BASIC - OBS & GYNAE Flashcards
1
Q
What are the short acting methods of contraception?
A
Pill, patch, ring
2
Q
What is in COCP?
A
Ethinyl Oestradiol + a progesterone
3
Q
Give the types of progesterone possible?
A
2nd gen (norethisterone, levonorgestrel) 3rd gen (desogestrel, gestodene, norgestimate) Yasmin (contains drospirenone) Dianette (cyproteone acetate, used in acne)
4
Q
Give brand names of different generations of COCP?
A
2nd Gen (microgynon, rigevidon) 3rd gen (Marvelon, Yasmin, Cilest) 4th gen (Glaira)
5
Q
PEARL index in COCP?
A
0.3-4
6
Q
How is COCP taken?
A
21 pills OD then 7 days off
Take at same time everyday
7
Q
How does COCP work?
A
Stops ovulation by preventing FSH/LH release
Also thickens cervical mucus and thins endometrial lining
8
Q
Common SE of COCP?
A
Breakthrough bleeding – 1st 3 months but then may become lighter
Weight gain, acne, mood changes, headache
Nausea, breast tenderness, tiredness, bloatedness
Increased risk of blood clots, breast/cervical cancer
9
Q
Benefits of COCP?
A
Reduced menstrual blood loss and pain
Non-contraceptive benefits - acne, PCOS, PMS, endometriosis, irregular bleeding, menorrhagia
Decrease in PID, ovarian cysts, ovarian, uterine and colon
10
Q
Risks of COCP?
A
Oestrogen thickens blood so VTE (x3-5), stroke (x2), MI, breast (returns to background risk after 10 years of stopping) and cervical cancers
P450 enzyme inducer interactions (reduce efficacy)
COCP- Affected by D&V and some Abx – use condoms from onset of Abx or D&V
11
Q
Absolute CI of COCP?
A
<6 weeks post-partum & breastfeeding Smoking (>15/day) >35yrs (may use 1 year after stopping) BP >160/100 - PMH of: o Migraine with aura o Current or past VTE o CHD/CVA/IHD/AF o Current or history of Breast Ca (Oestrogen dependent tumours) o Decompensated liver cirrhosis
12
Q
Relative CI of COCP?
A
- BMI>35
- Migraine > 35
- Adequately controlled hypertension
13
Q
When do missed pill confer more risk? Missed pill rules of COCP?
A
Pills missed at beginning and end of pack confer more risk of pregnancy
If one pill missed (>24 hours and <48h) – take missed pill, even if means two at once, take rest of pack as usual
If two or more pills missed (>48h late) – last pill missed should be taken, leave earlier missed pills, take rest of pack as normal, condoms used for 7 days
14
Q
If two or more COCP pills missed (>48h late) - what rules for each week are there?
A
- If in week 1 – emergency contraception needed
- If in week 2 – no need for EC, normal regimen
- If in week 3 – start next pack immediately
15
Q
Rules for missed pills Qlaira COCP?
A
- If <12h late, pill taken immediately, take as usual
- If >12h late, read packaging
16
Q
Rules for missed pills for Zoely COCP?
A
- If <12h late, pill taken immediately, take as usual
- If >12h late, read packaging
17
Q
When are COCP effective postpartum?
A
Postpartum – start day 21 (not breastfeeding), 6 weeks (breastfeeding)
18
Q
When are COCP effective according to menstrual cycle?
A
If started day 1-5 of cycle, effective immediately
After day 5- condoms for 1 week
19
Q
When can COCP be started after EC and what else is needed for each type?
A
Started immediately after EC – use additional contraception for 7 days after levonorgestrel and 14 days after ulipristal acetate
20
Q
What is in the combined patch? Brand name?
A
150mcg norelgestromin and 20mcg ethinyl oestradiolEvra
21
Q
PEARL index of combined patch?
A
1.25
22
Q
How is combined patch taken?
A
Change weekly, 1 patch-free week per month
23
Q
How does combined patch work?
A
Synthetic oestrogen and progesterone prevent FSH/LH release, preventing follicular development and ovulation
24
Q
Common SE of combined patch?
A
Local reaction
Patch detachment
Nausea, breast tenderness, headache, initial irregular bleeding, tiredness, mood swings, bloatedness, acne, weight gain
25
Benefits of combined patch?
Decrease in PID, ovarian cysts, ovarian, uterine and colon cancers, menstrual control, less benign breast disease
26
Risks of combined patch?
Oestrogen thickens blood so VTE (x3-5), stroke (x2), MI, breast and cervical cancersP450 enzyme inducer interactions
27
CI of combined patch?
```
<6 weeks post-partum & breastfeeding
Smoking (>15/day) >35yrs (may use 1 year after stopping)
BP >160/100
- PMH of:
o Migraine with aura
o Current or past VTE
o CHD/CVA/IHD/AF
o Current or history of Breast Ca (Oestrogen dependent tumours)
o Decompensated liver cirrhosis
```
28
What happens if combined patch falls off?
Replace fallen patch with new
If off <48 hours – it will cover you for 9 days
If off >48 hours – may need EC and condoms
29
When is combined patch effective?
If started day 1-5 of cycle, effective immediately
After day 5- condoms for 1 week
30
What is in a Ring? Brand name?
15mcg ethinyl estradiol and 120ug etonogesterolNuvaRing
31
PEARL index of ring?
1.2
32
How is ring contraception taken?
Used for 21 days, then 1 week off
| Inserted into vagina and not removed
33
How does ring work?
Synthetic oestrogen and progesterone prevent FSH/LH release, preventing follicular development and ovulation
34
Common SE of ring?
Vaginitis, vaginal discharge
Nausea, breast tenderness, headache, initial irregular bleeding, tiredness, mood swings, bloatedness, acne, weight gain
Pain during sex
35
Benefits of ring?
Decrease in PID, ovarian cysts, ovarian, uterine and colon cancers, menstrual control, less benign breast disease
36
Risks of ring?
Oestrogen thickens blood so VTE (x3-5), stroke (x2), MI, breast and cervical cancersP450 enzyme inducer interactions
37
CI of ring?
```
<6 weeks post-partum & breastfeeding
Smoking (>15/day) >35yrs (may use 1 year after stopping)
BP >160/100
- PMH of:
o Migraine with aura
o Current or past VTE
o CHD/CVA/IHD/AF
o Current or history of Breast Ca (Oestrogen dependent tumours)
o Decompensated liver cirrhosis
```
38
What happens if ring comes out? Washing technique?
If out >3h or more than once per cycle- effect lost
Efficacy lost if ring free week extended
If comes out wash with tepid water and reinsert
39
When is ring effective?
If started day 1-5 of cycle, effective immediately
After day 5- condoms for 1 week
40
What is in the POP?
Contains either levonorgestrel, norethisterone or etynodiol acetate
Traditional or Cerazette (75mcg desogestrel)
41
PEARL index of POP?
0.4-5
42
How is POP taken? Rules for menstrual cycle, after miscarriage and pregnancy?
Taken every day, best at same time each day
If started on day 1, no extra contraception needed
If stated after day 5 – extra contraception used for 48h
After miscarriage – start on day
After pregnancy – starts on day 21
43
How does POP work?
Thickens cervical mucous
Desogestrel only pill prevents ovulation
44
Common SE of POP?
Irregular bleeds
Loss of libido
Ovarian cysts
Progesterone – headache, mood change, weight gain, acne, breast tenderness
45
Benefits of POP?
Can be used in breast feeding, older age
| Can be used in sickle cell disease, SLE, other autoimmune diseases
46
Risks of POP?
Menstrual disturbance – regular, irregular or amenorrhoeic
Enzyme inducer interactions (increase metabolism of POP, reducing efficacy)
Remember to take at same time
47
CI of POP?
Pregnancy
Breast cancer in last 5 years
Current enzyme inducers
Decompensated liver disease
48
Missed pill rules of traditional POP? What happens if vomits?
Traditional – If >3h late – take missed pill ASAP, take subsequent pill at usual time and use extra contraception for next 48h
Consider EC if unprotected sex in 2-3 days prior, or since missed pill
If vomit within 2h of pill ingestion – take another pill now, use extra contraception for next 48h
49
Missed pill rules of Cerazette POP? What happens if vomits?
Cerazette – If >12h late – take missed pill ASAP, take subsequent pill at usual time and use extra contraception for next 48h
Consider EC if unprotected sex in 2-3 days prior, or since missed pill
If vomit within 2h of pill ingestion – take another pill now, use extra contraception for next 48h
50
When is POP effective?
If started on day 1-5, effective immediately
After day 5 – condoms for 48h
51
What are the types of long-acting contraception?
Injectable, implant, Intrauterine Contraception
52
What is the implant?
Nexplanon (etonogestrel)
53
PEARL index of implant?
0.05
54
How is implant taken?
Single sub-dermal implant lasting 3 years
Requires a small procedure under LA
Inserted into upper part of arm (between biceps and triceps)
55
How does implant work?
Inhibits ovulation
Thickens cervical mucous
56
Common SE of implant?
Irregular bleeds
Progesterone – headache, mood change, weight gain, acne, breast tenderness
Insertion bruising, infection, scarring, expulsion
57
Benefits of implant?
As effective as sterilisation, quick return to fertility once removed
Can forget about it
58
Risks of implants?
Irregular bleeding in 80%
| 20% amenorrhoeic
59
CI of implants?
Breast cancer in last 5 years, current enzyme inducers, CVA, severe liver disease
60
When is implant effective?
If started day 1-5 of cycle, effective immediately
After day 5- condoms for 1 week
61
What is in injection?
DepoProvera (medroxyprogesterone acetate)
| Noristerat (norethisterone)
62
PEARL index of injection?
0.4
63
How is injection taken?What if late?
IM injection into buttocks
Depo – 12 weeks
Noristerat – 8 weeks
If start/late (>14w) then condoms for 7 days
64
How does injection work?
Slow-release progesterone, bypasses circulation
Inhibits ovulation
Thickens cervical mucus
65
Common SE of injection?
Irregular bleeds
| Progesterone – headache, mood change, weight gain, acne, breast tenderness
66
Benefits of injection?
No drug interactions
Amenorrhoea in 70%
Good for those with heavy/painful periods
67
Risks of injection?
Proven weight gain (3kg in 2 years)
Decrease in bone mineral density (>5 years stop)
Fertility delay (6-12 months after stopping)
Once given, cannot remove so SE can last 3 months
68
CI of injections?
Breast cancer in last 5 years, current enzyme inducers, CVA, severe liver disease
69
What is the IUS?
Levonorgesttrel-releasing system (daily dose 20mcg)
| Mirena
70
PEARL index of IUS?
0.2
71
How is IUS taken?
Inserted into uterus lasting 3-5 years
STI check before insertion
Nurse/Doctor will put speculum into vagina and special inserter puts IUD through opening of cervix into uterus (<5 minutes)
Need to check strings monthly
72
How does IUS work?
Prevents endometrial proliferation
Thickens cervical mucus
73
Common SE of IUS?
Irregular bleeds – for 6 months then have shorter/lighter periods
Progesterone – headache, mood change, weight gain, acne, breast tenderness
74
Benefits of IUS?
Useful in menorrhagia and HRT
| Can forget about it
75
Risks of IUS?
Small risk of perforation on insertion (1 in 1000) and expulsion (5%) can occur
Increased risk of ectopic if IUS fails
May continue to have unpredictable spotting
76
CI of IUS?
Breast cancer in last 5 years, current enzyme inducers, CVA, severe liver disease
Unexplained vaginal bleeding
Cervical/Endometrial cancer
Uterine abnormalities, current chlamydia/gonorrhoea, PID <3 months ago
Postpartum sepsis
77
Missed pill rules of IUS?
If expelled, then efficacy lost
| Strings must be checked regularly
78
When is IUS effective?
Exclude possible pregnancy
Menstruating, no sex since menstruation, no sex in last 3 weeks + negative pregnancy test or using other forms of reliable contraception (not condoms)
79
What is IUCD?
Copper ions
| ParaGard
80
PEARL index IUCD?
0.6-0.8
81
How is the IUCD taken?
Inserted into uterus lasting 5-10 years
Nurse/Doctor will put speculum into vagina and special inserter puts IUD through opening of cervix into uterus (<5 minutes)
82
How does IUCD work?
Copper ions inhibit sperm motility and survival
83
Common SE of IUCD?
Heavy bleeding, irregular in first 3-6 months
| Dysmenorrhoea
84
Benefits of IUCD?
No hormones, long-lasting method
Effective instantly
If fitted >40, can stay til no longer required
85
Risks of IUCD?
Risk of infection (screening for chlamydia)
Worsen menorrhagia
Risk of perforation on insertion
Expulsion – most common in <3 months, 1 in 20
86
CI of IUCD?
```
Undiagnosed bleeding
Uterine abnormalities, current chlamydia/gonorrhoea, PID <3 months ago
Endometrial/Cervical cancer
Copper allergy
Postpartum sepsis
Long QT syndrome
```
87
Missed rules for IUCD?
If expelled efficacy lost – strings must be checked regularly
88
When is the IUCD effective?
Exclude possible pregnancy
- Menstruating, no sex since menstruation, no sex in last 3 weeks + negative pregnancy test or using other forms of reliable contraception (not condoms)
89
What barrier methods of contraception?
Condoms, diaphragm, spermicide
90
What are condoms made of?
Latex (male) or polyurethane (both)
91
PEARL index of condoms?
If used correctly, M98%, F95%
| User failure rate 15%
92
How are males condoms used?
Unroll onto erect penis with teat or end pinched to expel air (prevents bursting at ejaculation)
Use new condom with each episode of sexual intercourse
Do not use oil-based lubricants & topical clindamycin as destroys latex
93
How do condoms work?
Barrier preventing sperm entering vagina and cervix
94
Benefits of males condoms?
- Helps prevent STIs, no serious SE, widely available
- No hormones
- Easy to obtain
95
Benefits of female condoms?
- Inserted 8 hours before sex
- Protection against STIs
- Latex free & no known adverse effects
- Less likely to tear
96
Risks of male condoms?
- Can split/slip off
- Requires forward planning
- Loss of sensitivity during intercourse
97
Risks of female condoms?
- Need to ensure penis is inside and not pushing it out of place
- Noisy
- Can be dislodged
98
What happens if condoms split?
If splits – need emergency contraception
99
When are condoms effective?
Immediately effective
100
What is the diaphragm?
Flexible silicon or latex device
101
PEARL index of diaphragm?
92-96% Effective with spermicide
102
How is the diaphragm taken?
Sits on top of vagina, barrier to cervix
Fitted by clinician and technique taught
Inserted 2h before sex and removed >6h after
Check cervix is covered after insertion
103
How does diaphragm work?
Barrier for sperm so cannot enter cervix
| Use with spermicide
104
Benefits of diaphragm?
No serious SE
Can be inserted before sex
Latex free
No hormones
105
Risks of diaphragm?
```
Need to use correct size
UTIs
Rubber insensitivity
No STI protection
Predispose to cystitis
Don’t use when menstruating
```
106
CI of diaphragm?
Can take time to learn correct technique to insert
107
What happens if diaphragm does not work or falls out?
EC needed
108
When is the diaphragm effective?
Immediately
109
What is spermicide?
Nonoxinol-9
110
PEARL index of spermicide?
Unreliable unless used with a barrier
111
How is spermicide taken?
Comes in creams, gels, foams, suppositories (soft inserts that melt into a cream)
112
How does spermicide work?
Stop semen reaching an egg and blocks cervical entrance
Put in vagina before sex
Add before each sexual encounter
113
Common SE of spermicide?
Sore vagina/penis
114
Benefits of spermicide?
Cheap, easy-to-use
| Hormone free
115
Risks of spermicide?
Irritation to vagina/penis
Increased risk of STDs
Messy
116
CI of spermicide?
Not recommended for those at high risk or with HIV as increases transmission chances
117
What happens if spermicide is not used?
Emergency contraception
118
When is spermicide effective?
Effective after 10-15 minutes
119
Indication of danazol?
o Endometriosis
| o Hereditary angioedema
120
Mechanism of danazol?
o Inhibits pituitary gonadotrophins
o Combines androgenic activity with antiestrogenic and antiprogestogenic activity
o Reduces oestrogen and progesterone levels
o Causes atrophy of endometrium
121
SE of danazol?
o Hirsutism, acne, deepened voice, adverse lipid profiles
o Breast atrophy, hot flushes, elevated liver enzymes, mood changes
o Increased risk of ovarian cancer
122
How can HRT be given?
- Can be given systemically for hot flushes and oestoporosis or vaginally (or topically) for local symptoms such as vaginal dryness
123
Indications of HRT?
* Treatment of menopausal symptoms where benefits outweight risks
* Women with early menopause until age of natural menopause, even if asymptomatic
* Women under 60 at risk of osteoporotic fractures in which other treatment unsuitable
124
Types of HRT - other hormones?
* Tibolone (synthetic steroid compound – converted to metabolites with oestrogentic, progestogenic and androgenic actions)
* Testosterone (patches and implants – to improve libido)
125
Routes of administration of HRT?
* Oestrogen = oral, transdermal, subcut, vaginal.
| * Progesterone = oral, transdermal, intrauterine (levoorgestrel – mirena coil).
126
Why are non-oral preparation beneficial in HRT?
* By avoiding the first pass metabolism through the liver, non-oral preparations (ie patches or gels):
* Have less effect on clotting factors.
* Reduce triglycerides.
* Are are often more suitable for:
* Women with lots of side-effects, liver disease or gallstones, history of malabsorption, risk of thrombosis, diabetes, BMI >30 kg/m2, taking enzyme-inducing drugs, history of migraines (the bolus effects of oral medication can trigger migraines in some women).
127
What HRT preparations given to women with uterus?
Women with uterus – combined HRT
• Oestrogen and cyclical progestogen if still having periods, or within 12 months of period
• Continuous combined HRT in post-menopausal women
128
What HRT preparations given to women without uterus?
• Women without uterus – oestrogen-only HRT (unopposed oestrogens increases risk of endometrial cancer so only when hysterectomy)
129
Prescribing HRT general tips?
* Lowest effective dose of HRT for minimum duration
* Start with low-dose oestrogen and consider gradually increasing after 4-6 weeks
* Transdermal oestrogen can be used as fewer risks
* Micronised progesterone good to start
130
What HRT prescription changes if women having progestogen SE?
• Women with progestogen side-effects (eg, fluid retention, mood swings, weight gain) can have the progestogen dose halved or the duration of taking progestogen reduced to 7-10 days.
131
Which progestogens have fewer side effects in HRT?
• Fewer progesteronic side-effects occur with micronised progesterone and dydrogesterone.
132
Is the IUS used in HRT?
• The intrauterine system (IUS) can be used as an alternative for endometrial protection. Its licence for this use is four years
133
Contraindications of HRT?
* Oestrogen-dependent cancers
* Past PE
* Undiagnosed PV bleeding
* LFT increased
* Pregnant, breastfeeding
* Phlebitis
* Avoid/Monitor closely in Dubin-Johnson/Robin syndrome
134
Side effects in all types of HRT?
• Weight gain
135
SE in combined HRT?
• Irregular, breakthrough bleeding
136
SE of oestrogen related HRT?
* Fluid retention
* Bloating
* Breast tenderness/enlargement
* Nausea
* Headaches
* Leg cramps
* Dyspepsia
137
SE of progesterone related HRT?
* Fluid retention
* Breast tenderness
* Headache/migraine
* Mood swings
* Depression
* Acne
* Lower abdominal pain
* Backache
138
Investigation of HRT?
* Personal/family Hx of VTE – haematology opinion
* If high risk of breast cancer – mammography or MRI scan
* Arterial disease of risk factors – consider lipid profile check
139
Follow-up of HRT?
```
- 3 month and then annual Check-Up
• Breast examination
• BP (stop if >160/100mmHg pending investigation)
• Weight
• Any bleeding?
```
140
Benefits of HRT - vasomotor?
* Oestrogen is effective in treating hot flushes.
* Improvement within 4 weeks.
* Most common indication for HRT.
* More effective than SSRIs or clonidine
141
Benefits of HRT - urogenital/sexual?
* Urogenital symptoms respond well to oestrogen.• Improvement may take several months (may need to be long term)
* Systemic therapy does not improve urinary incontinence.
* Sexuality may be improved by oestrogen alone (add progesterone if hysterectomy).
142
Benefits of HRT - skin and hair/bone?
* Improves skin and hair appearance
| * Reduced risk of osteoporosis, osteoporotic fractures and colorectal cancer by 1/3
143
Risks of HRT?
* Side Effects
* Increased risk of breast cancer
* Increased risk of endometrial cancer (unopposed oestrogen)
* Increased risk of VTE
* Increase risk of stroke
* Increased risk of gallbladder disease
144
Risks of HRT and breast cancer details?
* Dependent on duration of HRT.
* Effect not sustained once HRT has stopped.
* Greatest risk with oestrogen-progesterone therapy.
145
Risks of HRT and endometrial cancer?
• Unopposed oestrogen increases risk of endometrial ca.• Risk remains for ~5 years after stopping HRT.
146
Risks of HRT and VTE?
* HRT more than doubles the risk of VTE
* VTE more likely in first year
* Older age, obesity and thrombophilia significantly increased risk of VTE.
147
Risks of HRT and gallbladder?
* Risk increases with age and obesity
| * Women who use HRT may have pre-existing disease
148
Alternatives to HRT therapy?
- SSRIs can help vasomotor symptoms (clonidine)
- Osteoporosis treated with Ca, VitD and bisphosphonates or SERMS
- If only local vaginal dryness – local treatment best – oestrogens or lubricants
- Psychological symptoms may benefit from CBT
149
Indication in obstetrics of erythromycin?
* PPROM
| * Severe pneumonia added to penicillin to cover atypicals
150
Abx in UTI in pregnancy?
- Nitrofurantoin (avoid in last trimester)
- Amoxicillin
- Cefalexin
151
Indications of metronidazole?
* Perineal tears
* C.diff infection
* Oral infections or aspiration pneumonia
* Surgical infections
152
Indications of oral iron supplements?
• Treatment and prophylaxis of iron-deficiency anaemia in pregnancy
153
Indications for aspirin prophylaxis?
* Given at 12 weeks if one high risk for pre-eclampsia or greater than 1 moderate risk factors
* High RF – Hx of PET, diabetes, chronic HTN, renal disease, twins, SLE, APS, sickle cell disease
* Moderate RF – Nilliparity, BMI >30, FHx of PET, >35
154
When is labetalol?
• Used in PIH and PET
155
Uses of methyldopa?
• Used in PIH and PET
156
Uses of nifedipine?
• Used in PIH and PET
157
Indications of Syntometrine?
Syntometrine (ergometrine/oxytocin)
• 3rd Stage of labour if delayed – 0.5mg ergometrine + 5IU oxytocin IM
158
Mechanism of Syntometrine?
* Synthetic oxytocin - hormone produced in hypothalamus
* Ergometrine – alpha-adrenergic, dopaminergic and serotonin (5-HT) receptor agonist
• Cause uterus contraction
159
SE of Syntometrine?
* Nausea and vomiting
* Abdominal pain
* Headache
* Dizziness
* Hypertension
* Arrhythmias
160
Warnings of Syntometrine?
• Contraindications – first stage of labour, second stage of labour, severe kidney/liver/heart/HTN disorders, PET, sepsis
161
Interactions of Syntometrine?
• Prostaglandins increase effect of oxytocin
162
Indications of Syntocinon?
Syntocinon (oxytocin)
* Used in prevention and management of PPH
* Induction of labour – after PGE2
* Labour – Delayed 1st stage, 2nd stage, hypertension, cardiac disease
* Stimulate breastmilk production
163
Mechanism of Syntocinon (oxytocin)?
* Synthetic oxytocin - hormone produced in hypothalamus
| * Causes uterine contractions to increase speed/start labour and stop bleeding following delivery
164
SE of Syntocinon (oxytocin)?
* Slow HR, nausea
* Hypertension
* Rupture of uterus
165
CI of Syntocinon (oxytocin)?
* Malpresentation
* Obstetric emergency where surgery is needed
* Foetal distress
* Umbilical cord prolapse
* Hyperactive uterus
* Vaginal delivery CI
166
Medication for constipation in pregnancy?
- Stimulant laxatives should be avoided – cause uterine contractions
167
Indications of mefenamic acid/tranexamic acid?
o Menorrhagia
| o Local fibrinolysis
168
Medications used in stress incontience?
- Duloxetine
- Anticholinergics (oxybutynin)
- Oestrogens
- Botulinum Toxin A
169
Indications of oxybutynin?
- Anticholinergics (oxybutynin)
Reduce urinary frequency, urgency and urge incontinence in overactive bladder (1st line)
170
When are oestrogens used in stress incontinence?
o Used in urge incontinence if vaginal atrophy present
171
Indications of botulinum toxin A?
o Used in urge incontinence
172
Mechanism of botulinum toxin A?
Purified botulinum toxin produced by Clostridium botulinum
| Binds to acceptor sites on motor or sympathetic nerve terminals, inhibiting release of acetylcholine
173
Names of GnRH agonists?
- Goserelin, Buserelin, Leuprorelin
174
Indications of GnRH agonists?
```
o Fibroids
o Menorrhagia
o Premenstrual syndrome
o Endometriosis
o Subfertility
o Prostate/Breast cancer
```
175
Mechanism of GnRH agonists?
o Produces initial phase of stimulation
o Continued administration is followed by down-regulation of GnRH receptors, reducing release of FSH and LH so inhibiting androgen and oestrogen production
176
SE of GnRH agonists?
o Hot flushes, sexual dysfunction, vaginal atrophy, osteoporosis, infertility
o Diminished sex-specific physical characteristics
o Hypercalcaemia
177
CI of GnRH agonists?
o Undiagnosed vaginal bleeding
o Use >6 months in endometriosis
o Pregnancy
178
Monitoring in GnRH?
o Need annual DEXA scan
179
Indications of prostaglandins?
- Prostaglandins (PGE2)
o Used in IOL
180
Mechanism of prostaglandins?
Binding and activating PGE2 receptor which activates Wnt signalling pathway
Opens and softens cervix and dilation of blood vessels
181
Indications of mifepristone?
- Used in termination of pregnancy
182
Mechanism of mifepristone?
o Antiprogestogen
o Works by blocking competitively antagonising progesterone receptor of progesterone, making cervix easier to open and promoting contraction of uterus when exposed to misoprostol
o Antiglucocorticoid and antiandrogen – competitively antagonises cortisol action
183
SE of mifepristone?
o Abdominal pain, tiredness, vaginal bleeding, uterine cramping
o Nausea, vomiting, diarrhoea, dizziness
o Malformed baby
184
CI of mifepristone?
```
o IUD
o Ectopic pregnancy
o Adrenal failure
o Bleeding disorders
o Anticoagulant or long-term corticosteroid therapy
```
185
Monitoring of mifepristone?
o BP and pulse monitoring for 3h after given
| o Pregnancy test done 3 weeks later if aim is abortion
186
Indications of misoprostol?
- Used in termination of pregnancies, following priming from mifepristone & gastric ulcers
- Dilating uterus before surgical abortion
187
Mechanism of misoprostol?
o Synthetic prostaglandin analogue that stimulates the uterus to contract and ripen
o Also has antisecretory and protective properties, promoting GI ulcer healing
188
SE of misoprostol?
o Constipation, diarrhoea, dizziness, headache, nausea & vomiting
o Irregular bleeding
o Uterine rupture
189
Examples of tocolytics?
- Atosiban, nifedipine (CCB)
190
Indications of tocolytics?
- Used in prematurity between 24-33 weeks gestation
191
Mechanism of tocolytics?
o Nonapeptide, desamino-oxytocin analogue and competitive vasopressin/oxytocin receptor antagonist
o Inhibits oxytocin-mediated release of inositol triphosphate from myometrial cell membrane
o Reduced Ca influx and reduced PGE/PGF release
o Antagonises uterine contractions and relaxes uterus
192
SE of tocolytics?
o Dizziness, headache, hot flush, hyperglycaemia, hypotension, tachycardia, N&V
o Uterine atony
193
CI of tocolytics?
o Placental abruption/previa
o Antepartum haemorrhage
o Eclampsia/severe pre-eclampsia
o IUGR, IU infection
194
Monitor of tocolytics?
- Monitor blood loss after delivery
195
Indications of hydralazine?
- Used in eclampsia, given IV if needed
196
Indications of MgSO4?
- Used in severe acute asthma, tosardes de pointes, prevention and treatment of seizures in pre-eclampsia/eclampsia and hypomagnesaemia
197
Mechanism of MgSO4?
o Reduces systolic blood pressure (leaving blood flow to foetus intact)
o Depresses neurones action so reducing seizure risk/activity
198
What does Carboprost have in?
Carboprost (Ergometrine and Hemabate) IM
199
Uses of Carboprost?
- Used in PPH when unresponsive to Syntocinon
200
Mechanism of Carboprost?
o Synthetic prostaglandin analogue of PGF2a
| o Induces contractions
201
SE of Carboprost?
```
o Diarrhoea
o Flushing
o Fever, chills
o N & V
o Uterine disorders
```
202
Indications of methotrexate?
- Used in ectopic pregnancy, molar pregnancy and choriocarcinoma (oral, once weekly)
203
Indications of podophyllotoxin?
- Used in genital warts (condylomata acuminate)
204
Mechansim of podophyllotoxin?
o Destabilises microtubules by binding tubulin and preventing cell division
205
SE of podophyllotoxin?
o Itching, irritation and redness
206
Caution of podophyllotoxin?
o Avoid normal skin, open wounds
| o Avoid face and very irritant to eyes
207
Use of podophyllotoxin?
Applied BDS for 3 days, then 4 days off – weekly up to 4-week treatment
208
Indications of imiquimod?
- Used in genital warts (condylomata acuminate)
209
Mechansim of imiquimod?
o Stimulates TLR7 to secrete cytokines and TNF-a – enhances immune system function to area
210
SE of imiquimod?
o Local skin reactions – blisters, burning, sensation, redness, itching
o Fever, flu-like symptoms, headache, tiredness
211
Caution of imiquimod?
o Autoimmune disease, immunosuppression
| o Avoid broken skim, eyes, lips, open wounds
212
Use of imiquimod?
o Used at night three times a week for up to 16 weeks
