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GYN Pharm Contracept

GYN Pharm Contraception

QuestionAnswer
Contraception methods with the lowest pregnancy rates Combined OCPs, IUD, Vasectomy
MOA of Estrogen Inhibits ovulation
MOA of Progestin Promotes endometrium atrophy
Incidence of ovulation when taking OCPs 10%
early or mid-cycle BTB, increased spotting and hypomenorrhea is associated with Estrogen deficiency
Nausea, bloating, HTN, Migraines, edema and breast fullness are associated with Excess estrogen
Weight gain, fatigue, acne, depression and breast regression are associated with Excess Progestin
Late BTB, amenorrhea and hypermenorrhea are associated with Progesting Deficiency
Reason for Tricycling Severe PMS or cyclic depression, endometriosis, cyclic HA, wish to avoid menses at a specific time, wish to avoid menses as much as possible. (these are continuous pills, no week off)
CI to estrogen Hx of thromboembolism, Uncontrolled HTN, Migraine worsened by EE, Current liver impairment or tumor, current DVT, Smoker>35 yo, Breast feeding
Ortho-Micronor Progestin only "minipill". Need to take at the same time every day, if >3 hrs late, backup for 48 hrs. STRICT compliance needed
Which OCP can be used while lactating? Progestin Minipill (ortho-micronor)
Risk associated with combination contraceptives Biggest risk: Increase risk of thromboembolis, stroke and heart attack. Also: hepatic neoplasia, gallbladder dz, HTN
Absolute CI to combo pill Thromboembolic disorders, severe liver dysfxn, known or suspected breast CA, undiagnosed abnl vaginal bldg, known or suspected pregnancy, smoker >35yo
Relative CIs to combo pill Migraine HA, HTN, Uterine leiomyoma, Gestation DM, Elective surgery, epilepsy, Obstructive jaundice in pregnancy, SS dz, DM, Gallbladder dz
Stop OCPs immediately if Visual disturbances, Unilateral numbness, weakness tingling (stroke), Severe chest, left arm or neck pain (heart attack), Hemoptysis (PE), Leg pain, swelling and tenderness (DVT), slurred speech, hepatic mass
Seek medical attention immediately for ACHES abdominal pain; Chest pain, SOB, Hemoptysis; Headache; Eye problems; Severe leg pain
The following decrease the efficacy of OCPs and may require back up contraceptive methods Antibiotics, barbituates, Griseofulvin, Phenytoin, Primidone
The following are drugs that have decreased efficacy when used with OCPs Acetaminophen, Anticoagulants, Benzodiazepines, Guanethidine, Methyldopa
The following are drugs that have increased effect when used with OCPs Alcohol, Antidepressants, Benzodiazepines, Beta-Blockers, Corticosteroids, Theophylline
Conservative recommendation with OCPs and abx Use back-up method during short course of antibiotic treatment and for one week afterward
When is back up required if you miss a pill dosage? If 2 days of pills are missed: take 2 pills the first day and 2 pills the second day and then resume back. Condoms MUST be used for 7 days as a back-up method
Patch Ortho-Evra: contains progestin and EE. 3 weeks on, one week off. Less effective for pts weighing >90kg
Approved locations for Ortho-Evra patch Buttock, abdomen, upper outer arm, upper torso.
FDA warning with the patch higher estrogen exposure with the patch.
Women breastfeeding or those with intolerance to estrogens, smokers, on anti-epileptics may take Depo-Provera. IM Shot q 3 mo.
Main AE of Depo-provera Weight gain. 5.4 lbs in the first year
Depo notes: evaluate BMD after 2 years of use; use only for 2 years
Implanon releases for etonogestrel 60mcg/day for ___ years 3
Emergency contraception administration Norgestrel or levonorgestrel products; must be delivered within 72 hours after unprotected intercourse. Antiemetic should be given prior to first dose of combo to reduce estrogen related N/V
low estrogen combo options LoEstrin, Alesse
High androgenic progesterone pill Lo-Ovral. May need to switch to less androgenic like: Ortho-cyclen
Created by: ltm12
 

 



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