Contraception

Question 1

Which ONE of the following methods of contraception is the MOST likely to reduce bone mineral density?

Combined oral contraceptive
Combined transdermal patch
Progestogen-only implant
Progestogen-only injection

Answer 1

Progestogen-only injection

Depot medroxyprogesterone acetate: associated with small loss of bone mineral density with use over one year. Recovered after stopping the injection and there is no evidence of increased risk of fracture. Other forms of contraception should be considered for women under 18 years and those with significant risk factors for osteoporosis.

Question 2

Which ONE of the following is the MOST EFFECTIVE method of contraception to use if the woman is taking carbamazepine for epilepsy?

  Combined hormonal contraceptive patch 
  Condoms 
  Progestogen-only implant 
  Depot medroxyprogesterone acetate 
  Progestogen-only pill

Answer 2

Depot medroxyprogesterone acetate

There are no clinical interactions with enzyme-inducing drugs and the progestogen injection. This is a long-acting contraceptive and is more than 99% effective

Question 3

A 17 year old female requests emergency contraception four days after unprotected sexual intercourse.
Ulipristal is licensed to be given four days after UPSI?

T/F?

Answer 3

True, EllaOne /Ulipristal is licensed for 120 hours (5 days) after UPSI. Levonorgestrel is licensed for 72 hours after UPSI (but may be given as an unlicensed indication up to 5 days under PGDs).

Make sure the woman is aware of the Intrauterine device as a method of emergency contraception and contraception and refer if necessary.

Question 4

Which ONE of the following drugs is the LEAST likely to interact with ulipristal?

  Lamotrigine 
  Esomeprazole 
  Topiramate 
  St. Johns Wort 
  Rifampicin

Answer 4

Lamotrigine. have to check drug list on NICE CKS site, stockleys. still have to monitor but least liekly

            Why not: Esomeprazole: 

Topiramate (anti-epileptic): is an enzyme inducer and reduces the efficacy of ulipristal

St johns wort: St. Johns Wort is an enzyme inducer and can reduce the efficacy of ulipristal

Rifampicin: “

Question 5

what is desogestrel and how does it work?

3

Answer 5

progestogen only pill

prevents pregnancy by: thickening mucus in cervix to stop sperm reaching egg
reduced susceptibility of endometrium to implantation
reduced fallopian tube motility and cilia activity

Question 6

advice on how to take desogestrel and what to do if forgotten?
(3)

Answer 6

take 1 pill every day (28 in a pack). no break inbetween so move onto next pack right away

if missed pill: only take 1. even if 2 been missed

Question 7

4 disadvantages of Evra: contraceptive patch?

Answer 7

• application site reactions
• small increased risk of breast cancer
• increased risk of blood clotting
• menstrual pain