pc5 4.4 contraception

combined oral contracdeptive, contraceptive patch, contraceptive ring

what products for contraception have estrogen and progestin combined

progestin only pills, injectable medroxyprogesterone, subdermal implant, levonorgestrel inutrauterine system

what products for contraception have only progestin

copper containing IUD, condom, diaphragm, sponge, etc

what products for contraception have no hormones

release of FSH/LH, ovum implantation

mechanism of estrogen in COC is to inhibit ____

ovum transport

mechanism of estrogen in COC is to accelerate __

ethinyl estradiol, estradiol valerate, estetrol

estrogens include what agents

10-50mcg daily

dose range for estrogen

thicken cervical mucus, inhibit spermatic enzymes, inhibit ovulation

MOA of progestins

norethindrone, norethindrone acetate, norgestrel, levonorgestrel, norgestimate, desogestrel, drospirenone, dienogest

available progestins include what

not key factor, may be used in managing AE

when is progestational activity considered in COC selection

levonorgestrel, norgestrel

what progestins have high androgenic activity

norethindrone

what progestins have moderate androgenic activity

norgestimate, desogestrel

what progestins have low androgenic activity

drospironeone, dienogest

what progestins have no or anti androgenic activity

AE

estrogenic activity in progestins may be used in managing what

monophasic

what COC have active pills have the same hormone content

multiphasic or sequential

what COC type has varying amount of hormone

triphasic

7/7/7 is an example of what kind of COC

sequential

21/2/5 is an example of kind of COC

35mg

what is the most common dosages of EE in COC

adolescents, under 100 lbs, over 35 yo, perimenopausal

who should take a lower EE dose in COC

CDC medical eligibility criteria

what resource can be used to determine if COC is okay with a coexisting

family planning, predictable cycles, reduced mentrusal symptoms, lower risk of endometrial and ovarian cancer, acne, premenstrual dysphoric disorder

benefits of COC

synthesis of SHBG

COCs help acne via ethinyl estradiol increasing what

norgestimate, desogestrel, drospirenone, dienogest

what progestins have low androgenic activity

norgestimate, drospirenone

what progestins have an FDA indication for acne

when to start, need for back up, what to do if missed pills, DI, AE, doesn't protect against STD, ACHES

patient counseling points for COC

sunday start, Day 1 start, quick start

options for starting COCs

sunday after menses begins

for a "sunday start" of COCS when are COCs started

for 1 week

for a "sunday start" of COCs should a backup method be started

first day of menses

for a day 1 start for COCs when are COCs started

no

for a "day 1 start' of COCs should a back up method be used

day of visit, rule out pregnancy

for a "quick start" COC when are COCs started

yes for 1 week

for a "quick start" of COCs should a back up method be used

take missed pill asap, continue taking remaining pills at usual time(even if two pills in one day)

if a COC is missed within 48 hours what should a patient do

take most recent missed pill asap, discard any other missed pills, use backup contraceptive, emergency contraception can be considered

if COC is missed over 48 hours what should a patient do

rifampin, anticonvulsants, st john's wort, antibiotics(contraversal), anticoagulants

Drug interactions of COCs

lower dose

do high or lower dose COCs have higher risk of Drug interaction

breast tenderness, n/v, hypertension, thromboembolism

AE of estrogen

acne, oily skin, depression, fatigue, lethargy, hirutism, libido, weight gain

AE of progestin

initation of COC, missed pills, too little estrogen or progestin

what could cause COC breakthrough bleeding

3 months

how long should COCs be used with breakthrough bleeding before change

early

breakthrough bleeding ___ in the cycle could indicate too little estrogen

late

breakthrough bleeding ___ in the cycle could indicate too little progestin

Abdominal pain, chest pain, ha, eye problems, severe leg pain

severe AE of COCs

liver problem, gallbladder disease

abdominal pain on a COC could indicate what

PE, MI

chest pain on a COC could indicate what

HTN, stroke, migraine

HA on a COC could indicate what

stroke, HTN

eye problems on a COC could indicate what

DVT

severe leg pain on a COC could indicate what

pregnancy, breast cancer, thromboemolbism, MI, ASCVD, over 35 and smoker, severe uncontrolled HTN

absolute contraindications to COC

SBP 160, DBP 100

severe uncontrolled HTN is indicated by what SBP and DBP

gallbladder disease, immobilization, under 35 and smoker, severe headaches, uncontrolled htn

relative contraindications to COC

chewable, fe component, shorter hormone free interval, extended cycle, continuous cycle

unique OC include what

YAZ/EE + dropsireone, beyaz/Yaz and levomefolate calcium , EE 20 + desogestrel (kariva), ultra low dose (lo loestrin FE)

what COC have shorter hormone free interval

improved menstrual symptoms

benefit of shorter hormone free interval

dropspirenone

what is an antiandrogenic and antimineralocortioicd progestin

monitor K, DI(ace and K), risk of clots

negatives of drospirenone/Yasmin/Yaz/beyaz

spironolactone

dropspirenone is related to what

21 active, 2 placebo

what COC has 21 active tabs, 2 placebo, and 5 days of 10 mcg EE

EE 20/desogestrel/kariva

what COC has 21 active tabs, 2 placebo, and 5 days of 10 mcg EE

EE 10 mcg, norethindrone 1 mg

what COC has 24 active tabs, 2 tabs 10 mcg EE, 2 tabs iron

plant derived estrogen/nextstelis

what COC is composed of estetrol + drospirenone

soy beans

where does estetrol come from

24/4 day regimen

what regimen is plant derived estrogen/nextstellis

four phasic/natazia

what product is estradiol valerate/dienogest

four phasic/natazia

what product has estogen step down and progestin step up

9 days

four phasic/natazia requires a backup contraceptive for how many days

extended cycle contraception

what COC has one cycle per season

30mcg EE/0.15 mg LNG(jolessa), 20mcg EE/0.10 LGN (loseasonique)

what products exist for extended cycle contraceptive

minimize PMS

extended cycle contraceptive has what clinical benefits

seasonale/jolessa/seasonique aka 30mcg EE/0.15 mg LNG

what extended cycle contraception has 7 placebo pills

seasonique

what extended cycle contraception has no placebo- and 7 days of 10mcg EE

loseasonique

what extended cycle contraception has no placebo

amethyst aka 20 mcg EE + 90 mcg LVG

what product is a continuous cycle contraceptive

no

in amethyst aka 20 mcg EE + 90 mcg LVG is there any placebo pills

yes

in amethyst aka 20 mcg EE + 90 mcg LVG is amenorrhea comon

breakthrough bleeding

AE of amethyst aka 20 mcg EE + 90 mcg LVG

decreased PMS, cramps, migraine, anemia, endometriosis, endometrial/ovarian cancer, loss of work

benefits of continuous oral contraceptive

norelgestromin 150mcg/EE mcg (xulane/zafemy), LNG 120 mcg/EE 30 mcg (twirla)

options for transdermal contraceptive patch

each week for 3 weeks

when are transdermal contraceptive patches changed

one week patch free

after 3 weeks of a transdermal contraceptive patches what should be done

9 days

the transdermal contraceptive patch releases hormone for how many days

withdrawal bleeding

bleeding that occurs when hormone is taken away

no

(not true menses)

does withdrawal bleeding indicate no pregnancy

breast, wasteline, undergarment seams

where should contraceptive patch not be placed

simple, adherence easy, effective

advantages of transdermal contraceptive patch

patch detachment, reduced effectiveness in certain populations, increased estrogen exposure thus increase VTE risk

disadvantages of transdermal contraceptive patch

over 90 kg or 198 lbs

xulane has reduced effectiveness in what patients

BMI 25 to 30

twirla has reduced effectiveness in what patients

women over 35 who smoke, women with BMI 30 or higher(bc blood clot)

contraindications for the contraceptive patch

ethinyl estradiol 15mcg/ etonegestrel 120mcg, or ethyinyl estradiol 13 mcg/segesterone 150mcg

contraceptive vaginal rings

on or before day 5

in reference to the cycle, when should a vaginal contraceptive ring be started

3 weeks

how long is a vaginal contraceptive ring left in place

remove and discard in safe manner

counseling points for removing nuvaring

remove and clean with warm water and soap, dry, store in case

counseling points for removing annovera

1 week

how long is patient ring free for in contaceptive vaginal ring use

yes

do contraceptive vaginal rings have similar efficacy to COCs

HA, breast tenderness, nausea, irritation, leukorrhea, infection

AE of contraceptive vaginal rings

any ring that won't be used for at least 4 months

what nuvarings should be stored in the fridge