Adolescent, Gyne, Mental Health Flashcards
dose of estrogen for OCP
30-35 mcg min
starting OCP
should do preg test before starting
if unprotected sex in preceding month, they need another pregnancy test in 3 weeks
need to use condoms for 7 days after starting (or 14 days if recently used ella)
emergency contraception
plan b
- can’t be used if overweight
- use within 72 hr
- if they throw up within 2hr, give another dose
Ella
- can be used for up to 7 days
- use in overweight patients >BMI 25
- don’t start a progesterone containing OCP within 5 days of taking ella
- don’t use if the pt is on progesterone OCP alreaedy
- if thrown up within 3 hours, repeat dose
birth control missed pill
if miss 2 pills, use condoms x 7 days and if unprotected sex within the last 5 days,
if weeks 2-3 post period, dont need to use condoms
recommended STI screening
annual for chlam and gonorrhea
HIV and syphilis if over 15 (or if <15 and RFs)
is test of cure required for chlamydia and gonorrhea
chlamydia: TOC not needed but should be screened q6mo
gonorrhea: test of cure at 3-4 weeks with urine NAAT if concern for compliance or reinfecting
STI treatment
Chalmydia: Azithro
Gonorrhea: Ceftriaxone (or cefixime) plus azithro
no sex for 7 days post abx
syphillis: penicillin G once
genital herpes: acyclovir or valacyclovir
trich: flagyl x 7 d
Physiologic Leukorrhea
Clear discharge 6-12 mos prior to menarche
NOT itchy or painful
OCP for patients with epilepsy
avoid low dose estrogen (AEDs can increase hepatic clearance and decrease the efficacy of the AED)
underlying medical condition causing heavy menstrual bleeding
bleeding disorder in up to 20% - esp von willebrand disease
Repeat dosing for emergency contraception
**If vomiting within 2 hours of plan B-> need a repeat dose now
**If emesis within 3 hours of Ella-> need a repeat dose now
HPV vaccine
routine for all girls and boys between 9-13 yrs
vaccinate before first sexual contact
If 9-14 yrs
- 2 doses at least 6 mo apart
If 15 yrs and older
- 3 doses now, 1mo, 6 mo
immunocompromised
- 3 doses
most common side effect of marijuana
gynecomastia
gynecomastia ddx
normal pubertal
meds: anabolic steroids, TCA, spironolactone, cannabis, H2 receptor blockers
Endocrinopathy
Klinefelter
malignancy
Male teen who is football player. Has gynecomastia, hepatitis, and jaundice. Most likely taking:
anabolic steroids
