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Summer 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are basic methods of contraception

A

Periodic abstinence
Barriers (condoms, diaphragms, cervical caps, sponges)
Spermicides
Hormonal

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2
Q

What can alter the efficacy of condoms (male or female)

A

Decrease barrier: mineral oil based formulas, lotions, lubricants

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3
Q

Should you use condoms with spermicide

A

No longer recommended- no added protection against pregnancy or STD’s
Increase vulnerability to HIV

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4
Q

What are absolute contraindications of Diaphragms with spermicide

A

Allergy to latex
Recurrent UTI
Hx of TSS (bc they increase the incidence of UTI and TSS)

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5
Q

How do you use a diaphragm with spermicide

A

insert up to 6 hours before sex
MUST leave in place for 6 hours after intercourse
Do not leave in longer than 24 hours (TSS risk)
If you have sex again, leave diaphragm in, but also use a condom

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6
Q

What are absolute CI of a cervical cap

A

Hx of TSS
Abnormal PAP (can cause dysplasia)
allergic to spermicide

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7
Q

How do you use a carvicle cap

A

Same as a diaphragm with spermicide!

Only difference is cervical cap you can wear up to 48 hours before risk of TSS

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8
Q

Do cervical caps and diaphragms protect against STDs

A

NO!!

Not against STD or HIV- so if you are concerned, use a condom as well

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9
Q

How do you use a sponge

A

Moisten with water and insert 6 hours before sex
Provides protection for 24 hours
Leave in for 6 hours after intercourse
Do not leave in >24-30 hours

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10
Q

What are the different hormonal contraceptives in order from least to most efficacious

A 
Combined hormonal contraceptives 
Hormonal transdermal patch 
Hormonal transvaginal ring 
Depo-Provera 
Copper IUD 
Levonorgestrel IUD 
Progestin only implant
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11
Q

What is cool about the progestin only implant

A

It is more effective than a tubal ligation or vasectomy

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12
Q

What is the temperature method good for

A

Retrospectively telling you when you ovulated- but you can’t use it to predict when you will ovulate (temp shoots high after ovulation)

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13
Q

The HPO axis has

A

negative feedback! (GnRH, FSH/LH, estrogen/progesterone)

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14
Q

The major pathways in adrenocortical hormone biosynthesis lead you to

A

production/release of estradiol

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15
Q

What are the aromatase inhibitors

A

Arimidex
Aromasin
Femara
-they decrease the level of estrogen in women with estrogen dependent cancer

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16
Q

Why do new OCP have lower levels of hormones

A

Because older high dose formulas were found to be associated with vascular and embolic events, cancer, and significant ADE

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17
Q

What is the MOA of combined hormonal contraceptives

A

prevent conception prior to fertilization

-Progestin provides most of the contraceptive effect

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18
Q

How does progestin prevent conception

A

thicken cervical mucus (sperm cant penetrate)
slow tubal motility
induce endometrial atrophy
block LH surge= no ovulation

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19
Q

How does estrogen prevent conception

A

suppress FSH= helps block LH surge= block ovulation
stabilize endometrial lining
provide cycle control
thicken cervical mucus

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20
Q

What 3 synthetic estrogens are available in the US

A

Ethinyl estradiol
Mestranol (prodrug- has to be converted by liver to ethinyl estradiol to be active)
Estradiol valerate
-Most COC have estrogen doses at 20-50 mcg of EE

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21
Q

Are progestins all the same

A

No- differ in respect to inherent estrogenic, antiestrogenic, and androgenic effects

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22
Q

Androgenic activity depends on these 2 variables

A

presence of sex hormone binding globulin
androgen:progesterone activity
(if SHBG decreases, free testosterone rises, more prominent androgen ADE)

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23
Q

What are the 4 generations of progestins

A
  1. well tolerated. low dose= more breakthrough bleeding (Norethindrone)
  2. long 1/2 life. more androgens (hirsutism/acne/lipids). better libido (Levonorgestrel)
  3. same activity as 2nd gen, less androgen effects (Desogestrel)
  4. anti-androgen (drospirenone)
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24
Q

How do you take progestin only pills

A

SAME time every day (3 hour window, max)
If >3 hours late, use another form of contraception
less effective than CHC BUT can be used post-partum

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25
Q

What are negative aspects of progestin only pills

A

40% of women still ovulate
Higher risk ectopic pregnancy
May cause irregular and unpredictable bleeding

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26
Q

Contraindications to progestin only pills are

A

Gastric bypass
ischemic heart disease
Rifampin therapy

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27
Q

What is great about monophasic OCPs

A

can string them together to avoid periods all together (normal to have some breakthrough bleeding)
Cheapest option
92% effective

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28
Q

Caution when using OCPs in women

A 
>35 
smoker
HTN 
Dyslipidemia 
DM 
Migraines 
breast cancer 
thromboembolism 
obesity 
SLE
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29
Q

What does the CDC say about using CHC in smokers

A

If <35: level 2 (green)
If >35 and <15x day: level 3 (pink)
If >35 and >15x day: level 4 (red)

30
Q

What does the CDC say about postpartum women using CHC

A

<21 days: level 4 (red)
21-42 days w/ VTE RF: level 3 (pink)
21-42 days w/o VTE RF: level 2 (green)
>42 days: level 1 (green)

31
Q

What does the CDC say about using IUD in postpartum women

A

<10 min after delivering placenta: level 2
10 min after placenta-4 wks PP: level 2
>4 weeks: level 1
Puerperal sepsis: level 4

32
Q

What hormones can you co-administer for added benefits

A

Caziant or Cyclessa: estrogen to prevent HA during menses

Tilia Fe or Tei-legest Fe (iron)

33
Q

PEARLS for CHC

A

Encourage patients to use condoms to prevent STDs

Extensive history and safety concerns with using high dose estrogen

34
Q

How much estrogen is ideal in different populations

A

No existing med conditions: 35 mcg or less of EE/ 0.5mg Norethindrone (1 gen)
Teens, Underweight, >35, perimenopausal: 20-25 mcg EE
Non-adherence: 35+mcg
Oily skin, acne, hirstism: low androgenic dose

35
Q

What OCP are preferred to start on

A

Monophasic

36
Q

What can women with dysmenorrhea, menstrual migraines, or severe PMS benefit from

A

extended cycle regimens (eliminate/reduce # of periods per year)

37
Q

ADE of CHC are

A 
N/v
tender breasts 
weight gain 
acne, oily skin 
depression, fatigue 
MC**breakthrough bleeding 
Vaginal irriation (ring) 
application site rxn (transdermal)
38
Q

What Sx should make you immediately d/c CHC

A 
ACHES! 
Abdominal pain 
Chest pain 
Headaches 
Eye problems 
Severe leg pain
39
Q

VERY serious ADE of CHC that should make you stop immediately include

A 
vision loss, proptosis, diplopia 
unilateral numb, weak, tingle 
hemoptysis 
slurred speech 
severe ttp, swelling, or palpable cord on leg 
hepatic mass
40
Q

These ADE of CHC require evaluation but don’t emergently d/c

A 
no menses 
spotting 
breast mass 
RUQ pain 
midepigastric pain 
Migraine 
galactorrhea
jaundice 
depression 
pruritis 
uterus increase in size
41
Q

When would you need to adjust estrogen/progestin content

A

if breakthrough bleeding occurs past 6 months

42
Q

When should you start the pill

A

typically on first sunday after menstrual cycle begins (weekend free periods)
can also do quickstart and start today
-either way, use another method of contraception for first 7 days (for whole first cycle to be even safer)

43
Q

What happens if you get pregnant while on OCP

A

nothing! no adverse effects to fetus because they’re just hormones
simply stop taking the pill once you find out

44
Q

What factors are concerning about using CHC postpartum

A

if mom is hypercoagulable (effects of lactation)
in first 21 days, risk for VTE is higher
if you absolutely need contraception, use progesterone only
if breastfeeding: avoid for first 24 days if you have RF, 30 days everyone else
No restriction after 42 days

45
Q

How can you adjust hormones to counteract certain ADE

A

minimize risk of DVT: low dose estrogen
min. nausea, breast ttp, vascular HA: low estrogen dose
min. spotting/bleeding: high dose estrogen/progestin
min androgen effects: 3 gen progestin
avoid dyslipidemia: 3 gen progestin

46
Q

What are long acting reversible contraceptives

A

Nexplanon (etonorgestrel)
Mirena, Liletta, Kyleena, Skyla: levonorgestrel (2 gen)
Paragard (copper IUD)

47
Q

What contraceptive is first line for teens

A

LARC aka IUD’s

Skyla is smaller and good for teens or women with a smaller uterus

48
Q

DO NOT use LARC if

A 
anatomic abnormalities 
Hx breast, cervical, or endometrial cancer 
PID 
post-abortion 
postpartum 
pregnant 
pelvic TB
STD 
unexplained vaginal bleeding
49
Q

What is Mirena

A

5 year IUD that reduces bleeding, can shrink fibroids, and reduce endometriosis
99% effective 7 days after insertion

50
Q

How long is Skyla good for

A

3 years

51
Q

What is ParaGard

A

10 year copper IUD that can be off label for emergency contraception
Great for women >35 and a smoker
99% effective immediately
but, causes more menstrual bleeding

52
Q

Contraindications to ParaGard are

A

SLE w/ thrombocytopenia

Wilson’s disease (in theory) 2/2 copper

53
Q

What is Nexplanon

A

single rod good for 3 years

may cause irregular bleeding patterns but 99% effective

54
Q

Contraindications to Nexplanon are

A

cirrhosis

ischemic heart disease

55
Q

ADE of using Levonorgestrel IUD are

A 
irregular menses 
insertion complications 
expulsion 
PID 
-must council on STD prevention!
56
Q

What is Depo-Provera

A

birth control shot good for those w/ sickle cell dz, older smokers, or seizure pts
97% effective BUT can cause:
weight gain, irregular menses, bone loss (reverses after stopping shot)- hirsutism, acne, depression

57
Q

If worried about bone loss, stop depo-provera at

A

2 years

58
Q

Contraindications of depo-provera

A

current breast cancer

59
Q

If giving depo-provera, consider these things

A 
cirrhosis 
breast cancer in last 5 years 
DM with microvascular dz 
CVD 
uncontrolled HTN 
SLE 
unexplained vaginal bleeding 
women close to menopause (less time to reverse osteoporosis)
60
Q

What is OrthoEvra

A

one patch, good for 3 weeks and remove for the 4th week- do NOT wear over breasts
+/- nausea if placed on abdomen
92% effective

61
Q

Contraindications to usinf OrthoEvra

A

high risk VTE
skin condition
obesity

62
Q

What is NuvaRing

A

intravaginal ring placed in for 3 weeks, out for 1 (35 days of meds in each)- use tampon applicator to help place
Can decrease frequency of BV
92% effective

63
Q

Contraindications to NuvaRing are

A

intact hymen

-if it falls out, rinse and re-insert

64
Q

If you switch, how long do you need to overlap

A 
pill-to-pill: none 
pill-to-ring: none 
pill-to-patch: 1 day 
pill-to-implant: 4 days 
pill-to-copper IUD: 5 days 
pill-to-shot: 1 week 
pill-to-hormone: 1 week
65
Q

Common ADE of emergency contraceptives are

A 
n/v (less if using progesterone only) 
irregular bleeding (menses onset 1 week early)
66
Q

What do you NO need to do after using emergency contraception

A

screen for pregnancy! if already pregnant, it will not harm the fetus

67
Q

How does emergency contraception work

A

High dose progesterone that creates an environment not conducive to fetus implantation or stops/delays ovulation- BUT- not harmful to a fetus
Must take within 72 hours of unprotected intercourse- the earlier, the less chance of pregnancy

68
Q

What are the emergency contraceptives

A 
Plan B one step 
next choice one dose 
Next choice 
Levonorgestrel generic 
-available OTC in US now!
69
Q

What is Ulipristal

A

Selective progesterone receptor modulator- delays ovulation
Rx only as single dose (30mg) taken w/in 5 days (120 hrs) of unprotected intercourse

70
Q

MOA of Ulipristal depends on

A

timing of administration relative to menstrual cycle

71
Q

Future contraceptive is

A

microchip! remote controlled contraception

very similar to an implant, but it is said to last 16 years

Summer 1 (16 decks)

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