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cardiovascular system 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

List the three types of contraception

A

Hormonal
IUD
Barrier method

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2
Q

Which method of contraception is contraindicated in women with Pelvic inflammatory disease?

A

INTRAUTERINE DEVICE

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3
Q

What are Combined Hormonal Contraception

A

Oral contraception containing Estrogen and progestogen

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4
Q

State the estrogen content in CHC

A

Ethinylestradiol( main One)
Other Estradiol and mestranol

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5
Q

State the progestogen content in CHC

A

Desogestrel, Gestodene, Drospirenone, Levonogestrel , Northisterone , normegestrol and dienogest

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6
Q

What are the factors that may cause contraception failure?

A

Weight, malabsorption and drug interaction

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7
Q

It’s highly recommended that CHC are not used beyond what age?

A

50 as safer alternative exists due to risk of cancer due to estrogen content

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8
Q

Content of CHC

A

Take one tablet daily for 21days , 7days pill free interval for withdrawal bleeding

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9
Q

Advantages of CHC

A

Reduces periods pain and heavy bleeds
Reliable and reversible
Reduced menopausal symptoms
Predictable bleeding pattern
Improvement of acne
Reduced risk of ovarian, endometrial and colorectal cancer
Maintain bone density in peri- menopausal women under 50

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10
Q

Examples of pills that are monophasic

A

Fixed amount of estrogen and progestogen in each active tablet
Yasmin
Microgynon
Rigevidon
Cilest

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11
Q

State when to give low strength Ethinylestradiol to women

A

20mcg
For women with risk factors for circulatory disease eg obesity, smoking, HTN, MI

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12
Q

What’s the standard strength of ethinylestradiol

A

30-35mcg

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13
Q

What’s drospirenone

A

A derivative of Spironolactone
Can cause Hyperkalaemia

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14
Q

Examples of multiphasic COC

A

Qlaira , symphase,
Use for women who have breakthrough bleeding with monophasic or who do not have withdrawal bleeding

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15
Q

Surgery and contraception

A

Discontinue CHC 4weeks before major elective surgery and all surgery to legs or pelvis which involve prolonged immobilisation to lower limbs

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16
Q

What to offer women on CHC during surgery if estrogen cannot be stopped

A

Thromboprophylaxis ( unfractionated or LMWH) and graduated stockings to prevent risk of dvt cause by estrogen

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17
Q

Symptoms to stop CHC

A

See photo fav.
Signs of DVT
Migraines
HTN
Signs of liver disease

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18
Q

Caution with CHC

A

Increased risk of VTE, increases with age and other risk factors
Increased risk of breast and cervical cancer ( risk disappear after stopping)

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19
Q

State when to use CHC with caution or avoid

A

Avoid if BMI is greater than 30kgm
Long tern immobilisation
If smokes greater than 40 cigarettes daily
Avoid if greater than 50yrs
Avoid in diabetes complications
Migraine with aura

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20
Q

Pt and carer advice for those on CHC travelling

A

If greater than 3hrs on flight reduce risk of dvt by wearing graduated compression hoselery or exercising during the journey

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21
Q

Pt and carer advice for vomiting and diarrhoea on CHC

A

Take another pill ASAP if vomiting occurs 3hrs with taking the combined pill or if severe diarrhoea occurs for more than 24hrs
Use non oral contraception if diarrhoea and vomiting persist

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22
Q

What is missed pill for desogestrel, Zoely and Qlaira

A

Greater than or equal to 12hrs

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23
Q

What’s missed pill time for Levonorgestrel and Northisterone?

A

Greater than or equal to 3hrs

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24
Q

What’s missed pill time for othe r contraception?

A

Greater than or equal to 24hrs

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25
Q

See table for CHC missed pill

A
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26
Q

State when to take EHC when pill is missed for CHC

A

If you miss 2 or pills on day 1-7
Advise pt to abstain from sex or use additional protection for 7days or 9days for zoely and Qlaira

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27
Q

State what to do if 2 or more CHC pills missed from day 14-21days

A

No EHC needed
Omit the pill free and start a new pack

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28
Q

State three forms of Progestogen Only Contraception

A

Oral
Parenteral
IUD

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29
Q

State when to use POC

A

Suitable alternative to CHC when estrogen is C.I

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30
Q

POC affects the menstrual cycle in what way?

A

Menstrual irregularities such as heavy or light periods more common

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31
Q

What’s the MOA for Oral POC

A

Eg desogestrel only preps consistently inhibit ovulation

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32
Q

What are the examples of Oral Progestogen Only Contraception?

A

Levonorgestrel 30mcg, desogestrel 75mcg. , noresthisterone 350mcg
Take everyday
No pill free period

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33
Q

What’s the dose of Progestogen Only Levonorgestrel for EHC

A

1.5mg has to be given within 3days of UPSI

34
Q

State what to do if missed pill with POC eg Levonorgestrel

A

If the pill was >3hrs overdue, you are not protected, continue normal pill taken but use another method eg condom for 2days

35
Q

State when to use EHC when missed pill with POC

A

If 1 or more pill missed or taken more than 3hrs late and UPSI has occurred before 2pills correctly taken

36
Q

PO pill vomiting and diarrhoea

A

If vomiting occurs within 2hrs of taking POC, take another pill ASAP
In the case of illness, diarrhoea, additional precautions should be used for 2days until recovery

37
Q

Facts about Oral PO eg Desogestrel

A

Dose 75mcg
Take Dose same time each day
Start on day 1 of cycle
If started on day 5 of cycle, additional protection required
If admin delayed for 12hrs or more, it’s a missed pill
Use additional protection for 2days

38
Q

Facts about Parental PO ( Long acting)

A

Injections or implant

39
Q

Eg of Parental POC that last up to 2years

A

Medroxyprogesterone acetate eg Depo provera, SAYANA press

40
Q

Eg of Parental POC that can last for 8weeks

A

Noresthisterone enantate ( Noristerat)

41
Q

Eg of Parental POC that last for up to 3years

A

Eg Etonosgestrel (Nexplanon)

42
Q

MHRA warning for NEXPLANON

A

See BNF

43
Q

Facts about depo provera

A

Admin with full counselling and PIL
Can cause troublesome bleeding and menstrual disturbance
Can cause osteoporosis
Only used in adolescents when other methods inappropriate

44
Q

What’s the contraception of choice for women with heavy periods

A

PO IUD

45
Q

List Examples of PO IUD

A

Mirena
Jaydess
Levosert

46
Q

Facts about non hormonal contraceptive eg cu IUD

A

Suitable for women of all ages but caution if less than 25yrs due to increased risk of PID
Most effective IUDs have atleast 380mm^2 of cu and branded cu on the arm
Smaller devices have less side effect

47
Q

What is the most effective contraceptive method

A

CU IUD

48
Q

What’s the most effective Emergency contraceptive

A

Ellaone

49
Q

What method of EHC is affected by BMI and Weight

A

Levonelle

50
Q

State the duration of avoid Breastfeeding when taking Ellaone

A

Avoid for BF for 1 WEEK

51
Q

Enzyme inducer reduces contraceptive effect of EHC. T/F

A

True
Hence give 5days apart

52
Q

Levonell is contraindicated in

A

Breast cancer and acute porphyria

53
Q

Ulipristal acetate is contraindicated in

A

Breast cancer, ovarian and uterine cancer
Undiagnosed Vaginal bleed
Severe Asthma controlled by oral glucocorticoid

54
Q

State when to start Hormonal contraception after taking EHC

A

Start it immediately ( for Levonelle)
Ellaone- 5days after

55
Q

State when to offer EHC after child birth

A

Day 21

56
Q

State when to offer EHC after abortion, miscarriage and ectopic pregnancy

A

After 5days

57
Q

Counselling advice of EHC

A

If vomiting occurs within 3hrs- Take another tablet

58
Q

Examples of enzymes
Inducers

A

CRAPGPS
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
St John’s wort

59
Q

State what prostaglandin and oxytocics do

A

Induce abortion
Induce or augment labour
Minimise blood loss from the placenta
Induce uterine contraction with different levels of pain

60
Q

List examples of Oxytocics and Prostaglandin

A

Oxycotin, Gemeprost, Carboprost, Ergometrine

61
Q

List the drugs used in induction of abortion

A

Gemeprost
Misoprostol
Mifepristone

62
Q

Which drugs are used to induce labour

A

Dinoprostone, Oxytocin , misoprostol (unlicensed)

63
Q

What drug is used to control bleeding from miscarriage or abortion

A

Ergometrine and Oxytocin

64
Q

What drug can be used in severe post partum haemorrhage

A

Carboprost

65
Q

Facts about Mifepristone

A

For termination of pregnancy
A single dose of Mifepristone is followed by admin of prostaglandin ( Gemeprost or misoprostol)

66
Q

What drug is used for the management of ectopic pregnancy

A

Systemic methotrexate

67
Q

What’s vaginal atrophy

A

Thinning, drying and inflammation of vaginal walls due to less oestrogen production occurs mostly after menopause

68
Q

Examples of drugs used in vaginal atrophy

A

Vagifem, ovestin and Gynest
Creams containing estrogen applied short term to improve symptoms

69
Q

See vaginal and vulval infections

A

See chapter 5 bnf

70
Q

Risk factors of erectile dysfunction

A

Sedentary lifestyle
Obesity
Smoking
Metabolic syndrome
Hypercholesterolaemia

71
Q

Erectile dysfunction increases the risk of CVD true or false?

A

True

72
Q

Drugs use to tx erectile dysfunction

A

Ist line- Oral phoshodiesterase type v inhibitors

73
Q

MOA of phosphodiesterase type 5 Inhibitor

A

Act by increasing blood flow to the penis

74
Q

List examples of short acting drugs used to tx erectile dysfunction suitable for occasional use

A

Avanafil, sildenafil and Vardenafil

75
Q

A long acting drug used for spontaneous or those that have frequent sexual activities is called

A

Tadalafil

76
Q

Side effect of Phosphodiesterase type 5 Inhibitor

A

Vasodilation, headache, G.I, dizziness, vision disorder and arthymias

77
Q

Contraindications of Phosphodiesterase type 5 inhibitors

A

Recent hx of M.I or stroke ,avoid if systolic BP is bellow 90mmHg

78
Q

Interaction with Phosphodiesterase type 5 inhibitors

A

CCB, nitrate , alpha blockers

79
Q

Common side effect of Tamsulosin

A

Dizziness, sexual dysfunction

80
Q

Contraindication of tamsulosin

A

Hx of micturition syncope and postural hypotension

81
Q
A

cardiovascular system 1 (41 decks)

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