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IOS 9 Exam 1
Contraception
| Question | Answer |
|---|---|
| 1820BC Egyptains | Vaginal insertions with crocodile dung pessaries, gums, and mistures of honey &sodium bicarbonate |
| 1550 BC | Sugary paste mistures of dates;acacia bark & honey into vulva concert to lactic acid=specmicide |
| 1400BC | Book of genesis-coitus interruptus, withdrawal |
| 1640AD | Condoms made of fish intestine or animal intestines |
| 1844 AD | Rubber condoms invented and mass produced by Charles Goodyear |
| 1928AD | Intrauterine ring |
| 1930 AD | Latex condoms |
| 1960AD | First OC |
| Define conception | Prevention of pregnancy, endometriosis, iron deficiency anemia |
| Epidemiology of unintended pregnancy | 62% of 62 million practice contraception, 64% reversible (pill) |
| Pill is most common method of contraception used by | Women <30 |
| 21% Teenagers choose what as primary method | condom |
| Racial differences: whites, blacks, hispanics | Pill, female sterilization, female sterilization |
| MOA of hormone contraception | Progestin provide most of birth control activity-suppress ovulation inhibiting LH &FSH. Reduce sperm transport thickening cervical mucus |
| Advantages of OC | Effective 92 typical, 99.7 perfect, reversible, regulates menses (PCOD), reduce endometrial cancer, ovarian cancer, Reduce breast mass in benign breast disease, androgen excess (acne, hirsutism), vasomotor symptoms reduced |
| Disadvantages of OC | No HIV/STD protection, must be used iwth barrier method, HA,Nausea, wt gain |
| WHO contraindications for COC | Breastfeeder< 6wk, smoker >35 (15 cigs), CVD, complicated DM, liver disease, thrombogensis, ischemic heart disease, migraine HA, current breast cancer |
| Contraindications for POP | Pregnancy, Current breast cancer |
| Progestogenic side effects | Increased appetite, depression, fatigue, Acne, oily skin, bloating |
| Estrogenic side effects | Nausea, increased breast size, HTN, decreased libido, telangiectasia |
| Increased Progestin causes | Bone thinning, amenorrhea, irregular spotting, depression, breast tenderness, water retention, weight gain |
| Decreased progestin causes | Irregular menstrual cycles, heavy mentral bleeding, weight gain |
| Increased estrogen causes | Nausea, increased breast size, HTN, increased risk for DVT |
| Manage breakthrough bleeding by | 1. Rule PID, DI, 2. Increase estrogen-first 14 days 2. Increase progestin(Desogen or Mircette or Nordette or Alesse -after 14 days 3. Both- If Mid-cycle- COC Demulen, OVcon, Ortho-Novum |
| Higher progestation pills | Desogen or Mircette |
| POP wil Androgenic activity | Norgette or Alesse |
| Control OC nausea | Related to estrogen concentration. Take with food or switch to (Mircette, ALesse, Loestrin |
| Acne -OC | Choose with less androgen activity- Desogen, Ortho-tri-cyclin, Yasmin, or get highe estrogen (ortho-tri-cyclin & Estrostep) |
| Hirutism issues can be solved by selecting | OC with less androgen-Desogen, ortho-tri-cyckin, Yasmin (AVOID-Ovral,Lo-ovral,nordette, Alesse) |
| OC DI's | Seizure meds, rifampin, protease inhibitors, st johns wort |
| Missed OC 2 pills weeks 1-2 | 2 pills x 2 days plus back-up 7 days |
| Miss 2 pills in week 3 of cycle | Begin new pack and BUM 7days |
| Miss 3 pills in first 3 weeks | Begin new pack + BUM 7 days |
| Progestin only pill conseling | Take 1 pill at same time every day, if > 3hrs take pill and BUM 2 days, consider EOC |
| ACHES of OC counseling | A-abdominal pain, C-chest pain SOB, H-headache indicates stroke, E-eyes problems, S-severe leg pain could be clot |
| Monophasic pill dosing | Provides same dose of estrogen and progestin for 21 days. Can be used as 84 active pills followed by 7 days of inactive pills. High Break through bleeding |
| Biphasic pills- | Provide simular levels of estrogen for 21 days but different progestin doses either days 1-10 or 11-21 |
| Triphasic Pills | Could provide simular or differene levels of estrogen for 21 days and doses of progestin varies weekly. Mimic of matural cycle and reduces break through bleeding |
| Mircette OC | 21 active pills, 2 inactive, and 5 days of 10mcg of ethinyl estradiol to minimize menstral migraines, dysmenorrhea, and PMS |
| Estroestep | 25mg of ferrous fumarate for the 7 inactive days to minimize anemia |
| Minimize acne choose | Ortho-cyclen, Ortho-Tricyclin, Estrostep, Desofen (low androgen) |
| Minimize spotting | Higher estrogen or triphasic) Ortho-cyclen, Ortho-tricyclin, Desogen, Leven |
| Minimize estrogen SE | ALesse, Loestrin 1/20, or Lo-ovral |
| Chewable Ovcon 35 | Spearmeint flavor |
| POP candidates | Thrombosis or FHx of VTE, postpartum, breastfeeding, smoker over 35 yo, |
| IUS SE | Progestin related side effects-acne, irregular menses, expulsion |
| IUD SE | Monthly blood loss increased, Dysmenorrhea, expulsion, comfort level lowm risk of infection |
| PAINS for IUS/IUD | P- Period late, A- abdominal pain, I-Infection or discharge, N-Not feeling well, S- missing shorter or longer. |
| IUS | Levonorgestrel 20mcg/day for 5 years <1% failure |
| IUS | Copper spermicide to inhibit sperm motility |
| Good candidates for IUS | Have at least 1 child, monogamous , no Hx PID, heavy menses, cramps, anemia, want long term BC (>2years) |
| Good candidates for IUD | Monogamous relationship, > 2year contraception, Nulligravid women low STD risk, do not want hormone use |
| Emergency contraception | 1.Yuzpe regimen w/in 72 hrs 2. Plan-B |
| Counsel EC patient | Take initial 72-120hrs of intercoursem 12 hours later take second, can take both at once. |
| EC side effects | May see mentral changes early or late, n?V, HA, breast tenderness, dizziness |
| Advantage of spermacidials | 1. Easy to use, extra lubrication |
| Disadvantage of spermicidals | Not STD protectant, may increase HIV transmission, irritation, Use with diaphram or cap increase infection, must reapply after 1 hour |
| Spermacidal creams and jellies | Higer concentrations if mono, reapply after 1 hour, must leave in for 6 hours after intercourse. WIth diaphram or cap, fill device 1/3 and place near cervix and leaven inplace at least 6 hours. |
| Spermicidal Foams | DO NOT used with diaphram or Cap! Shake and reapply after 1 hour leave in 6 hours |
| Spermicidal Contraceptive films | Activated by vaginal secretions, do not used with cap or diaphrams |
| Cap or diaphram-RX | Use with applied spermicide, (nulliparous failure 20% and parous 40%), increased risk of TSS, or bladder infections |
| Diaphram counseling | Insert up to 6 hours before intercouse and leave in at least 6 hours NTE 24 hours, spermicide necessary for additional sex |
| Cap counseling | Insert up to 48 hours before intercourse, leave in place > 8 hours, NTE 48 hours, spermicide optional for additional sex |
| Contraceptive sponge-OTC | Polyurethane foam + 1 gram nonoxynol-9 |
| Sponge MOA | 1. Spermicidal, Mechanical barrier, absorbs semen |
| Sponge typical use % | 18% failure in nulliparous women, 36 parous women |
| Sponge protection lasts | 24hours reguardless of how many sexual acts, buit increased risk of TSS, and vaginal and cervical ulcers |
| Sponge counseling | Moisten with water, insert, and leave in 6 hours after intercourse not to exceed 24-30hrs |
| Latex condom avoid | OIL lubricants, but KY is ok |
| Polyurethane condoms | Oil and water lubricants ok |
| Lamb cecum condoms | NO STD, HIV protection |
| Female condom-Reality failure rate | 21%, and break less than male condoms |
| Female condom description | 2 rings, and extends out of the vagina, removal does not have to occur immediately, can be inserted 8 hours before intercourse |
| Male condome failure rate % | 15% (breakage 0.41-7.9%) |
Created by:
liza001
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