Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y5 OG Conditions > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the 3 main types of emergency contraception?

A

Levonorgesterol
Ulipristal
Copper IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does each type of emergency contraception work?

A

Levonorgesterol- <72 hrs
Ulipristal- <120 hrs
Copper IUD- <120 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the brand names for the emergency contraceptions?

A

Levonelle (£25)
ellaOne (£25)
Copper IUD (GP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How effective is levonorgesterol?

A

95% effective in <24 hours, 84% effective <72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the MoA of levonorgesterol?

A

stops ovulation and inhibits implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the dose of levonorgesterol?

A

1.5mg STAT [n.b. double dose if >26 BMI or >70kg]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How well tolerated is levonorgesterol?

A

o Safe, well-tolerated (potential slight menstrual cycle disturbance)

o If vomiting within 2 hours of dose, repeat the dosage

o Can be used >1 in each menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How effective is Ulipristal acetate?

A

95% effective in <120 hours (5 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MoA of Ulipristal acetate?

A

selective progesterone receptor modulator -> inhibits ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the dose of Ulipristal acetate?

A

30mg STAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How well tolerated is Ulipristal acetate?

A

Not to be used: alongside levonorgesterol, severe asthma

o If normally on hormonal contraception, they should restart 5 days after ulipristal (use barrier for 5 days)

o If vomiting within 3 hours of dose, repeat the dosage

o Unsure if safe if used >1 in each menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you deal with emergency contraception in overweight people?

A

o BMI >26 or >70kg:

§ 1st line: Ulipristal acetate 30mg STAT (ellaOne); continue oral contraception after 5 days

§ 2nd line: Levonorgesterol (Levonelle) double dose (3mg / 3000ug) + barrier contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How effective is copper IUD?

A

99% effective in <120 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the indications of copper IUD?

A

§ <5 days of last UPSI; OR

§ Up to 5 days after the likely ovulation dat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the MoA of copper IUD?

A

spermicide and prevents implantation

Prophylactic antibiotics if at high risk of STI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Can copper IUD be used long term?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What other advice do you give for emergency contraception?

A

· Cost of morning after pill: £25 (can be free from GUM clinic and GP walk in centre)

· ADVICE: offer STI screen and recommend taking a pregnancy test if her next period is late

· Side-Effects of Emergency Contraception (NOT IUD): N&V, headache, breast tenderness, abnormal menstrual bleedin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the pearl index?

A

describes the chance of becoming pregnant on contraception:

o Pearl index = the number of pregnancies occurring per 100 woman-years

o I.E. Pearl of 2 = 2 pregnancies per year in 100 women

§ This is a bad contraception… an index of 0.2 is more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the time to effect for long term contraception?

A
  • Instant: Copper Coil
  • 2 days: POP
  • 7 days: COCP, IUS, injection, implant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is barrier method?

A

Condom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the daily methods of contraception?

A

Combined oral contraceptive pill (COCP)

Transdermal Patch (weekly)

Progesterone only pill (POP)

Vaginal ring (3-weekly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the hormone in the COCP (microgynon 30)?

A

OESTROGEN (ethinyl oestradiol) and PROGESTERONE (progestin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does COCP work?

A

Prevents ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you take COCP?

A
  1. OD for 3 weeks -> 1 week off (withdrawal bleed); OR
  2. Tricycle: OD for 9 weeks -> 1 week off (withdrawal bleed)

If started on the first 5 days of the cycle (28-day cycle) -> confers immediate contraceptive protection If starting at any other time, use additional measures for the first 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the benefits of COCP?

A

+ >99% effectiveness

+ Reversible on stopping

+ Less pain, more regular, lighter periods (used in dysmenorrhoea)

+ Reduced risk of ovarian cancer, endometrial cancer, bowel cancer [BEO]

o N.B. ovarian cancer risk is associated a greater number of OVULATIONS during life

26
Q

What is the disadvantages of COCP?

A
  • Easy to forget to take May cause breakthrough bleeding and spotting at first
  • Does not reduce risk of STIs
  • Increased risk of VTE (stroke, heart disease), breast cancer, cervical cancer [BC]
  • Side effects: headache, N&V (if vomit <2hr since pill, take another), breast tenderness
  • Stop 4w before surgery, restart 2w after surgery [switch to POP]
27
Q

What are the absolute contraindications to the COCP?

A
28
Q

How do you deal with 1 missed dose of COCP?

A

take last pill and current pill (even if 2 in 1 day) -> no further action needed

29
Q

How do you deal with 2 missed doses of COCP?

A

take last pill and current pill (even if 2 in 1 day) -> further action

o Use condoms until pill has been taken correctly for 7 days in a row

o 2 Missed in Week 1: consider emergency contraception

o 2 Missed in Week 2: no need for emergency contraception

o 2 Missed in Week 3: finish current pack, start new pack immediately (no pill-free break

30
Q

What is the hormone/ mechanism of POP?

A

PROGESTERONE (progestin) -> levonorgestrel, norethisterone, desogestrel (cerazette)

Mechanism: Thickens cervical mucus (desogestrel/cerazette primarily stops ovulation)

31
Q

What are the benefits of POP?

A

No oestrogen pill risks (n.b. ABx has no effect on POP)

32
Q

What are the disadvantages of POP?

A

– Very easy to forget to take

– Initial irregular bleeding (which may continue) = most common complaint:

20% -> amenorrhoeic

40% -> bleed regularly

40% -> bleed irregularly

– Osteoporosis and ovarian cyst risks

– SEs: irregular bleeding, acne, constipation, irritability, breast tenderness, mood changes, headache

33
Q

What do you do for traditional POPs if you’ve missd a dose?

A

o <3 hours late: continue as normal

o 3+ hours late: take missed pill ASAP, continue with rest of pack, extra precautions (condoms) until pill taking has been re-established for 48 hours

§ If missed 2 pills, take last missed pill and next pill, and use barrier methods until pill-taking has been re-established for 48 hours

§ Emergency contraception needed if UPSI during this interval

34
Q

What do you do if you miss a dose of cerazette (desogesterel)?

A

o <12 hours late: continue as normal

o >12 hours late: take missed pill ASAP, continue with rest of pack, extra precautions (condoms) until pill taking has been re-established for 48 hours

35
Q

What is the combined hormonal transdermal patch?

A

OESTROGEN (ethinyl oestradiol) and PROGESTERONE (norelgestromin)

Mechanism: Thickens cervical mucus and prevents ovulation

36
Q

How do you take CHTP?

A
  1. Applied (and replaced weekly) for 3 weeks ->1 week off (withdrawal bleed); OR
  2. Tricycle: Applied (and replaced weekly) for 9 weeks -> 1 week off (withdrawal bleed)
37
Q

What are the pros and cons of CHTP?

A

Pros

+ Harder to forget to do (less frequent)

Cons

– Skin sensitivity

– Contraindications (see COCP contraindications)

38
Q

What do you do for a missed dose of CHTP?

A

· Delayed change <48 hours: change immediately with no further precautions

· Delayed change >48 hours (week 1 or 2): change immediately, use barrier protection for 7 days o If UPSI <5 days or during extended patch-free period, consider emergency contraception

· Delayed removal >48 hours (week 3): remove immediately and apply next patch on the usual start date of the next cycle (no additional contraception is needed)

· Delayed at the end of the patch-free week: use barrier contraception for 7 day

39
Q

What is the combined hormonal ring?

A

OESTROGEN (ethinyl oestradiol) and PROGESTERONE (norelgestromin)

Mechanism: Thickens cervical mucus and prevents ovulation

40
Q

How do you take the combined hormonal ring (nuva ring)?

A

Applied for 3 weeks -> 1 week off (withdrawal bleed)

41
Q

What are the pros and cons of the combined hormonal ring?

A

Pros

+ Harder to forget to do (less frequent)

Disadvantages

– Skin sensitivity

– Patch adherence

– Contraindications (see COCP contraindications)

42
Q

N.B. any progesterone LARC will cause initial irregular bleeding

A

N.B. any progesterone LARC will cause initial irregular bleeding

43
Q

What is an intrauterine system (Mirena)?

A

PROGESTERONE (levonorgestrel)

Mechanism: Prevents endometrial thickening, thickens cervical mucus

44
Q

How do you insert a mirena?

A

· Inserted and left for 3-5 years

· Can be the progesterone component of HRT

· Contraindications to IUDs/IUS = pregnancy, PID, malignancy, unknown bleeding

Additional contraception needed for 7 days after insertion (unless <5 days of new cycle)

45
Q

What are the pros and cons of mirena?

A

Benefits

+ 99% effective

+ Lasts for 3-5 years

+ Initially irregular bleeding, followed later by lighter menses or amenorrhoea

+ Indications: heavy bleeding periods, PMS (good for mood symptoms)

Disadvantages

– SEs: irregular bleeding, acne, constipation, irritability, breast tenderness, mood changes, headache

– Risk of expulsion (<1m), infection (<2m), perforation

46
Q

What is Jaydess and Kyleena?

A

Jaydess

· Smaller IUS, indicated for contraception, not indicated in menorrhagia

· Lasts for 3 years

Kyleena

· Smaller IUS, indicated for contraception, not indicated in menorrhagia

· Lasts for 5 years

47
Q

What is an IUD (copper coil)?

A

Hormone Copper

Mechanism Decrease sperm motility and survival (causes sterile inflammation -> implantation not possible)

48
Q

How do you insert an IUD?

A

· Inserted and left for 5-10 years

· Contraindications to IUDs/IUS = pregnancy, PID, malignancy, unknown bleeding

· After childbirth, insert: <48 hours OR after 4 weeks

Immediate contraceptive ability, inserted at any point in cycle

49
Q

What are the pros and cons of an IUD?

A

Benefits + Lasts for up to 10 years + Works immediately

Disadvantages – Side effects: heavy, painful periods, risk of expulsion (<1m), infection (<2m), perforation – NOT TO BE USED IN MENORRHAGIA

50
Q

What is the implant (nexplanon)?

A

Hormone PROGESTERONE (etonogestrel)

Mechanism Main: prevents ovulation, other: thickens cervical mucus

51
Q

How do you insert an implant?

A

· Small rod inserted sub-dermally into non-dominant arm · Lasts for 3 years Additional contraception needed for 7 days after insertion (unless <5 days of new cycle)

52
Q

What are the pros and cons of the implant?

A

Benefits + Lasts for up to 3 years + Fertility reversible immediately

Disadvantages – SEs: irregular bleeding, acne, constipation, irritability, breast tenderness, mood changes, headache – Contraindication: IHD

53
Q

What is the injection (depo-provera)?

A

Hormone PROGESTERONE (medroxyprogesterone acetate)

Mechanism Main: prevents ovulation, other: thickens cervical mucus

54
Q

How do you take the injection?

A

· Lasts for 12-14 weeks Additional contraception needed for 7 days after insertion (unless <5 days of new cycle)

55
Q

What are the pros and cons of the injection?

A

Benefits + Nil

Disadvantages – SEs: irregular bleeding, acne, constipation, irritability, breast tenderness, mood changes, headache – Fertility takes 6-12 months to return from last injection – Associated with weight gain and ectopic pregnancy

56
Q

How do you do PACES counselling?

A

IMPORTANT: all LARCs take 1 week to start being effective (except copper IUD)

o Key Aspects of History

§ Previous personal or family history of VTE, migraine, cancer, stroke and hypertension

§ Menstrual problems (e.g. heavy periods)

o Explain that the contraception can be divided into long-acting and short-acting

57
Q

How do you prescribe post partum contraception?

A

· N.B. no contraception required within 21 days postpartum

· COCP NO: <6w post-partum + breastfeeding; WARNING: 6w-6m postpartum + breastfeeding

NOT breastfeeding -> can start from day 21, if starting >21 days, use barrier for 7 days

· POP start ANY TIME but if starting after day 21 post-partum, use barrier for 2 days

· IUD/IUS within 48 hours of childbirth (uncomplicated CS or SVD) OR after 4 weeks

· Lactational 98% effective if: FULLY breastfeeding (no bottle), amenorrhoeic, <6m postpartum

58
Q

How do you stop non hormonal contraception in under and over 50’s?

A

<50: Stop contraception ≥2 years amenorrhoea

>50: Stop contraception ≥1-year amenorrhoea

59
Q

How do you stop COCP contraception in under and over 50’s?

A

<50: Continue to 50 years (no longer

>50: Switch to non-hormonal or POP

60
Q

How do you stop implant, POP and IUS contraception?

A

Continue beyond 50 years

61
Q

How do you stop Depo-Provera contraception in under and over 50’s?

A

<50: Continue to 50 years (no longer

>50: Switch to non-hormonal + stop ≥2y amenorrhoea Switch to POP

62
Q

What are the fraser guidelines?

A

· The young person understands the professional’s advice

· The young person cannot be persuaded to inform their parents

· The young person is likely to begin or continue having sex with or without contraceptive treatment

· Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer

· The young person’s best interests require them to receive contraceptive advice or treatment ± parental consent

· N.B. if the child is <13yo (being 13 is OK), they cannot be competent (even under ‘Gillick’ guidelines) and so you can never prescribe contraception (regardless of the situation) -> contact the local safeguarding lead

· There is NO lower age-limit for Gillick competence (but, in practice, it’s under the age of 13)

Y5 OG Conditions (76 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions