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kyleannkelsey
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What is the contraceptive patch?
OrthoEvra (150 mcg norelgest and 20 mcg EE)
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How often should you apply the Contraceptive patch (OrthoEvra)?
Wear for 3 weeks then one week patch free
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What are the AE of OrthoEvra (patch)?
- Higher estrogen = higher risk of thromboembolism
- Les effective in women = to or > 90kg
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If the OrthoEvra patch is detached for < or = to 24 hours what should the patient do?
Reapply without back-up
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If the OrthoEvra patch is detached for > 24 hours what should the patient do?
- New 4 week cycle should be started
- Use back-up method fr 7 days
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What is the combination injection?
Lunelle (Medroxyprogesterone acetate and Estradiol cypionate injectable suspension)
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What is the return to fertility after taking Lunelle (Combo injection)?
~ 1month
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What is the frequency of dosing for Lunelle (Combo injection)?
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What is the route of administration for Lunelle (Combo injection)?
IM
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What is the added benefit of Lunelle (Combo injection)?
Less amenorrhea, decrease in cycle irregularities after 3 cycles
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Adverse effects that are dose related are due to the estrogen or progestin component?
Estrogen
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Adverse effects that are dose related are due to the estrogen or progestin component?
Progestin
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N/V is usually cause by Etrogen or Progestin?
Estrogen
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Acne is usually cause by Estrogen or Progestin?
Progestin
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If a patient has: N, breast tenderness, HA, weight gain and fluid retention, what changes would you make to their contraception?
- Decrease estrogen
- Consider IUD or Progestin only contraception
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If a patient has: Dysmenorrhea, menorrhagia or uterine fibroid growth, what changes would you make to their contraception?
- Decrease estrogen
- Consider extended cycle or continuous regimen
- Just the 1st 2 symptoms:
- Increase progestin
- Consider extended or continuous, consider progestin only or IUD
- NSAIDs for dysmenorrhea
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If a patient has: Vasomotor symptoms, nervousness and decreased libido, what changes would you make to their contraception?
Increase estrogen
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If a patient has: Early cycle break through bleeding (days 1-9), what changes would you make to their contraception?
Increase estrogen
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If a patient has: Absence of withdrawal bleeding, what changes would you make to their contraception?
- Exclude pregnancy
- Increase estrogen for menses
- Continue for amenorrhea
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If a patient has: Increased appetite, weight gain, bloating and constipation, what changes would you make to their contraception?
Decrease progestin
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If a patient has: Acne, oily skin and hirsutism, what changes would you make to their contraception?
- Increase estrogen
- Choose a less androgenic progestin
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If a patient has: Late cycle breakthrough bleeding (days 10-21), what changes would you make to their contraception?
Increase progestin
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What are the serious side effects of contraceptives?
- A abdominal pain = gallbladder or hepatic adenoma
- C chest pain, cough and SOB = MI or PE
- H HA, Dizziness, Numbness, Slurred speech and tingling in extremities = Stroke, HTN or migraine
- E Eye problems (blurring or vision loss) = Stroke or HTN
- S severe leg pain = DVT
- Breast mass, pain or swelling = breast cancer
- Excessive spotting or bleeding = endometrial, cervical or vaginal cancer
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What are the absolute CIs for COCs?
- Thrombophlebitis, thromboembolic disorders
- Cerebral vascular disease
- Coronary artery disease
- Peripheral vascular disease
- Markedly impaired liver function
- Known or suspect breast CA, or other estrogen dependent tumor
- Undiagnosed abnormal vaginal bleeding
- Known or suspected pregnancy
- Smokers > 35 years of age
- Migraine headache with focal aura
- Uncontrolled hypertension
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A lower or higher dose of hormone in a contraceptive has a greater risk of resulting in decreased efficacy with a DDI?
Lower
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What antibiotics may alter GI flora and reduce the efficacy of OCs?
Rifampin, Beta-lactams, tetracyclines, erythromycin, SMX/TMP
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What drug categories generally have interactions with OCs?
- Antibiotics
- Antifungals
- Anticonvulsants
- NNRTIs
- Protease inhibitors
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What interaction do Anticonvulsants have with OCs?
Make OCs not last as long
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A smoker who is over 35 and smokes more than 15 cigarettes a day should get what type of OC?
- Progestin only
- If have to have estrogen, choose a low dose <20 mcg formulation
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A women over 35 who hasn’t smoked for at least a year should get what OC?
Lowest dose of estrogen possible
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A woman with HTN should get what OC?
Progestin only
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When taking Drosperinone (Yasmin) in a patient with HTN, what should be monitored?
K
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