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BASIC - OBS & GYNAE Flashcards

1
Q

What are the short acting methods of contraception?

A

Pill, patch, ring

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2
Q

What is in COCP?

A

Ethinyl Oestradiol + a progesterone

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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)
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4
Q

Give brand names of different generations of COCP?

A 
2nd Gen (microgynon, rigevidon)
3rd gen (Marvelon, Yasmin, Cilest)
4th gen (Glaira)
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5
Q

PEARL index in COCP?

A

0.3-4

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6
Q

How is COCP taken?

A

21 pills OD then 7 days off

Take at same time everyday

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7
Q

How does COCP work?

A

Stops ovulation by preventing FSH/LH release
Also thickens cervical mucus and thins endometrial lining

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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

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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

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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

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11
Q

Absolute CI of COCP?

A 
<6 weeks post-partum &amp; 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
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12
Q

Relative CI of COCP?

A
  • BMI>35
  • Migraine > 35
  • Adequately controlled hypertension
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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

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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
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15
Q

Rules for missed pills Qlaira COCP?

A
  • If <12h late, pill taken immediately, take as usual

- If >12h late, read packaging

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16
Q

Rules for missed pills for Zoely COCP?

A
  • If <12h late, pill taken immediately, take as usual

- If >12h late, read packaging

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17
Q

When are COCP effective postpartum?

A

Postpartum – start day 21 (not breastfeeding), 6 weeks (breastfeeding)

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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

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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

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20
Q

What is in the combined patch? Brand name?

A

150mcg norelgestromin and 20mcg ethinyl oestradiolEvra

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21
Q

PEARL index of combined patch?

A

1.25

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22
Q

How is combined patch taken?

A

Change weekly, 1 patch-free week per month

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23
Q

How does combined patch work?

A

Synthetic oestrogen and progesterone prevent FSH/LH release, preventing follicular development and ovulation

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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

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25
Q

Benefits of combined patch?

A

Decrease in PID, ovarian cysts, ovarian, uterine and colon cancers, menstrual control, less benign breast disease

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26
Q

Risks of combined patch?

A

Oestrogen thickens blood so VTE (x3-5), stroke (x2), MI, breast and cervical cancersP450 enzyme inducer interactions

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27
Q

CI of combined patch?

A 
<6 weeks post-partum &amp; 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
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28
Q

What happens if combined patch falls off?

A

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

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29
Q

When is combined patch effective?

A

If started day 1-5 of cycle, effective immediately

After day 5- condoms for 1 week

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30
Q

What is in a Ring? Brand name?

A

15mcg ethinyl estradiol and 120ug etonogesterolNuvaRing

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31
Q

PEARL index of ring?

A

1.2

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32
Q

How is ring contraception taken?

A

Used for 21 days, then 1 week off

Inserted into vagina and not removed

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33
Q

How does ring work?

A

Synthetic oestrogen and progesterone prevent FSH/LH release, preventing follicular development and ovulation

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34
Q

Common SE of ring?

A

Vaginitis, vaginal discharge
Nausea, breast tenderness, headache, initial irregular bleeding, tiredness, mood swings, bloatedness, acne, weight gain
Pain during sex

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35
Q

Benefits of ring?

A

Decrease in PID, ovarian cysts, ovarian, uterine and colon cancers, menstrual control, less benign breast disease

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36
Q

Risks of ring?

A

Oestrogen thickens blood so VTE (x3-5), stroke (x2), MI, breast and cervical cancersP450 enzyme inducer interactions

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37
Q

CI of ring?

A 
<6 weeks post-partum &amp; 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
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38
Q

What happens if ring comes out? Washing technique?

A

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

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39
Q

When is ring effective?

A

If started day 1-5 of cycle, effective immediately

After day 5- condoms for 1 week

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40
Q

What is in the POP?

A

Contains either levonorgestrel, norethisterone or etynodiol acetate

Traditional or Cerazette (75mcg desogestrel)

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41
Q

PEARL index of POP?

A

0.4-5

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42
Q

How is POP taken? Rules for menstrual cycle, after miscarriage and pregnancy?

A

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

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43
Q

How does POP work?

A

Thickens cervical mucous

Desogestrel only pill prevents ovulation

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44
Q

Common SE of POP?

A

Irregular bleeds
Loss of libido
Ovarian cysts
Progesterone – headache, mood change, weight gain, acne, breast tenderness

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45
Q

Benefits of POP?

A

Can be used in breast feeding, older age

Can be used in sickle cell disease, SLE, other autoimmune diseases

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46
Q

Risks of POP?

A

Menstrual disturbance – regular, irregular or amenorrhoeic

Enzyme inducer interactions (increase metabolism of POP, reducing efficacy)

Remember to take at same time

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47
Q

CI of POP?

A

Pregnancy
Breast cancer in last 5 years
Current enzyme inducers
Decompensated liver disease

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48
Q

Missed pill rules of traditional POP? What happens if vomits?

A

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

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49
Q

Missed pill rules of Cerazette POP? What happens if vomits?

A

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

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50
Q

When is POP effective?

A

If started on day 1-5, effective immediately

After day 5 – condoms for 48h

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51
Q

What are the types of long-acting contraception?

A

Injectable, implant, Intrauterine Contraception

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52
Q

What is the implant?

A

Nexplanon (etonogestrel)

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53
Q

PEARL index of implant?

A

0.05

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54
Q

How is implant taken?

A

Single sub-dermal implant lasting 3 years
Requires a small procedure under LA
Inserted into upper part of arm (between biceps and triceps)

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55
Q

How does implant work?

A

Inhibits ovulation

Thickens cervical mucous

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56
Q

Common SE of implant?

A

Irregular bleeds
Progesterone – headache, mood change, weight gain, acne, breast tenderness
Insertion bruising, infection, scarring, expulsion

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57
Q

Benefits of implant?

A

As effective as sterilisation, quick return to fertility once removed
Can forget about it

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58
Q

Risks of implants?

A

Irregular bleeding in 80%

20% amenorrhoeic

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59
Q

CI of implants?

A

Breast cancer in last 5 years, current enzyme inducers, CVA, severe liver disease

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60
Q

When is implant effective?

A

If started day 1-5 of cycle, effective immediately

After day 5- condoms for 1 week

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61
Q

What is in injection?

A

DepoProvera (medroxyprogesterone acetate)

Noristerat (norethisterone)

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62
Q

PEARL index of injection?

A

0.4

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63
Q

How is injection taken?What if late?

A

IM injection into buttocks
Depo – 12 weeks
Noristerat – 8 weeks

If start/late (>14w) then condoms for 7 days

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64
Q

How does injection work?

A

Slow-release progesterone, bypasses circulation

Inhibits ovulation

Thickens cervical mucus

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65
Q

Common SE of injection?

A

Irregular bleeds

Progesterone – headache, mood change, weight gain, acne, breast tenderness

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66
Q

Benefits of injection?

A

No drug interactions
Amenorrhoea in 70%
Good for those with heavy/painful periods

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67
Q

Risks of injection?

A

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

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68
Q

CI of injections?

A

Breast cancer in last 5 years, current enzyme inducers, CVA, severe liver disease

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69
Q

What is the IUS?

A

Levonorgesttrel-releasing system (daily dose 20mcg)

Mirena

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70
Q

PEARL index of IUS?

A

0.2

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71
Q

How is IUS taken?

A

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

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72
Q

How does IUS work?

A

Prevents endometrial proliferation

Thickens cervical mucus

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73
Q

Common SE of IUS?

A

Irregular bleeds – for 6 months then have shorter/lighter periods
Progesterone – headache, mood change, weight gain, acne, breast tenderness

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74
Q

Benefits of IUS?

A

Useful in menorrhagia and HRT

Can forget about it

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75
Q

Risks of IUS?

A

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

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76
Q

CI of IUS?

A

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

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77
Q

Missed pill rules of IUS?

A

If expelled, then efficacy lost

Strings must be checked regularly

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78
Q

When is IUS effective?

A

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)

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79
Q

What is IUCD?

A

Copper ions

ParaGard

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80
Q

PEARL index IUCD?

A

0.6-0.8

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81
Q

How is the IUCD taken?

A

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)

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82
Q

How does IUCD work?

A

Copper ions inhibit sperm motility and survival

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83
Q

Common SE of IUCD?

A

Heavy bleeding, irregular in first 3-6 months

Dysmenorrhoea

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84
Q

Benefits of IUCD?

A

No hormones, long-lasting method
Effective instantly
If fitted >40, can stay til no longer required

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85
Q

Risks of IUCD?

A

Risk of infection (screening for chlamydia)
Worsen menorrhagia
Risk of perforation on insertion
Expulsion – most common in <3 months, 1 in 20

86
Q

CI of IUCD?

A 
Undiagnosed bleeding
Uterine abnormalities, current chlamydia/gonorrhoea, PID <3 months ago
Endometrial/Cervical cancer
Copper allergy
Postpartum sepsis 
Long QT syndrome
87
Q

Missed rules for IUCD?

A

If expelled efficacy lost – strings must be checked regularly

88
Q

When is the IUCD effective?

A

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
Q

What barrier methods of contraception?

A

Condoms, diaphragm, spermicide

90
Q

What are condoms made of?

A

Latex (male) or polyurethane (both)

91
Q

PEARL index of condoms?

A

If used correctly, M98%, F95%

User failure rate 15%

92
Q

How are males condoms used?

A

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
Q

How do condoms work?

A

Barrier preventing sperm entering vagina and cervix

94
Q

Benefits of males condoms?

A
  • Helps prevent STIs, no serious SE, widely available
  • No hormones
  • Easy to obtain
95
Q

Benefits of female condoms?

A
  • Inserted 8 hours before sex
  • Protection against STIs
  • Latex free & no known adverse effects
  • Less likely to tear
96
Q

Risks of male condoms?

A
  • Can split/slip off
  • Requires forward planning
  • Loss of sensitivity during intercourse
97
Q

Risks of female condoms?

A
  • Need to ensure penis is inside and not pushing it out of place
  • Noisy
  • Can be dislodged
98
Q

What happens if condoms split?

A

If splits – need emergency contraception

99
Q

When are condoms effective?

A

Immediately effective

100
Q

What is the diaphragm?

A

Flexible silicon or latex device

101
Q

PEARL index of diaphragm?

A

92-96% Effective with spermicide

102
Q

How is the diaphragm taken?

A

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
Q

How does diaphragm work?

A

Barrier for sperm so cannot enter cervix

Use with spermicide

104
Q

Benefits of diaphragm?

A

No serious SE
Can be inserted before sex
Latex free
No hormones

105
Q

Risks of diaphragm?

A 
Need to use correct size
UTIs
Rubber insensitivity
No STI protection
Predispose to cystitis
Don’t use when menstruating
106
Q

CI of diaphragm?

A

Can take time to learn correct technique to insert

107
Q

What happens if diaphragm does not work or falls out?

108
Q

When is the diaphragm effective?

A

Immediately

109
Q

What is spermicide?

A

Nonoxinol-9

110
Q

PEARL index of spermicide?

A

Unreliable unless used with a barrier

111
Q

How is spermicide taken?

A

Comes in creams, gels, foams, suppositories (soft inserts that melt into a cream)

112
Q

How does spermicide work?

A

Stop semen reaching an egg and blocks cervical entrance
Put in vagina before sex
Add before each sexual encounter

113
Q

Common SE of spermicide?

A

Sore vagina/penis

114
Q

Benefits of spermicide?

A

Cheap, easy-to-use

Hormone free

115
Q

Risks of spermicide?

A

Irritation to vagina/penis
Increased risk of STDs
Messy

116
Q

CI of spermicide?

A

Not recommended for those at high risk or with HIV as increases transmission chances

117
Q

What happens if spermicide is not used?

A

Emergency contraception

118
Q

When is spermicide effective?

A

Effective after 10-15 minutes

119
Q

Indication of danazol?

A

o Endometriosis

o Hereditary angioedema

120
Q

Mechanism of danazol?

A

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
Q

SE of danazol?

A

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
Q

How can HRT be given?

A
  • Can be given systemically for hot flushes and oestoporosis or vaginally (or topically) for local symptoms such as vaginal dryness
123
Q

Indications of HRT?

A
  • 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
Q

Types of HRT - other hormones?

A
  • Tibolone (synthetic steroid compound – converted to metabolites with oestrogentic, progestogenic and androgenic actions)
  • Testosterone (patches and implants – to improve libido)
125
Q

Routes of administration of HRT?

A
  • Oestrogen = oral, transdermal, subcut, vaginal.

* Progesterone = oral, transdermal, intrauterine (levoorgestrel – mirena coil).

126
Q

Why are non-oral preparation beneficial in HRT?

A
  • 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
Q

What HRT preparations given to women with uterus?

A

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
Q

What HRT preparations given to women without uterus?

A

• Women without uterus – oestrogen-only HRT (unopposed oestrogens increases risk of endometrial cancer so only when hysterectomy)

129
Q

Prescribing HRT general tips?

A
  • 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
Q

What HRT prescription changes if women having progestogen SE?

A

• 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
Q

Which progestogens have fewer side effects in HRT?

A

• Fewer progesteronic side-effects occur with micronised progesterone and dydrogesterone.

132
Q

Is the IUS used in HRT?

A

• The intrauterine system (IUS) can be used as an alternative for endometrial protection. Its licence for this use is four years

133
Q

Contraindications of HRT?

A
  • Oestrogen-dependent cancers
  • Past PE
  • Undiagnosed PV bleeding
  • LFT increased
  • Pregnant, breastfeeding
  • Phlebitis
  • Avoid/Monitor closely in Dubin-Johnson/Robin syndrome
134
Q

Side effects in all types of HRT?

A

• Weight gain

135
Q

SE in combined HRT?

A

• Irregular, breakthrough bleeding

136
Q

SE of oestrogen related HRT?

A
  • Fluid retention
  • Bloating
  • Breast tenderness/enlargement
  • Nausea
  • Headaches
  • Leg cramps
  • Dyspepsia
137
Q

SE of progesterone related HRT?

A
  • Fluid retention
  • Breast tenderness
  • Headache/migraine
  • Mood swings
  • Depression
  • Acne
  • Lower abdominal pain
  • Backache
138
Q

Investigation of HRT?

A
  • 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
Q

Follow-up of HRT?

A 
-	3 month and then annual Check-Up
•	Breast examination
•	BP (stop if >160/100mmHg pending investigation)
•	Weight
•	Any bleeding?
140
Q

Benefits of HRT - vasomotor?

A
  • Oestrogen is effective in treating hot flushes.
  • Improvement within 4 weeks.
  • Most common indication for HRT.
  • More effective than SSRIs or clonidine
141
Q

Benefits of HRT - urogenital/sexual?

A
  • 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
Q

Benefits of HRT - skin and hair/bone?

A
  • Improves skin and hair appearance

* Reduced risk of osteoporosis, osteoporotic fractures and colorectal cancer by 1/3

143
Q

Risks of HRT?

A
  • 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
Q

Risks of HRT and breast cancer details?

A
  • Dependent on duration of HRT.
  • Effect not sustained once HRT has stopped.
  • Greatest risk with oestrogen-progesterone therapy.
145
Q

Risks of HRT and endometrial cancer?

A

• Unopposed oestrogen increases risk of endometrial ca.• Risk remains for ~5 years after stopping HRT.

146
Q

Risks of HRT and VTE?

A
  • 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
Q

Risks of HRT and gallbladder?

A
  • Risk increases with age and obesity

* Women who use HRT may have pre-existing disease

148
Q

Alternatives to HRT therapy?

A
  • 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
Q

Indication in obstetrics of erythromycin?

A
  • PPROM

* Severe pneumonia added to penicillin to cover atypicals

150
Q

Abx in UTI in pregnancy?

A
  • Nitrofurantoin (avoid in last trimester)
  • Amoxicillin
  • Cefalexin
151
Q

Indications of metronidazole?

A
  • Perineal tears
  • C.diff infection
  • Oral infections or aspiration pneumonia
  • Surgical infections
152
Q

Indications of oral iron supplements?

A

• Treatment and prophylaxis of iron-deficiency anaemia in pregnancy

153
Q

Indications for aspirin prophylaxis?

A
  • 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
Q

When is labetalol?

A

• Used in PIH and PET

155
Q

Uses of methyldopa?

A

• Used in PIH and PET

156
Q

Uses of nifedipine?

A

• Used in PIH and PET

157
Q

Indications of Syntometrine?

A

Syntometrine (ergometrine/oxytocin)

• 3rd Stage of labour if delayed – 0.5mg ergometrine + 5IU oxytocin IM

158
Q

Mechanism of Syntometrine?

A
  • Synthetic oxytocin - hormone produced in hypothalamus
  • Ergometrine – alpha-adrenergic, dopaminergic and serotonin (5-HT) receptor agonist

• Cause uterus contraction

159
Q

SE of Syntometrine?

A
  • Nausea and vomiting
  • Abdominal pain
  • Headache
  • Dizziness
  • Hypertension
  • Arrhythmias
160
Q

Warnings of Syntometrine?

A

• Contraindications – first stage of labour, second stage of labour, severe kidney/liver/heart/HTN disorders, PET, sepsis

161
Q

Interactions of Syntometrine?

A

• Prostaglandins increase effect of oxytocin

162
Q

Indications of Syntocinon?

A

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
Q

Mechanism of Syntocinon (oxytocin)?

A
  • Synthetic oxytocin - hormone produced in hypothalamus

* Causes uterine contractions to increase speed/start labour and stop bleeding following delivery

164
Q

SE of Syntocinon (oxytocin)?

A
  • Slow HR, nausea
  • Hypertension
  • Rupture of uterus
165
Q

CI of Syntocinon (oxytocin)?

A
  • Malpresentation
  • Obstetric emergency where surgery is needed
  • Foetal distress
  • Umbilical cord prolapse
  • Hyperactive uterus
  • Vaginal delivery CI
166
Q

Medication for constipation in pregnancy?

A
  • Stimulant laxatives should be avoided – cause uterine contractions
167
Q

Indications of mefenamic acid/tranexamic acid?

A

o Menorrhagia

o Local fibrinolysis

168
Q

Medications used in stress incontience?

A
  • Duloxetine
  • Anticholinergics (oxybutynin)
  • Oestrogens
  • Botulinum Toxin A
169
Q

Indications of oxybutynin?

A
  • Anticholinergics (oxybutynin)

 Reduce urinary frequency, urgency and urge incontinence in overactive bladder (1st line)

170
Q

When are oestrogens used in stress incontinence?

A

o Used in urge incontinence if vaginal atrophy present

171
Q

Indications of botulinum toxin A?

A

o Used in urge incontinence

172
Q

Mechanism of botulinum toxin A?

A

 Purified botulinum toxin produced by Clostridium botulinum

 Binds to acceptor sites on motor or sympathetic nerve terminals, inhibiting release of acetylcholine

173
Q

Names of GnRH agonists?

A
  • Goserelin, Buserelin, Leuprorelin
174
Q

Indications of GnRH agonists?

A 
o	Fibroids
o	Menorrhagia
o	Premenstrual syndrome
o	Endometriosis
o	Subfertility
o	Prostate/Breast cancer
175
Q

Mechanism of GnRH agonists?

A

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
Q

SE of GnRH agonists?

A

o Hot flushes, sexual dysfunction, vaginal atrophy, osteoporosis, infertility
o Diminished sex-specific physical characteristics
o Hypercalcaemia

177
Q

CI of GnRH agonists?

A

o Undiagnosed vaginal bleeding
o Use >6 months in endometriosis
o Pregnancy

178
Q

Monitoring in GnRH?

A

o Need annual DEXA scan

179
Q

Indications of prostaglandins?

A
  • Prostaglandins (PGE2)

o Used in IOL

180
Q

Mechanism of prostaglandins?

A

 Binding and activating PGE2 receptor which activates Wnt signalling pathway
 Opens and softens cervix and dilation of blood vessels

181
Q

Indications of mifepristone?

A
  • Used in termination of pregnancy
182
Q

Mechanism of mifepristone?

A

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
Q

SE of mifepristone?

A

o Abdominal pain, tiredness, vaginal bleeding, uterine cramping
o Nausea, vomiting, diarrhoea, dizziness
o Malformed baby

184
Q

CI of mifepristone?

A 
o	IUD
o	Ectopic pregnancy
o	Adrenal failure
o	Bleeding disorders
o	Anticoagulant or long-term corticosteroid therapy
185
Q

Monitoring of mifepristone?

A

o BP and pulse monitoring for 3h after given

o Pregnancy test done 3 weeks later if aim is abortion

186
Q

Indications of misoprostol?

A
  • Used in termination of pregnancies, following priming from mifepristone & gastric ulcers
  • Dilating uterus before surgical abortion
187
Q

Mechanism of misoprostol?

A

o Synthetic prostaglandin analogue that stimulates the uterus to contract and ripen
o Also has antisecretory and protective properties, promoting GI ulcer healing

188
Q

SE of misoprostol?

A

o Constipation, diarrhoea, dizziness, headache, nausea & vomiting
o Irregular bleeding
o Uterine rupture

189
Q

Examples of tocolytics?

A
  • Atosiban, nifedipine (CCB)
190
Q

Indications of tocolytics?

A
  • Used in prematurity between 24-33 weeks gestation
191
Q

Mechanism of tocolytics?

A

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
Q

SE of tocolytics?

A

o Dizziness, headache, hot flush, hyperglycaemia, hypotension, tachycardia, N&V
o Uterine atony

193
Q

CI of tocolytics?

A

o Placental abruption/previa
o Antepartum haemorrhage
o Eclampsia/severe pre-eclampsia
o IUGR, IU infection

194
Q

Monitor of tocolytics?

A
  • Monitor blood loss after delivery
195
Q

Indications of hydralazine?

A
  • Used in eclampsia, given IV if needed
196
Q

Indications of MgSO4?

A
  • Used in severe acute asthma, tosardes de pointes, prevention and treatment of seizures in pre-eclampsia/eclampsia and hypomagnesaemia
197
Q

Mechanism of MgSO4?

A

o Reduces systolic blood pressure (leaving blood flow to foetus intact)
o Depresses neurones action so reducing seizure risk/activity

198
Q

What does Carboprost have in?

A

Carboprost (Ergometrine and Hemabate) IM

199
Q

Uses of Carboprost?

A
  • Used in PPH when unresponsive to Syntocinon
200
Q

Mechanism of Carboprost?

A

o Synthetic prostaglandin analogue of PGF2a

o Induces contractions

201
Q

SE of Carboprost?

A 
o	Diarrhoea
o	Flushing
o	Fever, chills
o	N &amp; V
o	Uterine disorders
202
Q

Indications of methotrexate?

A
  • Used in ectopic pregnancy, molar pregnancy and choriocarcinoma (oral, once weekly)
203
Q

Indications of podophyllotoxin?

A
  • Used in genital warts (condylomata acuminate)
204
Q

Mechansim of podophyllotoxin?

A

o Destabilises microtubules by binding tubulin and preventing cell division

205
Q

SE of podophyllotoxin?

A

o Itching, irritation and redness

206
Q

Caution of podophyllotoxin?

A

o Avoid normal skin, open wounds

o Avoid face and very irritant to eyes

207
Q

Use of podophyllotoxin?

A

Applied BDS for 3 days, then 4 days off – weekly up to 4-week treatment

208
Q

Indications of imiquimod?

A
  • Used in genital warts (condylomata acuminate)
209
Q

Mechansim of imiquimod?

A

o Stimulates TLR7 to secrete cytokines and TNF-a – enhances immune system function to area

210
Q

SE of imiquimod?

A

o Local skin reactions – blisters, burning, sensation, redness, itching
o Fever, flu-like symptoms, headache, tiredness

211
Q

Caution of imiquimod?

A

o Autoimmune disease, immunosuppression

o Avoid broken skim, eyes, lips, open wounds

212
Q

Use of imiquimod?

A

o Used at night three times a week for up to 16 weeks

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