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Contaception 2 Flashcards

1
Q

How does the copper coil work?

A
  1. It releases copper into the uterus which is toxic to sperm and ova - inhibits fertilisation
  2. Copper alters cervical mucus
  3. Prevents implantation
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2
Q

What is the licensed duration of the copper coil?

A

5-10 years

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3
Q

What are the advantages of the copper coil?

A
  1. If fitted after 40 can be left in place in situ until post-menopausal
  2. Suitable for patients on enzyme inducers - no interactions
  3. No evidence of a delay in the return to fertility once removed
  4. Licensed as an emergency contraceptive
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4
Q

What are the disadvantages of the copper coil?

A
  1. Must be fitted by a specialist
  2. Periods may become heavier, longer or more painful
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5
Q

What patient groups is the copper coil not suitable for?

A
  1. Untreated vaginal or pelvic infection
  2. Dysmenorrhea or menorrhagia
  3. Allergy to copper
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6
Q

How does the Progestogen only IUS work?

A
  1. Progestogen effects on the endometrium which prevents implantation
  2. Alters cervical mucus
  3. Releases levonorgestrel after insertion
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7
Q

What are the advantages of the IUS?

A
  1. Reduced menorrhagia
  2. Reduced dysmenorrhea
  3. Amenorrhea
  4. Reversible
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8
Q

Which patient groups is the Progestogen IUS not suitable for?

A
  1. Untreated genital/vaginal infection
  2. Current breast cancer/breast cancer in the past 5 years
  3. Current liver disease
  4. Less than 4 weeks post-partum
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9
Q

What are the risks associated with IUD/IUS?

A
  1. Pain in insertion
  2. Expulsion of the device
  3. Perforation if the uterine wall at the time of insertion or after
  4. LNG-IUS - breast pain, weight gain, acne, headache and ovarian cysts
  5. Weight gain
  6. Ectopic pregnancy
  7. Pelvic inflammatory disease
  8. Unscheduled bleeding
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10
Q

How does the Progestogen only injection work?

A
  1. Inhibit ovulation
  2. Thicken cervical mucus
  3. Create an unfavourable endometrium
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11
Q

What are the benefits of the injection?

A
  1. Can be used in patients with a BMI >35kg/m2
  2. Reduce PMS
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12
Q

What are the disadvantages of the injection?

A
  1. Not readily available
  2. ADR’s - unscheduled bleeding, weight gain, loss of bone mineral density (recovered with discontinuation)
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13
Q

Who can’t use the injection?

A
  1. Current or past breast cancer
  2. Current liver disease
  3. Current osteoporosis
  4. History of IHD/CVA/thromboembolic disease
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14
Q

How does the nexplanon (etonogestrel 68mg) work?

A
  1. Inhibits ovulation
  2. Alters cervical mucus
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15
Q

What are the advantages of the implant?

A
  1. Help relieve dysmenorrhea
  2. Associated with reduced pain in endometriosis
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16
Q

Who isn’t suited for the implant?

A
  1. Active breast cancer/last 5 years
  2. Liver disease
  3. Active venous thromboembolic disorder
17
Q

What are the ADR’s with the implant?

A
  1. Unscheduled bleeding
  2. Complications with removal
18
Q

What is the copper IUD for emergency contraception?

A

Inhibits fertilisation - emergency contraceptive taken within 120 hours of upsi

Painful to insert
Most effective

19
Q

How does levonorgestrel 1.5mg work as an emergency contraceptive?

A

Inhibits ovulation if taken within 72 hours of unprotected sex

  • N&V - if within 3 hours repeat dose
  • Reduced efficacy if taken with enzyme inducing drugs
  • Women >70kg or BMI >26 need double dose
20
Q

How does ulipristal acetate 30mg work as an emergency contraceptive?

A

Inhibits/delays ovulation if taken within 120 hours of unprotected sex

  • N&V - if within 3 hours repeat dose
  • Reduced efficacy if taken with enzyme inducing drugs
  • Reduced efficacy with drugs that increase gastric pH
  • Not suitable for women taking oral corticosteroids for asthma
  • Cannot use with contraceptives - pharmacodynamic interaction - wait 5 days before starting restarting contraceptive
21
Q

Which drugs induce CYP P450?

A

Rifampin, St John’s wort, Carbamazepine, Phenytoin

Cause increased clearance of contraceptive (CHC, POP, Imolant and EHC) - ineffective

22
Q

What drugs inhibit CYP P450?

A

Erythromycin, Fluoroquinolones, ketoconazole, colchicine

Cause increased exposure increasing the risk of toxicity and VTE and exposure to other drugs

23
Q

What causes reduced absorption of EHC?

A
  1. Vomiting and diarrhoea
  2. Drugs which alter gastric transit
  3. Drugs which alter gastric pH
  4. Chelating drugs
24
Q

How do condoms work?

A
  • provide a barrier to ejaculate, pre-ejaculate secretions and cervicovaginal secretions
  • prevent fertilisation and reduce the risk of STI
  • male - 18% failure
  • female - 21%
25
How do diaphragms and caps work?
- 92% - 96% effective with correct use - shallow rubber cup - spermicide is inserted into the diaphragm and then placed in the vagina - covers the cervix - must remain in place up to 6 hours after sex - must be fitted by a trained HCP - refitted if you gain/lose more than 3kg, have a baby, miscarriage or absorption - not suitable if you have an unusually shaped cervix, history of TSS or UTI and allergy to latex or spermicide
26
How does spermicide work?
- gygel contains 2% nonoxynol-9 - acts as a surfactant dissolving the lipids in the sperm cell membrane killing sperm - not adequate contraception alone - discourage use of condoms coated with spermicide as they increase risk of genital lesions in the rectum and vaginal and can increase HIV and other STI transmission - advocate use with diaphragm and caps - irritant to the vaginal tissue and can lead to UTI
27
How does female sterilisation work?
- operation to permanently prevent pregnancy - fallopian tubes are blocked or sealed preventing the egg reaching the sperm to be fertilised - doesn’t affect hormone levels and periods still happen - patient requires contraception before and up to 3 months after - blocked fallopian tubes can re-join ectopic pregnancy - 99% effective - lifetime failure (0.5%)
28
How does a vasectomy work?
- undertaken under local anaesthetic - scalpel method - two incisions in scrotak skin to expose vas deferents which is then occluded and divided - minimally invasive - puncture wound in scrotakl skin and vas deferens occluded - lifetime failure - (0.05%) - contraception continued until 3 months after - doesn’t increase risk of impotence, testicular cancer or HD
29
What is else is norethisterone used for?
A Progestogen that delays menstriation in someone not taking hormonal contraception 5mg TID for 3-4 weeks
30
What else is medroxyprogesterone used for?
A Progestogen used to delay menstruation 10mg BD or TDS
31
What else is mifepristone used for?
An anti Progestogenic steroid that sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix for labour induction or termination of pregnancy
32
What else is misoprostal used for?
A synthetic prostaglandin analogue that is a potent uterine stimulant used for the termination of pregnancy (pv) and to prevent and treat gastric and duodenal ulcers

Pharmacology (19 decks)

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