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Pre-reg Exam 2021 > Contraception > Flashcards

Contraception Flashcards

1
Q

When can you provide hormonal contraceptives to under 16s?

A

She understands the doctors advice
She cannot he persuaded to inform her parents
She is very likely to continue having sex
Unless she receives contraception her mental and physical health will suffer
In her best interests to provide treatment

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2
Q

What are the combined oral contraceptives oestrogens?

A

Ethinylestradiol
Mestranol
Estradiol - zoely with normegestrol, qlaira with diemogest

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3
Q

What are the oral contraceptives progestogen?

A 
Norgestimate
Desogestrel
Drosperinone
Gestodene
Norethisterone
Dienogest
Nomegestrel
Levonorgestrel
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4
Q

Which progestogens are best used for acne, depression, headaches, breast symptoms, breakthrough bleeding?

A

Norgesitmate
Desogestrel
Drosperinone

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5
Q

What are the transdermal contraceptive patches?

A

Evra - norelgestromin with ethinylestradiol

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6
Q

What are the progesterone only pills?

A

Desogestrel - cerelle, cerazette
Norethisterone - micronor, noriday
Levonorgestrel - norgeston

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7
Q

What are the parenteral progestogen contraceptives?

A

Medroxyprogesterone (injection)
Northisterone (injection)
Etonorgestrel (implant)

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8
Q

What hormone is in the IUD?

A

Levonorgestrel

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9
Q

What are the hormones in the NuvaRing?

A

Etonogestrel with ethinylestradiol

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10
Q

How do you take the combined oral contraceptives?

A

One tablet daily for 3 weeks + 1 week pill free interval for withdrawal bleeding

Start any time in menstrual cycle; if started on day 6 or later use protection for 7 days

Not for women above 50 years

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11
Q

What is a monophasic preparation?

A

Fixed amount of oestrogen and progestogen

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12
Q

What is a phasic preparation?

A

Varying amount of oestrogen and progestogen

For women who do not have withdrawal bleeding

Or have breakthrough bleeding with monophasic preparations

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13
Q

What is an every day preparation?

A

Pill free interval replaced with inactive pills

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14
Q

What are the low strength oestrogen preparation?

A

Risk factor for circulatory disease - 20mg ethinylestradiol

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15
Q

What do you need to be careful of with oestrogens?

A

Increased risk of VTE

Increased risk of arterial thromboembolism

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16
Q

When do you stop taking contraceptives that contain oestrogen before surgery?

A

4 weeks before for major surgery and all surgery to the legs or surgery that results in prolonged immobilisation of a lower limb

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17
Q

When should you stop oestrogen containing preparations?

A

VTE
Stroke
Liver dysfunction
Blood pressure
Prolonged immobility after surgery or leg injury
Detection of a risk factor which contraindicates treatment

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18
Q

How do the progestogen only pills work?

A

Prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg

Alternative when oestrogens contraindicated

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19
Q

How do you take POPs?

A

Take one daily on a continuous basis, starting on day 1 of cycle and taken at the same time each day

If started after day 5 of menstrual cycle, additional precaution is required for 2 days

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20
Q

What are the other side effects of hormonal contraceptives?

A

Combined - increase risk of cervical and breast cancer

Progestogen - increase risk of breast cancer

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21
Q

What are the benefits of combined oral contraceptives?

A

Reduces risk of ovarian and endometrial cancer

Reduces dysmenorrhea and menorrhagia, premenstrual tension, reduced risk of PID

22
Q

When is a COC considered missed?

A

> 24 hours

Zoely/qlaira > 12 hours

23
Q

What do you do if you miss a COC?

A

1 missed pill - take one ASAP and one at normal time even if it means taking two together

2+ missed pills - take one pill ASAP + condom for 7 days (9 days if zoely/qlaira)

Omit pill free interval if missed in last 7 days

EHC - if missed in first 7 days and unprotected sex occurs

24
Q

How many hours is a POP considered missed?

A

3 hours (desogestrel > 12 hours)

25
Q

What do you do if you miss a POP?

A

Take ASAP + condom for 2 days

EHC - unprotected sex occurs before 2 pills are taken correctly

26
Q

What do you do if you have vomiting/diarrhoea while taking a COC?

A

Vomiting < 2 hours of taking - take one ASAP

> 24 hours - protection until 7 days after recovery and pill is resumed (9 days if Qlaira)

If it occurs in last 7 days - omit pill free interval

27
Q

What do you do if vomiting/diarrhoea and taking a POP?

A

Vomiting < 2 hours of taking = take another ASAP

Severe of if pill not taken within 3 hours of normal time (12 hours if desogestrel) = protection until 2 days after recovery and pill is resumed

28
Q

What do you do if a transdermal patch is detached for >24 hours or delayed application at beginning of cycle?

A

Apply new patch ASAP

Start a new day 1 cycle + condom for 7 days

29
Q

What do you do if a transdermal patch has delayed application in the middle of cycle?

A

< 48 hours apply new patch and continue as normal

> 48 hours start a new day 1 cycle + condom for 7 days

30
Q

What are the enzyme inducers that affect hormonal contraception by reducing their effectiveness?

A 
Carbamazepine 
Phenytoin
Phenobarbital
St. John’s wort
Rifampicin 
Rifabutin
31
Q

What reduces the efficacy of ulipristal?

A

Antacids
H2 receptor antagonists
PPI

32
Q

How long after sex can the copper IUD be used as EHC?

A

120 hours (5 days) after unprotected intercourse or up to 5 days after the earliest calculated ovulation

33
Q

Which EHC do you use if patients BMI > 26 kg/m2

A

Ulipristal or double dose of levonorgestrel

34
Q

How does levonorgestrel work?

A

Prevents ovulation and fertilisation

35
Q

What is the dose of levonorgestrel for EHC?

A

1500mg < 72 hours after unprotected sex

If vomiting < 3 hours of taking dose, give replacement dose

36
Q

What are the cautions with levonorgestrel?

A

Crohn’s
Past ectopic pregnancy
Ciclosporin

37
Q

What is the mechani of action of ulipristal?

A

Progestogen receptor modulator inhibits or delays ovulation

More effective than levonorgestrel

38
Q

When do you use ulipristal?

A

30 mg 96-120 hours after unprotected sex

39
Q

What are the cautions for ulipristal?

A

Severe asthma treated by oral corticosteroids

Avoid in severe liver impairment

40
Q

What are the contraindications of ulipristal?

A

Repeated use within the same menstrual cycle

41
Q

What are the counselling points for ulipristal?

A

Reduces effectiveness of regular contraceptives

Wait 5 days before starting regular hormonal contraception

42
Q

What are the hormonal contraception side effects?

A

Menstrual irregularities

43
Q

What are the counselling points for hormonal contraception?

A

Next periods may be early or late
Use barrier protection until next period
If lower abdominal pain see gp to rule out ectopic pregnancy
If periods are abnormal take a pregnancy test

44
Q

Why should an IUD not be used in under 25s?

A

Increased risk of PID

45
Q

What are the side effects of IUD?

A

Pain on insertion and bleeding
Uterine perforation
Risk of infection

46
Q

What is the MHRA warnings for IUDs?

A

Uterine perforation

Report severe pelvic pain, sudden changes in periods pain during sex, unable to feel threads

47
Q

When do you remove IUD?

A

Do not remove mid cycle unless additional contraceptive used for 7 days

If removal is essential and unprotected sex occurs give EHC

If pregnant remove in 1 st trimester

48
Q

What are the counselling points for medroxyprogesterone injection?

A

Lasts 2 years
Delay in return to fertility and menstrual irregularities
Osteoporosis risk

49
Q

How often do you need norethisterone injection?

A

8 weeks

50
Q

What is the MHRA warning for etonogestrel implant?

A

Nexplanon contaceptive implants - reports of device in vasculature and lung

51
Q

When should spermicidal contraceptives not be used?

A

At high risk of STIs, high use associated with genital lesions and increased risk of acquiring infections

Pre-reg Exam 2021 (79 decks)

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