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99 Cards in this Set
- Front
- Back
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Why do we give women options in contraceptives
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because of compliance. Compliance is the main key to birth control. Some women comply better on certain contraceptives.
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Why is STDs (ex. Herpes, HPV) so important with pregnancy
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= Not all STDs go away. Some remain viral and stay in the body for life. Some could be recurrent so it’s really not a quick fix for antibiotic. So just because they are on birth control, it doesn’t mean that they are protected from STDs
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Why do we check all medical history even when giving birthcontrol on young adolescents
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because even the young have disorders such as clotting disorders.
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What is the main key when dealing with adolescence
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confidentiality
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Once a minor becomes pregnant, do they still need parents consent
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no they are automatically emancipated minors. But may vary from state to state. If needs aborption, it may require parents consent. But C-section or any other delivery procedures; they don’t need parents consent.
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What behaviors do adolescents normal show in terms of STDs or pregnancy
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risk behaviors. “it won’t happen to me.” Or even if it happens to them once, they think it will not happen to them again.
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Perimenopausal
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woman that are late 30s early 40s. They start to have menstrual changes. Sometimes they have it sometimes they don’t have it.
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Do you think perimenopausal woman can still get pregnant =
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yes they can because they are still having menses. It doesn’t matter if it’s regular or not regular menses. So you need counsel them of the right contraceptive for this age group.
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What contraceptive can you offer perimenopausal woman
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low-dose Contraceptives
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What do you assess them for before you give them contraceptive s
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screen them for smoking, cholesterol issues, blood pressure issues, kidney or gallbladder disease
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What type of contraceptives can perimenopausal woman take that is less risky =
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IUD (Intra Uterine Device). Lower maintenance.
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What are older women at risk for in pregnancy
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= 40yrs old or older are at risk for having multiple fertility; twins.
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BTL (bilateral Tube ligation)
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they tie the tube. It is more invasive and more expensive than males sterilization.
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What type of anesthesia does it require for female BTL (sterilization)
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regional or block
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How effective is female sterilization
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95%. So 5% of the woman can still get pregnant after having the procedure.
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What is the most effective type of birth control
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abstinence
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What is the male’s sterilization called
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vasectomy
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Which sterilization is more invasive and costly, the male or the female’s
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the females. The female’s could cause 5000 vs with the male, it’s only $600.
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Where can vasectomy be done
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IT can be done in the office because it only requires local anesthesia.
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what is the cause that male or female could sometimes be pregnant after having permanent sterilization
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at a lot of times they don’t come back for their check up to see if they have any live sperms or eggs
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what do normal birth control comes with
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progesterone and estrogen
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Why do some birth control only come with progesterone =
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people who can’t tolerate estrogen, coagulation issues who can’t have estrogen.
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So what is the most common type of progestin only contraceptive
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Depo Provera
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Depo Provera
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given IM at 150ml every 3months or 12 weeks
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What happens if you miss your injection of depo provera
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you can get pregnant
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What is depo also good for besides birth control
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Women who have menstrual disorders. it greatly reduces bleeding, and cramping.
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How does depo provera reduces bleeding
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it thins out the lining of uterus. So they would have less lining to shed thus less menstrual bleeding.
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What is the action of depo provera
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suppresses ovulation
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What is the side effect of depo provera
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irregular bleeding es. Those patients who have it after delivery because they have irregular bleeding initially. So you have to teach them that they may have some spotting so that they don’t freak out.
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How does depo affect weight
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some can have weight gain. Could be due to insulin resistant associated with it.
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How does depo affects the skin =
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acne, mood changes,
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Good candidate for depo
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Patients that have coagulapathy or heart disease, pace maker. Because these people can’t tolerate estrogen and depo do not have estrogen
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Implanon
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another form of progestin only contraceptive. It uses rods
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How long does implanon last
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2-3yrs
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What’s the improvement in implanon
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it is easier to insert, easier to remove, and only 1 rod system
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Emergency contraceptive
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good up to 72 hrs (plan b). But not a form of birth control
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How old do they have to be to use emergency contraceptive
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= 17 and older
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When is emergency pill taken
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12 hrs after unprotected sex.
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Evra patch
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estrogen & progestin birthcontrol.
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What is the problem with evra patch
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= it increases risk of blood clotting – but still in the market so we need to counsil the patient about it
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What is the contraindication of evra patch
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it is contraindicated to patients who smokes or older because of the increase in risk for blood clotting
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How many days in a pack of envra patch
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28 or 21 day pack
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The last seven day of the pack is wat
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placebo pill which only contains sugar just to get patient in a habit of taking a pill everyday. So we normally use the 28day pack due to this reason
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Where can you put the evra patch
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= abdomen, shoulder. Rotate the site.
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Where cant you not apply the evra patch
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= near the breast is not a good place.
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Nuva ring
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hormonal contraceptive that you leave in the vagina for 3wks
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When and why do you remove the nuva ring
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so that you can have menstrual cycle for a week. After the 7days, you put another one in.
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Action of hormonal contraceptives (ortho, evra patch, and nuva ring
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suppresses ovulation
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If patient have family history of coagulapathy but wants to get in hormonal contraceptive, what do u do
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have them get a blood test to make sure they don’t’ have that disorder. If they don’t then they can get on it.
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If first time using birth control, who long do you have to use condom
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use condom for 1st 2weeks just to make sure you give time for the contraceptive to work or becomes effective
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How often should they come for check up after starting on birth control pill and why
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= 3months. Just to make sure that they are ok with the birth control they are on now . They can be given different type if they don’t’ like their pills because some are good for cramps, cycle control, etc. depending on their symptoms
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What vital sign should they be evaluated for when they come in for check up from birth control
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Blood pressure, even in younger population because they can also have alteration in their B/P.
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Once they their pill, when should they start taking it
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on first day of menses (the real pill or placebo?)
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Why do you take the birthcontrol on say time everyday day
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to make the therapeutic level continuous.
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Why do you take the pill with food
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because the estrogen could cause nausea and vomiting. So take it wid food until the body gets used to the hormone.
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What do you counsel patient wid regarding their bleeding when on birth control pill
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that they may have irregular spotting in the 1st 2-3months
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What do you assess on patients taking estrogen related birthcontrol
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ACHES when they come in for their check up.
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ACHES stands for =
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abdominal pain, chest pain, headache, eye problem, severe leg pain.
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taking estrogen related birthcontrol , abdominal pain that does not go away with meds could be related to
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= gallbladder, liver
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taking estrogen related birthcontrol, chest pain, dyspnea, hemoptysis
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could be related to blood clotting
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taking estrogen related birthcontrol, headache especially with neurological changes such as numbness or weakness of extremities , what should we do
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so switch them to something different because this is concerning signs.
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taking estrogen related birthcontrol, eye problem could be related to
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visual changes, blurry, double
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taking estrogen related birthcontrol, severe leg pain, or swelling of calf, thigh could be related to
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DVT
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How long can you leave on IUD
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5-10 years without removal. But you don’t have to put it on that long. You can remove it anytime by pulling the string that’s attached to it.
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Example of IUD
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mirena and paraguard
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What is mirena IUD composed of
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progestin
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What is the mirena good for
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for people that have heavy bleeding and severe cramping because it does have progestin in it which helps with the bleeding and cramping
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What is the advantage of mirena
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it doesn’t really have systemic side effects and it is pretty local as far as it’s effectiveness and does last for 5yrs
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Why do we need to make sure that the patient is practicing monogamy prior to insertion of IUD
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because it increases the risk for pelvic inflammatory disease. So also screen for STDs as well especially that they are asymptomatic
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What is Paraguard made out of
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only copper
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How long does paraguard good for
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10 yrs.
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What type of allergy is contraindicated for using paraguard IUD
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women who are allergic to copper.
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Can you still get pregnant with IUD
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yes but rare.
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If the patient is already having heavy bleeding and cramping, can IUP can you give to them
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Mirena and not the paraguard becaue paraguard already causes severe cramping and bleeding
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What’s the action of IUD which prevents pregnancy
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Spermicidal effect and local antiinflamatory effect on the endemetrium
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Which method of contraceptive is the least effective
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barrier methods such as condoms, diaphragm, cap, and sponge; because they can break and fall off.
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What allergies do you screen for when giving barrier method of contraceptive
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latex especially diagram
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what does cap need to be fitted for before use
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needs to be fitted specifically over the cervix. Nuva ring you just push it up.
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What do you add on the diagram before use
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spermicidal gel. So it can be very messy
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If patient don’t use tampons and are nor confortable touching themselves which method of contraceptive should you not recommend
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diagram, cap
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How long do you leave the diagram on for
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leave for at least 6hrs after intercourse and add more gel in the vagina if they need to have intercourse again during that time frame.
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How does sponge method of birthcontrol work
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= you wet it cuz it has spermicidal on it and then you put over the os of the cervix.
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What can you use in conjuction with condoms
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spermicidal
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What does spermicidal come on =
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vaginal film, gel, nonoxyl -9
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What is nonoxyl-9
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= it is contained in spermicidal that kills sperm
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How effective is spermicidal
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only 74% effective
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Withdrawal =
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81% effective - There’s an initial sperm in the ejaculate ?
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If you are on a 28day menstrual cycle, when do you normally ovulate
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14days of the 28day cycle
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What do you check for when you are ovulating
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basal body temp. if elevated, you are ovulating
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What is the cervical mucous have to be that suggests sperm can’t survive
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when the cervical mucous is thick. This is safer sex. As opposed to when mucous is very thin and slippery, this is the time frame that they are ovulating. This is the time you need to watch out for if you are not planning to be pregnant.
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Is hormonal methods more effective than barrier method
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yes because they tend to also regulate cycle especially estrogen and progestin birthcontrol. It also reduces bleeding.
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What is dysmenorrheal and what can improve it
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= it is a painful cramp that can be improved with hormonal methods of birthcontrol.
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How do hormonal birthcontrol improve acne
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es. Yasmin, orthotricyclin. Because they have lower endrogenic progestine which causes oily skin and acne. But because some hormonal birthcontrol have lower endrogenic progestin, they can improve acne by suppressing some endrogens.
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Which cancer does hormonal contraceptives reduce
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= it reduces risk for endometrial because it reduces the lining of the uterus. It also reduces ovarian cancer because it suppresses ovulation
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How does hormonal contraceptive lower anemia
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because it decreases bleeding
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If they have TWO agents of Hypertension can they have hormonal contraceptive
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no
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Contraindications FOR hormonal contraceptive
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Hypertension; Thromboembolic disease; >35 y.o.* (DEPENDING ON THEIR RISK FACTOR. IF NON, THEY CAN GO ON LOW DOSE BIRTH CONTROL ; Smoker; Liver disease, Hyperlipidemia
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Side Effects OF hormonal contraceptive:
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Headaches; Nausea; >appetite, wgt gain; Irregular bleeding; Melasma, Severe: HTN, stroke
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What is melasma =
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hyperpigmentation of the skin due to estrogen
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