Arcadia - Oral And Hormonal Contraceptives

Front 1

Most OCPs contain synthetic estrogen in the form of?

Back 1

ethinyl-estradiol

Front 2

Most OCPs contain which progestins? (4 most common)

Back 2

norethindrone, levonorgestrel, and the newer desogestrel and norgestimate

Front 3

T/F - Progestin is most important for contraception

Back 3

True

Front 4

T/F - Both estrogen and progestin (a balance between the two) are involved in cycle control.

Back 4

True

Front 5

Estrogen doses range between?

Back 5

Dosage ranges 50mcg to 20mcg

98% of products contain 35 mcgs of estrogen or less

Front 6

Indications for progestin only formulations

Back 6

Postpartum < 6 weeks
Lactating patients (may change to COC when supplemental feedings are introduced)

Front 7

Proposed advantages of variable regimens

Back 7

more physiologic hormone levels (phasic regimens do not approximate “normal” cycle patterns),
improved cycle control with lower total hormone doses
reduced side effects (possibly due to lower hormone doses)

Front 8

Describe monophasic hormone regimen

Back 8

Estrogen & Progesterone levels constant.

Most common.

Front 9

Describe bi-phasic hormone regimen

Back 9

Estrogen constant for 21 days;
progestin decreases late in cycle.

Front 10

Describe tri-phasic hormone regimen

Back 10

Progestin (and/or estrogen) varies in three phase cycle

Front 11

T/F - Oral contraceptives can be used safely by women until menopause.

Back 11

True.

The FDA removed the age restriction for COCs in non-smokers.

Front 12

T/F - The risk for thromboembolism increases over the age of 35 for women who are obese and who smoke.

Back 12

True

Front 13

The lowest dose of estrogen is recommended. What is recommended dose?

Back 13

20 ug

Front 14

T/F - Progestin only pills have higher efficacy rates?

Back 14

F

Front 15

Contraindications to COCs

Back 15

Pregnancy
Malignancy (breast, endometrial, hepatic)
Thromboembolic disorders
Major surgery with expected prolonged immobilization
Smokers > 35
Heavy smokers of any age
CAD
Uncontrolled hypertension
Undiagnosed vaginal bleeding
Migraine h/a with aura

Front 16

What typically guids the selection of one COC prep over another?

Back 16

Differences in the side effect profiles of the progestin component is determining factor.

Front 17

Describe early BTB and the tx

Back 17

Early BTB (occurs in the first 3-4 cycles of use) generally requires no treatment.

Front 18

Describe late BTB and the tx

Back 18

BTB occurring later, after 3-4 cycles of use or after many cycles of use may require intervention. The most common cause, missed pills, should be ruled out before making changes to formulations.

Front 19

Causes of late BTB

Back 19

Missed pills* - MC
Smoking
Infection
Formulation adjustment needed
Drug interactions

Front 20

Estrogen related side effects such as nausea, breast tenderness may be minimized by _________?

Back 20

selection of low dose formulations.

Or, use of progestin only products

Front 21

Breakthrough bleeding or spotting may be minimized by _____?

Back 21

altering the ratio of estrogen to progestin.

and/or verify compliance

Front 22

Progestin related side effects such as acne and hirsutism can be improved by _______?

Back 22

May improve on newer progestins
Switching to alternative progestin

Front 23

What can you do to prevent risk of thrombosis?

Back 23

Use lowest possible estrogen dose

No increased risk of thrombosis from current low dose estrogens is seen.

Front 24

What can you do to prevent risk of dyslipidemia?

Back 24

Use low dose progestin formulations
Consider newer progestins

Front 25

Mechanisms leading to drug interactions with OC include _____ and _____?

Back 25

CYP3A4 induction and interference with intestinal flora.

Front 26

T/F - If you take an OC and Antibiotics (broad spectrum) penicillins, tetracycline or Griseofulvin, you need to use back up contraception.

Back 26

True

Front 27

T/F - A person taking OCs and Acitretin (soratane) should use a back-up method of contraception.

Back 27

True

Front 28

Anticonvulsants such as phenytoin, carbamazepine, phoneobarbital and primidone reduce the effectiveness of OCPs by what mechanism?

Back 28

Cytochrome P450 interaction (CYP3A4 induction)

Front 29

Implanon
Drug and MOA

Back 29

etonogestrel (3-keto-desogestrel), the active metabolite of desogestrel (newer progestin)
Effective for 3 years
Inhibits ovulation during the entire treatment period

Front 30

NuvaRing
Drug and MOA

Back 30

Releases 15 ug of ethinyl estradiol and 120 ug of etonogestrel (progestin, metabolite of desogrestrel) daily

Front 31

Mirena
Drug and MOA

Back 31

Releases 20 ug of levonorgestrel (progestin) per 24 hrs
Duration: 5 years

Front 32

OrthoEvra
Drug and MOA

Back 32

Delivers continuous systemic doses of hormones

150 µg norelgestromin (NGMN)(metabolite of norgestimate)
20 µg ethinyl estradiol (EE)

Front 33

OrthoEvra causes a significantly increased risk of ___?

Back 33

thromboembolism

Front 34

Estimated Effectiveness of E.C.

Back 34

75%

Front 35

Options for E.C.

Back 35

Emergency contraceptive pills
Progestin only pill administration
Danazol administration
Post-coital IUD insertion
High dose estrogen administration
Mifepristone (RU 486)
Early pregnancy identification and early abortion

Front 36

What is the Yuzpe Method for E.C.?

Back 36

Using combined oral contraceptives with a total dose of estrogen (ethinyl estradiol) of 200 mcg and progestin (norgestrel) of 2 mg

The first dose is taken as soon as possible after unprotected intercourse (up to 72 hours later) and the second dose is taken 12 hours after the first

Front 37

Meclizine or Diphenhydramine may be given with COCs as E.C. to prevent ___?

Back 37

n/v

Front 38

Synthetic androgen that can be used as E.C.?

Back 38

Danazol

mixed results but consider for women with contraindications to estrogens.

Front 39

Potent anti-progesterone that can be used as E.C.?

Back 39

Mifepristone

Endometrium b/c unsuitable for implantation.