Imported: Repro_Test 1: Schriefer_Chemical Contraception

Front 1

what is Ethinyl estradiol? use?

Back 1

estrogen with an ethinyl group to prevent first pass effect

Contraceptive

Front 2

if something has Nor or gest in its name, what kind of drug is it?

Back 2

Progestin

Front 3

MOA of contraceptive steroids?

Back 3

Combination preps inhibit ovulation.

giving estradiol/progesterone turns off the release of GnRH, thus turning of FSH/LH, thus inhibiting ovulation

Front 4

if you have a combo drug such as Ortho-Novum 1/35....what is the 1/35?

Back 4

1=mg of progestin

35=mg of estrogen

important because if someone is having a side effect you can lower the dose

Front 5

if a person is on Ortho-Novum 10/11 28

what is meant by the numbers?

Back 5

you have a biphasic drug

you are getting different doses of progesterone to start followed by a certain dose of estrogen

Front 6

When would you give a pt a progestin only methods? why aren't they preferred?

Back 6

if they have contraindicaions (DVT)

you get unpredictable spotty bleeding for the first year

Front 7

DES is what kind of drug? Side Effect?

Back 7

Emergency contraceptive

Teratogenic

Front 8

what is Levonorgestrel?

Back 8

PLAN B

Front 9

a pt with a BMI>27 must do what with respect to contraceptive steroids?

Back 9

must take a higher dose...contraceptives can be sequestered in fat

Front 10

how are contraceptive steroids metabolized? what does this allow for?

Back 10

hepatic metabolism

allows for re-uptake and thus low dose

Front 11

What are some of the mild side-effects of contraceptive steroids?

Back 11

Nausea, mastalgia, breakthrough bleeding, edema are related to estrogen

Changes in serum proteins may alter endocrine function

Mild headache

Diuresis or hyperkalemia with drospirenone (progestone that is like spironolactone)

Front 12

What are some of the moderate side-effects of contraceptive steroids?

Back 12

Breakthrough bleeding
Weight gain
Increased skin pigmentation
Acne
Hirsutism
Vaginal infections
amenorrhea

Front 13

What are some of the serious side-effects of contraceptive steroids? 4

Back 13

Vascular disorders such as venous thromboembolic disease (slightly higher with drosperinone), myocardial infarction and cerebrovascular disease. Ortho Evra patch and 3rd gen progestins have elevated risk of venous thromboembolism.

GI disorders such as cholestatic jaundice, gall bladder disease, hepatic adenoma

Depression (progesterone)

Cancer; estrogen containing contraceptives may stimulate growth of pre-existing tumors, but risk of endometrial or ovarian cancer is less. Risk of cervical and breast cancer is controversial. Probably do not increase risk.

Front 14

pt starts taking a contraceptive and after 2 cycles is still complaining of nausea, bloating, HTN, and migrane headaches... What is going on and what should you do?

****

Back 14

giving too much estrogen

back off the dose

Front 15

pt starts taking a contraceptive and after 2 cycles is still complaining of early or midcycle breakthrough bleeding, increased spotting, and hypomenorrhea...... What is going on and what should you do?

****

Back 15

giving too little estrogen

give more

Front 16

pt starts taking a contraceptive and after 2 cycles is still complaining of... increased appetite, weight gain, tiredness, fatigue, acne, oily scalp, hair loss, and hirsutism...What is going on and what should you do?

****

Back 16

giving too much progestin

back off the dose

Front 17

pt starts taking a contraceptive and after 2 cycles is still complaining of late breakthrough bleeding, amenorrhea, and hypermenorrhea... What is going on and what should you do?

****

Back 17

giving too little progestin

give more

Front 18

at what age do contraceptive pills stop giving a protective effect?

Back 18

40

sorrrryyyyy

Front 19

if a pt is a smoker and takes oral contraceptives, what happens as they get older

Back 19

the risk of death increases as they age

Front 20

what are some important contraindications of birth control? 7

Back 20

thromboembolic disease

past/present history of cerebrovascular disease

hepatic adenoma

>35 years old (esp if smoker)

impaired liver function

Pregnancy

Past/present history of malignancy of breast, repro system, or any estrogen dependent tumor

Front 21

headaches are effected by contraceptives in 2 very different ways...please explain

Back 21

migraine with aura-->contraindication for contraceptive

migraine that is assoc with period-->can be treated with oral contraceptives

Front 22

pt has known seizures and is taking phenytoin...if a pt is on oral contraceptives what do you have to consider?

**

Back 22

phenytoin induces microsomal drug metabolism

so you need to increase the dose or find some other form of contraceptive

Front 23

how do antibiotics decrease the effectiveness of oral contraceptives? 2 drugs most likely to do this?

**

Back 23

getting rid of normal flora of the gut...

remember that after hepatic conjugation the bacteria deconjugate and allow the contraceptive to recirculate. So this would be decreased on ABX

examples: rifampin (TB drug) /griseofulvin (anti-fungal)

Front 24

side effects of vaginal spermicides?

Back 24

– candidiasis, increased vaginal infections, toxic shock syndrome
Studies have shown that nonoxynol 9 increased the risk of HIV infection when used frequently be women at high risk of infection.

Front 25

What is the MOA of intrauterine devices

Back 25

do not prevent fertilization but do prevent implantation of blastocyst in uterus.

releases copper/progestin-->
Copper may block estrogen effects on endomentrium which inhibits implantation.
Progestins cause thickened cervical mucous and endometrial changes (glandular atrophy and a chronic decidual reaction) which inhibit implantation

Front 26

why are IUDs good for pts who have already had their kids?

Back 26

more difficult to get pregnant after IUD

Front 27

what is Implanon?

Back 27

long acting progestin

subQ implant, 3 year contraceptive effect

Front 28

what is a concern when using long acting progestins?

Back 28

Inhibition of gonadotropin release decreases estradiol levels, which may decrease bone mineral density.

Front 29

a pt has been on OC for about 5 years and wants to stop it so she can get preggo. How long after stopping will she be able to make babies

Back 29

within 3 months of stopping oral contraceptive use

Front 30

pt calls worried that they missed a dose of the their OC. what can they do?

Back 30

likely just take 2, but read package for specific instructions

Front 31

what is the idea behind using a biphasic OC?

Back 31

biphasic allows for lower levels of steroids to hopefully have less side effects

Front 32

Benefits of Oral Contraception:

Patients will have less of a risk for what cancers/diseases (4)?

Back 32

- ovarian cysts and cancer
- endometrial cancer
- benign breast disease
- ectopic pregnancy