Contraception Flashcards
List the three types of contraception
Hormonal
IUD
Barrier method
Which method of contraception is contraindicated in women with Pelvic inflammatory disease?
INTRAUTERINE DEVICE
What are Combined Hormonal Contraception
Oral contraception containing Estrogen and progestogen
State the estrogen content in CHC
Ethinylestradiol( main One)
Other Estradiol and mestranol
State the progestogen content in CHC
Desogestrel, Gestodene, Drospirenone, Levonogestrel , Northisterone , normegestrol and dienogest
What are the factors that may cause contraception failure?
Weight, malabsorption and drug interaction
It’s highly recommended that CHC are not used beyond what age?
50 as safer alternative exists due to risk of cancer due to estrogen content
Content of CHC
Take one tablet daily for 21days , 7days pill free interval for withdrawal bleeding
Advantages of CHC
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
Examples of pills that are monophasic
Fixed amount of estrogen and progestogen in each active tablet
Yasmin
Microgynon
Rigevidon
Cilest
State when to give low strength Ethinylestradiol to women
20mcg
For women with risk factors for circulatory disease eg obesity, smoking, HTN, MI
What’s the standard strength of ethinylestradiol
30-35mcg
What’s drospirenone
A derivative of Spironolactone
Can cause Hyperkalaemia
Examples of multiphasic COC
Qlaira , symphase,
Use for women who have breakthrough bleeding with monophasic or who do not have withdrawal bleeding
Surgery and contraception
Discontinue CHC 4weeks before major elective surgery and all surgery to legs or pelvis which involve prolonged immobilisation to lower limbs
What to offer women on CHC during surgery if estrogen cannot be stopped
Thromboprophylaxis ( unfractionated or LMWH) and graduated stockings to prevent risk of dvt cause by estrogen
Symptoms to stop CHC
See photo fav.
Signs of DVT
Migraines
HTN
Signs of liver disease
Caution with CHC
Increased risk of VTE, increases with age and other risk factors
Increased risk of breast and cervical cancer ( risk disappear after stopping)
State when to use CHC with caution or avoid
Avoid if BMI is greater than 30kgm
Long term immobilisation
If smokes greater than 40 cigarettes daily
Avoid if greater than 50yrs
Avoid in diabetes complications
Migraine with aura
Pt and carer advice for those on CHC travelling
If greater than 3hrs on flight reduce risk of dvt by wearing graduated compression hoselery or exercising during the journey
Pt and carer advice for vomiting and diarrhoea on CHC
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
What is missed pill for desogestrel, Zoely and Qlaira
Greater than or equal to 12hrs
What’s missed pill time for Levonorgestrel and Northisterone?
Greater than or equal to 3hrs
What’s missed pill time for othe r contraception?
Greater than or equal to 24hrs
See table for CHC missed pill
State when to take EHC when pill is missed for CHC
If you miss 2 or more pills on day 1-7
Advise pt to abstain from sex or use additional protection for 7days or 9days for zoely and Qlaira
State what to do if 2 or more CHC pills missed from day 14-21days
No EHC needed
Omit the pill free and start a new pack
State three forms of Progestogen Only Contraception
Oral
Parenteral
IUD
State when to use POC
Suitable alternative to CHC when estrogen is C.I
POC affects the menstrual cycle in what way?
Menstrual irregularities such as heavy or light periods more common
What’s the MOA for Oral POC
Eg desogestrel only preps consistently inhibit ovulation
What are the examples of Oral Progestogen Only Contraception?
Levonorgestrel 30mcg, desogestrel 75mcg. , noresthisterone 350mcg
Take everyday
No pill free period
What’s the dose of Progestogen Only Levonorgestrel for EHC
1.5mg has to be given within 3days of UPSI
State what to do if missed pill with POC eg Levonorgestrel
If the pill was >3hrs overdue, you are not protected, continue normal pill taken but use another method eg condom for 2days
State when to use EHC when missed pill with POC
If 1 or more pill missed or taken more than 3hrs late and UPSI has occurred before 2pills correctly taken
PO pill vomiting and diarrhoea
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
Facts about Oral PO eg Desogestrel
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
Facts about Parental PO ( Long acting)
Injections or implant
Eg of Parental POC that last up to 2years
Medroxyprogesterone acetate eg Depo provera, SAYANA press
Eg of Parental POC that can last for 8weeks
Noresthisterone enantate ( Noristerat)
Eg of Parental POC that last for up to 3years
Eg Etonosgestrel (Nexplanon)
MHRA warning for NEXPLANON
MHRA/CHM advice (updated February 2020): Nexplanon® (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration
There have been reports of neurovascular injury and migration of Nexplanon® implants from the insertion site to the vasculature, including the pulmonary artery in rare cases. Correct subdermal insertion by an appropriately trained and accredited healthcare professional is recommended to reduce the risk of these events. Healthcare professionals are advised to review the updated guidance from the manufacturer and the statement from the Faculty of Sexual and Reproductive Healthcare (FSRH) on how to correctly insert the implant. Patients should be advised on how to locate the implant, informed to check this occasionally and report any concerns. An implant that cannot be palpated at its insertion site should be located and removed as soon as possible; if unable to locate implant within the arm, the MHRA recommends using chest imaging. Implants inserted at a previous site that can be palpated should not pose a risk and should only be replaced if there are issues with its location or if a routine replacement is due.
Facts about depo provera
Admin with full counselling and PIL
Can cause troublesome bleeding and menstrual disturbance
Can cause osteoporosis
Only used in adolescents when other methods inappropriate
What’s the contraception of choice for women with heavy periods
PO IUD
List Examples of PO IUD
Mirena
Jaydess
Levosert
Facts about non hormonal contraceptive eg cu IUD
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
What is the most effective contraceptive method
CU IUD
What’s the most effective Emergency contraceptive
Ellaone
What method of EHC is affected by BMI and Weight
Levonelle
State the duration of avoid Breastfeeding when taking Ellaone
Avoid for BF for 1 WEEK
Enzyme inducer reduces contraceptive effect of EHC. T/F
True
Hence give 5days apart
Levonell is contraindicated in
Breast cancer and acute porphyria
Ulipristal acetate is contraindicated in
Breast cancer, ovarian and uterine cancer
Undiagnosed Vaginal bleed
Severe Asthma controlled by oral glucocorticoid
State when to start Hormonal contraception after taking EHC
Start it immediately ( for Levonelle)
Ellaone- 5days after
State when to offer EHC after child birth
Day 21
State when to offer EHC after abortion, miscarriage and ectopic pregnancy
After 5days
Counselling advice of EHC
If vomiting occurs within 3hrs- Take another tablet
Examples of enzymes
Inducers
CRAPGPS
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
St John’s wort
State what prostaglandin and oxytocics do
Induce abortion
Induce or augment labour
Minimise blood loss from the placenta
Induce uterine contraction with different levels of pain
List examples of Oxytocics and Prostaglandin
Oxycotin, Gemeprost, Carboprost, Ergometrine
List the drugs used in induction of abortion
Gemeprost
Misoprostol
Mifepristone
Which drugs are used to induce labour
Dinoprostone, Oxytocin , misoprostol (unlicensed)
What drug is used to control bleeding from miscarriage or abortion
Ergometrine and Oxytocin
What drug can be used in severe post partum haemorrhage
Carboprost
Facts about Mifepristone
For termination of pregnancy
A single dose of Mifepristone is followed by admin of prostaglandin ( Gemeprost or misoprostol)
What drug is used for the management of ectopic pregnancy
Systemic methotrexate
What’s vaginal atrophy
Thinning, drying and inflammation of vaginal walls due to less oestrogen production occurs mostly after menopause
Examples of drugs used in vaginal atrophy
Vagifem, ovestin and Gynest
Creams containing estrogen applied short term to improve symptoms
See vaginal and vulval infections
See chapter 5 bnf
Risk factors of erectile dysfunction
Sedentary lifestyle
Obesity
Smoking
Metabolic syndrome
Hypercholesterolaemia
Erectile dysfunction increases the risk of CVD true or false?
True
Drugs use to tx erectile dysfunction
Ist line- Oral phoshodiesterase type v inhibitors
MOA of phosphodiesterase type 5 Inhibitor
Act by increasing blood flow to the penis
List examples of short acting drugs used to tx erectile dysfunction suitable for occasional use
Avanafil, sildenafil and Vardenafil
A long acting drug used for spontaneous or those that have frequent sexual activities is called
Tadalafil
Side effect of Phosphodiesterase type 5 Inhibitor
Vasodilation, headache, G.I, dizziness, vision disorder and arthymias
Contraindications of Phosphodiesterase type 5 inhibitors
Recent hx of M.I or stroke ,avoid if systolic BP is below 90mmHg
Interaction with Phosphodiesterase type 5 inhibitors
CCB, nitrate , alpha blockers
Common side effect of Tamsulosin
Dizziness, sexual dysfunction
Contraindication of tamsulosin
Hx of micturition syncope and postural hypotension
