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MFSRH Part 1 CM > Contraception > Flashcards

Contraception Flashcards

1
Q

When does the risk from cervical cancer and CHC stop

A

10 years after stopping

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2
Q

What cancers is CHC associates with

A

Breast and cervical

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3
Q

What cancers are CHC protective for

A

Ovarian, endometrial (bowel)

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4
Q

First line CHC?

A

</= 30mcg ethinylestradiol +
Levonorgestrel/northisterone

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5
Q

Perfect use CHC

A

<1%

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6
Q

Typical use CHC

A

9% failure

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7
Q

What is the theoretical weight limit risk with CHC patch

A

> 90kg

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8
Q

Lowest risk CHC for VTE

A

COC with levonorgestrel, northisterone, norgestimate

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9
Q

First generation progestogen?

A

Northisterone (NET)

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10
Q

Second generation progestogen

A

Levonorgestrel (LNG)

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11
Q

Third generation progestogen

A

Desogestrel, gestodene, norgestimate*
LNG is an active metabolite

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12
Q

Newer progestogens?

A

Drospirinone, dienogest, nomegestrol acetate

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13
Q

What is etonogestrel an active metabolite of?

A

Desogestrel

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14
Q

Do women using co-cyprindiol for acne and hirsutism management need additional contraception?

A

No

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15
Q

What is in the patch

A

EE and norelgestromin

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16
Q

What is in the vaginal ring

A

EE and etonogestrel

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17
Q

Is the first line COC multiphasic or monophasic

A

Monophasic

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18
Q

How does CHC work

A

Acts on the HPO to supress LH and FSH thus inhibiting ovulation

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19
Q

Can multiphasic COC be used in tailored regiemes

A

No

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20
Q

What symptoms are more common during the HFI?

A

Headache, pelvic pain, bloating, breast tenderness

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21
Q

How many women have menstrual cycles shorter than 20 days

A

<5% (<2% in the 20-39 group)

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22
Q

Is condoms needed when switching traditional POP to CHC

A

Yes

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23
Q

Is 7 days of condoms needed when switching to CHC from desogestrel/implant/depo

A

No (if in licence/time frame!)

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24
Q

What happens if CHC/POP taken in the the 5 days after taking UPA-EC?

A

UPA effectiveness decreased, no effect on the CHC/pop

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25
Q

Yearly VTE risk for someone on CHC Vs normal

A

5-12 in 10,000 Vs 2 in 10,000

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26
Q

Fatality of VTE in CHC users

A

1%

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27
Q

CHC containing which progesterones are at highest risk of vte

A

Desogestrel, drospirinone, gestodene
(9-12 in 10,000)

28
Q

What route of administration has best bioavailability

29
Q

What is the implant etonogestrel dose per day?

A

Week 5-6 60-70mcg
End of year 1 35-45mcg
End of year 3 25-30mcg

30
Q

Rates of deep inplants

A

0.4% of insertions

31
Q

Most likely nerve injury from insertion

A

Ulnar nerve (roots C8-T1)

32
Q

When should implant removal be discussed with other team(s)?

A

If plts below 50.
Warfarin use not an issue however

33
Q

What concentration of etonogestrel is required to inhibit ovulation with the implant?

A

90pg/ml = achieved by day 2

34
Q

Women with meningioma should avoid what contraception

A

Cyproterone acetate

35
Q

Why does EE not convert to E2?

A

The ethinyl group on carbon 17 does not get removed during metabolism

36
Q

What estrogen is in Qlaira

A

E2V (estradiol valerate)

37
Q

What estrogen is in zoely

A

E2 (estradiol)

38
Q

EE effect on clotting

A

Increase procoagulatory factors
Decrease anticoagulation mechanisms

39
Q

CHC levonorgestrel VTE risk

40
Q

CHC norgestimate VTE risk

41
Q

CHC northisterone VTE risk

42
Q

CHC etonogestrel VTE risk

43
Q

CHC norelgestromin VTE risk

44
Q

CHC gestodene VTE risk

45
Q

CHC desogestrel VTE risk

46
Q

CHC drospirinone VTE risk

47
Q

CHC dienogest VTE risk

48
Q

CHC nomegestrol VTE risk

49
Q

52mg IUS dose release after insertion

A

20mcg a day

50
Q

19.5mg IUS dose release after insertion

A

17.5mcg a day

51
Q

13.5mg IUS dose release after insertion

A

15mcg a day

52
Q

52mg IUS dose release at end of licence

A

9mcg a day

53
Q

19.5mg IUS dose release at end of licence

A

7.4mcg a day

54
Q

13.5mg IUS dose release at end of licence

A

5mcg a day

55
Q

Which IUS have silver ring for USS visibility

A

Jaydess and kyleena

56
Q

What to do in regards to IUD fits in patients with adrenal insufficiency

A

Double glucocorticoid 1hr before and for 24 hours after
Fit early morning.
No adjustments if mineralocorticoid

57
Q

Which HIV meds classes interact with hormonal contraception

A

Protease inhibitors and some NNRTIs

58
Q

What is the rule for COC and atazanavir?

A

At least 35mcg EE required (high dose!)

59
Q

Definitely contraception safe hiv drugs?

A

Rilpivirine, maraviroc, raltegravir, dolutegravir

60
Q

Downsides of DMPA and art treatments

A

No efficacy affected but BMD worries

61
Q

EC on HAART?

A

IUD
Double dose levonorgestrel
? UPA

62
Q

Teratogenic hiv meds

A

Stavudine, didanosine
Efavirenz

63
Q

When should missed pill rules be followed in a women on CHC with severe diarrhea

64
Q

VTE risk with CHC patch and ring

A

6-12 in 10,000

65
Q

CHC VTE risk with dienogest, nomegestrol, mestranol

66
Q

What CHC contains estradiol

A

Estradiol/nomegestrol acetate (zoely)
Estradiol valerate/dienogest (Qlaira)

67
Q

Signs of lamotrogeine toxicity

A

Diplopia 👀
Ataxia 🍂
Dizziness 🌪️

MFSRH Part 1 CM (15 decks)

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