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Stage 3 Case 4 > Contraception > Flashcards

Contraception Flashcards

1
Q

Two types of oral contraception

A

Progesterone only contraceptive (POP)- ‘mini pill’
Combined oral contraceptive (COC)- ‘pill’
-MONOPHASIC
-PHASIC

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2
Q

Mechanism of Action of oral contraception coc?? (3)

A
  1. prevent fertilization via inhibition of ovulation
  2. thickening of the cervical mucus.
  3. Decrease motility of the uterus and fallopian tubes thereby inhibiting ova and sperm transport.
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3
Q

Contraception-assessment

A

Exclude pregnancy
Record BP, BMI, smoking status
History
Plans of pregnancy/reason for contraception

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4
Q

Advantages of Combined oral contraceptive (7)

A
  • reliable and reversible
  • reduced dysmenorrhoea (painful periods) and
    menorrhagia (abnormal heavy bleeding)
  • reduced incidence of premenstrual syndrome
  • less symptomatic fibroids/functional ovarian cysts
  • less benign breast disease
  • reduced risk of ovarian and endometrial cancer
  • reduced risk of pelvic inflammatory disease.
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5
Q

Consideration for COC?

A
  • Lowest dose to provide effective control
  • Well tolerated
  • Affordable
  • Addition benefits if desired
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6
Q

Low strength preparations (COC)

A
  • Contain ethinylestradiol 20 micrograms

- For women with risk factors for circulatory disease

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7
Q

Standard strength preparation (COC)

A
  • Contain ethinylestradiol 30-35 micrograms, or 30-40 micrograms in phased preparations.
  • For women who do not have withdrawal bleeding or have breakthrough bleeding with monophasic products.
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8
Q

Standard strength preparation (COC) example

A

Microgynon 30

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9
Q

Side effects that may be experienced with COC?

A

Acne, headache, breast symptoms, and breakthrough bleeding.

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10
Q

What is used for women who have side effects with other progestogens (COC)?

A

Progestogen desogestrel/drospirenone/gestodene

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11
Q

‘Pill-free interval’ (HFI)

A

Most COCs contain calendar strips of 21 active tablets

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12
Q

No pill-free interval

A

To support adherence, woman may prefer 21 active tablets and 7 placebo tablets

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13
Q

Low strength, monophasic.

7-day break in pill taking.

A

Mercilon (ethinylestradiol and desogestrel)

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14
Q

Standard strength, monophasic.

7-day break in pill taking.

A

Yasmin (ethinylestradiol and drospirenone)

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15
Q

Standard strength, monophasic.

No break in pill taking.

A

Femodene ED (ethinylestradiol and gestodene)

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16
Q

Standard strength, phasic.

7-day break in pill taking.

A

Logynon (ethinylestradiol, levonorgestrel)

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17
Q

Standard strength, phasic.

No break in pill taking.

A

Qlaria (estradiol valerate and dienogest)

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18
Q

Cautions with use of COCs

A 
Family history of VTE
 Obesity (measure BMI)
 Long-term immobilization
 > 35 years and smoker
 Smoking
 FMH of arterial disease
 Diabetes mellitis
 HBP (avoid if systolic > 160 mmHg and diastolic > 100 mmHg)
 Migraine
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19
Q

Which 5 cautions may POP be preferred?

A 
Family history of VTE
 Smoking
 Diabetes mellitis
 HBP (avoid if systolic > 160 mmHg and diastolic > 100 mmHg)
 Migraine
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20
Q

Starting a COC: Not currently on any contraception

A
  • Start the COC on day 1 of cycle (no other req)

- If started another time but need to use barrier method for first 7 days.

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21
Q

Starting a COC: Switching from another COC/combined contraceptive patch/combined
vaginal ring

A

-Start COC on the day after the last active (no other req)

pill/patch/vaginal ring

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22
Q

Starting a COC: Switching from a POP or levonorgestrel IUS

A

-Start any time in cycle but need to use barrier method for first 7 days.

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23
Q

Starting a COC: Switching from a Cu-IUD

A

-Remove on day 1-5 of cycle and start COCO on the same day. (no other req)

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24
Q

Adverse effects of COCs

A 
Nausea and abdominal pain
 Headache
 Breast pain and/or tenderness
 Menstrual irregularities
 Hypertension
 Changes in lipid metabolism-weight gain?
 Mood changes?
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25
Q

What type of drugs can reduce the effect of enzymes?

A

Enzyme inducing drugs

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26
Q

Enzyme inducing drugs that can reduce the effects of COC

A
  • Antibiotics (rifamipicin)
  • Antiepileptics
  • Antiretroviral
  • St John’s worts
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27
Q

Enzyme inducing drugs that can reduce the effects of COC advice

A

Swap to progesterone-only injectable, Cu-UDI or LNG-IU (change contraception if long term med)

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28
Q

What does COC do to lamotrigine?

A

Serum levels of lamotrigine reduced. When lamotrigine is combined with sodium valproate it does not causes the reduction)

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29
Q

Reasons to stop taking COC

A 
Sudden severe chest pain
 Sudden breathlessness
 Unexplained swelling or severe pain in calf of one leg
 Severe stomach pain
 Serious neurological effects
 Jaundice
 Raised BP
 Prolonged immobility after surgery
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30
Q

1 pill missed (24-48 hours) COC

A

Take as soon as remembered, continue as usual. EC no req but might if another in the week missed.

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31
Q

2 or more pills missed (>48 hours) COC

A

Most recent taken as soon as remembered, continue as usual. Condoms used 7 consecutive active pills.

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32
Q

Pills missed in first week (1-7) COC

A

EC considered.

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33
Q

Pills missed second week (8-14) COC

A

No EC but rest of the pills for the week should be continued. Other methods used as caution.

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34
Q

Pills missed in third week (15-21) COC

A

Omit the pill free interval and continue active pills.

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35
Q

Progestogen only pill (POP) uses (7)

A

Very useful when oestrogens are contraindicated
PMH/high risk of venous thrombosis
heavy smokers
those with HTN above systolic 160 mmHg or diastolic 95 mmHg
valvular heart disease
diabetes mellitus with complications
migraine with aura

36
Q

Advantages of POP (2)

A

Good for breastfeeding

Fewer adverse drug reactions than COC

37
Q

Disadvantages of POP

A

Higher heart failure rate

38
Q

POP characteristics

A

No pill free interval

Must take within a 3 hour window

39
Q

Which POP can be taken in a 12 hour window?

A

Desogestrel

40
Q

Starting POP: Not currently on any contraception

A
  • Start POP on days 1-5 of cycle (nothing else req)

- If stated another time use barrier method for 7 days.

41
Q

Starting POP: Switching from another POP

A

Start anytime (nothing else req)

42
Q

Starting POP: Switching from CHC

A

Start on days 1-7 of hormone free interval (day 1 optimal, nothing else req)

43
Q

Starting POP: Switching from a Cu-IUD or LNG-IUS

A

Start at least 2 days before coil removal.

44
Q

Adverse effects and risks of POPs (4)

A

Menstrual irregularities
Breast tenderness — this is usually transient.
Ovarian cysts
Ectopic pregnancy — risk smaller with desogestrel.
Increased cancer risk?

45
Q

More than 3 hours late (> 27 hours since last) POP

A

Take ASPA, more than 1 take only 1. Continue as normal. Barriers advised for 2 days.

46
Q

More than 12 hours (>36 hours since last) POP- Desogesterel

A

Take ASPA, more than 1 take only 1. Continue as normal. Barriers advised for 2 days.

47
Q

3 types of EC

A

Copper bearing IUD (First choice)
Oral progesterone- only
Ulipristal Acetate (UPA)

48
Q

Two oral EC

A

Lavonelle (levonorgestrel 1.5 mg) LNG

EllaOne (ulipristal acetate 30mg) UPA

49
Q

Dose (EllaOne)

A

1 tablet within 120 hours

50
Q

Patients on CYP34A enzyme inducing medicines in last 4 weeks (EllaOne)

A

Not recommended

51
Q

Weight and BMI (EllaOne)

A

> 70 kg and >26 BMI may be given

52
Q

Severe asthma on oral glucocorticoids (EllaOne)

A

Not recommended

53
Q

Breastfeeding (EllaOne)

A

Not recommended for 1 week

54
Q

Dose (Lavonelle)

A

1 tablet within 72 hours

55
Q

Patients on CYP34A enzyme inducing medicines in last 4 weeks (Lavonelle)

A

Give two tablets

56
Q

Weight and BMI (Lavonelle)

A

> 70 kg and >26 BMI less effective

57
Q

Severe malabsorption syndrome (Lavonelle)

A

Reduced efficacy

58
Q

Breastfeeding (Lavonelle)

A

Can breastfeed

59
Q

Vomiting within 3 hours of EHC?

A

Repeat dose

60
Q

Regular contraception Levonelle

A

Continue

61
Q

Regular contraception EllaOne

A

It can reduce efficacy of COC and POPs. Restart after 5 days.

62
Q

EHC periods effects

A

Early or late period. See GP if change in flow

63
Q

EHC abdominal pain

A

Medical attention

64
Q

EHC barrier methods

A

Required

65
Q

What to do: suitable / request Cu-IUD to be fitted

A

Refer

66
Q

What to do: with clinical conditions where use of EHC is not recommended

A

Refer

67
Q

What to do: suspected pregnancy

A

Refer

68
Q

What to do: with previous allergy to active ingredients in EHC

A

Refer

69
Q

What to do: if unprotected sex/contraceptive failure occurred > 120 hours ago

A

Refer

70
Q

What to do: if severe lower abdominal pain experienced after taking EHC

A

Refer

71
Q

What to do: at risk of an STI

A

Refer

72
Q

What to do: repeat requests for EHC

A

Refer

73
Q

Transdermal ring containing…

A

Oestrogen and progesterone

74
Q

Vaginal ring containing…

A

Oestrogen and progesterone

75
Q

Parenteral injections or implants containing…

A

Progesterone only

76
Q

Intra-uterine devise or systems (copper IUD or IUS) containing…

A

Progesterone only

77
Q

Barrier methods examples

A

Condoms, caps and diaphragms

78
Q

LARC

A

Long-acting contraception is reversible contraception administered less than once a month.

79
Q

High effective contraception for patient taking medication with teratogenic potential (5)

A

LARC
Copper intrauterine device (Cu-IUD), Levonorgestrel intrauterine system (LNG-IUS)
Progestogen-only implant (IMP)
Male and female sterilization.

80
Q

What does the vaginal ring contain?

A

Ethinylestradiol (2.7mg), Etonogestrel (11.7mg)

81
Q

What does the transdermal patch contain?

A

Ethinylestradiol 33.9mg + Norelgestromin 203mg per 24 hours - transdermal

82
Q

How does the vaginal ring work?

A

Delivering 0.12mg/0.015mg per day by vagina

83
Q

How is vaginal ring used?

A

1 unit inserted on day 1 of cycle; left in place for 3 weeks; remove ring on day 22. Next ones is 7 days after ring free interval.

84
Q

Important: advise specific directions for vaginal ring

A

-changing from other methods of
contraception
-post-partum or post abortion use
-expulsion, delayed insertion/ removal or broken ring (<3 hrs)

85
Q

How does the transdermal patch work?

A

1 patch applied once weekly for 3 weeks; 1st patch applied on day 1 of cycle; change patch on days 8 and 15; remove 3rd patch on day 22 and apply new patch to start subsequent course after 7-day patch free interval during which withdrawal bleeding occurs

86
Q

Important: advise specific directions for transdermal patch

A
  • changing from other methods of contraception
  • post-partum or post abortion use
  • delayed application or detached patch
87
Q

What is the Evra patch restricted to?

A

Restrict Evra patches to those likely to comply poorly with COCs

Stage 3 Case 4 (11 decks)

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