AGPCNP MEGA REVIEW Questions and answers, Graded A. updated Version

AGPCNP MEGA REVIEW Questions and answers, Graded A. updated Version What is the most common estrogen preparation? - ESTRODIOL Combined contraceptive pills alter the doese of what during the cycle? - Estrogen & Progestin Are progenstin-only (min pills) as effective as combination pills? - NO What are 4 estrogenic effects of contraceptives? - 1. Ovulation inhibited by suppression of FSH/LH 2. Implantation inhibited by alteration of the endometrium 3. Ovum transport accelerated Leutolysis as progesterone levels fall What are 5 progestational effects of contraceptives? - 1. Thick cervical mucus interrupts sperm transport 2. Capacitiation may be inhibited 3. Ovum tranport may be slowed 4. Inplantation is hampered by suppression of the endometrium 5. Ovulation inhibited by hypothalmic-pituitary-ovarian disturbance Advantages of oral contraception? - Excellent protection against pregnancy Safe for most women Excellent reversibility May provide protection againd endometrial CA, PID, ovarian cysts, fibroids etc... 3 non-contraceptive benefits of OCs? - 1. Decreased menstrual cramps 2. Less menstrual blood flow 3. Improvement in facial acne Disadvantages of OCs? - Mood changes No HIV protection Rare circulatory complications Must be take every day SE of N/V, HA, breakthrough bleeding Excessive estrogen effects? - CVA DVT PE Hepatic tumors Cholasma cervical changes Estrogen deficiancy effects? - POST-MENOPAUSE Decreased duration in menstrual bleeding Continuous spotting Breakthrough bleeding DOC 1-9 Atrophic Vaginitis Excess progesterone effects? - HTN DEPRESSION INCREASED APPETITE Progesterone deficiency effects? - Breakthrough bleeding DOC 10-21 Delayed menses Ecessive androgenic effects? - Hirsuitism Acne Oily skin Edema Increased libido What is a major absolute contraindications to OC's? - UNDIAGNOSED UTERINE BLEEDING Where to begin with OC's? - Low-dose COMBINED or multi-phasic (35mcg or less) Which OC to use in hx of migraines? - Progestin-only What to do for missed pills with OC's? - Miss ONE day - Take 2 pills use backup Miss TWO days - Take 2 X 2 and use backup Miss THREE days - Throw out and restart next cycle with backup What to do with abnormal bleeding with OCs? - May need higher dose Should breast CA hx take OC's? - NO HTN on OC's? - Look at changing contraception first What to do with weight gain, depression, etc... on OC's? - May need to lower dose Should heavy smokers be on OC's? - NO What can decrease the effectiveness of OC's? - Antibiotics and anticonvulsants What do OC's decrease the effectiveness of? - Warfarin Insulin Certain oral hypoglycemics What does the Nuva Ring use? - Synthetic Estrogen and Progestin (similar to OC's) Contraindications of Nuva Ring - 35yo Smoker Uncontrolled HTN How long is Nuva Ring in place? - 21 days How quickly must Nuva Ring be re-inserted if it comes out? - 3 HOURS What does the Ortho Evera PATCH use? - Estrogen Progestin (similar to OC's) How often is the Ortho Evera patch changed? - Weekly What are some disadvantages of the Ortho Evera Patch? - Reduced effectiveness 90kg Increased risk of cardioembolic events Where can the ortho ever patch NOT be placed? - Breast How long can the patch be off before a new cycle must be started? - 24hrs What does Depo-Provera use? - Long-acting