CCFP Exam marathon > Contraception > Flashcards

Contraception Flashcards

(51 cards)

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1
Q

What should be assessed before prescribing combined hormonal contraception? (4)

A
  • Blood pressure
  • Cardiovascular risk factors (HTN, CAD, dyslipidemia, DM)
  • Family history of VTE
  • STI risk/screening

These assessments help identify potential risks associated with hormonal contraception.

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2
Q

Name FIVE non-contraceptive benefits of combined hormonal contraception. (5)

A
  • Cycle regulation
  • Decreased menstrual flow
  • Decreased dysmenorrhea
  • Improvement of acne / hirsutism
  • Increased bone mineral density
  • Reduced risk of colorectal cancer
  • Reduced risk of endometrial cancer
  • Reduced risk of ovarian cancer

These benefits enhance the overall health and quality of life for users.

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3
Q

Name FOUR major risks associated with combined hormonal contraception. (4)

A
  • Venous thromboembolism
  • Myocardial infarction
  • Stroke
  • Breast cancer

Awareness of these risks is crucial for informed decision-making.

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4
Q

Name FOUR common adverse effects of hormonal contraception. (4)

A
  • Irregular bleeding
  • Weight gain
  • Breast tenderness
  • Headache

These side effects can affect user compliance and satisfaction.

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5
Q

Name FOUR category 4 contraindications to combined hormonal contraception. (4)

A
  • History of VTE not on anticoagulation
  • Active VTE
  • Migraine with aura
  • Coronary artery disease
  • Stroke
  • Current breast cancer
  • Severe cirrhosis
  • Hepatocellular adenoma
  • Severe hypertension (>160/100)
  • Smoking >15 cigarettes/day and age >35

These contraindications indicate situations where the risks outweigh the benefits.

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6
Q

Name THREE category 3 conditions where combined hormonal contraception should generally be avoided. (3)

A
  • Smoking <15 cigarettes/day and age >35
  • Hypertension <160/100
  • Diabetes >20 years without complications
  • VTE on anticoagulation without risk factors
  • Breast cancer without recurrence in 5 years

These conditions require careful consideration before prescribing.

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7
Q

What examination is required before starting combined oral contraceptives?

A
  • Blood pressure measurement

This is essential to ensure safety in prescribing hormonal contraceptives.

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8
Q

When should backup contraception be used when starting combined OCPs?

A
  • If started >5 days after the first day of LMP → use backup for 7 days

This helps prevent unintended pregnancy during the initial phase of OCP use.

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9
Q

Where can the contraceptive patch be applied? (3)

A
  • Buttocks
  • Deltoid
  • Lower abdomen
  • (Avoid breasts)

Proper application sites ensure effective delivery of hormones.

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10
Q

What is a contraindication to the contraceptive patch related to weight?

A
  • BMI >30

Higher BMI may increase the risk of side effects and reduce efficacy.

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11
Q

Name TWO common side effects of the contraceptive patch. (2)

A
  • Skin reactions
  • Increased breast tenderness

These side effects may affect user compliance.

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12
Q

Name TWO side effects of the vaginal ring. (2)

A
  • Leukorrhea
  • Expulsion

Users should be informed about these potential side effects.

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13
Q

Name TWO advantages of the vaginal ring compared with OCPs. (2)

A
  • No daily dosing
  • Shorter withdrawal bleed

These advantages may improve user adherence.

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14
Q

Name THREE methods of emergency contraception. (3)

A
  • Copper IUD
  • Ulipristal acetate
  • Levonorgestrel (Plan B)
  • Yuzpe method

These methods vary in effectiveness and timing for use.

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15
Q

How long after intercourse can a copper IUD be inserted for emergency contraception?

A
  • Up to 7 days after intercourse

This is the window for optimal effectiveness.

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16
Q

What is the first-line hormonal emergency contraceptive agent?

A
  • Ulipristal 30 mg single dose

It is preferred for its efficacy and safety profile.

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17
Q

When is levonorgestrel emergency contraception most effective?

A
  • Within 24 hours

Timing is crucial for maximizing effectiveness.

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18
Q

Why may hormonal emergency contraception fail? (2)

A
  • Taken on the day of ovulation
  • Higher BMI

These factors can influence the effectiveness of hormonal methods.

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19
Q

What follow-up should occur after emergency contraception?

A
  • Bleeding expected within 21 days
  • If no bleeding → perform pregnancy test

This ensures that the emergency contraception was effective.

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20
Q

What are the TWO main mechanisms of progestin-only contraception? (2)

A
  • Thickening cervical mucus
  • Partial suppression of ovulation

These mechanisms help prevent pregnancy effectively.

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21
Q

Which patients are good candidates for progestin-only contraception? (4)

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A
  • Smokers >35 years
  • Migraine headaches
  • Breastfeeding patients
  • Endometriosis
  • Patients taking anticonvulsants

These conditions make progestin-only methods safer.

22
Q

Name THREE contraindications to progestin-only contraception. (3)

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A
  • Pregnancy
  • Unexplained vaginal bleeding
  • Current breast cancer

These contraindications indicate situations where progestin-only contraception should not be used.

23
Q

Name TWO common side effects of progestin-only contraception. (2)

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A
  • Weight gain
  • Menstrual irregularities

Users should be informed about these potential side effects.

24
Q

What medication is used in progestin-only oral contraceptives?

Study These Flashcards
A
  • Norethindrone

This medication is commonly used in progestin-only pills.

25
What is a key adherence rule for the **progestin-only pill**?
* Must be taken **within the same 3-hour window daily** ## Footnote Adherence to this rule is crucial for effectiveness.
26
What is the expected **amenorrhea rate** with progestin-only pills?
* ~10% ## Footnote This rate indicates the likelihood of not having a menstrual period while on the pill.
27
What is the **dosing schedule** for depot medroxyprogesterone?
* 150 mg IM every **12–13 weeks** ## Footnote This schedule helps maintain effective contraception.
28
What lifestyle counseling should be provided to reduce **bone loss** with depot medroxyprogesterone? (3)
* Vitamin D supplementation * Calcium supplementation * Weight-bearing exercise * Smoking cessation ## Footnote These measures help mitigate the risk of osteoporosis.
29
Name **THREE contraindications** to the etonogestrel implant. (3)
* Pregnancy * Liver disease or tumors * Undiagnosed vaginal bleeding * History of breast cancer * VTE ## Footnote These contraindications indicate situations where the implant should not be used.
30
Name **THREE complications** of contraceptive implants. (3)
* Irregular bleeding * Weight gain * Breast or abdominal pain * Implant migration * Infection ## Footnote Awareness of these complications is important for patient counseling.
31
How long are the following **IUDs effective**? (3)
* Mirena → 8 years * Kyleena → 5 years * Jaydess → 3 years ## Footnote These durations indicate the longevity of each IUD type.
32
Name **THREE benefits** of levonorgestrel IUD. (3)
* Reduced menstrual bleeding * Reduced dysmenorrhea * Reduced risk of endometrial cancer ## Footnote These benefits enhance the overall health of users.
33
Name **THREE complications** of IUD insertion. (3)
* Uterine perforation * Expulsion * Ectopic pregnancy * Pelvic infection ## Footnote These complications highlight the importance of skilled insertion techniques.
34
What should be done if **IUD strings are not visible**? (3 steps)
* Rule out pregnancy * Perform speculum exam * Ultrasound * If still not located → abdominal X-ray ## Footnote These steps help ensure the IUD is correctly positioned.
35
What should be done if **pregnancy occurs with an IUD in place**?
* Remove the IUD immediately * Rule out ectopic pregnancy ## Footnote This is crucial for the safety of the patient.
36
A 24-year-old woman takes a **progestin-only pill** daily but realizes she took yesterday’s pill **6 hours late**. She had intercourse earlier that day. What should she do?
* Take pill immediately * Use **backup contraception for 48 hours** ## Footnote This ensures continued protection against pregnancy.
37
A 29-year-old woman using **depot medroxyprogesterone** presents at **15 weeks since her last injection**. She had **no unprotected intercourse**. What should be done?
* Perform pregnancy test * Administer injection ## Footnote This ensures she remains protected against pregnancy.
38
A 31-year-old woman using depot medroxyprogesterone presents **15 weeks after her last injection** and had **unprotected intercourse 3 days ago**. What is the correct management?
* Give **Plan B** * Pregnancy test * Administer injection * Repeat pregnancy test in **4 weeks** ## Footnote This approach addresses potential pregnancy while ensuring continued contraceptive coverage.
39
What are the **two main forms of surgical contraception**? (2)
* Tubal ligation (female sterilization) * Vasectomy (male sterilization) ## Footnote These methods provide permanent contraception options.
40
What is a key **counseling point** before surgical sterilization?
* It should be considered **permanent contraception** ## Footnote Patients must understand the irreversible nature of these procedures.
41
What additional benefit is associated with **bilateral salpingectomy** compared with simple tubal ligation?
* Reduced risk of ovarian cancer ## Footnote This procedure offers protective benefits beyond contraception.
42
Name **THREE complications** of tubal ligation. (3)
* Surgical injury to bowel or vessels * Infection * Bleeding * Failure with ectopic pregnancy ## Footnote These complications highlight the risks involved in the procedure.
43
What important **pregnancy complication** is associated with failed tubal ligation?
* Ectopic pregnancy ## Footnote This is a critical concern if pregnancy occurs post-sterilization.
44
What are common **complications** after vasectomy? (3)
* Hematoma * Infection * Sperm granuloma * Chronic scrotal pain ## Footnote These complications can occur but are generally manageable.
45
What **counseling** is essential after vasectomy regarding contraception?
* Contraception must continue **until semen analysis confirms azoospermia** ## Footnote This ensures that the patient does not rely on the procedure until confirmed.
46
When should **semen analysis** be performed after vasectomy?
* About **3 months after procedure** * After **~20 ejaculations** ## Footnote This timing allows for accurate assessment of sperm presence.
47
How many **semen samples** confirming azoospermia are typically required before stopping contraception?
* One (sometimes two depending on protocol) ## Footnote This ensures reliability in confirming sterility.
48
Name **TWO advantages** of vasectomy compared with female sterilization. (2)
* Lower complication rate * Simpler outpatient procedure * Local anesthesia only ## Footnote These factors make vasectomy a preferred option for many.
49
A 36-year-old man undergoes vasectomy and asks when he can stop using condoms. What should you advise?
* Continue contraception until **semen analysis confirms azoospermia (≈3 months)** ## Footnote This ensures that he does not risk unintended pregnancy.
50
A 33-year-old woman had tubal ligation 5 years ago and presents with abdominal pain and positive pregnancy test. What must be ruled out?
* **Ectopic pregnancy** ## Footnote This is a critical condition that requires immediate attention.
51
A couple asks which permanent contraception method has **fewer complications** and faster recovery. What should you recommend?
* **Vasectomy** ## Footnote This method is generally less invasive and has a quicker recovery time.
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