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What are the risks of using a diaphragm or cervical cap?
Increased UTIs, yeast infections and TSS
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How is the cervical cap used?
Place of cervix ½ hour before intercourse and leave on at least 8 hrs after but NMT 48 hrs total
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What is the pregnancy rate with male and female condoms?
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What can destroy the integrity of condoms?
Mineral oil (by 90% in 60 seconds)
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What advantage do spermicides have?
Some protection against cervical cancer
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What is the today sponge?
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How is the Today sponge used?
- Leave in 6 hours after intercourse
- NMT 24hrs total due to increased risk of TSS
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Do spermicides protect against STDs?
No
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What are the estrogens in OCs?
- Ethinyl Estradiol
- Mestranol
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Which Progestins are a potent progestin with no estrogenic effects and are less androgenic?
- Desogestrel
- Norgestimate
- Drosperinone
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What is the effect Estrogens in OCs?
Suppress FSH and LH and inhibit implantation
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What is the effect of Progestins in OCs?
Inhibit LH, Cervical mucus thickening an thinning of endometrial lining
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What are estrogen side effects?
- Nausea
- Fluid retention
- Breast tenderness
- Headaches
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Do combination OCs or progestin only OCs have more progestin mini-pills?
COCs
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What should you counsel a patient on when dispensing Progestin only mini-pills?
- Start on the first day of menses
- Take at same time every day!!!
- There are No inactive pills
- Back up method for first 1 to 2 months
- Use a Backup method: whenever ANY pills are missed, If a pill is more than 3 hours late, mid-cycle and 4 days pre/post possible ovulation
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What are the long acting progestin Contraceptives?
Medroxyprogesterone acetate (DepoProvera)
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How does Medroxyprogesterone acetate (DepoProvera) work?
- Blocks LH surge, preventing ovulation
- Reduces ovum motility in fallopian tubes
- Thins endometrium
- Thickens cervical mucus
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How should Medroxyprogesterone acetate (DepoProvera) be administered?
- 150mg IM Q3 months within 5 days of onset of menses
- Gluteal or deltoid muscle
- SQ = abdomen or thigh
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What are the advantages of Medroxyprogesterone acetate (DepoProvera)?
- Good for: Breast feeding, seizures, Intolerant to estrogens, Women experiencing
- Premenstrual weight gain, Nausea, Acne, HTN, HLD, h/o VTE, premenstrual bleeding or h/o SLE
- May prevent PID due to mucus thickening
- Pregnancy rates similar to sterilization
- Fewer DDIs
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What is the brand name for Medroxyprogesterone acetate?
DepoProvera
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What is the generic name for DepoProvera or Depo-SubQ Provera 104?
Medroxyprogesterone acetate
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What are the disadvantages of Medroxyprogesterone acetate (DepoProvera)?
- Reduced bone mineral density with chronic use
- Black box warning!!! = only take for 2-3 years
- Return of fertility may be delayed = Median time to conception 10 months, 1 year fertility rate – 68%
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