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CONTRACEPTION Flashcards

1
Q

Can condoms be given out for free at screening and treatment sites?

A

Yes

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2
Q

_ _ _s enable supply of medicines associated with sexual health

A

PGDs

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3
Q

The National Chalamydia Screening Programme allows pharmacies to provide what?

A

Easy to use, non-invasive chlamydia testing kits

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4
Q

If you are under _ _ you can get a free and confidential chlamydia test as part of the NCSP

A

25 years

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5
Q

NCSP provides free ____ tablets specifically ____ for the treatment of Chlamydia

A

Antibiotic - Azithromycin 1G stat dose

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6
Q

You are at higher risk of catching an STI if you have had more than 2 partners in the last ___ months

A

6

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7
Q

Chlamydia can increase risk of ___ ___ ___

A

Pelvic Inflammatory Disease (PID)

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8
Q

A Chlamydia retest should take place at ___ months to test for re-infection/ success of treatment

A

3 months

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9
Q

Herpes simplex virus can be treated with _____

A

Aciclovir
- 200mg 5 times a day for 5 days
OR
- 400mg tds for 5 days

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10
Q

Some patients need a suppressive Rx for treatment of recurrent Herpes. This will be considered if they have had Herpes __ times in a 12 month period.

A

6

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11
Q

Are males or females vaccinated against HPV 6, 11, 16, 18?

A

Females

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12
Q

HPV causes what?

A

Genital warts

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13
Q

Vaginal candidiasis is more common in ____ women than ___ ____ women

A

Pregnant women more common than in non pregnant women

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14
Q

Gonorrhoea can be treated with ceftriaxone 500mg IM (inj in buttock) and ______ 1g as synergistic

A

Azithromycin

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15
Q

As a pharmacist we have a duty to ____ guard all children that we may be concerned about

A

SAFEGUARD

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16
Q

A young person must have ___ and be able to give ___ to treatment

A

Capacity and consent

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17
Q

Levonorgestrel must be taken within ___ hours of unprotected sex/failure of contraceptive method

A

72

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18
Q

Ulipristal Acetate must be taken within ___ hours of unprotected sexual intercourse or failure of method

A

120 hours (5 days)

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19
Q

Which of the following drugs will prevent a mother from being able to breastfeed for a week after taking due to expression in milk? Levonorgesterel or Ulipristal Acetate?

A

Ulipristal Acetate.

Levonorgesterel is expressed in small amounts in breast milk but should not be harmful to the baby. Advise to take immediately after a feed to reduce levels baby may take in next feed

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20
Q

Should patients use a reliable barrier method until their next period after taking Ulipristal Acetate?

A

Yes - it can reduce ht efficacy of COC’s and POP’s

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21
Q

Refer patient if…

A
  • Interactions
  • Pregnancy and suspected pregnancy
  • If after time limit
  • If lower abdo pain after taking EC - risk ectopic preg
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22
Q

Children under the age of __ are legally too young to consent to any sexual activity. Report to social services unless exceptional circumstances and documented reasoning

A

13 years of age

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23
Q

List 5 indications for use of EC:

A

1) UPSI
2) Barrier method fail
3) Pill failure
4) IUD failure
5) Risk of conception whilst advised to avoid pregnancy

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24
Q

COC loss of contraception most likely when…

A

If 2 or more active pills missed from first 7 tabs in packet and UPSI occurred since finishing last packet. (7 day pill free interval extended)

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25
Q

Contraception is lost in COC if more than __ pills are missed

A

2 - additional protection needed until taken COC for 7 days consecutively

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26
Q

Missed POP is pill taken more than 3 hours late (12 if cerazette) Additional protection should be used until __ further tablets have been taken

A

2

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27
Q

Which two COC’s have different missed pill rules to the others?

A

Qlaria and Zoely

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28
Q

Qlaria have continuous 28 day cycle with __ active tablets and __ inactive tablets

A

26 active tablets and 2 placebo tablets

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29
Q

Missed pill in Qlaria is if it is taken more than ___ hours late

A

12 - compared to 24 with other COC’s

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30
Q

If a women misses her Qlaria pill in days 1-24 of cycle then additional protection required for ____ days

A

9 days - compared to 7 with other COC’s

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31
Q

Zoely has __ active and __ placebo pills

A

24 active and 4 placebo pills

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32
Q

Zoely missed pill is when more than __ hours or more late

A

12 hours

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33
Q

A copper IUD can be fitted up to how many days after UPSI?

A

5 days

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34
Q

Ovulation occurs __ to __ days before next period due

A

12 to 14 days

35
Q

Fraser Ruling and Guidance protects under __ year olds

36
Q

Levonelle should be provided to those aged __ and over

37
Q

Ulipristal acetate (ellaONE) is licensed as a P for ______

A

adolescents and women with no age restriction

38
Q

Fraser Ruling states that young person (under 16) can have contraceptive advice without parental consent if… (4 things)

A
  • Understand advice
  • Cannot persuade to tell parents
  • Likely to begin/continue having unprotected sex
  • In their best interests to have advice/treatment
39
Q

UKMEC1 means…

A

No restriction for use of contraceptive

40
Q

UKMEC3 means…

A

Risks usually outweigh advantages of using the method - refer to specialist

41
Q

UKMEC 2 means…

A

Advantages of method generally outweigh risks

42
Q

UKMEC4 means…

A

Unacceptable health risk if contraceptive method used

43
Q

If wanting to use COC and equal to or >30-34kg/m2 then UKMEC?

44
Q

What is UKMEC criteria for…
History of current VTE:
COC…
POP…

A

COC - UKMEC 4

POP - UKMEC 2

45
Q

What is UKMEC criteria for VTE risk in first degree relative 45 in COC?

A

45 UKMEC 2

46
Q

If wanting to use COC and equal to or >35m2 then UKMEC?

47
Q

UKMEC criteria for >40 wanting COC

48
Q

Enzyme inducing drugs such as St Johns wort, SOME antibiotics (Rifampicin) and anti epileptics may…

A
  • Reduce efficacy of COC and EHC as increased metabolism of drug
  • Even after 4 weeks of stopping
49
Q

List 2 positives and 2 negatives of COC’s

A

+ = cycle should be lighter, more regular, reduced pain, reduced anaemia

  • = increased risk of VTE, stroke, hypertension, breast cancer
  • Daily compliance
  • Side effects
50
Q

Put these in order of VTE risk…

No known risk
Age over 40
FH VTE
BMI over 30

A

No known risk
BMI over 30
Age over 40
FH VTE

51
Q

Name some advice to help patients remember to take pill

A
  • Take same time each morning e.g with breakfast/brush teeth
  • My iPill app
  • Alarm each day
  • Leave pill pack in same place each day
52
Q

Evra patch is applied __ for __ followed by a __

A

Weekly for 3 weeks followed by a patch free week

53
Q

Tricycling regimen is used when pill is given with enzyme inducing drugs. It involves…

A

Taking 3 pill packs back to back containing at least 30mcg of Estradiol in each tab and then having a 4 day break between packets

54
Q

Sayana Press (SC) and Depo (IM) are injected every ___ weeks

55
Q

Implant can last for ___ years

56
Q

Implant contains…

A

Progesterone only

57
Q

Coil generally lasts for ___ years

58
Q

When might a copper IUD be a more appropriate recommendation for a women over EHC (EllaOne/Levonelle)?

A
  • If on enzyme inducing drugs
  • If want long term contraception after (lasts 5 years once inserted)
  • If have severe hepatic impairment
  • If UPSI and after 72 hours but has asthma treated with gluticorticoid (not recommended in EllaOne)
59
Q

What age can Levonelle and EllaOne be supplied to?

A
  • EllaOne = Any age

- Levonelle = Over 16 years

60
Q

What further information should you provide after suppling EHC?

A
  • Advise that it does not protect against STI’s, need to use condoms
  • Advise that an STI check may be appropriate if UPSI
  • Advise that barrier method should be used until next period
  • If period more than 7 days late EllaOne or 5 days late Levonelle then see GP for advise
61
Q

What advice can be given to breastfeeding women wanting EHC?

A
  • EllaOne can be used but breastmilk must be expressed and discarded for 1 week
  • Small amounts of Levonelle are secreted but exposure to drug can be reduced by feeding and then taking immediately after (leave around 8hrs before next feed)
  • Copper IUD can be fitted as this will not affect breastfeeding and not affect baby. Needs to be fitted at GP or sexual health clinic. Advantage is that it is a LARC.
62
Q 
Put the following EC methods in order of efficacy...
(worst to best) 
EllaOne
Levonelle
Copper IUD
A

Levonelle
EllaOne
Copper IUD

63
Q

If a women experiences PERSISTENT vomiting after taking EHC what can be done?

A
  • Suggest IUD instead
  • Take another dose of Lev/Ella AND
  • Anti-emetic
    e. g Domperidone (lowest dose possible)
64
Q

When should a patient take another EHC tablet if they are sick?
EllaOne and Levonelle.

A

EllaOne - 3 hours

Levonelle - 2 hours

65
Q

Can EHC be used more than once in a cycle?

A
  • Levonorgestrel can be used more than once in a cycle if clinically indicated. However, the manufacturer does not recommend this as it may disturb the cycle. (off label)
  • BNF suggests not to for EllaOne
66
Q

If a patient regularly uses antacids, PPIs and H2 antagonists, what should be recommended for EHC?

A
  • Drugs increase gastric pH
  • Avoid use with ulipristal acetate
  • Offer a copper IUD or levonorgestrel.

Drugs that increase gastric pH, such as antacids, proton pump inhibitors (such as lansoprazole and esomeprazole),and histamine receptor antagonists (such as ranitidine and cimetidine), may reduce the plasma concentration of ulipristal acetate and decrease its efficacy.

67
Q

When might a women have missed her COC pill/pills but not need EHC? (except Qlaria)

A
  • 1 pill missed missed (more than 24 hours and up to 48 hours late) considered if pills have been missed earlier in the packet or in the last week of the previous packet (extend PFI)
  • 2 or more missed in the second week (pills 8–14), EC not required if pills in preceding 7 days taken consistently and correctly (assuming the pills thereafter are taken correctly and additional contraceptive precautions are used).
  • 2 or more missed in third week (pills 15–21), emergency contraception is not required if the pill-free interval is omitted.
68
Q

When does a women on a progesterone only pill need EHC?

A
  • If pill is missed or late (3 hours except cerezette 12hrs) and UPSI in 48 hours period after before protection re-established
69
Q

What are the quick start rules? For COC? Excluding Qlaria and Zoley?

A
  • COC on the first day of the period for immediate contraceptive cover. No additional contraception is required.
  • Can start COC within 5 days of the start of the menstrual cycle.
    No additional contraception is required unless the woman is starting Qlaira® or Zoely®.
  • Qlaira®, advise her to avoid sexual intercourse or use a barrier method of contraception (such as condoms) first 9 days of taking Qlaira®.
  • Zoely®, advise her to avoid sexual intercourse or use a barrier method of contraception (such as condoms) first 7 days of taking Zoely®.
  • Start the COC at any other time in the menstrual cycle provided a barrier method has been used consistently and correctly and/or it is reasonably certain that the woman is not pregnant.
  • Advise the woman to avoid sexual intercourse or use a barrier method of contraception (such as condoms) for the first 7 days of pill taking (9 days for Qlaira®).

Inform the woman that medical advice may differ from that included in the packet of pills.

If pregnancy cannot be excluded and the woman wishes to start hormonal contraception without delay:
Prescribe the COC and advise the woman to take a pregnancy test no sooner than 3 weeks after the last episode of unprotected sex.

70
Q

Name the most common oestrogen used.

Name some of the most common progesterones used.

A
  • Ethinyloestradiol
  • Norethisterone
  • Levonorgestrel
  • Desogestrel
71
Q

How do COCs work?

A
  • Suppress ovulation
  • Cervical mucus thickening
  • Endometrial thinning
72
Q

What is the UK MEC classification for COC Smoker over 35 smoking less than 15 cigarettes a day?

73
Q

What is the UK MEC for somebody aged over 35 who stopped smoking over a year ago?

74
Q

What is the UK MEC for a smoker under 35?

75
Q

What is the UK MEC for a smoker over 35 smoking more than 15 cigarettes a day?

76
Q

Which COC may be better to reduce BTB?

A
  • Qlaria

- 26-2

77
Q

What are advantages to vaginal ring?

A
  • Longer acting option without commitment to a LARC
  • Want CHC but can’t remember pill
  • Less BTB
78
Q

How do progestogens work?

A
  • Cervical mucus changes
  • Endometrial changes
  • Prevent ovulation
79
Q

Women with increased risk of osteoporosis should not use WHAT method of contraception?

A
  • Injectable
80
Q

At what BMI does levonelle become ineffective?

What should be suggested instead?

A
  • Over 30
  • 25-30 less effective
  • IUD then
  • EllaOne if not want IUD
81
Q

A systolic BP of over 160
A diastolic BP of over 95
is UKMEC for COC

A

4 - contraindicated

82
Q

A BP of over 140/90 is UKMEC for COC

83
Q

Adequately controlled hypertension for COC is UKMEC

84
Q

Which of the following may interfere with hormonal contraceptives?
EllaOne
Levonelle

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