PHRM 825 > Contraception > Flashcards

Contraception Flashcards

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1
Q

What are other indications for hormonal contraceptives?

A
  • acne, hirsutism, alopecia
  • regulation of cycle
  • menorrhagia
  • PMS/PMDD
  • endometriosis
  • dysmenorrhea
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2
Q

What are the roles of estrogen in contraceptives?

A
  • suppress FSH production –> prevent dominant follicle
  • increase sex-hormone binding globulin –> increase binding of free androgens
  • Estrogen helps progestin work better, but plays very little role in preventing pregnanct
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3
Q

Side effects of not enough estrogen:

A
  • breakthrough bleeding early in cycle
  • light menses
  • vaginal dryness
  • spotting
  • no withdrawal bleeding
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4
Q

What are the roles of progestin in contraceptives?

A
  • prevent LH surge –> inhibit ovulation
  • thicken cervical mucus –> inhibit sperm penetration / transport
  • change motility of fallopian tubes –> impair transport of sperm/ova
  • atrophy of endometrium –> impair implantation
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5
Q

What are the three characteristics of progestins and the desirable concentration for each one?

A
  • progestational (high)
  • androgenic (low)
  • antiestrogenic (low)
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6
Q

Which progestins have the highest androgenic component?

A
  • levonorgestrel
  • norgestrel
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7
Q

Which progestins have the lowest androgenic component?

A
  • drospirenone
  • segeresterone
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8
Q

What are the excess androgen progestin side effects?

A
  • acne
  • hirsutism
  • increase sex drive
  • cholestatic jaundice
  • hair loss
  • swelling in arms/legs
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9
Q

What is the name of the implant?

A

Nexplanon (etonogestrel)

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10
Q

Hormone in nexplanon implant?

A

progestin only (etonogestrel)

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11
Q

How to start the Nexplanon (etonogestrel) implant?

A
  • Insert within 5 days of start of period
  • If greater than 5 days, use backup method for 7 days
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12
Q

Nexplanon (etonogestrel) side effects:

A
  • irregular bleeding for first 6-12 months (no bleeding, regular periods, frequent spotting or bleeding)
  • acne (serious)
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13
Q

Frequency of administration for nexplanon (etonogestrel)?

A

Every 3 years

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14
Q

When does fertility return upon removing nexplanon (etonogestrel)?

A

May be delayed or rapid return (within 6 weeks)

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15
Q

Hormones in levonorgestrel IUD:

A

progestin

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16
Q

Frequency of administration of levonorgestrel IUD:

A

3-7 years (depends on strength of IUD)

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17
Q

How to start levonorgestrel IUD:

A

Use a backup method for 7 days after insertion

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18
Q

Levonorgestrel IUD common side effects:

A
  • Periods may become lighter or less frequent
  • Spotting for first 3-6 months
  • Cramping with insertion
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19
Q

Benefits of levonorgestrel IUD:

A
  • lighter periods; amenorrhea
  • safe to breastfeed
  • lower risk of uterine cancer
  • long term protection
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20
Q

When does fertility return upon stopping levonorgestrel IUD?

A

immediately

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21
Q

Copper IUD frequency of administration:

A

Left in place for up to 10+ years

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22
Q

How to start copper IUD:

A

No backup method needed; effective immediately

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23
Q

Common copper IUD side effects:

A
  • periods may become heavier
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24
Q

Benefits to copper IUD:

A
  • Lower risk of uterine cancer
  • safe to breastfeed
  • long term protection
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25
When does fertility return upon stopping Copper IUD?
Immediately
26
Hormones in Depot medroxyprogesterone shot:
Progestin
27
Frequency of administration of medroxyprogesterone shot:
every 3 months
28
How to start the medroxyprogesterone shot:
- Quick start: start today and use backup for 7 days - Next period: start within 7 days of period
29
Medroxyprogesterone side effects:
- weight gain - heavy bleeding (serious) - lower bone density (serious)
30
Benefits of medroxyprogesterone shot:
- lower risk of uterine cancer - safe to breastfeed - lighter, less painful periods; amenorrhea
31
When does fertility return upon stopping the medroxyprogesterone shot?
possibly delayed return
32
What is a very low dose of estrogen (ethynyl estradiol) in a COC?
20-25 mcg
33
What is a low dose of EE in a COC?
30-35 mcg
34
What is a high dose of EE in a COC?
50 mcg
35
What hormones are contained in COCs?
progestin and estrogen
36
Frequency of administration for COCs?
- daily at the same time - most packs have 4-7 placebo pills
37
How do you start a COC?
- Start today - If it's been more than 5 days after period, use backup for 7 days - If it's w/in 5 days of starting period, no backup necessary
38
How long do you have to wait to start a COC if ulipristal acetate has been used?
5 days
39
If you've missed one pill of a COC, what do you do?
Take it as soon as possible.
40
If you've missed 2 or more pills of a COC, what do you do?
Take one pill ASAP, then take the next one at the normal time. Use backup for 7 days.
41
Side effects of COCs:
- blood clots (estrogen related) - breast discomfort - nausea, spotting
42
Benefits of COCs:
- improved acne - lower risk of ovarian/uterine cancer - more regular, lighter, less painful periods
43
When does fertility return upon stopping COCs?
immediate
44
What is the benefit of multiphasic COCs?
may reduce side effects
45
What hormone does Mini-pill - norethindrone have?
progestin
46
How to start mini-pill norethindrone:
- quick start: start today; if more than 5 days after period use backup for 2 days - next period: start within 5 days of period - wait 5 days to start if ulipristal acetate used
47
Frequency of mini-pill norethindrone:
- daily within 3 hours of the same time - timing is super sensitive
48
Side effects of mini-pill norethindrone:
- spotting and menstrual changes more common than COCs - severe headaches
49
Benefits of mini-pill norethindrone:
- safe to breastfeed - lack of estrogen-related side effects
50
When does fertility return upon stopping mini-pill norethindrone?
immediately
51
Why do post-partum patients reach for progestin-only contraceptives?
Estrogen possibly reduces milk production
52
Hormone in drospirenone 4mg (slynd):
progestin
53
How to start drospirenone:
- quick start: start today, if more than 5 days after period use backup for 7 days - next period: start within 5 days of period - wait 5 days to start if ulipristal acetate used
54
When does fertility return upon stopping drospirenone?
immediately
55
Side effects of drospirenone:
- severe headaches - hyperkalemia - spotting and menstrual changes more common than COC
56
Benefits of drospirenone:
- safe to breastfeed - lack of estrogen-related side effects
57
Hormones in Nuvaring:
progestin (etonogestrel) estrogen (EE) - releases 15 mcg per day
58
Frequency of administration for Nuvaring:
- left in place for 3 weeks --> removed for 1 - new ring inserted after 7 days
59
How to start Nuvaring:
- quick start: start day; if more than 1 day after period, use backup for 7 days - Next period: start on first day of period - wait 5 days to start if ulipristal acetate used
60
Nuvaring if late for dose:
- If the ring is out for more than 3 hours, reinsert, use backup for 7 days - In for 3-4 weeks, remove ring, put new ring in 7 days later - If the ring is in for more than 4 weeks; remove ring; put new ring immediately; use backup for 7 days
61
Nuvaring side effects:
- Blood clots - stroke - nausea, spotting, breast discomfort - change in mood or headache
62
Nuvaring benefits:
- improved acne - lower risk of ovarian/uterine cancer - more regular, lighter, less painful periods - don't have to remember daily
63
When does fertility return upon stopping Nuvaring?
Immediately
64
Hormones in Annovera:
progestin (sergesterone acetate) estrogen (ethinyl estradiol) - releases 13 mcg per day
65
Frequency of administration for Annovera:
- left in place for 3 weeks --> removed for 1 week - wash with mild soap/warm water; pat dry, and place in case - reinsert into vagina
66
How to start Annovera
- quick start: start today, if more than 5 days after period, use backup for 7 days - next period: start on days 2-5 of period - wait 5 days to start if ulipristal acetate used
67
If later for dose of Annovera:
- If the ring is out for less than 2 hours, reinsert it - If the ring is out for more than 2 hours, reinsert and use backup for 7 days - If left in for more than 3 weeks, take it out for 7 days and then reinsert
68
Side effects of Annovera:
- headaches, migraine - nausea/ vomiting - vulvovaginal infection/ candidiasis - blood clots - stroke
69
Benefits of Annovera:
- improved acne - more regular, lighter, less painful periods - don't have to remember daily - lower risk of ovarian/uterine cancer - can use one device up to 13 times
70
When does fertility return upon stopping Annovera?
immediately
71
Hormones in Xulane patch?
progestin (norelgestromin) estrogen (EE) - 35 mcg/day
72
Frequency of administration for Xulane patch:
- new patch every week for 3 weeks --> patch free for 7 days - apply new patch
73
How to start Xulane patch:
- quick start: backup for 7 if more than 5 days after - next period: start w/in 5 days - wait 5 days if ulipristal acetate used
74
If late for dose of Xulane patch:
- If patchless for more than 24 hours, apply a new patch and use backup for 7 days - If same patch is kept on for more than 9 days, apply new patch and use backup for 7 days
75
Xulane patch side effects:
- skin irritation - blood clots
76
Benefits of Xulane patch:
- improved acne - lower risk of ovarian/uterine cancer - more regular, lighter, less painful periods - don't have to remember daily
77
When does fertility return upon stopping Xulane?
immediately
78
Hormones in Twirla patch?
progestin (levonorgestrel) estrogen (ee) - 30 mcg per day
79
If late dose for Twirla?
- If the patch is off for less than 24 hours, apply a new patch; no backup needed - If the patch is off for more than 24 hours, apply a new patch and use backup for 7 days
80
Twirla patch side effects:
- nausea, spotting, weight gain - skin irritation
81
When does fertility return upon stopping Twirla patch?
immediately
82
What are the severe side effects from estrogen?
ACHES - Abdominal pain - Chest pain - Headache - Eye problems - Swelling or sudden leg pain
83
What kind of contraceptives are recommended for pts experiencing migraines with aura?
progesterone only
84
When are progesterone only methods contraindicated?
current breast cancer
85
Which hormonal contraceptive option can provide gender affirmation to transgender men?
Progestin-only because they're more likely to stop having periods
86
What are the irreversible contraception methods for transgender women?
- orchiectomy -- removal of the testicles - vasectomy -- blockage of vas deferens tubes
87
List the three emergency contraception methods:
- Levonorgestrel - Ulipristal acetate - Copper IUD
88
Which emergency contraception method uses hormones?
levonorgestrel (progestin)
89
What is the time frame for emergency contraception?
within 5 days of unprotected sex
90
Side effects of emergency contraception:
- nausea, vomiting, headache, dizziness, breast pain, stomach pain - if a patient vomits within two hours of taking, consider repeating dose - next period may start early or late; may have spotting
91
Time frame for medication abortion:
up to 70 days (10 weeks) gestation
92
What are the contraindications for medication abortion?
- current IU - long-term systemic corticosteroids - chronic adrenal failure - coagulopathy/anticoagulopathy therapy - inherited porphyria - intolerance/allergy
93
Which drugs are used for medication abortion?
mifepristone then misoprostol
94
When is the pain most severe during a medication abortion?
2.5-4 hours after misoprostol
95
What are the steps to a medication abortion?
- mifepristone - 200 mg orally x 1 dose - wait 24-48 hours - misoprostol - 2 x 200 mcg tablets in each cheek (30 min) (800 mcg)
96
What can be recommended for a pt experiencing irregular bleeding when taking pills?
- take pill at same time each day - Ibuprofen 800 mg po TID x 5 days - Mefenamic acid 500 mg PO TID x 5 days - change pill formulation
97
What can be recommended for a pt experiencing irregular bleeding when using the implant or IUD?
- Ibuprofen 800 mg PO TID for 5 days - Mefenamic acid 500 mg PO TID for 5 days - combined pill with levonorgestrel for 1 cycle - ethinyl estradiol 50 mcg daily for 21 days
98
What can be recommended for a pt experiencing heavy/prolonged bleeding?
- Ibuprofen 800 mg PO TID x 5 days when bleeding starts - ethinyl estradiol 50 mcg for 21 days (or combined pills) - Tranexamic acid 1500 mg PO TID x 3 days then 1000 mg PO daily x 2 days when bleeding starts
99
What can be recommended to a pt experiencing headaches during their hormone free week?
- consider extended use
100
What can be recommended to a pt experiencing nausea?
- take pill at bedtime or with food - if at beginning of cycle, consider continuous use / extended cycle
101
What can be recommended to a pt experiencing breast tenderness?
- wear supportive bra at all times - hot/cold compress - ibuprofen, acetaminophen, or other pain reliever - consider product with lower dose of estrogen
102
What can be recommended to a pt experiencing acne?
- topical treatments - try difference formulations of pills (dropsirenone) - switch from implant/IUD --> combined pill
PHRM 825
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