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109 Cards in this Set
- Front
- Back
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The cervical lesions of HPV are caused by a ____ response to the HPV infection
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cellular
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In HPV, the specific viral proteins interact with host ___ ___
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cytoskeletal structures
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High risk HPV subtypes causes ___ ___ of cervical cells
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preneioplastic changes
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Low risk subtypes of HPV cause __ __
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genital warts
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ToF: penile cancer from HPV often occurs
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false: it is rare
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Pap smears are now not recommended until age ___
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21
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according to ACOG, the first cervical cancer screen should occur at age __-
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21
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most women younger than __ should undergo cervical screening once every ___ years instead of anually?
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30; 2
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After age 30, women can be rescreened for cervical cancer every __ years
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3
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why are cervical cancer screens more strict under ACOG?
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because there was a significant increase in the number of premature births related to frequent cervical cancer screens
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Which testing method can identify the presence of HPV from cervical sample without the presence of lesions?
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Hybrid II capture
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Whta is the Thin prep pap smear?
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liquid cytologic testing for cervical abnormalities
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in 2011, ___ % did not used any form of birth control during their last sexual intercourse
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77
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Only __% of high school students were taught hot to correctly use a condom during health
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38
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what % of high school students were taught abstinence as the most effective method to avoid pregnancy, HIV, and other STD's.
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87%
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About __% of adolescent pregnancy end in life birth; __% end in abortion; and ___ % end in miscarraige
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51; 35; 14
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what are the 5 patterns of adolescent heterosexual experience?
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-delayers
-anticipators -one timers -steadies -mutliples |
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ToF: pregnant teens have an absence of negative attitudes toward having babies, not negative attitude toward birth control
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true
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ToF: pregnant teens tend to have a lack of knowledge regarding birth control
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false: they have a lack of motivation to use it
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What are the qualities needed for contraceptive readiness?
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-knowledge
-ability to plan for the future -willingness to acquire needed contraceptives publicly -Communication skills |
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What is the follow-up plan for a new birth control prescription?
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close follow-up, in one month to take BP, check for belly pain
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in the general counseling session, the NP should support a decision for __ at the outset
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abstinence
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to use continuous contraception you must get a ___ __ prior to the initiation.
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pregnancy test
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what are the 4 mechanisms of action of birth control?
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-prevention of ovulation through hypothalamic and pit secretion secondary to estrogenic and progestin activity
-alteration of cervical mucus, creating hostile enviroment for sperm -alteration of endometrial lining -alteration of tubal motility |
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Estrogen may exert an ___ effect in the uterus by interfering with hypothalamic-pituiatry axis causing bleeding
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antiprogestational
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If ovulation does occur, high dose of __ may increase the rate of degeneration of the corpus luteum
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estrogen
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Progestins may decrease rate of __ __ and altering tubal secretions and peristalsis.
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ovum transport
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Thick cervical mucus are promoted by ___
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progestins
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__ may decrease penetration into the sperm
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progestins
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THe injections of depo-provera are done every __ weeks
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12
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Ortho evra is a __ cm patch with __ mg of ___ and 75 mg of __
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20;6; norelgestromin; EE (ethinyl estradio)
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what are the side effects of ortho eva?
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-irregular/absent period
-weight gain or loss -nausea -breast tenderness -mood changes -recent report of thromboembolism and trombophlebitis risk is higher with this method |
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what are the hormones in the nuva ring?
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-etonogestrel and ethinyl estradiol
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what does the nuva ring do?
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prevents ovulation, thickens cervical mucus and suppresses endometrial growth
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the nuva ring can be removed for __ hours without loss of efficacy
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3
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what is the dosing of nuva ring?
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insert for 3 weeks, remove for 1 week and reinsert the fourth
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what are the side effects of Nuva ring?
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-vaginitis
-headache -leukorrehea -nausea -vaginal discomfort -spotting with breath through bleeding less common than with OCP -weight gain -return to fertility within 2-3 months |
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Describe the characteristics of an intradermal implant.
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-requires special training for insertion
-effective for long term contraception -side effects have caused early removal and adolescents are particularly vulnerable |
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what are the side effects of the intradermal implant
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-irregular bleeding
-headaches -depression -weight gain or loss -visibility or scarring at insertion site |
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what is the second most used BCM?
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depo-provera
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how does depo-provera work?
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-inhibits ovulation by inhibiting LH and FSH
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Cannot give dep-provera if you have 12+ weeks without a __ __
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pregnancy test
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Depo depletes __ storage
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calcium
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the average weight gain with Depo is __ lbs
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8
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what are the side effects of depo?
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-breath through bleeding/irregular/ absent periods
-weight gain due to increase -depression -headaches -acne |
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what are the two basic combinations of oral contraceptives?
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-formulation that contains estrogen (less than 50micrograms) progestin in a low dose
-progestin-only minipill |
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what are the advantages of oral contraceptives?
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-effective and safe
-no long term effect on reproduction -improves hursitism -decrease menstrual cramps, midcycle pain, bleeding PMS -prevents ectopic pregnancies -Can increase libido and increase HDL and decrease LDL |
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what are the disadvantages of oral contraceptives?
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-cost
-no protection from STI -unwanted menstrual changes -NV -increased headache and depression -Decreased libido -increase risk of DVT -increase risk of HTN |
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List the non-contraceptive health benefits of OCs.
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Decreases risk for:
-ovarian cancer -endometrial cancer -benign breast disease -PID -ectopic pregnancy -fucntional ovarian cysts -menstrual cycle disorders -IDA -low bone density -colorectal cancer |
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what are the major advantages of triphasic?
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-reduction of PMS
-reduction of anemia -decrease in PID -reduction of ovarian and endometiral cancer -acne clear up -decreased effect on high-density lipoproteins (with use of triphasics) -decreased effect on blood pressure -decrease effect on carb metabolism |
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what are the disadvantages of OCP?
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-confusion about color of package
-increased incidence of breakthrough bleeding -no studies reliably document long-term effect on lipids -some adolescents find the triphasic prep confusing, especially if they forget to take a pill |
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___ is the lowest effective dose of estrogen (EE) approved for OCs in the US?
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20 micrograms
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if the patient is over 150 pounds consider a dose of ___ of the pill
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35 mcg
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describe the chewable pill/
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femcon Fe ).4 mg norethindrone and 35 mcg ethinyl estradiol. and is spearmint flavored
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Describe Cylessa
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25 mcg EE
-desogestrel (desogen, mircette) -tricylic -decrease in adrogen side effects -better for PCOS |
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what is the generic warning given my the FDA in terms of OCP?
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FDA only rquires generic OCP manufacturers to sue 20% of listed ingredients
-if using 20 mcg pill, 20% may make it ineffective |
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Yasmin should not be used with adolescents with what issues?
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renal, hepatic or adrenal insufficiency.
-or on ACEIs, or antiinflammatory drugs due to risk of hyper K |
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what are the medications that interact with hormonal contraceptives?
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-barbituates
-carbamaz -oxcarbazepine -henytoin -phenytoin -primidone -topiramate -modafinia -rifamin -griseolfulvin -certain antivirals -non liver induing drugs -lamotrigine -cyclosporine -K sparing diuretics |
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what are the names of the minipills?
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-micronor
-ovette -microval |
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progestin's used in low dose OC are derivatives of ____
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19-nortestosterone
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Yasmin (drosperinone) is a derivative of ____ and has recently been linked to increase in ___
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spirolactone; thromboemboli
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what are the advantages of the minipill?
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-decreased cramps
-decreased bleeding -decreased breast tenderness -fewer headache -less acne and depression |
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what are the side effects of progesterone?
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-acne, hair growth
-amenorrhea or irregular bleeding -diuretic and antiandrogen side effects (drosperidone) -May affect appetite |
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what are the disadvantages of minipill?
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-increased chance of ectopic pregnancy
-increased in ovarian cysts -drug interaction similar to combination pill |
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what are the reasons behing OCP failure?
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-patient failure/user effectiveness
-concurrent drug interactions -OCPs can increase actions of diazepam, librium, ticyclics and theophylline |
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what are the classes of drugs that interact with OCPs?
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-Cyto P450 systems
-antibiotics and antifungals -herbal preps: St. John's wort |
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With seasonale OCPs you have withdrawal ___ every 3 months
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bleed
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what are the formulations of OCPs? ie the days that they are used and not?
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-active pills x 21 days then inactive pills for 22-28 days
-seasonale 84 continuous pills then 7 days inactive (get withdrawal bleed every 3 months) |
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Headache and fatigue while on the pill may be related to ___
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guilt
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Changes in vaginal discharge while on the pill may be related to ___ or ___
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estrogen or STD
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if breakthrough bleeding occurs while ont he pill early in the cycle, need a pill higher in ___
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estrogen
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if breakthrough bleeding occurs late int he cycle, treat with pill higher in ___ on days (__ to __)
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progestin; 15-21
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ToF: irregular bleeding is common with minipill and cannot be managed without adding estrogen
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true
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when should a patient be counseled to start taking the pill?
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within the first five days after menses:
sunday following menses |
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ToF: must use backup the first month of taking the pill
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true
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If a pill is missed it should be taken as soon as remembered in the ___
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same 24 hours
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if 2 or more pills are missed, what is the catchup
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take them twice a day, morning and night until they are caught up
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When should an NP follow up with a new Rx for OCP?
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one month later. ONly give 1 refill
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What does ACHES stand for?
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pneumonic for the thromboembolitic problem with OCP
A: abdnormal pain (severe) C: chest pain , SOB, coughing up blood H: headache (severe) E: Eye problem S: severe leg pain (calf and thigh) |
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what are the possible cause for Severe abdominal pain while on OCPs, THink aches
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-gallbladder disease, hepatic adenoma, blood clot, pancreatitis
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what are the contraindications for OCPs?
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-HTN
-> 35 smokers -active liver disease -thrombophlebitis or thromboembolitic disorders -CVD, CAD -breast or other estrogen dependent neoplasm -undiagnosed abnormal gential bleeding -presence of Leiden factor V mutation -deficienies of antithrombin, protein C, protein S or raised concentrations of Factor VIIC |
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what is the first line method of contraceptive recommended by ACOG?
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IUD
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what are the myths and misunderstandings of IUD?
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-an IUD is unsuitable for nilliparous women
-an IDU causes PID -more infertility after removal -more ectopic pregnancies |
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ToF: 3 weeks or more after IUD insertion show the rate of PID with an IUD higher than than without and IUD?
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false: no difference
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what are the screenings if IUD insertion in relation to PID?
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increase risk of PID if cervical infection at the time of the insertion
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what are the advantages of the diaphragm?
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-low cost
-can be placed in 6 hours before intercourse to not reduce spontaneity -decreased incidence of some STDs -decreased incidence of cervical neoplams |
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what are the disadvantages of diaphragms?
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-is latex, can cause allergy
-may not fit well -some sizes are expensive -must use spermicide -must leave in for 6 hours after intercourse/toxic after 24 -must be comfortable touching cervix -can cause trauma -may be used during lactation -office visit required -possible greater incidence of pap smear abnormalities |
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what are the contraindications for diaphragm use?
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-allergy to rubber
-abnormal vagina anatomy -recurring UTI -history of TSS -inability to learn correct insertion |
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what are the important teaching points for diaphragm use/
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-wash hands first
-need yearly fitting -recent weight loss/gain of 10 lbs = refit -must train to learn to fit -increased infections -BV -UTIs |
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there is a __ % failure rate with spermicide
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21
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a Lea Shield must be left in for __ hours but less than __ hours
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8; 48
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what should you tell a teen that said her BF is allergic to latex and doesn't want to use condoms?
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use latex without non-oxynol-9 but use water based sperm jelly
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Must tell teens to use only __ based lubricants while using a condom
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water
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ToF: while using a condom, the male must withdraw the penis while still erect
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true: for maximum effectiveness, and hold on to it to stop from slipping
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what are the type of condoms that those with allergic reactions can use>?
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avanti polyurethane condom
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what should be done if condom breaks?
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-immediate insert spermacidal jelly
-within 72 hours: emergency contraception |
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what are the advantages of Natural family planning?
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-may meet religious needs
-no office visit -no concern about allergies, side effects or medical conditions -low cost |
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what are the disadvantages to NFP?
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-loss of spontaneity
-no protection against STD |
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what are the adolescent issues with emergency contraception?
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-lack of awareness/misconceptions about the product
-high teenage pregnancy rate: missed opportunities for use -problems with access (approved for 17 and older) |
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what are the options for emergency contraception?
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-combined estrogen-progestin or preogestin only pill
-antiprogestins -ella -IUD |
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what are the 4 brands of the ECP regimens used in the US?
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1. Ella
2. Plan B one-step is a single tablet that contains 1.5mg of levonorgestrel 3. next choice: contains 2 doses which each have 0.75 mg of levonorgestrel. can be taken at same time or two doses 12 hours apart 4. levonorgestrel tab 1.5 mg |
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what is Ella?
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ECP approved august of 2010
-one pill of ulipristal acetate, 30mg -prevents ovulation for 5 days after unprotected sex -cannot protect against preg from additional acts of unprotected sex after the first day |
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what is the effectiveness of the yupze method?
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75%
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why is the yupze method not as liked?
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many side effects such as NV
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which IUD do they use for emergency contraception?
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copper IUD
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what are the contraindications for the emergency contraceptive pills?
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-sensitivity/allergy to any component of the pill
-undiagnosed abdominal vaginal bleeding -current pregnancy |
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what are the most common side effects to emergency contraception?
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1. bleeding
2. nausea 3. fatigue 4. lower abdominal pain 5. headache 6. bleeding was more common in women taking levonorgestrel |
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what are the male versions of contraception, done on caucasians males in clinical trials?
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-concentrate on testosterone combine with norethisteron, desogestrel, etonogestrel or depotp-medroxyprogesterone acetate
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principle of hormonal MALE contraception based on suppression of ___ and ___
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gonadotropins and spermatogenesis
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