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5- Foundation year Genito Urinary > Contraception > Flashcards

Contraception Flashcards

1
Q

what does Fraser guidelines when prescribing contraception?

A

-she understands the doctors advice
- she cant be persuaded to inform her parents
-she is very likely to continue having sex
-unless she receives contraception her mental and physical health will suffer
-in her best interests to provide treatment

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2
Q

what are the different types of contraceptions?

A

-combined oral oestrogen content
-combined oral progestogen content
-progestogen only oral
-progestogen parenteral
-progestogen IUD
-transdermal patch
-vaginal ring

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3
Q

what is an example of a combined oral oestrogen content pill?

A

estradiol

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4
Q

what is an example of a combined oral progestogen content pill?

A

-norgestimate
-desogestrel
-drosperinone
these can be used for women with acne, headaches, depression and other symptoms

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5
Q

how do the oral contraception’s work and example of what they are?

A

-oral contraception is the combined oral contraceptive and progestogen only pill
-inhibits ovulation. Contains oestrogen and progestogen

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6
Q

how do you take the combined oral contraception?

A

-take one tablet daily for 3 weeks + 1 weeks pill free interval for withdrawal bleeding
-start any time in menstrual cycle; if started on day 6 or later use protection for 7 days
-not for women above 50 years

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7
Q

when to avoid CHC?

A

patients who are:
-hypotensive
-age 35 years who smoke
women with multiple risk factors of:
smoking
hypertension
high BMI
dylipidemida
Diabetes
-migraine with aura
-new onset migraine with aura during use of chi

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8
Q

what is monophasic and multiphase preparations?

A

mono= fixed dose of oestrogen and progestogen in each tablet
multi= different does of each in each tablet

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9
Q

what can increase the risk of VTE using oestrogens?

A

-type of progestrogen
-obesity BMI >30
-smoking
-primary relative under 45 with VTE
-superficial thrombophlebitis
-long term immobilisation
-age .35 years

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10
Q

what are the risk factors for increased risk of arterial thromboembolism using oestrogens?

A

-DM
-hypertension
-migraine without aura

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11
Q

when should you avoid using oestrogens?

A

when you have 2 risk factors or more

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12
Q

if your having surgery when should you stop taking the oestrogen pill?

A

4 weeks before surgery
-for major surgery and all surgery to the legs or that result in prolonged immobilisation of the lower limb

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13
Q

what are the options for people having surgery on the oestrogen pill?

A

-progestogen-only pill contraceptive is an alternative
-restart usal contraception on the first menses at least 2 weeks after full mobilisation
-thromboprophylaxis in emergency surgery or if combined contraceptive was not stopped

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14
Q

what should you do if you are travelling taking the oestrogen pill?

A

-for journeys over 3 hours. reduce the risk by wearing compression stocking and leg exercises

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15
Q

when should you stop the combined or oestrogen containing HRT?

A

-Venous thromboembolism: severe chest pain, sudden breathlessness or cough with blood-stained sputum (pulmonary embolism), unexplained swelling or severe pain in calf of one leg (DVT)

-Stroke: serious neurological effects: prolonged severe headaches, sudden partial or complete loss of vision, disturbance in hearing, dysphasia- slurred speech, bad fainting attacks, collapse, sudden numbness of one side or part of the body
-liver dysfunction: jaundice, hepatitis, liver enlargement, severe stomach pain
-blood pressure: above systolic 160mmHg or diastolic 95mmHg
-prolonged immobility after surgery or leg surgery
-detection of a risk factor which contraindicates treatment

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16
Q

how does the progestogen only pill work?

A

prevents pregnancy by thickening the mucus of the cervix to stop sperm reaching an egg

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17
Q

how is the progestogen only pill taken?

A

take one daily on a continuous basis starting day one of cycle and taken same time each day.
If started after 5 days of menstrual cycle, additional precautions is required for 2 days

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18
Q

what are some side effects of hormonal contraceptives?

A

-increased risk of cervical cancer (combined) and breast cancer (progestogen only and combined)

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19
Q

what is the benefits of combined oral contraceptives?

A

-reduces the risk of ovarian and endometrial cancer
-reduces dysmenorrhea and menorrhagia, premenstrual tension, reduced risk of PID, less benign breast cancer, less symptomatic fibroids or functional ovarian cysts.

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20
Q

what should be done if you miss a pill >24 hours of the combined oral contraception? 1 missed or 2 or more missed pills?

A

-1 missed= take one pill ASAP + condom for 7 days (9 days if zoely /qlaira)
-no extra precautions
-2 or more missed pill= take one pill ASAP + condom for 7 days (9 days if zoely /qlaira)
-omit pill free interval, if missed in last 7 days
-EHC, if missed in first 7 days and unprotected sex occurs. Use condoms till 7 consecutive doses take. Week 2-3 no EHC needed tKE asap 7 DAYS CONDOM. If missed 7 days before HFI carry on taking pill throughout HFI.

21
Q

what to do if you miss the progestogen only pill >3 hours (DESTOGESTREL >12HOURS)?

A

-take it asap + use a condom
-EHC= unprotected sex occurs before 2 pills AFTER RESTARTING or between missed pills are taken correctly

22
Q

what to do if you are vomiting/have diarrhoea when taking the COC?

A

-vomiting <2 of taking= take another ASAP
- >24hours (severe)= protection until 7 days after recovery and pill is resumed (9 days if qlaira)
-if it occurs in last 7 days= omit pill free interval

23
Q

what to do if vomiting /diarrhoea what should you do if taking POP?

A

-vomiting <2hrs of taking it=take another one asap
-severe of if pill not taken within 3hrs of normal time (12hrs if desogestrel) = protection until 2 days after recovery and pill is resumed

24
Q

how do you used the transdermal patches?

A

1 cycle: weekly patch for 3 weeks then one patch free week

25
Q

what to do if detached for >24hr or detached application at the beginning of cycle when using the transdermal patches?

A

-apply new patch ASAP
-start a ‘new day 1 cycle” _ condom for 7 days

26
Q

what should you do if you delay application in the middle of the cycle or beginning of week 2 (day 8) or week 3 (day 15)?

A

<48hrs =apply new patch and continue as normal
>48 hrs= start a ‘new day 1 cycle’ + condom for 7 days

27
Q

what are some main interactions with drugs that are enzyme inducers and hormonal contraceptive drugs cause reduced contraceptive effectiveness?

A

-caramazepine
-phenytoin
-phenobarbitol
-st johns wort
-rifampicin
-rifabutin

28
Q

what regular contraception should be used until after 4 weeks after stopping the interacting drug?

A

copper IUD
progestogen- only injection

29
Q

what are the different types of emergency contraception?

A

-copper IUD
-3mg dose of levonorgestrel (unlicensed)
-ulipristal efficacy is also reduced by drugs that increase gastric pH (antacids, H2 receptor antagonists, PPIs)

30
Q

what is the first line emergency hormonal contraception? and why?

A

Copper IUD
-most effective form of EHC
-inserted up to 120hrs (5 days) after unprotected sex or unto 5 days after earliest calculated ovulation

31
Q

what is the second line EHC?

A

hormonal methods
-if a copper is not appropriate to the patient
-oral EHC: levonorgestrel or Ulipristal (more effective)
-offer asap after unprotected intercourse to increase efficacy
-if BMI >26kg/m2 or over 70kg: ulipristal or a double dose of levonorgestrel ( high body weightier BMI may reduce the effectiveness of oral EHC, partially levonorgestrel)

32
Q

what is the dose of levonorgestrel? and their cautions?

A

dose: 1500mg <72hrs of unprotected sex
-if vomiting <3hrs of taking dose give replacement

cautions:
-crohns disease (severe malabsorption syndromes)
past ectopic pregnancy
-ciclosporin (toxicity)

33
Q

how does levonorgestrel work?

A

prevents ovulation and fertilisation

34
Q

how does ulipristal work?

A

progestogen receptor modulator inhibits or delays ovulation. more effective than levonorgestrel

35
Q

how is ulipristal used and the dose?

A

> 96-120 hours unprotected sex
-within the last 5 days of unprotected sex was likely during 5 days before the estimated day of ovulation
-dose: 30mg<120rs of unprotected sex
if vomiting <3hrs of taking dose give replacement

36
Q

what is the cautions and contra-indicators of ulipristal?

A

-cautions: severe asthma treated by oral steroids (not recommend)
-avoid on severe liver impairment
-contraindications: repeated use within the same menstrual cycle. (repeated use with levonorgestrel is not contra-indicated but manufactorers advice to avoid, due to increased menstrual irregularities

37
Q

what is some counselling for ulipristal?

A

-redcued the effectiveness of regular contraceptives
-use additional barrier protection
~combined= 14 days (16 days if qlaira)
~progestogen-only= 9 days for pill (14 days if parenteral)
-also wait 5 days before starting regular normal contraception or using levonergesteral as EHC. Use condoms reliably or abstain from intercourse during this period as contraceptive effect of ulipristal will be reduced

38
Q

what are some normal contraception side effects?

A

-menstrual irregularities

39
Q

what is the counselling points for normal contraception?

A

-next period may be early or late
-use barrier protection until next period
-if lower abdominal pain; see GP to rule out ectopic pregnancy
-if periods are abnormal; light heavy brief or absent; take a pregnancy test (must be at least 3 weeks after unprotected sex)

40
Q

why is IUD less suitable
for prescribing in under 25 years?

A

can increase risk of pelvic inflammatory disease

41
Q

what are the different types of IUD?

A

-copper and levonorgestrel

42
Q

what are the notes to be taken from levonorgestrel?

A

-reduced bleeding and period pain and has a lower risk of pelvic inflammatory disease
-prescribed by brand as caring indicators, duration of use and introducers

43
Q

what are the 3 types of IUD levonorgestrel releasing?

A

-mirena
-levosert
-jaydess

44
Q

how long should each IUD releasing levonorgestrel ?

A

-mirena = 5 years
-levosert = 3 years
-jaydess = 3 years

45
Q

what are some side effects of IUDs?

A

-pain on insertion and bleeding
-uterine perforation
-risk of infection, excess risk in first 20 days= pre-insertion chlamydia screening for high risk groups, antibiotics prophylaxis

46
Q

what are the notes for removal of IUDs?

A

-dont remove IUD mid cycle unless additional contraception is used for 7 days
-if removal is essential and unprotected sex occurs give EHC
-if pregnant remove in 1st trimester

47
Q

what are the parenteral contraceptions

A

-medroxyprogestrone injection
-noresthieterone injection
-etonogestrel implant

48
Q

how long do they different type of parenteral contraceptions last? + side effects

A

-medroxyprogestrone injection = depot injection every 13 weeks. Can cause loss of bone density. delayed return to fertility of up to 1 year after treatment stopped

-noresthieterone injection= 8 weeks

-etonogestrel implant= 3 years, implant can reachh the lungs via pulmonary artery, must be palpable- otherwise locate and remove asap, if unable to locate implant in arm use chest imaging

49
Q

what is a spermicdal contraceptive?

A

-barrier preparations along (condoms, caps, diaphragms) are less effective but can be reliable in well-motivated couples who use a spermicide

-not suitable for those at high risk of STI, high use associated with genital lesions and increased risk of acquiring infections

5- Foundation year Genito Urinary (4 decks)

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