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PR - GENITO-URINARY TRACT SYSTEM > CONTRACEPTION > Flashcards

CONTRACEPTION Flashcards

1
Q

Children <16

A

Can supply to children under 16 without parental consent if they meet fraser guidelines

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2
Q

Fraser guidelines

A

Understands Drs advice
Cannot be persuaded to inform her parents
Very likely to continue having sex
Unless she receives contraception her mental + physical health will suffer
In her best interests to provide treatment

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3
Q

Types of non-hormonal contraception

A

barrier methods
spermicidal contraceptives
IUDs

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4
Q

Barrier methods

A

condoms, diaphragms, cervical caps
vaseline, baby oil etc can damage these methods

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5
Q

Spermicidal contraceptives

A

used in addition only

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6
Q

IUDs

A

copper coil
contraindicated in PID or unexplained vaginal bleeding

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7
Q

Progesterone only contraceptives examples

A

levonorgestrel
norethisterone
desogestrel

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8
Q

MOA of POC

A

1) thickening of the cervical mucus
2) suppression of ovulation
3) changes in the uterine lining

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9
Q

POC pill free

A

There is no pill free period with these
Daily

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10
Q

What are the adverse effects with taking the ‘progesterone-only pill’?

A
  • weight increase
  • breast tenderness
  • libido changes
  • mood changes
  • ovarian cysts
  • skin reactions
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11
Q

What additional precautions need to be taken with POCs?

A

No additional precautions needed if started within first 5 days of cycle
Need 2 days precaution if taken after that

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12
Q

When should POCs be taken?

A

Taken at the same time each day for maximum efficacy
* Desogestrel needs to be taken within 12 hours otherwise considered missed pill
* Other POP’s need to be taken within 3 hours otherwise considered missed pill

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13
Q

When is POC considered a missed pill?

A
  • Desogestrel needs to be taken within 12 hours otherwise considered missed pill
  • Other POP’s need to be taken within 3 hours otherwise considered missed pill
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14
Q

Desogestrel missed dose

A

missed pill = 12h late
- Take pill ASAP -
- Take the next pill normally even if it means taking 2 pills in 24 hours -
- AVOID SI or use the barrier method for TWO DAYS

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15
Q

Drugs which interact with POC

A
  • Griseofluvin - effectiveness of POP may be reduced
  • Ulipristal - effectiveness may be reduced
  • REMEMBER ‘CRAPPS’ ENZYME INDUCERS! Carbamazepine, Rifampicin, Aprepitant, Phenytoin, Phenobarbital,
  • St John’s Wort - reduce effectiveness of POPs
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16
Q

When is POP considered missed?

A

Considered missed if >12 hours for desogestrel or > 3 hours for rest

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17
Q

Missed POP

A

Take pill as soon as you remember
Take the next pill at the usual time (can mean 2 in a day)
Need protection till 48 hours of pills are taken correctly (7 for desogestrel)
Need emergency contraception if UPSI happened between missed pill and 2 days after restarting medication

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18
Q

What should be done if a patient is taking a progesterone-only pill alongside an enzyme-inducing drug e.g., carbamazepine or phenobarbital?

A

additional barrier method is recommended, during taking and for 28 days after!

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19
Q

Parenteral POCs examples

A

Injections
Implants

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20
Q

POC injection

A

Depot medroxyprogesterone acetate
99.8% effective in correct usage
every 13 weeks

21
Q

How effective is the depo injection?

A

99.8% effective in correct usage

22
Q

How long does the depo injection last?

A
  • Lasts up to 3 years
23
Q

Side effects of depo injection

A
  • Loss of bone density may occur
  • Delayed return to fertility of up to one year after treatment cessation
24
Q

POC Implant

A

Etonogesterel (Nexplanon)
99.95% effective in correct usage
* Lasts up to 3 years
MHRA Warning: neurovascular injury and migration of the implant - remove ASAP

25
Q

How effective is nexplanon

A

99.95% effective in correct usage

26
Q

How long does nexplanon last?

A

3 years

27
Q

MHRA Warning: implant

A

neurovascular injury and migration of the implant - remove ASAP

28
Q
A
29
Q

MHRA Warning: nexplanon

A

neurovascular injury and migration of the implant - remove ASAP

30
Q

Combined hormonal contraceptives examples

A

Tablets
Patches
Vaginal rings

31
Q

Combined hormonal contraceptives

A

Not given in 50 yrs + of age as safer alternatives exist

32
Q

CHC health benefits

A
  • reduces risk of ovarian, endometrial and colorectal cancer
  • aligns bleeding patterns
  • reduces dysmenorrhoea and menorrhagia
  • manages symptoms of PCOs, endometriosis and PMS
  • improves acne
  • reduces menopausal symptoms
  • maintains bones density in peri-menopausal females under 50
33
Q

What age can contraception be given

A
  • COC: mena – 49
  • POC: mena – 54
34
Q

When to avoid CHCs

A
  • hypertension
  • 35 + and smoke
  • women with multiple risk factors for CV
  • migraine with aura
  • new onset migraine with aura during use of CHC
35
Q

Risk factors for CV

A
  • diabetes
  • dislipidaemia
  • high BMI over 30
  • smoking
  • hypertension
36
Q

Monophasic COC

A

fixed amount of an oestrogen and progestogen in each active tablet

37
Q

Multiphasic COC

A

varying amounts of 2 hormones

38
Q

Oestrogen

A

ethinylestradiol
mestranol
estradiol

39
Q

Switching to a CHC

A

From CHC - no additional contraception needed
From POP - 7 days extra precaution
From LNG-IUD - 7 days extra precaution needed

From Copper IUD -
if CHC started up to day 5 of menstrual cycle - no additional needed
If started after day 5 - 7 days extra

40
Q

Switching from CHC to others

A

Week 1 (or day 3-7 of hormone free interval) + No UPSI since start of HFI
* Cu-lUD - no extra precaution
* POP - 2 days precautions
Others - 7 days precaution

Week 1 (or day 3-7 of hormone free interval) + UPSI since start of HFI
* Carry on with CHC until 7 consecutives days taken
Then act as week 2 or 3

Week 2 or 3 - no extra precaution needed

41
Q

Reasons to stop taking CHC (urgent!!)

A
  • calf pain, swelling and or redness (DVT)
  • chest pain/ breathlessness and/or coughing up blood (PE)
  • loss of motor of sensory function (stroke)
  • severe stomach pain (hepatotoxicity)
  • very high bp (haemorrhagic stroke)
42
Q

Other reasons to stop

A

Medical Review or to Seek Advice:
Signs of breast cancer (lump, nipple pain)
New onset migraine
Persistent unscheduled vaginal bleeding
High blood pressure
High BMI (>35 kg/m2)
* DVT or PE
* Blood clotting abnormality
* Angina, heart attack, stroke or peripheral vascular disease
* Atrial fibrillation
Cardiomyopathy

43
Q

CHC and surgery

A

Discontinued at least 4 weeks prior for:
- major elective surgery, any surgery to the legs or pelvis
- surgery that involves prolonged immobilisation of a lower limb

  • CHC recommended 2 weeks after full remobilisation
  • If discontinuation is not possible (trauma not elective), consider thromboprophylaxis
44
Q

Side effects of hormonal contraceptives

A

headaches
unschedule bleeding
mood change
weight gain
libido change

45
Q

When do the missed pill rules apply

A

patient omits or has vomited / had diarrhoea within 2 hours of taking COC or POP - take another one ASAP to aim to be within time period
additional methods for 48h after

46
Q

Misses CHC

A

Late start after HFI (> 9 days since last active pill)
- emergency contraception if UPSI occurred
- take immediately and use condom till 7 consecutive days taken

1 missed pill (48-72 hrs since last active pill)
- Take ASAP - no further action needed (if previous 7 active pills consistent)

2 + missed pills (72 hours since last active pill)
- Week 1 of cycle: consider emergency contraception if UPSI happened within HFI and week 1. Take ASAP and use condom till 7 consecutive dose taken
- Week 2-3 of cycle: no emergency contraception needed - take ASAP. 7 days condom
- If 2+ pills missed in 7 days before HFI carry on taking pill throughout HFI

47
Q

Late start after HFI (> 9 days since last active pill)

A
  • emergency contraception if UPSI occurred
  • take immediately and use condom till 7 consecutive days taken
48
Q

1 missed pill (48-72 hrs since last active pill)

A
  • Take ASAP - no further action needed (if previous 7 active pills consistent)
49
Q

2 + missed pills (72 hours since last active pill)

A
  • Week 1 of cycle: consider emergency contraception if UPSI happened within HFI and week 1. Take ASAP and use condom till 7 consecutive dose taken
  • Week 2-3 of cycle: no emergency contraception needed - take ASAP. 7 days condom
  • If 2+ pills missed in 7 days before HFI carry on taking pill throughout HFI

PR - GENITO-URINARY TRACT SYSTEM (11 decks)

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