Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
32 Cards in this Set
- Front
- Back
what is Ethinyl estradiol? use?
|
estrogen with an ethinyl group to prevent first pass effect
Contraceptive |
|
if something has Nor or gest in its name, what kind of drug is it?
|
Progestin
|
|
MOA of contraceptive steroids?
|
Combination preps inhibit ovulation.
giving estradiol/progesterone turns off the release of GnRH, thus turning of FSH/LH, thus inhibiting ovulation |
|
if you have a combo drug such as Ortho-Novum 1/35....what is the 1/35?
|
1=mg of progestin
35=mg of estrogen important because if someone is having a side effect you can lower the dose |
|
if a person is on Ortho-Novum 10/11 28
what is meant by the numbers? |
you have a biphasic drug
you are getting different doses of progesterone to start followed by a certain dose of estrogen |
|
When would you give a pt a progestin only methods? why aren't they preferred?
|
if they have contraindicaions (DVT)
you get unpredictable spotty bleeding for the first year |
|
DES is what kind of drug? Side Effect?
|
Emergency contraceptive
Teratogenic |
|
what is Levonorgestrel?
|
PLAN B
|
|
a pt with a BMI>27 must do what with respect to contraceptive steroids?
|
must take a higher dose...contraceptives can be sequestered in fat
|
|
how are contraceptive steroids metabolized? what does this allow for?
|
hepatic metabolism
allows for re-uptake and thus low dose |
|
What are some of the mild side-effects of contraceptive steroids?
|
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) |
|
What are some of the moderate side-effects of contraceptive steroids?
|
Breakthrough bleeding
Weight gain Increased skin pigmentation Acne Hirsutism Vaginal infections amenorrhea |
|
What are some of the serious side-effects of contraceptive steroids? 4
|
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. |
|
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?
**** |
giving too much estrogen
back off the dose |
|
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?
**** |
giving too little estrogen
give more |
|
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?
**** |
giving too much progestin
back off the dose |
|
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?
**** |
giving too little progestin
give more |
|
at what age do contraceptive pills stop giving a protective effect?
|
40
sorrrryyyyy |
|
if a pt is a smoker and takes oral contraceptives, what happens as they get older
|
the risk of death increases as they age
|
|
what are some important contraindications of birth control? 7
|
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 |
|
headaches are effected by contraceptives in 2 very different ways...please explain
|
migraine with aura-->contraindication for contraceptive
migraine that is assoc with period-->can be treated with oral contraceptives |
|
pt has known seizures and is taking phenytoin...if a pt is on oral contraceptives what do you have to consider?
** |
phenytoin induces microsomal drug metabolism
so you need to increase the dose or find some other form of contraceptive |
|
how do antibiotics decrease the effectiveness of oral contraceptives? 2 drugs most likely to do this?
** |
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) |
|
side effects of vaginal spermicides?
|
– 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. |
|
What is the MOA of intrauterine devices
|
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 |
|
why are IUDs good for pts who have already had their kids?
|
more difficult to get pregnant after IUD
|
|
what is Implanon?
|
long acting progestin
subQ implant, 3 year contraceptive effect |
|
what is a concern when using long acting progestins?
|
Inhibition of gonadotropin release decreases estradiol levels, which may decrease bone mineral density.
|
|
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
|
within 3 months of stopping oral contraceptive use
|
|
pt calls worried that they missed a dose of the their OC. what can they do?
|
likely just take 2, but read package for specific instructions
|
|
what is the idea behind using a biphasic OC?
|
biphasic allows for lower levels of steroids to hopefully have less side effects
|
|
Benefits of Oral Contraception:
Patients will have less of a risk for what cancers/diseases (4)? |
- ovarian cysts and cancer
- endometrial cancer - benign breast disease - ectopic pregnancy |