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The Patient Y3 semester 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

Name some Combined hormonal contraceptive brands:

A
  • Microgynon (21 day and 7 day HFI)
  • Microgynon ED/Zoely - 28 days
  • Logynon
  • Logynon ED/Qlaria
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2
Q

Name some Progesterone only contraceptive brands:

A
  • Noriday

- Desogestrel (Cerazette)

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3
Q

What is a CHC?

A

COC: EE + progestogen

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4
Q

What is a POP?

A

Progesterone only pill

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5
Q

CHC mechanism of action?

A
  • Primary action - inhibit ovulation
  • Thickened cervical mucus and altered endometrium
  • Oestrogen – endometrial proliferation, progestogen opposes proliferation
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6
Q

POC mechanism of action?

A
  • Suppression of ovulation
  • Thickens cervical mucus, delays ovum transport, renders endometrium hostile to implantation, reduced cilia activity in FT
  • Various mechanisms to various degrees
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7
Q

Efficacy of hormonal contraception?

A

CHC and POC –similar effectiveness

  • 0.3% with perfect use in 12 months
  • 8% with typical use
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8
Q

Non-hormonal methods with ‘user’ failure?

A
  • Male condom up to 98% effective
  • Female condom up to 95% effective
  • Diaphragm or cap + spermicide up to 96% effective
  • Natural Family Planning:combining two or more fertility indicators new technologies (Persona) up to 98% effective
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9
Q

What is LAM?

A

LAM – lactational amenorrhoea

Breastfeeding (lactation) can be used as a contraceptive method (LAM).

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10
Q

Efficacy of LAM up to 98% only if ALL the following condition apply:

A
  • You are fully breastfeeding – (no other liquids or solid food)
  • You are nearly fully breastfeeding – (mainly breastfeeding & other liquids infrequently ) and
  • Baby under six months and
    Amenorrhoeic
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11
Q

The risk of pregnancy increases in LAM if:

A
  • breastfeeding reduces
  • long intervals between feeds – both day and night, or
  • night feeds cease and use supplement feeding occurs.

Risk of pregnancy increases once baby reaches 6 months, regardless of menstrual patterns, level of breastfeeding

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12
Q

What determines contraceptive choice ?

A
  • Patient choice
  • Medical conditions ?
  • Medication ? DDI?
  • UKMEC* categories for contraindications
  • Advise on other suitable methods and offer if appropriate
  • Discuss advantages, disadvantages, risks, efficacy, adverse effects and when to seek advice
  • Advise on how to start HC
  • CHC regimens – standard and tailored
  • Advise on missed/late pill/use of vaginal ring
  • Need for ‘Quick-starting’ contraception
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13
Q

Advantages of COC?

A
  • Menstrual period regular, lighter, less painful
  • Reduced acne, functional ovarian cysts, benign ovarian tumours
  • Reduced risk of ovarian, uterine, and colon cancer
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14
Q

Disadvantages of COC?

A
  • Minor ADRs – nausea, breast tenderness, cyclical weight gain?, loss of libido?, vaginal discharge, breakthrough bleeding
  • Increased risk blood pressure (angiotensin), MI, stroke, Venous thromboembolism, breast cancer, cervical cancer
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15
Q

Advantages of POC?

A
  • High efficacy
  • Suitable when COC isn’t
  • Reduced risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia
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16
Q

Disadvantages of POC?

A
  • ADRs – acne, headaches, depression?, loss of libido?, sustained weight gain?, vaginal dryness?
  • Menstrual irregularities (oligomenorrhoea and menorrhagia)
  • Efficacy – obesity
  • Increased risk of functional ovarian cyst, ectopic pregnancy, breast cancer
17
Q

Definition of a missed pill (COC)?

A
  • > 24* hrs LATE
  • If starting on day 6 or later, add precautions for 7 days
  • Critical at end or start of cycles as PF period elongated
  • If 2 or more missed (>24 hrs) and UPSI occurs EHC indicated
18
Q

Definition of a missed pill (POP)?

A
  • > 3/12hrs LATE
  • Continue pills with 2 days extra precautions
  • If 1 or more ACTIVE pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly] then EHC indicated
19
Q

Missed pill protocol for EHC when on COC:

A
  • Is it a missed pill (more than 24 hours late) - if yes move on to next point
  • 1 pill missed = EHC not required
  • 2 or more missed pills = EHC required if UPSI occurs before 7 tablets taken correctly
  • If Ellaone (ulipristal acetate) given, omit daily dose of COC for 5 days and extra precautions until next monthly period. If within last 7 days of ACTIVE pills, omit 7 day break/placebo pills
  • If levongestrel (Levonelle) given, miss daily dose of COC and use extra precautions for the next SEVEN days. If within last 7 days of ACTIVE pills, omit 7 day break/placebo pill
20
Q

Missed pill protocol for EHC when on POP:

A
  • Is it a missed pill (more than 24 hours late) - if yes move on to next point
  • 1 or more missed pills?
  • EHC required if UPSI occur before two tablets taken correctly
  • If supplying levongestrel, miss daily dose of POP and use extra precautions for the next two days
  • If UPA (Ellaone), omit daily dose of POP for 5 days and extra precautions until Nmp
21
Q

UK MEC health risks and the COC. Category 4 conditions:

A
  • Breast feeding women < 6 weeks post partum
  • Women>35 + 15 cigarettes a day
  • Multiple CVS risks
  • Consistently elevated BP
  • Vascular disease & history of VTE (inc thrombogenic mutations), IHD and stroke
  • Migraine WITH aura
  • Current breast cancer
  • DM with nephropathy, retinopathy or neuropathy
  • Benign hepatocellular adenoma and malignant hepatoma
  • SLE
22
Q

CVS risks with COC:

A
  • Increased risk of myocardial infarction; only current COC users who smoke
  • Normotensive, non-smoking COC users have no increased risk of haemorrhagic stroke, whilst the risk of ischaemic stroke, in this group, is 1.5 times higher than it is for non-users
23
Q

Starting COC protocol:

A
  • Day 1 of natural cycle
  • Day 1-5, no additional precautions

Quick-starting (day 6 or later) = additional precautions for 7 days

24
Q

Starting POP protocol:

A

Norethisterone (Noriday)
Desogestrel(Cerazette)

  • Day 1-5, no additional precautions
    Quick-starting (day 6 or later) - additional precautions for 2 days
25
Q

Changing oral hormonal contraception:

COC to POP

A
  • Ensure previous contraception taken effectively or exclude pregnancy; use additional precautions for 2/7, if pill-free period
  • COC(ED) to POP – use addition precaution for 2/7, if ED/placebo pills taken
  • COC(non-ED) to POP – for immediate cover, omit pill-free period, start POP immediately
  • COC to Cerazette (POP) – for immediate cover, omit pill-free period.
26
Q

Changing oral hormonal contraception:

POP to COC:

A
  • POP – Qlaira (COC) (additional precautions for 9 days)
  • POP – Zoely (additional precautions for 7 days)
  • POP-COC (add precautions for 7/7)
27
Q

Missed pill advice for COC:

A

Missed pill = > 24 hours late

If starting on day 6 or later, add precautions for 7 days
Critical at end or start of cycles as PF period elongated
EHC indicated if 2 or more missed (>24 hrs)*

Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7 or 2 days

28
Q

Missed pill advice for POP:

A

> 3 hrs late [Micronor/Noriday]
12hrs late [*Cerazette Cerrelle]
Continue pills with 2 days extra precautions
EHC indicated if 1 or more pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly]

29
Q

Example of non hormone contraception:

A

CU-IUD

30
Q

What dose is given for Levongestrel EHC?

A

1.5mg

31
Q

What dose is given for UPA Ellaone?

A

30mg

32
Q

Examples of hormonal contraception and DDI’s

A

Enzyme inducing drugs + griseofulvin e.g.
Antiepileptics:
- Carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate
Antiretrovirals: Nevirapine, ritonavir
Antibiotics: Rifabutin, rifampicin
Other: St John’s Wort and griseofulvin
INCLUDING 28 DAYS AFTER CESSATION

NOT AFFECTED by enzyme inducing drugs
Parenteral POC, IUS*

33
Q

Sodium valproate - PPP:

A
  • Valproate: epilepsy or bipolar disorder
  • Serious risk from taking valproate in pregnancy (Congenital malformation and neurodevelopmental disorders)
  • Specialist initiation
    Requires HIGHLY effective contraceptive option (LARC or any with failure rate of <1%), and if not, implement regular pregnancy testing
  • ALL female patients of child-bearing age, regardless of sexual activity
  • Give patient card, patient guide, and complete Annual risk Acknowledgement form
34
Q

Effectiveness of non hormonal contraception:

A
  • Cu-IUD: 99% effective
  • Male condom: 98% effective, typical use 82%
  • Female condom: 95% effective, typical use 79%
  • Diaphragm/cap with spermicide: 92-96% effective, typical use 71-88%

The Patient Y3 semester 1 (17 decks)

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