Adolescent Flashcards
what is the average age of first intercourse?
16.5
what is the age of consent in Canada? what is the close age exception?
age of consent in Canada: 16
close age exception:
14-15: can consent to sex with someone up to 5 years older
12-13: can consent to sex with someone up to 2 years older
must not be in a position of authority (teacher, coach, clergy etc)
18 years for exploitative sex (pornography, prostitution)
what are the contraceptive methods failure rates? chance condoms combined pill depo provera LARCs
chance- 85% condoms- 18% combined pill- 9% depo provera -6% LARCs- 0.2% * percentage of teens pregnant after 1 year of using this method
The patch, vaginal ring and OCP are less if effective if weight is greater than?
90kg
what is the number one contraceptive method recommended in Canada now?
LARCs (long acting reversible contraception)
What are the 3 options for LARCs
Mirena- good for up to 5 years, progesterone only
Jaydess- good for 3 years
kyleena- good for 5 years (smallest)
How can you increase the efficacy of condoms? who do you not recommend this for?
increased efficacy if combined with spermicidal form or jelly
high failure rate therefore recommend a backup for pregnancy protection
avoid spermicide in high risk for HIV populations (street youth or trading sex for money)
what are the estrogen related side effects associated with oral contraception? serious side effect?**
breast tenderness breakthrough bleeding nausea headaches hypertension thromboembolism drug interactions (P450) slight increased risk of cervical dysplasia (>5years)
Serious:
thrombosis (risk increases with smoking and age and in girls with migraine with aura and migraine with focal neurologic symptoms)
what would you do with your OCP if there was frequent breakthrough? nausea? headache?
breakthrough- increase the estrogen dose
nausea- decrease the estrogen dose
headache- use a monophasic pill, Lower estrogen
what dose of estrogen do we usually start with for our combined OCP
30-35 mcg estrogen
what drugs do OCP interact with?
anticonvulsants
- many decrease the efficacy of OCP
- valproate is NOT affected
- could use higher dose estrogen pill (35) or IUD
what are some contraindications to IUD (8) **
pregnancy/suspected pregnancy PID (current or within the last 3 months) acute/purulent cervicitis pelvic TB undiagnosed vaginal bleeding (suspicious for serious condition) distorted uterine cavity malignancy of genital tract Wilson disease (copper IUD)
Is weight gain a side effect from combined birth control?
NO!!! This is a myth. May have some fluid retention that comes and goes through the month
what type of OCP can be used for back to back?
Monophasic OCP (21, 21, 21, 21 then 5 days off) Seasonale (12 weeks of pills then 7 off)
what are some side effects from Depot Provera? **
irregular bleeding for 3-12 months amenorrhea weight gain (4-15 pounds) reduced bone density - caution if steroids, eating disorder, chronic renal failure - consider BMD depression/mood changes delays return to fertility- average 10 months!
what should you prescribe with Depo Provera
Calcium and vitamin D
when should you consider Depo Provera
Good choice when you don’t want a LARC
- can’t reliably take pills
- estrogen is contraindicated
- want amenorrhea
when should you give emergency contraception?
within 72 hours but up to 5 days
what options are available for emergency contraception?
Ella
- 30mg taken once
- up to 120 hours after unprotected sex
- does not reduce efficacy over time
Plan B (progesterone only)
- give 1.5mg once
- nausea 23%
Copper IUD
up to 7 days
what are 2 contraindications to emergency contraception?
pregnancy
history of anaphylaxis to product
what else should you do when you give emergency contraception?
arrange follow up in 1 week (ensure they are not pregnant- should have bleed within 3 weeks)
give prescription for emergency contraception
encourage condom use/regular contraception
what is gender dysphoria
a strong desire to be of the other gender or in insistence that one is the other gender
the condition is associated with clinically significant distress or impairment
what are some medical treatment options for transgender youth?
LUPRON Continuous OCP Testosterone Estrogen Sprionolactone Cyproterone acetate
** surgery (top or bottom) is not approved in children
what is the criteria for anorexia nervosa
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
what is binge eating disorder?
No compensatory behaviour
occurs 1/week for 3 months
eating an excessive amount of food
sense of lack of control during binge episode
- Eating, in a discrete period of time (e.g., within any 2 hr period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
what is the criteria for bulimia nervosa?
Binge eating + compensatory behaviour!
A. Recurrent episodes of binge eating.
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 mo.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
What is the criteria for ARFID?
A. An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
NO evidence of body image disturbance!!
what are indications for hospitalizations for eating disorder?
severe malnutrition:
weight <75-80% average body weight for age, sex and height
arrested growth and development
fluid and electrolyte abnormalities
- dehydration
- hypokalemia, hyponatremia, hypophosphatemia
cardiac abnormalities
- arrhythmia
- bradycardia <50bpm anytime, <45bpm at night
- hypotension (<80/50 mmHg)
- hypothermia (body temp <35.5)
- orthostatic changes in HR (>20bpm) or BP (>10mm Hg)
Behavioral
- acute food refusal
- uncontrollable binging ad purging
- acute psychiatric emergencies (suicidal ideation)
- comorbid diagnosis
Do the majority of teens with gonorrhoea or chlamydia have symptoms?
NO, most are asymptomatic!!!
what are some symptoms of chlamydia?
asymptomatic dysuria vaginal discharge abdominal pain vaginal spotting (especially after sex)
