAIDs
74
What is the most commonly prescribed dose of EE?
20-35 mcg
75
What are the advantages of extended dose COC regimens?
Disadvantages?
Advantages:
* Better suppression of ovulation
* Helps conditions worsened by menses (acne, pms, menstrual migraines, dysmenorrhea)
* Less bleeding throughout year
* Buffer for missed pills
Disadvantages
* Unpredictable bleeding
* No monthly bleeding
76
1. What you do if you missed one COC pill?
2. Missed 2 pills?
1. Take as soon as possible and 2nd pill on time. NO BACK UP NEEDED
2. Take most recent ASAP. Take next pill at usual time. BACK UP FOR 7 DAYS
77
What should you do if pills were missed during the 1st week and sexual intercourse occurred during the last 5 days?
Emergency contraception
78
What is a contraindication to the patch that is different from the pill?
BMI \>30 d/t increased risk of blood clots
79
What if the patch falls off for \<24 hours?
What if patch falls off for \>24 hours?
1. Reapply to same place or new patch.
1. Patch day is SAME
2. NEW PATCH
1. NEW DAY 1
2. NEW PATCH CHANGE DAY
3. BACK UP 7 DAYS
80
What is a unique side effect of NuvaRing
Vaginitis
Leukorrhea
81
CHC TRUE OR FALSE
1. Work primarily by suppressing ovulation?
2. If taken cyclic, causes regular monthly withdrawal bleed/pseudo menses
3. Are safe to start immediately post partum?
1. TRUE; progesterone suppresses LH \> \> suppresses ovulation
2. TRUE;
3. FALSE; increase risk of DVT
82
CHC TRUE OR FALSE
1. Are affected by seizure medications?
2. Are linked to increased risk ovarian cancer
3. Need to perform a pelvic exam before starting them?
1. True
2. FALSE
3. FALSE
83
What are the advantages of Progestin only methods?
Minimal effect on:
* Coagulation
* BP
* Lipid levels
* Can be started immediately Postpartum
* Safely used with BF
* Not contraindicated with CAD, migraines with aura or VTE history
84
What is the main mechanism of action for progestin only pills?
When do you need to use back BC on progestin only pills?
Thicken cervical mucus after (2-4 hours after taken and last 22 hours)
Back up needed if 3+ hours late taking pill
85
What is Slynd?
Advantages
What are you at risk for?
**Drospirenone**
* Inhibits ovulation reliably
**Advantages**
* Less antiandrogen or antimineralcorticoid activity
* Less unscheduled bleed
* More forgiven if taken late
**Risk**
* Hyperkalemia in 1st month. CHECK POTASSIUM FIRST
86
What progesterone inhibits ovulation reliably?
Drospirenone
87
1. How often do you give Depo injection?
2. How long does it suppress ovulation for?
3. MOA
4. When can someone expect fertility to return?
1. 11- 13 weeks
2. 14 weeks
**MOA**
* Inhibits HPO axis
**Fertility**: 15-49 weeks up to 1.5 years
88
#8 Depo Provera Side Effects
1. Altered bleeding
2. Weight gain 2kg at 12 months
3. Glucose intolerance
4. Lipids
5. Vaginal dryness (HIV risk)
6. Delayed fertility
7. Acne
8. BBW decreased bone mineral density
89
TRUE OR FALSE Progesterone BC
1. Usually have more unscheduled bleeding than with CHC
2. Cannot be used during breast feeding
3. Have to wait at least 4 weeks post partum to start
1. True
2. False
3. False; can start immediately post partum
90
TRUE or FALSE Progesterone BC
1. The POP works the same way the combined pill to prevent pregnancy
2. Deopo has to be given at exactly 12 week intervals or pregnancy can occur
3. All women should have a DEXA scan if on depo \>2 years
1. False; POP creates thick cervical mucus plug
2. False; up to week 13
3. False;
91
92
What is the most effective hormonal contraception?
Nexplanon is almost 100% effective
93
How long will fertility return when Nexplanon is removed?
6 weeks
94
How would you manage unscheduled bleeding on Nexplanon?
* Track bleeding on app
* Consider etiologies (STI, pregnancy, anemia)
* NSAID
* Tranexamic acid
* Hormonal therapy
95
What are the MOA for Levonorgestrel IUDs
Progestin effect
* thickened cervical mucus
* endometrial changes
* Miren/Liletta ovulation suppression
Foreign body effect toxic to sperm and ova
* inflammatory response
* Cytotoxic peptides and enzymes
96
Who is Skyla for?
How long does it last?
for people who have never been pregnant
3 years
97
How long is Mirena & Liletta able to be inserted for?
up to 6 years
98
how long can kyleena stay in?
5 years
99
How can you be reasonable sure someone is not pregnant?
1. \<7 days after start of menses
2. no intercourse since start of last menses
3. correctly using contraception
4. \<7 days after an abortion
5. within 4 weeks postpartum
6. Exclusively breast feeding
100
What emergency contraception is more effective in overweight women?
Ella
Prescription only
101
How long after Ella can you start hormonal birth control?
5 days because it is an antiprogestin
102
When can a D&C be used
up to 13 weeks
higher risk of complications: uterine perforation or cervical laceration
103
When is aspiration abortion used?
Less than 14 weeks
104
True or False?
1. Manual aspiration can be done up to 14 weeks?
2. D&C or D&E are performed usually after 14 weeks?
3. A patient is 8 weeks pregnant: can she get aspiration/surgical or a medical/medication abortion only?
1. True
2. True
3. She can get either
