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MFSRH Part II 2022 > Contraception > Flashcards

Contraception Flashcards

1
Q

A patient with Ulcerative Colitis is asking about her fertility rates compared to the general population. How would you advise?

A

Similar fertility rates to general population

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2
Q

What would you advise with regards to pre-conception planning in a patient with IBD?

A
  • concieve when disease under good control
  • slight increased risk of miscarriage, low birth rate
  • review any medications to check for potential teratogenicity
  • review any previous surgeries
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3
Q

When would 5mg folic acid be advised over the standard 400mcg dose?

A
  • previous intestinal resection surgery

- taking sulfasalazine

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4
Q

Which IBD medication causes reversible decreased sperm motility and count?

A

Sulfasalazine

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5
Q

How long should conception be avoided for if either partner is taking methotrexate?

A

3 months after cessation for male and female partners

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6
Q

How long should conception be avoided for after cessation of mycophenolate therapy? (male and female partner)

A

6 weeks - female - contraindicated during pregnancy

3 months - male

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7
Q

How long should conception be avoided for if either partner has recently stopped methotrexate?

A

3 months - male and female

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8
Q

Are thiopurines safe to take during pregnancy?

A

Yes

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9
Q

A patient is taking the TNF-alpha inhibitor infliximab. How long after cessation should she wait to conceive?

A

6 months

Sometimes used in pregnancy when discussed with gastro but often stopped in 3rd trimester to limit fetal exposure

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10
Q

What is the UKMEC for IUD/IUS in a patient with IBD?

A

UKMEC 1

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11
Q

What is the UKMEC for CHC in a patient with IBD?

A

UKMEC 2 - concerns re oral preparations

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12
Q

What is the UKMEC for depo in a patient with IBD?

A

UKMEC 1 but caution with osteoporosis risk - nutritional deficiency, malabsorption, corticosteroid use

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13
Q

What effect could EE or progesterone have on tacrolimus levels?

A

Could increase levels of tacrolimus

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14
Q

A patient using CHC is having having major elective surgery in 2 months. How would you advise her with regards to her contraception?

A

Stop 4 weeks prior

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15
Q

A patient has had IPAA surgery. How would you advise her with regards to her fertilty

A

3 fold increase in infertility

No guidance with regards to how to deliver

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16
Q

What are the two drugs in the combined quadraphasic contraceptive Qlaira?

A

Estradiol valerate (E2V) and Dienogest (DNG)

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17
Q

What proportions of E2V and DNG are in Qlaira day 1+2? (PHASE 1)

A

Estradiol valerate (E2V) 3mg only

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18
Q

What doses of E2V and DNG are present in days 3-7 in Qlaira? (PHASE 2)

A

Estradiol valerate (E2V) 2mg + DNG 2mg

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19
Q

What doses of E2V and DNG are present in Qlaira days 8-24? (PHASE 3)

A

Estradiol valerate (E2V) 2mg + Dienogest (DNG) 3mg

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20
Q

What doses of E2V and DNG are present in Qlaira days 25 and 26? (PHASE 4)

A

E2V 1mg only

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21
Q

What doses of E2V and DNG are present in Qlaira days 27 and 28?

A

Placebo tablets

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22
Q

How is the PEARL index calculated?

A

PEARL Index = (total no unintended pregnancies / total months of exposure) * 100

23
Q

What is E2V metabolised to in the gut?

A

Via hydrolysation E2V is converted to 17b-estradiol

24
Q

When starting Qlaira on day 2 of a natural mentrual cycle, how many days of additional precautions are required to maintain contraceptive efficacy?

A

9 days of additional precautions required (7 days as usual for CHC + 2 days of E2V only pills)

25
When starting Qlaira immediately following a 1st trimester TOP or m/c how many days of additional precautions are required?
No additional precautions required if commenced immediately
26
A patient who is 22 days post partum wishes to commence Qlaira. She is not breastfeeding and has no additional medical problems or VTE risk. How would you proceed?
OK to start. If starts on or before day 28, no additional precautions are required. If starts after day 28, 9 days of additional precautions are required.
27
A patient is having her in date SDI removed and wishes to start Qlaira. How many days of additional precautions are required?
9 days - all POC
28
A patient misses day 15 of her Qlaira pill pack. What would you advise her?
Take missed pill immediately even if it means taking 2 pills in the same day and use additional precautions for 9 days. (applies to days 1-17)
29
A patient misses her day 20 pill in her Qlaira pack. How would you advise her?
Discard all pills in current strip and start new strip immediately. Use additional precautions for 9 days. (applied to days 18-24)
30
A patient misses pill number 25 in her qlaira pack. How would you advise her?
Take missed pill immediately and next pill at usual time. No additional precautions required
31
Should prophylactic antibiotics be given to women at an increased risk of developing bacterial endocarditis at time of IUC insertion?
No
32
What are the indicators of a low risk cardiac condition?
- discharged from cardiology follow up or seen at intervals of 2 years or more - oxygen sats normal - not on cardiac medications
33
How long should pregnancy be avoided following solid organ transplant?
1 year
34
A 35 y old with a 6cm complex ovarian mass on ultrasound presents to you. She is pre-menopausal. What markers would you request?
LDH, a-FP, hCG
35
Which antiepileptic drug can increase seizure frequency during use of CHC and potentially cause toxicitiy during HFI?
Lamotrigine
36
Barrier methods, injectables, IUC advised with these AEDs and can increase risk of cleft lip and palate
Topiramate | Carbamazepine
37
Which AED can be used with all methods of contraception and generally safe in pregnancy with monitoring
Levetiracetam (keppra)
38
Which AED is generally advised not to prescribe to women of child bearing age due to teratogenicity but if no alternatives discuss a pregnancy prevention strategy LARC often best
Sodium valproate
39
A coumarin anticoagulant and vitamin K antagonist which acts by inhibiting clotting factors II, VII, IX and X that should not be given in first trimester as can result in congenital abnormalities, stopping before 6th week pregnancy may largely avoid this
Warfarin
40
Should avoid fitting IUC in the first 2 weeks of commencing this medication
Apixaban
41
Why is LMWH heparin the anticoagulant of choice in pregnancy?
LMWH does not cross the placenta
42
If LNG-EC has been taken already in the cycle and UPSI happens again in the same cycle, how long after the LNG-EC should UPA-EC be avoided?
7 days
43
What type of drug in UPA-EC?
Selective progesterone modulator
44
How many days after UPA-EC can a patient commence CHC?
5+7 = 12 days with PT 3 weeks from UPSI
45
How many days after UPA-EC can a patient commenced POP-DSG?
5+2=7 days
46
How many days after UPA-EC can a patient commence DMPA?
5+7=12 days
47
When switching from a traditional POP to to DSG-POP how many days of additional precautions are needed if taken correctly?
No additional precautions required
48
When switching from the traditional POP to CHC, how many days of additional precautions are required?
7 days
49
When switching from DSG-POP to CHC, how many days of additional precautions are required?
No additional precautions required
50
What is the treatment for severe lidocaine toxicity?
20% Intralipid
51
What is the maximum dose of lidocaine without adrenaline?
4mg/kg
52
What is the maximum dose of lidocaine without adrenaline?
7mg/kg
53
What is the maximum dose of bupivicaine without adrenaline?
2mg/kg
54
What is the dose of adrenaline that should be given in the event of cardiac arrest in an adult?
1 in 1000 500mcg IM

MFSRH Part II 2022 (8 decks)

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