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Misc. Notes Year 3 > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the only Long-Acting Reversible Contraception available to women

A

Depot

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2
Q

What actually is the depot

A

A depot of progesterone (medroxyprogesterone acetate) given IM

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3
Q

How long does the depot provide contraceptive cover for

A

14 weeks

Replaced every 13 weeks

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4
Q

What is the pearl index of the depot

A

0.2%

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5
Q

What is the mechanism of action of the depot

A

Inhibition of Ovulation

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6
Q

Name 4 absolute contra-indications to using the depot contraceptive

A

Pregnancy
Breast cancer
Severe cardiac disease
Undiagnosed vaginal bleeding

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7
Q

When can depot be started without the need for further contraception

A

Up to and including day 5 of the menstrual cycle

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8
Q

When can depot be started with regards to after a termination of pregnancy

A

Up to 5 days after

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9
Q

When can depot be started with regards to after a birth

A

Up to day 21 postpartum

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10
Q

What is the most common side effect of the depot

A

Weight gain

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11
Q

Which bone condition can the depot increase chances of

A

Osteoporosis

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12
Q

Which metal is the non-hormonal intra-uterine device made of

A

Copper

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13
Q

When can the copper IUD be started

A

At any time since it is non-hormonal

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14
Q

What is the mechanism of action of the copper IUD

A

Prevention of fertilisation

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15
Q

How long can a copper IUD be left in the uterus

A

5-10 years

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16
Q

What is the pearl index of the copper IUD

A

0.6-0.8%

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17
Q

Name 3 contraindications to using the copper IUD

A

Peptic ulcer disease
Current pelvic infection
Abnormal uterine anatomy
History or current endometrial or cervical cancer

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18
Q

When can the copper IUD be started with regards to after a birth

A

< 2 days or > 4 weeks post partum

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19
Q

Which VLARC can be used as emergency contraception a

A

Copper IUD

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20
Q

How many days after Unprotected Sexual Intercourse can you use the copper IUD

A

Up to 5 days

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21
Q

What is the main side effect of the copper IUD

A

Heavy, prolonged periods

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22
Q

What are the 3 IUS variants available

A

Mirena®-52 mg
Kyleena- 19.5 mg
Jaydess®- 13.5mg

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23
Q

How does the Mirena coil work

A

A coil that is impregnated with a synthetic progesterone

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24
Q

What is the mechanism of action of the Mirena Coil

A

Prevention of implantation

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25
Q

How long can the IUS be left in for

A

Either 3 or 5 years

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26
Q

When can the IUS be started

A

Within the first 7 days of a period

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27
Q

When can the IUS be started with regards to birth

A

<2 days or > 4 weeks postpartum

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28
Q

What are the side effects of the IUS

A

irregular menstrual bleeding, that usually becomes lighter with most women becoming amenorrhoeic

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29
Q

What is the pearl index of the Mirena IUS

A

0.2%

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30
Q

What is the implant

A

A non-degradable rod that is impregnated with progesterone and inserted into the arm

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31
Q

What is the mechanism of action of the implant

A

Inhibition of ovulation

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32
Q

How long can the implant be left in the arm of a woman

A

3 years

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33
Q

What is the pearl index of the implant

A

0.05%

the most effective form of contraception

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34
Q

When can the implant be inserted with no need for an additional cover

A

Within the first 5 days of a cycle

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35
Q

Name 3 scenarios in which additional 7/7 condom cover would be required upon inserting the implant

A

Started at any other time in the cycle other than first 5 days
Used as a quick start after emergency contraception.
Switching from POP, Mirena, IUD

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36
Q

Name 3 side effects of the implant

A

Weight gain
Irregular bleeding
Acne

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37
Q

What problems could you encounter upon insertion of the implant

A

Nerve damage
Vascular damage
Pain

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38
Q

How does short-acting combined hormonal contraception

A

Contains estrogen and progesterone

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39
Q

What is the mechanism of action of all combined hormonal contraception

A

Inhibition ovulation

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40
Q

How does the transdermal patch work

A

A single patch is applied for one week at a time for three weeks
Last week is a patch-free week which allows for a withdrawal bleed
Releases oestrogen and progesterone

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41
Q

What condition might decrease the efficacy of the patch

A

Obesity

42
Q

Which contraceptive comes with a slight thrombotic risk

A

Transdermal patch

43
Q

Name 3 side effects which are more common with the patch than with other combined hormonal preparations

A

Nausea
Breast pain
Painful period

44
Q

How many days is the vaginal ring inserted for

A

Inserted for 21 days

7 days left ring free to allow withdrawal bleed

45
Q

How many consecutive days is the COCP (pill) taken for

A

21 days

46
Q

What is the difference in how the pill works during the first 7 days and the next 14 days of taking it

A

First 7 days act to prevent ovulation and the next 14 days act to maintain anovulatory state

47
Q

When can the COCP pill be started with no additional cover required

A

Up to day 5 of the cycle

48
Q

When can the COCP pill be started with regards to termination of pregnancy

A

Immediately

49
Q

When can the COCP pill be started with regards to birth

A

3 weeks if not breastfeeding

50
Q

Which cancers does the COCP protect against

A

Ovarian
Endometrial
Colorectal

51
Q

Which dermatology condition can the COCP help with

A

Acne vulgaris

52
Q

Name 4 minor side effects of the COCP

A

Nausea + vomiting
Increase in blood pressure
Mood swings
Irregular bleeding

53
Q

What is the major side effect of the COCP

A

Increased VTE, stroke risk

54
Q

Which cancers does the COCP increase the risk of

A

Breast

Cervical

55
Q

What blood pressure reading would contraindicate the prescription of the COCP pill

A

> 160/95

56
Q

Which connective tissue disease is a contraindication to prescribing the COCP

A

Anti-phospholipid syndrome

57
Q

What is the mechanism of action of the progesterone only pill

A

thickens cervical mucus +/- suppression of ovulation

58
Q

What are the three options for Emergency Contraception

A

Copper IUD
Levonelle (LNG)
ellaOne (UPA)

59
Q

What is the most effective form of emergency contraception

A

Copper IUD

60
Q

How long after unprotected sexual intercourse can the Levonelle pill be used

A

Licensed for 72hrs post-UPSI

but ineffective after 96 hours

61
Q

What is the mechanism of action of the Levonelle pill

A

Levonelle is a high dose of progesterone – levonorgestrel

Mechanism of action: suppress ovulation

62
Q

What is the mechanism of action of the ellaOne pill

A

EllaOne is an anti progesterone – Ulipristal acetate.

Mechanism of action: inhibition or delay of ovulation

63
Q

With relation to the LH surge before ovulation, when can the Levonelle and ellaOne pills be used

A

Levonelle - works before LH surge

ellaOne - can work during LH surge but not after peak

64
Q

When can the copper IUD be used as emergency contraception

A

Up to 5 days post-UPSI
OR
Up to 5 days post ovulation

65
Q

What must you screen for before fitting the copper IUD

A

Chlamydia

66
Q

How long after unprotected sexual intercourse can the ellaOne pill be used

A

Up to 120hrs post-UPSI

67
Q

Within the terms of the abortion act, who can terminate a pregnancy

A

Only a registered medical practitioner

68
Q

What are the three legal forms which need to be filled out when an abortion is carried out

A

HSA1
HSA2
HSA4

69
Q

What is the HSA1 form

A

2 doctors are required to sign this form

70
Q

When must the HSA2 form be filled out

A

To be completed by the doctor within 24 hours of an emergency abortion

71
Q

What is the HSA4 form and who must it be sent to

A

Must be completed by the doctor and sent to the Chief Medical Officer (CMO) within 7 days of the abortion taking place

72
Q

When can treatment not be denied on the grounds of conscientious objection

A

When the treatment is in the event of an emergency

73
Q

What are the legal gestation limit for

  • social termination of pregnancy
  • fetal anomaly termination of pregnancy
A

For social termination of pregnancy – 23 weeks 6 days

For fetal anomaly- any gestation

74
Q

What is the NHS Tayside gestation limit for medical termination of pregnancy

A

18 weeks and 6 days

75
Q

What is the NHS Tayside gestation limit for surgical termination of pregnancy

A

12 weeks

76
Q

What are the three types of medical termination of pregnancy (gestation times)

A

Early - up to week 9
Late - 9-12 weeks
Mid-trimester 12-24 weeks

77
Q

What is the first stage of a medical termination of pregnancy

A

Oral Mifepristone 200mg (anti-progesterone)

78
Q

What is stage 2 of a medical termination of pregnancy and when can it be performed at home

A

24-48 hours after stage 1 – Vaginal (or oral) prostaglandin e.g. misoprostol, gemeprost
Can be performed at home if <9weeks

79
Q

What are the two types of surgical termination of pregnancy

A 
Vacuum aspiration (6-12weeks)
Dilatation and evacuation (13-24 weeks) - not available in Scotland
80
Q

If the IUS is started outside of first 7 days of period, what must be done

A

7 days of condom cover

81
Q

When can the IUS be started with regards to after a Termination of Pregnancy

A

Immediately

82
Q

How many days can the transdermal patch be worn for before efficacy is lost

A

9 Days

83
Q

How many days can the transdermal patch be removed for before efficacy is lost

A

2 days

84
Q

Which combined hormonal contraception has an increased thrombotic risk apart from the COCP

A

Transdermal Patch

85
Q

When can the COCP pill be started with regards to birth if breastfeeding

A

> 6 weeks

86
Q

When can the COCP pill be started with regards to emergency contraception

A

Immediately after levonelle

5 days after ellaONE

87
Q

What is the timeframe within which if you vomit, you should take the COCP again

A

2 hours

88
Q

What is the timeframe within which if you have diarrhoea, you should take the COCP again

A

24hours

89
Q

If you miss your COCP and it has been over 24hours but less than 48hours –>

A

Take missed pill and continue with pack

No EC needed

90
Q

If it is week 1 of your COCP regimen and you miss your pill and it has been over 48 hours –>

A

Take most recent pill
Use condoms 7 days
Consider EC if UPSI

91
Q

If it is week 2 of your COCP regimen and you miss your pill and it has been over 48 hours –>

A

Take most recent pill

7 days condoms

92
Q

If it is week 3 of your COCP regimen and you miss your pill and it has been over 48 hours –>

A

Take most recent pill
7 days condoms
Omit break

93
Q

If you miss more than 2 of your COCP pills –>

A

EC if in first week

Continue with rest of pack and omit break

94
Q

If you miss 1 POP –>

A

7 day condoms

95
Q

If you miss 1+ POP –>

A

EC + 7 days condoms

96
Q

For the old POP’s, if you are <3 hours late in taking your pill –>

A

Continue as normal

97
Q

For the old POP’s, if you are >3 hours late in taking your pill –>

A

Take missed pill

Condoms for 2 days

98
Q

What is the time period you are allowed to miss the new POP’s

A

12 hours

99
Q

Name 2 situations when the POP might be used instead of the COCP

A

Breastfeeding women

>35 and smoking

100
Q

Name 3 side effects of the POP

A

Dysfunctional Uterine Bleeding
Weight gain
Headaches

101
Q

Name a contraindication to the POP

A

Active breast cancer

102
Q

Why is EC not required before day 21 post-partum

A

The earliest date of ovulation in a non-breastfeeding woman is thought to be day 28 postpartum. Therefore, contraception is required from day 21 onwards, as sperm can survive for up to 7 days

Misc. Notes Year 3 (25 decks)

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