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Questions and Answers
How do combination oral contraceptives primarily prevent pregnancy?
How do combination oral contraceptives primarily prevent pregnancy?
- By directly killing sperm cells within the female reproductive tract.
- By creating a physical barrier that prevents sperm from reaching the egg.
- By increasing the thickness of the uterine lining to prevent implantation.
- By inhibiting the secretion of LH and FSH, thereby preventing ovulation. (correct)
Which factor is most crucial when considering the use of progestin-only pills (POPs) for contraception?
Which factor is most crucial when considering the use of progestin-only pills (POPs) for contraception?
- POPs are more effective at preventing ovulation compared to combination pills.
- POPs contain a higher dose of hormones, minimizing the risk of breakthrough bleeding.
- POPs have a longer duration of action, providing protection even with missed doses.
- POPs must be taken at precisely the same time each day to maintain efficacy. (correct)
What is the primary mechanism by which intrauterine devices (IUDs) containing levonorgestrel prevent pregnancy?
What is the primary mechanism by which intrauterine devices (IUDs) containing levonorgestrel prevent pregnancy?
- By forming a physical barrier that prevents the implantation of a fertilized egg.
- By inducing a systemic hormonal surge that inhibits the release of the egg.
- By creating a cytotoxic environment within the uterus that kills sperm cells.
- By causing a chronic inflammatory response toxic to sperm and ova, and thickening cervical mucus. (correct)
Why is the timing of administration crucial for postcoital contraceptives like Plan B?
Why is the timing of administration crucial for postcoital contraceptives like Plan B?
How do continuous dosage contraceptives like Lybrel function to prevent pregnancy?
How do continuous dosage contraceptives like Lybrel function to prevent pregnancy?
What is the rationale behind using different amounts of estrogen and progestin in biphasic and triphasic oral contraceptives?
What is the rationale behind using different amounts of estrogen and progestin in biphasic and triphasic oral contraceptives?
Why does the use of oral contraceptives in women over 35 who smoke present an increased risk of cardiovascular complications?
Why does the use of oral contraceptives in women over 35 who smoke present an increased risk of cardiovascular complications?
How do hepatic enzyme inducers reduce the efficacy of oral contraceptives?
How do hepatic enzyme inducers reduce the efficacy of oral contraceptives?
What is the potential effect of broad-spectrum antimicrobials on the efficacy of oral contraceptives, and why?
What is the potential effect of broad-spectrum antimicrobials on the efficacy of oral contraceptives, and why?
Why might a progestin-only contraceptive method be preferred over a combined estrogen-progestin method in certain clinical scenarios?
Why might a progestin-only contraceptive method be preferred over a combined estrogen-progestin method in certain clinical scenarios?
What critical aspect differentiates Seasonale from traditional monthly oral contraceptives?
What critical aspect differentiates Seasonale from traditional monthly oral contraceptives?
How might combination oral contraceptives reduce the risk of ovarian and endometrial cancers?
How might combination oral contraceptives reduce the risk of ovarian and endometrial cancers?
For which of the following conditions would combination oral contraceptives be absolutely contraindicated?
For which of the following conditions would combination oral contraceptives be absolutely contraindicated?
What is the significance of monitoring triglyceride levels in women using hormonal contraceptives?
What is the significance of monitoring triglyceride levels in women using hormonal contraceptives?
How does ethinyl estradiol, used in many oral contraceptives, differ from naturally occurring estradiol in terms of its metabolic stability?
How does ethinyl estradiol, used in many oral contraceptives, differ from naturally occurring estradiol in terms of its metabolic stability?
What specific characteristic of desogestrel makes it a unique progestin to use in oral contraceptives?
What specific characteristic of desogestrel makes it a unique progestin to use in oral contraceptives?
Why is the use of certain anticonvulsants a concern for women using hormonal contraceptives?
Why is the use of certain anticonvulsants a concern for women using hormonal contraceptives?
What distinguishes drospirenone from other progestins used in oral contraceptives?
What distinguishes drospirenone from other progestins used in oral contraceptives?
What is the primary reason some adolescents are considered to have a relative contraindication for oral contraceptive use?
What is the primary reason some adolescents are considered to have a relative contraindication for oral contraceptive use?
What is the rationale behind using anti-emetics in conjunction with post-coital oral contraceptives?
What is the rationale behind using anti-emetics in conjunction with post-coital oral contraceptives?
What are the long term effects of using progestin-only contraception on the endometrium?
What are the long term effects of using progestin-only contraception on the endometrium?
Why are combination contraceptives not recommended for smokers over the age of 35?
Why are combination contraceptives not recommended for smokers over the age of 35?
What key factor determines that progestin only medication is given?
What key factor determines that progestin only medication is given?
What is the efficacy dependance of Progestin only pills?
What is the efficacy dependance of Progestin only pills?
What is the common ingredient usually found in Progestin-only preperations?
What is the common ingredient usually found in Progestin-only preperations?
Flashcards
Contraceptives: Primary Use
Contraceptives: Primary Use
Primary use of estrogens and progestins in a clinical setting, delivered via pills, SC and IM injections, IUDs and implants.
Monophasic Oral Contraceptives
Monophasic Oral Contraceptives
Oral contraceptives that deliver a constant amount of estrogen and progestin throughout the cycle.
Biphasic/Triphasic Oral Contraceptives
Biphasic/Triphasic Oral Contraceptives
Oral contraceptives where estrogen and progestin levels vary during the cycle, mimicking the body's natural hormone fluctuations.
Seasonale
Seasonale
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Lybrel
Lybrel
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Combination Contraceptives: Mechanism
Combination Contraceptives: Mechanism
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Progestin-Only Pills
Progestin-Only Pills
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Medroxyprogesterone acetate
Medroxyprogesterone acetate
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Etonogestrel
Etonogestrel
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Intrauterine Device (IUD)
Intrauterine Device (IUD)
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Post-Coital Oral Contraceptives
Post-Coital Oral Contraceptives
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Cardiovascular Adverse Effects of Contraceptives
Cardiovascular Adverse Effects of Contraceptives
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Thromboembolic Disease & Contraceptives
Thromboembolic Disease & Contraceptives
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Reproductive Organ Effects
Reproductive Organ Effects
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Hepatobiliary System Effects
Hepatobiliary System Effects
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Absolute Contraindications of Oral Contraceptives
Absolute Contraindications of Oral Contraceptives
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Relative Contraindications of Oral Contraceptives
Relative Contraindications of Oral Contraceptives
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Drug Interactions Reducing Efficacy of Contraceptives
Drug Interactions Reducing Efficacy of Contraceptives
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Antimicrobials Interactions with Contraceptives
Antimicrobials Interactions with Contraceptives
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Hepatic Enzyme Inducers Interactions
Hepatic Enzyme Inducers Interactions
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Monophasic Combinations
Monophasic Combinations
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Biphasic/Triphasic combinations
Biphasic/Triphasic combinations
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Benefits of oral contraceptives
Benefits of oral contraceptives
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Contraceptive effect
Contraceptive effect
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Useful Progestin-Only
Useful Progestin-Only
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Study Notes
Class Overview
- Contraception pharmacology includes discussion of:
- Menstrual cycle
- Combination contraceptives
- Progestin-only methods
- Intrauterine devices
- Postcoital contraceptives
Contraceptives: General Information
- Estrogens and progestins are primarily used in a clinical setting
- Delivery Methods: pills, subcutaneous (SC) injections, intramuscular (IM) injections, intrauterine devices, and implants
- Formulations contain a combination of estrogen and progestins, or progestin only
Oral Contraceptives: Combination Pills
- Estrogen dosage ranges from 20-50 ug/day
- Including ethinyl estradiol or mestranol, which is metabolized to ethinyl estradiol
- Progestin dosage ranges from 0.05-2.5 mg/day
- Including norethindrone, norgestrel, levonorgestrel, norethindrone acetate, ethynodiol diacetate, drospirenone, and desogestrel
- Lower luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels lead to failure to ovulate
Oral Contraceptives: Mono, Bi, and Tri-Phasic
- Monophasic Combinations:
- Deliver a constant amount of estrogen and progesterone
- Involve 21 days of active pills followed by 7 days of inert tablets to induce menses
- Formulations can vary in the amounts of estrogen and progestin
- Biphasic/Triphasic Combinations
- Estrogen and progestin levels vary
- Mimic the endogenous ratio of hormones
- 21 days of active pills are followed by 7 days of inert tablets to induce menses
Oral Contraceptives: Continuous Dosage
- Seasonale:
- Contains ethinyl estradiol/levonorgestrel
- Taken for 84 days, followed by 7 days of inert tablets
- This results in 4 menses per year
- Lybrel:
- Contains ethinyl estradiol/levonorgestrel
- Constant dosing for 365 days, which suppresses menses
Combination Contraceptives: Mechanism of Action
- Inhibit LH and FSH secretion through feedback inhibition
- Suppress the midcycle LH surge needed for ovulation
- Impact the genital tract:
- Causes the thickening of cervical mucus
- Increases the speed of ovum transport
- Makes the endometrium less favorable for implantation
Progestin-Only Preparations
- Primarily contain norethindrone
- Taken daily and continuously
- Ovulation is typically not suppressed
- Less effective than combination therapy
- Contraceptive effect is unclear
- May lead to atrophic endometrium impairing implantation
- Increases viscosity of cervical mucus
- Abnormal menstrual bleeding can occur in 25% of users
- It is especially useful for women where estrogens are contraindicated due to health concerns
Progestin-Only Preparations: Specific Formulations
- Medroxyprogesterone Acetate:
- Administered via subcutaneous or intramuscular injections
- Provides contraception for 3 months
- Etonogestrel:
- Inserted as a single rod under the skin
- Contraception for 3 years
- Can result in menstrual and bleeding irregularities
- Intrauterine Devices:
- Contain levonorgestrel
Post-Coital Oral Contraceptives
- Plan A:
- Contains 100-120 ug ethinyl estradiol/0.5-0.75 mg levonorgestrel at higher doses
- Effective if treatment begins within 72 hours of coitus
- Plan B:
- Contains 0.75 mg levonorgestrel
- Effective if started within 72 hours of coitus
- Nausea and vomiting are common, and anti-emetics are often combined
- Contraindicated in confirmed pregnancy
Adverse Effects of Contraceptives: Cardiovascular
- Increased risk of morbidity and mortality due to myocardial infarction
- Can cause hypertension
- Increased levels of triglycerides
- Women over 35 have a heightened risk of cardiovascular complications
Adverse Effects of Contraceptives: Thromboembolic and Reproductive
- Thromboembolic Disease:
- Increased risk of stroke
- Due to fibrinogen and coagulation factors increases, antithrombin III levels are decreased
- Increased risk of stroke
- Reproductive Organs:
- Reduced incidence of ovarian and endometrial cancers
- Reduced incidence of pelvic inflammatory disease
Adverse Effects of Contraceptives: Other
- Hepatobiliary System:
- Increased incidence of gallbladder disease and gallstones
- Others:
- weight gain, edema, breast tenderness, headache, mood alteration, and spotting
Contraindications of Oral Contraceptives
- Absolute Contraindications:
- Vascular diseases
- Age over 35, particularly if the woman is a smoker
- Liver disease
- Suspected breast cancer or other estrogen-dependent cancer
- A strong family history of breast cancer
- Relative Contraindications:
- Hypertension
- Diabetes
- Migraines
- Convulsive disorder
- Undiagnosed menstrual bleeding
- Undiagnosed breast lumps
- Adolescents who have not completed bone fusion
Benefits of Oral Contraceptives
- Reduced Risk:
- Lower dose combinations lead to lower risk.
- Ovarian cysts and cancer
- Endometrial cancer
- Benign breast disease (fibrocystic)
- Pelvic inflammatory disease
- Lower dose combinations lead to lower risk.
- Improvements:
- Premenstrual syndrome
- Dysmenorrhea
- Endometriosis
- Acne
- Hirsutism
Drug interactions that reduce the Efficacy
- Antimicrobials:
- Decrease oral bioavailability by killing the GI flora needed for enterohepatic cycling of estrogens
- Hepatic enzyme inducers increase the metabolism of estrogens and progestins:
- Anticonvulsants
- Phenytoin
- Barbiturates
- Carbamazepine
- Ethosuximide
- Rifampin
- Griseofulvin
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