GYN Pharm Contraception
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| Contraception methods with the lowest pregnancy rates | Combined OCPs, IUD, Vasectomy
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| MOA of Estrogen | Inhibits ovulation
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| MOA of Progestin | Promotes endometrium atrophy
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| Incidence of ovulation when taking OCPs | 10%
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| early or mid-cycle BTB, increased spotting and hypomenorrhea is associated with | Estrogen deficiency
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| Nausea, bloating, HTN, Migraines, edema and breast fullness are associated with | Excess estrogen
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| Weight gain, fatigue, acne, depression and breast regression are associated with | Excess Progestin
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| Late BTB, amenorrhea and hypermenorrhea are associated with | Progesting Deficiency
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| 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)
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| CI to estrogen | Hx of thromboembolism, Uncontrolled HTN, Migraine worsened by EE, Current liver impairment or tumor, current DVT, Smoker>35 yo, Breast feeding
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| 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
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| Which OCP can be used while lactating? | Progestin Minipill (ortho-micronor)
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| Risk associated with combination contraceptives | Biggest risk: Increase risk of thromboembolis, stroke and heart attack. Also: hepatic neoplasia, gallbladder dz, HTN
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| 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
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| Relative CIs to combo pill | Migraine HA, HTN, Uterine leiomyoma, Gestation DM, Elective surgery, epilepsy, Obstructive jaundice in pregnancy, SS dz, DM, Gallbladder dz
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| 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
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| Seek medical attention immediately for ACHES | abdominal pain; Chest pain, SOB, Hemoptysis; Headache; Eye problems; Severe leg pain
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| The following decrease the efficacy of OCPs and may require back up contraceptive methods | Antibiotics, barbituates, Griseofulvin, Phenytoin, Primidone
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| The following are drugs that have decreased efficacy when used with OCPs | Acetaminophen, Anticoagulants, Benzodiazepines, Guanethidine, Methyldopa
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| The following are drugs that have increased effect when used with OCPs | Alcohol, Antidepressants, Benzodiazepines, Beta-Blockers, Corticosteroids, Theophylline
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| Conservative recommendation with OCPs and abx | Use back-up method during short course of antibiotic treatment and for one week afterward
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| 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
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| Patch | Ortho-Evra: contains progestin and EE. 3 weeks on, one week off. Less effective for pts weighing >90kg
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| Approved locations for Ortho-Evra patch | Buttock, abdomen, upper outer arm, upper torso.
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| FDA warning with the patch | higher estrogen exposure with the patch.
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| Women breastfeeding or those with intolerance to estrogens, smokers, on anti-epileptics may take | Depo-Provera. IM Shot q 3 mo.
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| Main AE of Depo-provera | Weight gain. 5.4 lbs in the first year
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| Depo notes: | evaluate BMD after 2 years of use; use only for 2 years
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| Implanon releases for etonogestrel 60mcg/day for ___ years | 3
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| 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
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| low estrogen combo options | LoEstrin, Alesse
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| High androgenic progesterone pill | Lo-Ovral. May need to switch to less androgenic like: Ortho-cyclen
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