Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
Considerations in choosing contraception
|
level of protection desired (absolute
vs. spacing children) -knowledge and attitude about methods -frequency of coitus -extent of male participation in contraception -patient compliance -attitude about contraceptive failure -cost THIS GROUP OF pts has low tollerence for adverse RXs always--remeber reversibility |
|
|
method effectiveness
versus use effectiveness: |
method effectiveness refers to efficacy
with consistent proper usage use effectiveness refers to efficacy under actual conditions of use (more compliance needed = less use effective) |
|
|
NAtural Birth control Methods
|
Natural family planning, ovulation detection
Periodic abstinence (traditional rhythm): low efficacy (sperm can hang out for days) and various methods to predict timing in cylce (Basal Body Temperature,cervical mucus, Breastfeeding) |
|
|
Timing methods
Basal Body Temperature |
P increases
basal body temperature; by time P rises, the oocyte is no longer viable and intercourse is safe. BBT rises 0.25-0.5°C (0.45-0.9°F). must check consistantly at the same time (say in the morning) |
|
|
Timing methods
cervical mucus: |
cervical mucus is thin,
watery and plentiful when estrogen is high, just prior to ovulation. A woman can often identify this and predict ovulation P causes thick mucus) |
|
|
Breast feeding as birth control
MoA |
Increased PrL (-) LH, FSH
2/3 return to ovulation w/in 9 Mo must be careful always feed baby...first menstration after first OVUlation |
|
|
Tubal ligation or vasectomy:
|
Should be
chosen only if irreversible and permanent contraception is desired. sometimes it is reversible |
|
|
Essure:
|
A microinsert composed of a spring-like coil is inserted into each Fallopian tube. The body reacts to the presence of the inserts and forms a blockage of the tubes. The reaction takes 3 months, so another form of birth control must be used until the tubes are blocked
|
|
|
Spermicides
named |
Nonoxynol 9
Octoxynol |
|
|
Nonoxynol 9
|
• Non-ionic detergent, sued as a topical contraceptive
Inhibits sperm motility and function Disrupts cell membranes Physical barrier cream, film, foam (fastest), jelly, gel, sponge, vaginal suppositories no absolute CIs |
|
|
octoxynol
SE DIs |
Nonoxynol-9 also spermatocide
• Irritation of vaginal/cervical epithelium May irritate partners skin • No contraindications • Not teratogenic • Intravaginal azoles may inactive or be inactivated by these drugs (inactivate eachother) increases AIDS infectivity********** |
|
|
Barrier method of contraception
SEs |
foreign body in vagina can result in infection and even TSS if left too long
|
|
|
Combination Oral Contraceptives (COC): defined
|
contain both estrogen and progesterone.
Natural estrogens and progesterone are not used because of first pass metabolism in the liver. |
|
|
Combination Oral Contraceptives (COC):
Estrogens |
Ethinyl estradiol
Mestranol |
|
|
Combination Oral Contraceptives (COC):
Progestins |
Norgestrel
Levonorgestrel Norethindrone Ethynodiol diacetate Norgestimate Desogestrel THESe are all sythetically derived from Testosterone all with some degree of androgen activity (first two the most, and also the most potent Ps) P alows differentiaition and bleeding(decid) Drospirenone is a synthetic progestin that is related to spironolactone. |
|
|
Seasonale
composition SEs |
(ethinyl estradiol + levonorgestrel)
extended cycle-taken for 84 days, followed by 7 days There is a greater incidence of spotting or irregular vaginal bleeding during the first cycles with inactive tablets. (MISSING A PILL IS A BIgger deal with these extended guys) |
|
|
progestins varied activity
|
Norgestrel and levonorgestrel: most
potent progestational, androgenic, and antiestrogenic activity -Norethindrone and ethynodiol diacetate: have slight estrogenic activity; norethindrone has slight androgenic activity -Norgestimate and desogestrel: very low androgenic activity and with antiestrogenic activity |
|
|
Combination Oral Contraceptives (COC):
MoA |
Inhibit gonadotropin secretion by negative
feedback, including prevention of both the midcycle LH surge (blocks ovulation) and the follicular phase FSH needed to stimulate follicular growth( fewer foll. recruited) -Progestin component causes increased viscosity of cervical mucus, decidualization of the endometrium, and reduced contractility of the uterus Uterine endometrium is unreceptive to implantation (Es job) -Gamete transport in fallopian tubes is disrupted |
|
|
Minor adverse effects of COC
|
Nausea, breast tenderness, water
retention, breakthrough bleeding Rarely: benign hepatic adenomas, Progestins(and andro)-serum lipid effects & hyperglycemia. |
|
|
Serious adverse effects of combination
oral contraceptives: |
stroke
-MI (paradox scene)(much now less with the low doses -DVT/embolus (due to synthetic) (much worse if smoke) -hep. adenoma(synthetic) -hypertension (5%) -atherosis (Prog) |
|
|
Contraceptive patch
contains SEs |
Contains norelgestromin (a progestin)
and ethinyl estradiol. 1 patch/week off week like normal pill very RECENT warning-----these release higher concentrations(knew THis)--and now they say increases DVT. |
|
|
Vaginal ring (NuvaRing)
|
(ethinyl estradiol + etonogestrel)
in three weeks then out 1 |
|
|
Absolute contraindications for COC
|
HTN
hyperlipidemia, pregnant, undiagnosed vaginal bleeding, estrogen- sensitive tumor, history of deep vein thrombosis, stroke, myocardial infarction, heart disease, or vasculitis |
|
|
Relative contraindications for COC
|
diabetes but otherwise healthy
-migraines |
|
|
SMoking and COC
|
Smoking increases the risks of oral
contraceptives. smoke over 35---no pill under thirty five only LOW dose pills over thirty five non smoke low dose only |
|
|
COC,hrt and Cancer(breast, endomet,cervical
|
Breast cancer controversial
The risk of ovarian and endometrial cancer decreases with COC Risk of cervical cancer increases (due to increased HPV exposure not hormones) |
|
|
Noncontraceptive indications for steroidal contraceptives
|
to increase menstrual cycle regularity
-to reduce menstrual blood loss -to decrease dysmenorrhea |
|
|
Noncontraceptive benefits of the pill
|
Reduction in the risks of benign fibrocystic
breast disease, menorrhagia, endometrial and ovarian cancer, endometriosis, iron deficiency anemia, dysmenorrhea, PMS, decreased severity of PID, and decreased ectopic pregnancy. there is also more menst. cycle regularity |
|
|
Progestin-only pill
contains |
Norethindrone
Norgestrel more breakthrough bleeding but becoming more popular can be used in lactation (E stops it ) |
|
|
Depot P prepiration
|
etonogestrel
lasts three years rod under arm Medroxyprogesterone acetate IM 1/ 3 months can decr bone density if given >2 years |
|
|
Combo depot prep
contains |
Medroxyprogesterone acetate and
estradiol cypionate 1/month more menst reg. |
|
|
mechanism of action Of
P only pill |
Causes cervical mucus to be thick and
viscous (unreceptive to sperm) -decidualization of endometr. -Affects transport time of the oocyte in the oviducts and of sperm in the uterus Inhibits gonadotropins,(less reliable than COC at (-) ovulation -Endometrium becomes atrophic and is not conducive to implantation |
|
|
depot progestins
SEs |
menstrual cycle irregularity:
(breakthrough bleeding, spotting, amenorrhea) |
|
|
Intrauterine devices (IUD’s)
indications |
• Recommended for Women that …
Have had 1 child Are in a stable monogamous relationship Have NO history of ectopic pregnancy or PID |
|
|
Intrauterine devices (IUD’s)
Named contents |
ALL IUDs in US are medicated
Progestasert: a progesterone-containing IUD requires yearly replacement -Copper IUD: (ParaGard T 380A) Effective for 10 years, releases copper -Mirena: releases levonorgestrel for 5 years |
|
|
Progestasert:
|
a progesterone-containing
IUD requires yearly replacement |
|
|
Intrauterine devices
SEs |
• Increased spotting/breakthrough bleeding
Especially in first 3-6 months • Ovarian cysts, acne, breast tenderness, mood changes • Perforate uterus/cervix during implantation (this is why most have been removed from market |
|
|
Mirena
|
IUD
releases levonorgestrel for 5 years |
|
|
Intrauterine devices (IUD’s)
MoA |
previously thought they aborted implanted.....But now think
• Modify biochemical environment of endometrium Causes inflammatory reaction in uterus that is toxic to sperm & ova (cytokines) • Progestins released have same affect on cervical mucus, oocyte transport, and gonadotropins as oral contraceptives |
|
|
emergency contraception
methods |
Plan B(Levonorgestrel)=Progestin-Only Emergency Contraception
IUD Can also use COC...or E alone but not good on the endometrium at the high doses(NEED to USE HIGH DOSES) same mechanism as OCT but quick (AND E is an emetic big time) Mifepristone (off label) (RU486) |
|
|
plan B
|
Levonorgestrel)=Progestin-Only Emergency Contraception
• 0.75 mg levonorgestrel • Two pills taken with a 12 hour interval within 72 hours of coitus. |
|
|
EMERGENCY contraceptives
SEs |
nausea vomit and breast pain are common in high dose E
plus estrogen is very potent at stimulating closure of the epiphyses. |
|
|
Drug interactions with steroidal contraceptives that decrease the efficacy of the second drug:
|
coumarin
-acetaminophen -thyroxine -OC may increase blood glucose so that increased insulin has to be given to type I diabetics |
|
|
Drug interactions with steroidal contraceptives that increase
the efficacy of the second drug: |
-cyclosporine
-theophylline -imipramine -corticosteroids (reduced metabolism) |
|
|
Drug interactions that decrease the
efficacy of the steroidal contraceptive: |
antiepileptic drugs (eg, phenytoin,
carbamazepine) -griseofulvin -rifampin -possibly ampicillin and tetracycline -St. John's Wort (+ CYP3A4) |
