week 3 Birth Control-part 2

Question 1

Mirena (levonorgestrel – 52 mg)

Answer 1

May prevent ovulation in 20% of cycles but works by altering cervical environment and thinning of endometrium
99% effective
Good for five years

Effects:
Irregular bleeding
PID
dysmenorrhea

Question 2

Skyla (levonorgestrel – 13.5 mg)

how does it work?
What is the effectiveness of skyla?
length of time?

Answer 2

small

Question 3

What are the side effects of skyla?

Question 4

Liletta (Levonorgestrel) 52 mg

How does it work?
What is the effectiveness of liletta?
length of time?

Question 5

What are the side effects of liletta?

Question 6

Vaginal contraceptive ring

Answer 6

-EE/etonogestrel
-98-99% effective
-Flexible ring inserted into the vagina by the 5th day of the menstrual cycle
-Left in place for three weeks
-MOA similar to COCs

Question 7

What are the side effects of the contraceptive ring?

Question 8

What patients should not have the contraceptive ring?

Answer 8

Not recommended for patients with a cystocele, rectocele, or uterine prolapse

Question 9

Management for the contraceptive ring?

Answer 9

How to take
Insertion
-If out of vagina for more than 3 hours must rinse off and reinsert – no need to use backup method

-Out of vagina more than 3 hours backup method for next seven days

-New ring inserted at same time as old one was removed

Question 10

Implant contraception?

Answer 10

-Single rod subdermal implant
-Releases 60-70 mcg of etonogestrel initially then decreasing
-Became available 2006
-Provides effective contraception for 3 years

Question 11

MOA?

Answer 11

Ovulation suppressed by inhibition of LH
Change in cervical mucous
Thin endometrium
98-99% effective
Same advantages and disadvantages as Depo
See pages 190-191

Question 12

Postcoital Contraceptive method

Answer 12

-Morning after or emergency contraception
-Used to prevent pregnancy after 1 night of unprotected intercourse
-Indications

Question 13

Postcoital contraceptive method

Answer 13

-Must be used within 72 hours if pills, have up to five days with IUDs

Available in following:
COCs
POPS
Copper-T IUD

Question 14

COC? (combined oral contraceptives?

Timing?
Pregnancies?
Advantage?
Disadvantage?
Side effects?
Avoid?

Answer 14

Timing= up to 72 hrs

Pregnancies= 3.2%

Advantage= many available

Disadvantage- N/V

Side effects- N/V

Avoid- pregnancy

Question 15

POPs (progesterone only pill)

Answer 15

Time= up to 72 hrs

Pregnancies= 1.1%

Advantage- less N/V

Disadvantage: N/V but lower rates

Avoid: pregnancy

Question 16

IUD?

Answer 16

TIme: up to 5 days

Pregnancies: 0.1%

Advantage: most effective

Disadvantage: pain, bleeding, risk of infection

Avoid Pregnancy

Question 17

combined oral contraceptives (COCS)

Answer 17

-preven or ovral
-Loveral
-Nordette
-Levlen
-Levora
-Triphasil
-Trilevlan
-Trivora
-Alesse
-Levlite

Question 18

progesterone only pills (POPs)

Answer 18

ovrette

20 yellow pills

Question 19

Barrier methods

Answer 19

Male condoms
Female condoms
Spermicides
All are over the counter

Question 20

Barrier methods: diaphragm

Answer 20

-Must be fitted by a health care provider
-Must have a prescription
-Must change if gain or loss ten pounds

Question 21

Fertility Awareness methods

Answer 21

-Client must be diligent in charting the menstrual cycle
-Must be diligent the body basal temperature
-Must be diligent in recording the change in cervical mucous

Question 22

Fertility Awareness methods: Calendar

Answer 22

-Client knows and understands her cycle, the life of the sperm, and the life of the ova

-Charts cycle for 8 months

-Uses longest and shortest to decide when she should refrain from sexual activity

Question 23

Body basal temperature: Fertility Awareness method

Answer 23

Uses changes in body temperature when ovulation occurs to predict the safe period of sexual activity

Question 24

Cervical mucous: Fertility Awareness method

Answer 24

-Assessment of mucous characteristics
-If resembles egg whites, ovulation is near
-Safe period is dry days and 4th night after peak mucous day to menses

Question 25

Cervical Position: Fertility Awareness method

Answer 25

-Assessment of position of the cervix
-If fertile – the cervix is high in the vagina, soft, open, and wet.

Question 26

Cervical Position: Fertility Awareness method
Effectiveness

Answer 26

-Must be done correctly
-Unforgiving of imperfect use
-72% effective

Question 27

Elective Abortion

Answer 27

-1973 won the right to have a legal abortion
-Death rate has decreased from 300 deaths/year in 1961 to 6 deaths/year in 1987
-There has also been a decrease in other complications

Question 28

Methods of Induced Abortion

Answer 28

Vacuum curettage:
Most common
Done before 14 weeks
Can be done under local
Cervix must be dilated either by metal dilators or osmotic dilators

Suction D&C:
Complications
IAB, cervix laceration, seizure, cardiac arrest, uterine perforation, bleeding, infection, uterine atony

Question 29

Methods of Induced Abortion

Answer 29

Dilatation and evacuation

-Completed after 14 weeks
-Involves dilation of cervix
Laminaria
Metal dilators
-Products removed by forceps followed by curettage and suction
-Safer than medical methods

Question 30

Medical methods of induced abortion (mostly medication for abortion)

Answer 30

-Prostaglandin E2 suppository
-Prostaglandin F2 IM
-Hypertonic intra-amniotic infusion
-Intra-amniotic prostaglandin infusion
-Hypertonic urea intra-amniotic infusion
-Cervical dilation
-Oxytocin IV
-Completed in hospital

Question 31

Medical methods of induced abortion (mostly medication for abortion)

Answer 31

1. Methotrexate/Misoprostol
   Given IM at 50mg/sq. meter of body surface
2. Misoprostol in 800 mcg by suppository or orally 3-7days later.
3. Methotrexate
   Toxicity to the tissue
   SE minimal
4. Misoprostol
   For uterine contractions
   N, V, D

Question 32

Medical methods of induced abortion (mostly medication for abortion)

Answer 32

RU486

Mifiprex and Cytotec
Mifiprex
Potent antiprogestogen and blocks the action of progesterone

1. First visit
   Counseled, given 3 pills and observed
2. Second visit
   Given 2 200 mcg and observed for 4 hours
3. Third visit
   Evaluation – after 12 days

Question 33

What is the NPS role in a well women visit?

Answer 33

*Counseling and client preparation
*Menstrual HX
*Contraceptive HX
*OB HX
*Reproductive disease
*Drug/anesthesia allergies
*Illness
*Current medications

Question 34

What is the NPS role in a well women visit?

What labs would you order?

Answer 34

Physical Exam

Labs
*Pregnancy test
*Sono
*HCT/HGB
*Blood type
*STD testing