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859-2 Women's Health
Depo Provera and Emergency Contraception
35
Nursing
Graduate
12/01/2011

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Cards

Term
What is the dose, route, and frequency of Depo Provera?
Definition
DMPA 150mg/mL is given by IM injection Q 12 weeks
Term
What is the effectiveness of Depo?
Definition
Correct and consistent use: Probability of pregnancy is 0.3%
Typical use: 3%
Term
What is the MOA of Depo?
Definition
Primary MOA is inhibition of ovulation. (Suppresses levels of FSH and LH and eliminates LH surge.) Also thickens and decreases quality of cervical mucus.
Term
What hormones are contained in Depo?
Definition
Progestin-only contraceptive
Term
What is the return to fertility when a patient stops the Depo shot?
Definition
As many as 9-10 months after last dose
Term
Is there a decrease in efficacy of Depo for overweight/obese women?
Definition
No.
Term
What is the effect of Depo on the menstrual cycle?
Definition
Irregular bleeding and amenorrhea. 10-30% amenorrheic after one injection; 40-50% after the fourth injection
Term
What are the advantage to how Depo affects the menstrual cycle?
Definition
Decreased ovulation pain, cyclic menstrual cramps, mood changes, headaches, breast tenderness, and nausea
Term
Other advantages to Depo
Definition
Minimal drug interactions (aminoglutethimide-Cushing's only)
Decreased grand mal seizures
Reduction in sickle cell crisis
Reduced pain from endometriosis, decreased PID
Term
20-25% of women will discontinue Depo in the first year for this reason
Definition
Irregular bleeding
Term
Disadvantage of Depo (not irregular cycle)
Definition
Weight gain
Term
How does Depo affect depression?
Definition
May experience increase in depression on Depo; not considered a contraindication
Term
How does Depo affect bone density?
Definition
Temporary and reversible decreased bone density
Term
How long does it take for Depo to clear from a woman's body?
Definition
6-8 months after last injection (keep in mind when considering reasons for discontinuing)
Term
What is the one absolute contraindication for Depo?
Definition
Current breast cancer
Term
How long should a post partum woman wait until beginning progestin-only methods of BC?
Definition
Several organizations have recommended waiting until 6 weeks so as to not slow breast milk production
Term
What is the rate of bone density return after stopping Depo?
Definition
For women over 21, returns to rates of non Depo users by 30 months after discontinuation
Term
When is a back up method needed for Depo?
Definition
First 7 days after first injection (unless given within 5 days of beginning of period) and past due for injection
Term
How long is Depo effective for?
Definition
11-13 weeks
Term
When can you begin pills or other contracpetion when switching from Depo?
Definition
Start BEFORE it is time for next injection
Term
Depo warning signs
Definition
Repeated, painful HAs
Heavy bleeding
Depression
Severe, lower abdominal pain (may be pregnancy)
Pus, pain, redness, itching, or bleeding at the injection site
Term
Medical contraindications to EC?
Definition
Pregnancy-only because it will be ineffective, not because it will be harmful to fetus.
Term
What hormone does Plan B contain?
Definition
Levonorgestrel
Term
What is the time frame for use of EC?
Definition
120 hours (5 days) after intercourse
Term
Does availability of EC increase sexual risk taking?
Definition
NO
Term
Who is able to purchase EC OTC?
Definition
18 and over
Term
What is the primary MOA of emergency contraception?
Definition
Inhibits ovulation
Term
Other possible MOAs of Plan B?
Definition
Interference with corpus luteum function, thickening of cervical mucus, interferes with migration of sperm
Term
What other method can be used as ED?
Definition
Copper containing IUD
Term
Side effects of hormonal EC
Definition
Nausea and vomiting (less common in Progestin only EC, such as Plan B) and menstrual changes
Term
Breastfeeding and EC
Definition
Ok 6 weeks post partum (progestin only preferable to estrogen containing EC
Term
Frequent use
Definition
Not as effective as regular contraceptives/frequent use decreases efficacy
Term
Multiple acts of intercourse
Definition
If more than 120 hours since first unprotected exposure, ECP less effective at preventing pregnancy
Term
EC counseling
Definition
Exclude possibility that she is already pregnant, is she using form of contraception?
Term
Follow up for EC
Definition
RTC if period does not start in 3 weeks for PT; do not have unprotected intercourse in the coming days/weeks (Plan B does not protect you)
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