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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
Q

When starting Qlaira immediately following a 1st trimester TOP or m/c how many days of additional precautions are required?

A

No additional precautions required if commenced immediately

26
Q

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?

A

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
Q

A patient is having her in date SDI removed and wishes to start Qlaira. How many days of additional precautions are required?

A

9 days - all POC

28
Q

A patient misses day 15 of her Qlaira pill pack. What would you advise her?

A

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
Q

A patient misses her day 20 pill in her Qlaira pack. How would you advise her?

A

Discard all pills in current strip and start new strip immediately. Use additional precautions for 9 days. (applied to days 18-24)

30
Q

A patient misses pill number 25 in her qlaira pack. How would you advise her?

A

Take missed pill immediately and next pill at usual time. No additional precautions required

31
Q

Should prophylactic antibiotics be given to women at an increased risk of developing bacterial endocarditis at time of IUC insertion?

A

No

32
Q

What are the indicators of a low risk cardiac condition?

A
  • discharged from cardiology follow up or seen at intervals of 2 years or more
  • oxygen sats normal
  • not on cardiac medications
33
Q

How long should pregnancy be avoided following solid organ transplant?

A

1 year

34
Q

A 35 y old with a 6cm complex ovarian mass on ultrasound presents to you. She is pre-menopausal. What markers would you request?

A

LDH, a-FP, hCG

35
Q

Which antiepileptic drug can increase seizure frequency during use of CHC and potentially cause toxicitiy during HFI?

A

Lamotrigine

36
Q

Barrier methods, injectables, IUC advised with these AEDs and can increase risk of cleft lip and palate

A

Topiramate

Carbamazepine

37
Q

Which AED can be used with all methods of contraception and generally safe in pregnancy with monitoring

A

Levetiracetam (keppra)

38
Q

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

A

Sodium valproate

39
Q

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

A

Warfarin

40
Q

Should avoid fitting IUC in the first 2 weeks of commencing this medication

A

Apixaban

41
Q

Why is LMWH heparin the anticoagulant of choice in pregnancy?

A

LMWH does not cross the placenta

42
Q

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?

A

7 days

43
Q

What type of drug in UPA-EC?

A

Selective progesterone modulator

44
Q

How many days after UPA-EC can a patient commence CHC?

A

5+7 = 12 days with PT 3 weeks from UPSI

45
Q

How many days after UPA-EC can a patient commenced POP-DSG?

A

5+2=7 days

46
Q

How many days after UPA-EC can a patient commence DMPA?

A

5+7=12 days

47
Q

When switching from a traditional POP to to DSG-POP how many days of additional precautions are needed if taken correctly?

A

No additional precautions required

48
Q

When switching from the traditional POP to CHC, how many days of additional precautions are required?

A

7 days

49
Q

When switching from DSG-POP to CHC, how many days of additional precautions are required?

A

No additional precautions required

50
Q

What is the treatment for severe lidocaine toxicity?

A

20% Intralipid

51
Q

What is the maximum dose of lidocaine without adrenaline?

A

4mg/kg

52
Q

What is the maximum dose of lidocaine without adrenaline?

A

7mg/kg

53
Q

What is the maximum dose of bupivicaine without adrenaline?

A

2mg/kg

54
Q

What is the dose of adrenaline that should be given in the event of cardiac arrest in an adult?

A

1 in 1000 500mcg IM

MFSRH Part II 2022 (8 decks)

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