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Chemical Contraception I & II by Mind Map: Chemical Contraception I &
II
5.0 stars - 1 reviews range from 0 to 5

Chemical Contraception I & II

Long-acting progestins

Implanon

Rods implanted in skin

Injection (Depo-Provera)

Can be used for endometriosis, too

MOA

Inhibit GnRH release, Inhibit ovulation, Endometrial thinning, Decreased E levels

SE

Menopausal Sx from decreased E

may take a while to regain fertility and normal cycle after use

Contraceptive Steroids

General

Estrogens, Ethinyl estradiol, mestranol

Progestins, If it has "nor" or "gest" in the name

MOA, E&P FB to Pit and HT to decrease release of GnRH, LH and FSH, Inhibit FSH -> prevent development of follicle, Inhibit LH -> prevent release of follicle (ovulation)

Types

Monophasic (combo of E&P), Each pill in pack has same dose of E/P

Biphasic, triphasic (multiphasic), Earlier in cycle don't need much P to prevent ovulation. Needs increase later in cycle, 24-day OCs, Yaz and Loestrin have 24 active pills, less steroid over longer time cause lighter periods

Transdermal, injectable, and vaginal E/P combos

Extended cycle OC

Progestin only, Mostly used for women who can't tolerate estrogens (Hx of TE, etc), SE: LOTS of spotting and irregular bleeding

Postcoital (morning after), Diethylstilbestrol (DES) is a teratogen

MOA

Inhibit ovulation

thicken cervical mucus, alter tubular transport of egg and sperm, make uterus less hospitable for implantation

PK

Highly lipophilic, Need higher dose in overweight (BMI > 27) women

Enters enterohepatic circulation, Why you can use such low doses - it just gets recycled

SE

Mild, Estrogen - Nausea, mastalgia, BTB, edema, Changes in serum proteins, Afffect endrocrine fn and will alter testing, Headache, But can improve PMS migraine Sx, Women w/ migraines w/ auras have increased risk of stroke on OC, Diuresis and hyperkalemia w/ drospirenone (similar to spironolactone)

Moderate, BTB, Wt gain, acne, hirsutism, Vaginal infections, increased skin pigmentation

Severe, TE Dz, MI, CVD, Risk increases w/ age and smoking, CI in smokers over 35, CI in Hx of TE Dz or CV events, GI disorders, cholestatic jaundice, GB Dz, hepatic adenoma, CI w/ Hx of hepatic adenoma or impaired liver fn, Depression, May or may not increase risk of Ca

Positive: Reduced risk of, Ovarian cysts and cancer, Endometrial Ca, Benign breast Dz, Ectopic pregnancy

DD interactions

effects or oral anticoagulants (Wafarin d/t decreased Vit K-dep CF)

Barbituates, anticonvulsants (phenytoin), metronidazole, St. John's Wort induce microsomal drug-metabolizing NZs, Reduce OC efficacy, Use higher dose OC

Abx (rifampin and griseofulvin), Reduce OC efficacy, Decrease normal gut flora needed for enterohepatic circulation, fall below therapeutic level of OC

Vaginal Spermacides

MOA

Nonoxynol-9 acts as surfactant to damage sperm cell membrane

SE

Candidiasis, increased vaginal infxns, TSS

Increased risk of STD infxn w/ very frequent use, Creates constant irritated state

Admin

Gel, cream, foam

Sponge

Suppository

IUD

MOA

Device releases copper or progestin to increase efficacy, P thickens mucus and causes endometrial changes

creates constant inflammatory state in uterus, Inhospitale environment for implantation

Does NOT prevent fertilization

New node

Devices

Progestasert, 1 year

Mirena, 5 years

Paragard T380A (copper), 10 years

SE

Can affect fertility after removal

increased incidence of PID, delayed ability to get pregnant, Best for women who've had kids

Uterine rupture during implantation

Male Contraceptives

All experimental!

GnRH analogs

suppress spermatogensis

Gossypol

Isolated from seed of cotton plant

Interferes with spermatogensis

May produce perminant infertility

Nifedipine

BP med that inhibits normal sperm fn