Risks And Benefits Of Combined Hormonal Contraceptives

Front 1

nausea, bloating, HA, increased BP, and cyclical weight gain due to fluid retention due to excess___________.

Back 1

estrogen
-if persistent, decrease amt of estrogen

Front 2

early cycle(days 1-9) BTB is due to ___________.

Back 2

insufficient estrogen
-inadequate hormonal support of endometrium early in cycle
-to tx, increase estrogen content

Front 3

increased appetite, weight gain, acne, hirsutism, and vaginal moniliasis are due to excess ____________.

Back 3

progestin
-androgenic effects
-tx by using progestin component with less androgenic activity

Front 4

late cycle (days 10-21) BTB due to _____________.

Back 4

progestin deficiency
-to tx:increase progestin activity

Front 5

what are the early danger signs associated with COC?

Back 5

ACHES:
-severe Abdominal pain: gall bladder dz
-severe Chest pain:pulmonary thrombisis or embolism, AMI
-severe Headache: stroke, HTN, migraine
-Eye problems(blurred vision): stroke, HTN
-Severe leg pain: VTE

Front 6

contraindications to COC use?

Back 6

-thromboembolic d/o
-Hx or high risk for DVT, PE, thrombophlebitis
-Hx or high risk CVA, CAD, or PVD
-focal neuro Sx or increased risk of stroke
-liver tumor or decreased liver fx
-breast CA or estrogen-dependent neoplasm
-smoker >35yrs (>/=15cig/d); increased CV risk
-migraine HAs with aura
-uncontrolled HTN
-DM with vascular complications or >20yrs

Front 7

what is suggested if pt is on COC and is pending surgery with suspected immobilization following

Back 7

-d/c COC temporarily

Front 8

COC use with breast feeding?

Back 8

AAP considers COC compatible with breast-feeding

Front 9

If pt has risk factor associated with contraindication to COC use, what are the possible solutions?

Back 9

-use progestin only contraceptive
-use nonhormonal contraceptive method

Front 10

FDA labeling requirement for desogestrel (DSG) containing OCs

Back 10

-warning that these products associated with a 2-fold increased risk of VTE

Front 11

risk of VTE in COC users vs nonusers

Back 11

-low dose users have 2-6 fold increased risk of DVT and PE

Front 12

DSG vs LNG containing COCs regarding VTE

Back 12

DSG has increased risk compared to LNG

Front 13

ECs and VTE risk

Back 13

-not associated with increased risk

Front 14

arterial thrombosis(AMI, stroke) association with COC use

Back 14

-most occur in users>35yr with CV RF and are due to thrombosis
-RF=HTN, smoking, estrogen
-low dose COCs do not increase risk in healthy nonsmoking women regardless of age

Front 15

what is the mechanism for increased incidence of CV dz in OC users

Back 15

-thrombotic/thrombolic events
-NOT atherosclerosis

Front 16

what is the mechanism of HTN complications in OC users?

Back 16

-estrogen and progestin cause fluid retention and increased action of RAAS
-progestins usually antimineralcorticoid (natiuretic) but some have significant estrogenic activity

Front 17

How much do OCs increase BP?

Back 17

-6-8mmHg in both normotensive and mildly hypertensive pts regardless of estrogen dose

Front 18

Can pts with HTN take OCs?

Back 18

-hypertensive women <35yrs who are healthy and do not smoke can use low-dose COC

Front 19

hypertensive women taking antihypertensive med that causes potassium retention may have?

Back 19

-DI with drospirenone-containing COCs

Front 20

liver dz with COC use

Back 20

-severe liver dz (tumor, cirrhosis, hepatitis) or acute/chronic cholestatic liver dz is an absolute contraindication to COC use

Front 21

gallbladder dz and COC use

Back 21

-increased incidence of cholelithiasis, esp in 1st yr of use
-overall risk of gallbladder dz is not increased , but may be activated or accelerated in 1st yr of use
-low dose should have very little effect, if any on healthy pts

Front 22

diabetes and COC use

Back 22

-low dose COC should not alter glucose tolerance
-do not increase risk of developing type II
-COCs can be used in diabetic women < 35yrs who don't smoke
-contraindicated in diabetic women with vascular dz or duration >20yrs

Front 23

cervical CA and COC use

Back 23

-increased risk for cervical dysplasia and carcinoma in situ
-however, COCs not thought to cause cervical CA
-pts using COCs for <5yrs and > 5yrs had increased risk of 1.5 and 3.4 x greater, respectively

Front 24

breast CA and COC use

Back 24

-little to no effect on developing breast CA

Front 25

patterns of BTB
-early cycle vs late cycle

Back 25

-early cycle(before day14) due to insuficient estrogen to induce endometrial proliferation
-late cycle(after day 14) due to progestin deficiency to support endometrium

Front 26

___________ is the most common cause for d/c of COC

Back 26

intermenstrual bleeding
-most clinicians continue COC for at least 3 mo if that is only complaint since it usually resolves

Front 27

HA and COC use

Back 27

d/c and avoid COCs if:
-hx of classic migraine with aura(for any age)
-development of migraines(with/without aura)

Front 28

PID and COC use

Back 28

-about 50% lower incidence of PID in COC users with multiple partners compared to other contraceptive methods
-risk of PID related hopitalization decreased by 50-60%

Front 29

ectopic pregnancy and COC use

Back 29

-COC users 1/10 as likely to have ectopic pregnancy compared to nonusers due to decreasedPID incidence

Front 30

ovarian CA and COC use

Back 30

-risk decreased by 33-60% in COC users

Front 31

endometrial CA and COC use

Back 31

-decreased risk 50-70%; protection directly related to duration of use

Front 32

dysmenorrhea, PMS, and PMDD and COC use

Back 32

-60% decrease in incidence of menstrual pain
-29% recuction in PMS Sx
-YAZ and BeYaz are FDA approved for tx of Sx of PMDD

Front 33

acne and COC use

Back 33

-COCs considered definitively beneficial in tx of acne and hirsutism
-some products carry indications