Contraceptive Drugs

mkofos's version from 2015-11-30 21:25


Question Answer
Estrogen MOAinhibit ovulation by suppressing FSH/LH, alter secretions/cellularity of endometrium, induce luteolysis,, provide cycle control
Progestin MOAinhibit ovulation by suppressing LH midcycle surge, inhibit implantation by suppressing the endometrium, thicken cervical mucus, slow tubal motility (decrease cilia activity of fallopian tubes), and delay sperm transport
Yuzpe MOA2 doses of combo PO estrogen/progestin to equal ethinyl estradiol and levonorgestrel 12 h apart, prevents ovulation, post-coital contraceptive
Levonorgestrel MOAprevents/delays ovulation (impair tubal transport of sperm), post-coital contraceptive
Ulipristal MOAselective progesterone receptor modulator, delays/inhibits ovulation, post-coital contraceptive
Mifepristone MOAprogesterone antagonist, post-coital contraceptive
Misoprostol MOAPGE1 analog (softens cervix, stimulates uterine contraction), post-coital contraceptive
more effective combo post-coital contraceptive than either alonemifepristone/misoprostol
Drospirenonesynthetic progestin w/ antialdosterone effect for pts to help prevent bloating, weight gain, HTN



Question Answer
Estrogen Only Indicationscontraception for women who smoke and are <35 yo
Progestin Only Indicationspostpartum contraceptive (to not decrease lactation from estrogen)
Progestin-Estrogen Combo Indicationsreversible contraception, decrease dysmenorrhea, decrease functional ovarian cysts, decrease menstrual flow, improve hirsutism, improve acne, decrease risk of ovarian/endometrial CA, decrease ectopic pregnancy
Monophasic OCPsconstant dose of estrogen/progesterone, EASIER TO USE (less complicated, more flexible, easier to ID and rectify AEs)
Multiphasic OCPsattempt to mimic natural hormonal cycle, HARDER TO USE (confusing for pts, less flexible, difficult to rectify AEs)
Extended Cycle regimensmay increase efficacy/adherence, decrease menstrual cycle-related AEs, “just because” avoidance of menses, monophasic or multiphasic
Emergency Contraceptive Indicationsprevent unwanted pregnancy after unprotected/inadequately protected intercourse (no contraception, condom break, OCP non-adherence, sexual assault)
Combo mifepristone/misoprostol indicationsearly pregnancy termination (up to 9 weeks)



Question Answer
Transdermal Estrogen AEhigher dose (eg., transdermal patch) → increase risk for clotting, VTE, etc.
Estrogen ExcessNAUSEA, Breast tenderness, Fluid retention (wt gain); If AE’s are intolerable after 3 mo than switch to progestin only
Estrogen DeficiencyEARLY CYCLE breakthrough bleeding/spotting, absence of withdrawal sx
Progestin ExcessWEIGHT GAIN, increase appetite, bloating, constipation, acne, oily skin, depression, fatigue
Progestin DeficiencyLATE CYCLE breakthrough bleeding
Drospeirenone AEhyperkalemia and VTE
OCP ContraindicationsHALC -45 (smokes, 160/100)

H Heart Problems
L Liver problems
*Over 45 yo and HEAVY SMOKER
*BP above 160/100 mmHg
OCP AEsHYPERCOAGUABILITY (though pregnancy increases your risk for clotting even more), no STI protection, daily admin, menstrual cycle changes, N/V, HA, decreased libido, GB dz
Only documented drug interaction for OCPsRIFAMPIN (CYP inducer) is the only antibiotic w/ document PK interaction;
Phenobarbital, phentoin, carbamazepine, St. John’s wart (induce metabolism of estrogen and progesterone)
Antiepileptic Problems (ex. Carbamazepine)Carbamazepine = teratogenic (neural tube defects)
When can adverse addects occur for OCPs? And how long must you stay on an OCP before changing?AEs may occur during the FIRST THREE CYCLES of OC use, but should decrease in # and severity afterwards,
Use for THREE MONTHS before changing
OCP Warning SignsACHES

A Abdominal pain (severe)
C Chest pain (severe), cough, shortness of breath
H Headache (severe), dizziness, weakness, or numbness
E Eye problems (vision loss or blurring), speech problems
S Severe leg pain (calf or thigh) – DVT
Yuzpe AEsVOMITING, Nausea, Rx antiemetic 1 h prior to each dose
Levonorgestrel AEsheavy menstrual bleeding, HA, fatigue, dizziness, NOT associated w/ fetal malformations if egg is fertilized
Ulipristal AEsDysmenorrhea, HA, fatigue, dizziness, back pain, NOT associated w/ fetal malformations if egg is fertilized
Combo mifepristone/misoprostol AEscramping, pain, bleeding, diarrhea

Timing and Patient Counseling


Question Answer
Time to take Yuzpew/in 72 h but ASAP
Time to take Levonorgestrelw/in 72 h of unprotected sex
Time to take UlipristalRx only, can take be taken up to 5 d after intercourse
Time to take mifepristone/misoprostolearly pregnancy termination (up to 9 weeks)
When can pt resume birth control after emergency contraception?Resuming regular birth control can be started immediately
What do you tell pt about timing of taking OCPs?Tell pt to take pill at the same time of day every day, need to have a backup method if pt forgets to take
Pt wants OCP birth control, what info do you get?Get sexual hx, medical hx, BP measurement; smoking/non-smoking
Smoking and OCPsIf > 35 yo and smoker (>15 cigarettes/d) = avoid combined OCPs
% Failure for most OCPs8% for typical use, <1% for perfect use
what pts have a higher % failure?Obesity pts (increase BMR and hepatic enzyme induction, hormonal sequestration in adipose)
Return to fertility time for OCP-CHC< 1 mo
Return to fertility time for Progestin-only pillimmediate
Return to fertility time for Patch1 mo
Return to fertility time for Ring1 mo
Return to fertility time for DMPATEN MONTHS!

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