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11. Contraception Flashcards

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1
Q

Informed Consent Acronym

A

BRAIDED

Benefits
Risks
Alternatives
Inquiries
Decision
Explanation
Documentation
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2
Q

Natural Family Planning Methods (4)

A
  • Coitus interuptus (Withdrawal)
  • Periodic abstinence (NFP)
  • Cervical mucus method
  • Symptothermal method (Combo of all)
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3
Q

Two methods of periodic abstinence (NFP)

A
  • Rhythm method (Calendar method)

* Basal body temperature method

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4
Q

What is the rhythm method?
• Type
• Must have what?

A
  • Form of periodic abstinence

* Must have regular, predictable cycles

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5
Q

Basal body temperature method (3)

A

• Taken immediately after waking and before getting out of bed.
• Temps recorded on the graph to document trend
• Observe for Thermal shift
o Abstinence from day of temp drop x3days

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6
Q

Thermal shift with BBT (2)

A
  • Right before ovulation: Slight drop in temp

* With ovulation the temp rises 0.2-0.4*C

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7
Q

Outside factors that affect BBT

A
  • Alcohol
  • # of hours of sleep
  • Infection
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8
Q

When do you start observation for cervical mucus method?

A

Last day of the menstrual flow

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9
Q

Cervical mucus method: What are you looking for?

A

Spinnbarkheit

mucus thin and watery like egg whites prior to ovulation

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10
Q

What is the most effective method of NFP?

A

Symptothermal – a combo of all methods

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11
Q

Standard days method: Def

A

Standardized version of calendar method

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12
Q

Requirement for standardized days method

A

Must have a cycle of 26-32 days

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13
Q

When are the fertile days for the standardized days method

A

8-19 – avoid unprotected intercourse

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14
Q

Predictor test for ovulation: What is it testing for?

A

Detects LH surge prior to ovulation

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15
Q

Predictor Test for ovulation: Benefit

A

Not affected by illlness, emotional upset or physical activity

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16
Q

Pre-ovulation mucus characteristics (4)

A
  • Thick
  • Cloudy
  • Sticky
  • Slippery
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17
Q

Ovulation mucus characteristics (4)

A
  • Clear
  • Wet
  • Sticky
  • Slippery
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18
Q

Types of barrier methods (4)

A
  • Condoms (male and female)
  • Diaphragm
  • Cervical cap
  • Lea’s Shield / Fem Cap
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19
Q

Patient teaching: Male condom (3)

A
  • Must counsel about proper use / application
  • Apply the condom on the penis after it is erect and before intimate contact
  • Lubricants: Do not use petroleum-based products because they cause the condom to break
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20
Q

Male Condom side effects (2)

A
  • Irritation

* Allergy (latex)

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21
Q

Female condom patient teaching (3)

A
  • Female controlled
  • Can insert 8 hours prior
  • Must remove after
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22
Q

Female condom side effects (2)

A
  • Irritation

* Polyurethane

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23
Q

When would a patient need a new diaphragm (2)

A

o Requires fitting and refitting if excessive weight gain or loss (20%)
o Replace every 2 years

By Rx only

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24
Q

Diaphragm: Method

A

o Works by covering the cervix to prevent sperm from entering and killing sperm with spermicide application

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25
Diaphragm insertion and removal (3)
* Diaphragm is used every time you have intercourse * Must be left in place for six hours after intercourse * Check device for integrity
26
Diaphragm patient teaching
o Efficacy diminishes with increased frequency of intercourse
27
Cervical cap characteristics (4)
o No longer in US o Fitting, use and efficacy similar to diaphragm o Must use with spermicide o Efficacy decreases with parity
28
• Other Cervical Barriers: Lea’s Shield, Fem Cap (6 characteristics)
``` o Use is similar to diaphragm, cap o Requires prescription o Femcap requires fitting o Reusable o Silicone o Use with spermicide ```
29
Contraceptive sponge (3 characteristics)
o Female controlled o Available OTC o Insertion and removal
30
Types of intravaginal spermicides (6 - don't memorize)
``` o Foams o Tablets o Suppositories o Creams o Films o Gel ```
31
Spermicides -- side effects (3)
o Irritations o Rash o Microlacerations
32
What is the most commonly used spermicidal chemical in the US?
N-9
33
Mechanism of N-9
o Surfactant that destroys the sperm cell membrane on the surface
34
When must spermicide be used?
Just before intercourse
35
How many different contraceptive formulations are available in the US?
More than 30
36
What do hormonal contraceptives consist of?
Estrogen-progesterone or just progesterone
37
Hormonal contraceptives: Mechanism of action (3)
o Estrogen suppresses production of FSH and LH, suppressing ovulation o Endometrium remains thin o Cervical mucus is thick
38
Hormonal contraceptive contraindications: Cardiovascular / blood (4)
o Thromboembolitic Disorders o Coronary artery or cerebral vascular disease o Severe diabetes (with vascular involvement) o Uncontrolled HTN
39
Hormonal contraceptive contraindications: Hormonal (3)
o Breast cancer (estrogen positive tumors) | o Estrogen dependent tumors
40
Hormonal contraceptive contraindications: Other things (3)
``` o Currently impaired liver function or liver tumor o Smoking (>35 y/o) o Migraines with neurologic symptoms ```
41
Hormonal contraceptive contraindications: Related to childbearing
``` o Lactation (no combined contraceptive pills) o Pregnancy ```
42
Possible side effects of Hormonal Contraceptives
• Estrogen excess
43
What are the symptoms of estrogen excess? (8)
* N/V * Dizziness * Edema * Increased breast size * chloasma * Visual changes * Hypertension * Vascular HA
44
Sxs of estrogen deficiency (7)
* Early spotting (days 1-14) * Hypomenorrhea * Nervousness * Vaginal dryness * Breast tenderness * Oily skin and scalp * Hiritruism
45
Sxs of progesterone deficiency (3)
* Late spotting (days 15-21) * Heavy flow with clots * Increased breast size
46
Hormonal contraception warning signs (5)
A - Abdominal Pains C - Chest pain H - Headache E - Eye changes S - Severe leg pain
47
Contraceptive warning signs: Abdominal pain
May indicate a problem with the liver or gall bladder
48
Contraceptive warning signs: Chest pain
Chest pain or shortness of breath may indicate possible clot problems within the lung or heart
49
Contraceptive warning signs: Headache (2)
* May be sudden or persistent | * May be caused by CVA or HTN
50
Contraceptive warning signs: Severe leg pain
May indicate a thromboembolitic process
51
How are combined oral contraceptives packaged?
21 or 28 days
52
When should you start taking oral contraceptives?
The first sunday after menses starts
53
What causes failures with oral contraceptives?
Missed pills
54
Side effects from oral bc (5)
* Nausea * Breast tenderness * Fluid retention * Chloasma * Early spotting (lo estrogen)
55
What is OrthoEvra
A transdermal contraceptive patch
56
Transdermal Contraceptive patch - what is it?
Delivers continuous levels of hormones
57
What is lunelle?
A combined monthly injection (IM)
58
Lunelle - mechanism (2)
* Works the same way as other combination hormonal contraceptives (pill, patch, ring) * Prevents ovulation so that no sperm can fertilize an egg
59
Vaginal / nuva ring - patient counseling (3 components)
o The ring is thought to be as effective as oral contraceptives o The first time the vaginal ring is used, it is inserted during the first five days of menstruation o Effectiveness of a vaginal ring is lowered when taken with certain medications
60
``` Extended use regimens • When approved • Contents • Time frame • Brand name ```
* Approved by the FDA in 2003 * Contains both estrogen and progestin and is taken in 3-month cycles * 12 weeks of active pills followed by 1 week of inactive pills * Brand name: “Seasonale”
61
Progestin only contraceptives - benefit
• Eliminates side-effects of estrogen
62
Progestin only contraceptives: Mechanism of action (3)
o Inhibits ovulation o Thickens and decreases the amount of cervical mucus o Thinning endometrium
63
What is Depo-Provera?
Injectable Progestin
64
Emergency Contraception: Def
High doses of oral contraception taken to prevent ovulation or implantation
65
Emergency Contraception: Effectiveness
75-89% effective
66
2 protocols of emergency contraception
- Split or single dose | - 72 or 120 hours
67
Emergency contraception: Mechanism
High hormonal levels prevent or delay ovulation, thicken the cervical mucus and later the sperm transport in order to prevent fertilization.
68
Emergency contraception -- must be used before...
IMPLANTATION
69
Intrauterine contraception -- mechanism of action (3)
o Damages sperm in transit to tubes o Uterine lining inhospitable o Effect mucus and endometrial maturation
70
Two types of IUDs
o Copper T: Approved for 10 years | o Progesterone based: Approved for 5 years
71
Contraindications of IUDs (8)
``` o Not monogamous o Pregnant o HIV + o Undiagnosed vaginal bleeding o Pelvic infections o Recent endometritis o Uterine / cervical cancer o Allergy to copper ```
72
What is Mirena?
A Type of IUD
73
Mechanism of Mirena (4)
* Thickens cervical mucus * Impairs sperm migration * Alters the endometrium to prevent implantation * Inhibits ovulation
74
Mirena -- Contraindications (3)
* Breast cancer * Undiagnosed vaginal bleeding * Liver disease
75
IUD Warning Signs
``` P - Period Late A - Abdominal Pain I - Infection Exposure N - Not feeling well S - String missing / changes in length ```
76
Male / Female sterilization:
Female: Tubal Ligation Male: Vasectomy
77
Induced abortion - types
Elective or therapeutic, Medical or surgical
78
Medical abortion: Timing
7-9 weeks or earlier
79
Surgical abortion: Types and Timing (3)
* Manual Vacuum Aspiration (MVA) <14 weeks | * Dilation and evacuation (D+E) up to 20 weeks
80
• Method (2 components)
o Complete abstinence during fertile period | o To determine fertile period, must record menses for 6 mo
81
Rhythm method: | • How to calculate
How to calculate: • Length of shortest cycle minus 18 days (start of fertile period) • Length of longest cycle minus 11 days (end of fertile period)
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