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week five Flashcards

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1
Q

What are considered the most effective forms of contraception?

A

LARC (intrauterine, implants) + sterilization

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2
Q

What are considered moderately effective forms of contraceptives?

A

Injectables
OC
Transdermal systems
Vaginal ring

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3
Q

What are considered the least effective forms of contraceptives?

A

Diaphragm
Cervical caps
Condoms
Spermicides
Withdrawal
Periodic abstinence

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4
Q

What is LARC? What contraceptives fall in this group?

A

Long Acting Reversible Contraceptives
IUDs and implants

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5
Q

What hx is important to attain in the interview for contraception?

A

Medical hx
Surgical hx
Ob hx
Gyn hx
Hx STIs
Hx and current partners
Previous difficulties with contraceptive use
Frequency of intercourse
FHx inc vascular events or female cancers, esp thrombocytopenia

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6
Q

Advantages of FAB methods of contraceptives

A

Avoid pregnancy
Conceive
Detect pregnancy
Detect impaired fertility
Detect need for medical attention

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7
Q

Disadvantages of FAB contraceptive methods

A

No STI protection

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8
Q

When would FAB methods of contraception not be indicated?

A

Irregular cycles
Inability to interpret fertility signs correctly
Persistent reproductive tract infxn that affects signs of fertility

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9
Q

Condoms typical use pregnancy rate

A

15-18%

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10
Q

Condoms non-contraceptive benefits

A

Protection against STIs
Reduces risk of PID and subsequent protection of female fertility

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11
Q

Diaphragm MOA

A

Barrier to the ascent of sperm from vagina into uterine cavity and spermicidal activity

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12
Q

Diaphragm typical use pregnancy rate

A

12-16%

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13
Q

Diaphragm non-contraceptive benefits

A

Reduced risk of some STIs

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14
Q

Cervical cap MOA

A

Barrier to ascent of sperm from vagina into uterine cavity, spermicidal

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15
Q

Cervical cap typical use pregnancy rate

A

13-16%

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16
Q

Cervical cap non-contraceptive benefits

A

Reduces risk of some STIs

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17
Q

What are the different types of IUDs?

A

Copper IUD
LNG from lowest to highest dose: Skyla, Kyleena, Mirena + Liletta

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18
Q

CI for IUD

A

Distorted uterine cavity
Pregnancy
Known pelvic tuberculosis
Current breast cancer (for LNG)
Immediate post-septic abortion
Puerperal sepsis
Unexplained vaginal bleeding
Pts with ca awaiting tx
Endometrial ca
Current malignant gestational trophoblastic dz
Hepatiocellular adenoma or hepatoma (LNG)
Wilson’s disease or copper allergy (copper)
Current purulent cervicitis infxn with CT/GC or current PID (3+ Mo after resolution)

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19
Q

What recommendations can you give your patient to take before IUD insertion?

A

Ibuprofen
Mag phos
Cramp bark tincture
Paracervical block

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20
Q

MOA copper IUD

A

Copper enhances cytotoxic inflammatory response within endometrium; toxic to sperm and ova; impairs implantation

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21
Q

Best pt for copper IUD

A

Avoidance of exogenous hormones (breast cancer hx)
Continuation of pre IUD bleeding pattern
Desire for long term or emergency contraception

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22
Q

Non contraceptive benefits of copper IUD

A

Reduction of endometrial, cervical, and ovarian cancer
Menstrual cyclicity

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23
Q

Risks and SE copper IUD

A

Ectopic pregnancies
Uterine perforation
Expulsion
PID
Spontaneous abortion
High serum copper
Abnormal uterine bleeding
Inc flow

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24
Q

Life plan of copper IUD

A

10 years

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25
LNG IUD MOA
Thickened cervical mucus to impede sperm from ascending into uterine cavity and changes endometrium to impair implantation
26
Candidates for LNG IUD
Same as copper IUD PLUS Reduction of bleeding and anemia Higher efficacy pregnancy prevention Possible amenorrhea Reduction of dysmenorrhea Tx of endometriosis related pelvic pain Emergency and ongoing contraception
27
Non-contraceptive benefits Mirena/LNG IUD
Dec menstrual flow Improvement of dysmenorrhea Tx iron def anemia related to HUB Tx heavy bleeding a/w fibroids or adenomyosis Protection of endometrium with estrogen therapy Dec risk of endometrial, ovarian, cervical cancer Dec risk PID Dec risk VTE Tx endometrial hyperplasia and cancer
28
Risks/SE of LNG IUD
Prolonged bleeding Unscheduled bleeding Amenorrhea Spotting Headache or migraine Acne Mastalgia Vulvovaginitis Abdominal/pelvic pain Hair loss Wt gain Depression Dec libido Dizziness Fatigue Breast tenderness Nausea MSK pain Infection, pain, itching at site
29
life span of LNG IUS
3 - Skyla 5 - Kyleena 6 - Liletta 8 - Mirena
30
COCs MOA
Suppresses ovulation by dec GnRH and eliminating LH release mid cycle Suppresses ovarian folliculogenesis via suppression FSH Makes endometrium less suitable for implantation Thickens cervical mucus dec ability of sperm to penetrate Alters tubal transport of sperm and oocytes
31
Typical use failure rate COCs
8%
32
Non-contraceptive benefits COCs
Reduction of all cancer risks esp ovarian and endometrial Reduction in ectopic pregnancy rates Reduced risk PID Reduced menstrual disorder sx Dec risk benign breast disease Improved acne Dec bone density loss Protection against RA and colon cancer
33
SE/risks COCs
CV events Venous thromboembolism MI Stroke Lipid changes PAD Breast cancer Cervical cancer and dysplasia SLE AUB/breakthrough bleeding Breast tenderness Headache Wt gain Nausea Asthma
34
Absolute CI for COCs
Current or hx DVT or PE Current or hx stroke, HD Known thrombogenic mutations Multiple RF for arterial CVD Complicated vascular disease Current DM with nephropathy, retinopathy, or other vascular dz DM over 20 yrs Current breast cancer SLE with high disease activity Pregnancy Lactation Migraine with aura/focal Neuro sx Major surgery with prolonged immobilization of legs 35 and smokes > 15 cigs HTN 160+/100+ with concurrent vascular dz
35
Relative CI for COCs
Postpartum < 21 days Lactation 3 wks, pt with other RF VTE 4-6 weeks Undiagnosed AUB Malabsorption bariatric surgery HTN Past hx breast CA with no recurrence 5 yrs Gallbladder dz Liver enzyme affecting drugs Migraine w/o aura Tobacco, HTN, hyperlipidemia, obesity, DM Age 35+ < 15 cigs Superficial venous thrombosis IBD with RF for VTE
36
When would extended COCs be indicated?
Endometriosis PMDD Hyperandrogenism Dysmenorrhea Lifestyle wanting to dec frequency of menses
37
WHO top tier contraceptive methods for older patients
IUDs Implants Sterilization
38
Concerns of COCs in older patients
Inc risk VTE, stroke, MI, cervical cancer, breast cancer, bone density loss
39
Typical failure rate contraceptive patch
0.7-0.88%
40
When is there dec efficacy of the contraceptive patch?
BMI > 25
41
Typical use failure rate vaginal ring
0.65%
42
SE of vaginal contraceptive ring
Same as OCs VTE Arterial thrombosis
43
What are some progestin only contraceptive options and their typical use failure rates?
Depo provera - 3% Mini pill - 8% Implants/nexplanon 0.38%
44
Non contraceptive benefits depo provera
Dec risk ectopic pregnancy, endometrial ca, freq in sickle cell crisis Improves endometriosis
45
Adverse risks depo provera
Dec BMD Wt gain Menstrual pattern alterations Delay of fertility after d/c
46
Mini pill non contraceptive benefits
Dec endometrial ca risk
47
SE mini pill
Irregular spotting Amenorrhea
48
Nexplanon SE
Irregular bleeding Headache Wt gain Acne Breast tenderness Emotion lability Abdominal pain
49
What are the various methods of emergency contraception available?
LNG plan B Paragard copper IUD LNG IUD Ulipristal acetate (Ella, Ella one, fibristal) High dose COCs or progestin only OCs
50
LNG plan B typical use failure rate and time to use after sexual activity
2.6% 72 hours
51
paragard copper IUD typical use failure rate and time to use after sexual activity
0.1% 5-7 days
52
CI Paragard copper IUD
GC/CT Acute cervicitis
53
LNG IUD typical use failure rate and time to use after sexual activity
0.3% 5 days
54
Ulipristal acetate typical use failure rate and time to use after sexual activity
1.8% 120 hours
55
Ulipristal acetate CI
Pregnancy Breastfeeding Don’t use contraceptives 5 days after use
56
High dose COCs and progestin only OCs timeframe to take for emergency contraception
Within 72 hours best, up to 120 hours
57
Gynecological presentations for HIV+ women
Candida vaginitis 4x+ per year Abnormal cervical cytology PID+ complications Genital ulcer dz; more diff to treat Menstrual abnormalities, inc early menopause
58
Clinical presentation GC in women
Often asx Vaginal mucopurulent dc and pruritis Dysuria Intermenstrual, prolonged, HMB Inflamed cervix Urethritis PID Bartholinitis
59
GC complications in women
Acute PID Bartholins gland abscess Perihepatitis Disseminated GC Pregnancy complications
60
Supportive tx GC
Immune supportive supplements Alternating sitz baths Warming sucks Castor oil packs Probiotics Vaginal lactobacillus Homeopathy
61
Clinical presentation CT in women
Most asx Cervicitis with mucopurulent dc and hypertrophic cervical ectopic Acute urethral syndrome Endometritis PID and potential sequelae Perihepatitis Conjunctivitis Pregnancy related complications
62
What other STIs should be testing for with a CT dx
GC, HIV, syphilis
63
Primary stage syphilis presentation
Painless ulceration chancre with raised borders and indurated base develops, LA frequently present
64
Secondary stage syphilis presentation
Skin and mucus membranes Generalized maculopapular rash on trunk and proximal extremities, spreads to entire body esp palms and soles Mucus patches, condyloma Latium, generalized LA CNS invasion of spirochetes (HA)
65
Latent stage syphilis presentation
No apparent clinical dz present > 1 year Not infectious sexually but transplacentally
66
Tertiary syphilis presentation
CV, CNS, MS
67
Pathognemonic CNS sx tertiary syphilis
Argyll Robertson pupil - no reaction to light, accommodation present
68
How is syphillis dx and what is the required tx?
Dx - fresh specimens from lesions, dark field exam or fluorescent ab test; serological testing Antibiotics necessary
69
Dx criteria herpes
3+ of the following 2+ extragenital sx Multiple bilateral genital lesions Persistence of genital lesions > 16 Distal HSV lesions on fingers, buttocks, or oropharynx
70
Genital herpes natural tx support
Stress management Sleep hygiene Sitz baths Eliminate nuts, seeds, chocolate, refined carbs, sugars, salt, alcohol Lysine supplements

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