Oral contraceptives

Question 1

types of oral contraceptives

Answer 1

combination: monophasic or multiphasic

more closely resemble normal menstrual cycle hormonal changes, lower total hormone dose per cycle

Question 2

Oral contraceptive MOA

Answer 2

progestin: suppression of the LH surge, preventing ovulation; thickening/impearability of cervical mucus; involution/atrophy of endometrium
estrogen: suppression of FSH release, preventing the development of a dominant follicle; potentiation of progestin component action; stabilization of endometrial lining

Question 3

Pros and Cons of COmbination OCs

Answer 3

Pros: effective contraception, decrease in pregnancy-related death, better cycle control, decrease in IDA, maintenance or improvement of bone density, protection from ovarian and endometrial CA

Cons: no protection against STIs, increase risk of thromboembolism and stroke, may elevate BP, estrogenic and progestin side effects, drug interactions, daily pill taking, cost >$30month

Question 4

CIs to Combo OCs

Answer 4

hx of stroke, thromboembolic disease, breast CA, pregnancy, heavy smoking, active liver disease

Question 5

Too much/too little estrogen

Answer 5

N, breast tenderness, increased BP, melasma, HA

too little: early or mid cycle breakthrough bleeding, increased spotting, hypomenorrhea

Question 6

Progestin generations and hormone activity

Answer 6

first: high estrogen, progestin, and androgen
second: high progestin and androgen
third: high progestin and lower androgen
other: drospirenone (Yaz) lower progestin and no estrogen or androgen

Question 7

Monophasic products and their activity

Answer 7

Alesse: low P, low E, low A
Ovcon 35: low P, high E, low A
Ovral: high P, high E, high A

Question 8

Five signals of serious trouble with OC

Answer 8

Abdominal pain
Chest pain
HA
Eye problems
Severe leg pain

Question 9

What is important to note about oral emergency contraceptive options

Answer 9

they vary in OTC and if there is a age limit or not and they should be taken within 72 hours

Question 10

AE of oral emergency contraceptive

Answer 10

N/V-less with Plan B

Irregular bleeding-mesntrual period occurs 1 week before or after expected time

Question 11

What OC to use

Answer 11

young and healthy: monophasic
acne: ortho-tricyclen, estrostep, yaz
minimize estrogen exposure: ALESSe, LESSina
breastfeeding or estrogen CI: avoid estrogen with Micronor
PMS, HA, anemia, endometriosis: consider extended cycle like Seasonale

Question 12

Pt education for use of OC

Answer 12

Adherence to regimen is essential for efficacy
Directions to start taking can be in office right away or start on the sunday after your menstrual cycle
If you miss a pill take it immediately and use back up
identify back up methods, OCs don’t protect against STDs, discuss AEs, discuss benefits, and five possible warning signs