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Prescribing PSA / Management > Contraception > Flashcards

Contraception Flashcards

1
Q

What happens if you miss a POP?

A

> 3hrs late -> take ASAP, continue next pill at usual time (even if 2 pills at once), use barrier until 48hrs of pill-taking
• Or >12hrs late for Cerazette (desogestrel)

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2
Q

What are the side effects of progesterone?

A

Headache
Nausea
Breast pain

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3
Q

What’s the brand name of the implant?

A

nexplanon

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4
Q

When can each of the 3 emergency contraceptions be given up until?

A

Levonorgestrel (Levonelle) up to 72hrs after UPSI (or up to 96hrs but less effective)

Uliprisal (EllaOne) up to 120hrs after UPSI

Copper IUD up to 5d after UPSI or up to 5d after the likely ovulation date

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5
Q

How do the POPs work?

A

Traditional POPs: Micronor, Noriday, Nogeston, Femulen (i.e. norethisterone / levonorgestrel)
 Thicken cervical mucus

Cerazette (desogestrel)
 Inhibits ovulation
 Also thickens cervical mucus

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6
Q

How soon after starting a POP are you protected?

A

o Effective immediately if start up to and including day 5 of cycle
o Otherwise use condoms for first 2d

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7
Q

What’s in the COCP?

A

Ethinylestradiol with a progesterone e.g. levonorgestrel or norethisterone

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8
Q

When does emergency contraception need to be given?

A
  • UPSI w/ no regular contraception

Patch:
- End of week 1 or 2, not changed patch for >48hrs, UPSI in last 5d or during patch-free interval

COCP:
- Missed 2 pills in week 1 and UPSI in pill-free period of week 1

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9
Q

What are 3 UKMEC stage 4 criteria for the COCP?

A
  • > 35yo AND >15cig/day
  • Migraine w/ aura
  • Hx of VTE or thrombogenic mutation
  • Hx of stroke / IHD
  • Breast feeding < 6w post-partum
  • Uncontrolled HTN
  • Current BC
  • Major surgery w/ prolonged immobilisation
  • Poorly controlled DM diagnosed >20yo
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10
Q

Give 3 disadvantages of the injectable depo provera contraception

A

o No immediate reversal once given
o Delayed return to fertility (maybe up to 12m)
o Irregular bleeding
o Weight gain
o Not recommended in adolescents as risk of osteoporosis
o UKMEC 3: past breast Ca
o UKMEC 4: current breast Ca

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11
Q

What is in the injectable contraceptive depo provera?

A

150mg medroxyprogesterone acetate

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12
Q

Which contraceptives thin the endometrium?

A

Injectable (depo provera)

IUS

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13
Q

What happens if you miss 1 COCP pill?

A

Take the missed pill, even if means taking 2 pills at once, then continue as normal

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14
Q

How long does the implant nexplanon last?

A

3yrs

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15
Q

Give 3 disadvantages of the implant nexplanon

A

o Invasive
o Irregular / heavy bleeding
o Progesterone effects (headache, nausea, breast pain)
o Interaction w/ enzyme-inducing drugs like rifampicin & antiepileptics
o Not licensed for use outside age 18-40yo
o UKMEC 3: IHD, stroke, unexplained/suspicious vaginal bleeding, past breast Ca, severe liver cirrhosis, liver Ca
o UKMEC 4: current breast Ca

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16
Q

Give 3 advantages of the copper coil

A

o Immediate contraception
o Can be used as emergency contraception
o Can be inserted w/in 48hrs after childbirth
o LARC (5yrs if stem only, 10yrs if stem and on the T arms)
o UKMEC 1 for anticonvulsants

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17
Q

Give 3 advantages of the COCP

A

o Highly effective (failure rate <1 per 100-woman years)
o Doesn’t interfere w/ sex
o Reversible contraception on stopping
o Periods ~ more regular, lighter, less painful
o Lower risk of ovarian Ca, endometrial Ca, colorectal Ca
o Possibly lower risk of PID, ovarian cysts, benign breast disease, acne vulgaris

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18
Q

Which contraceptive can be given w/in 48hrs of childbirth?

A

Copper IUD

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19
Q

What are the recommendations regards contraception around the menopause?

A
  • Stop COCP for contraception once 50yo
  • Remove IUD 2yrs after amenorrhoea if <50yo, 1yr after if >50yo

Progesterone only methods of any form:

  • If amenorrhoeic, check FSH. FSH>30 then stop after 1yr. FSH<30 then stop age 55.
  • If not amenorrhoeic, consider investigating abnormal bleeding pattern
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20
Q

What are the common side effects of the COCP?

A

Headache, nausea, breast tenderness

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21
Q

What’s the dose of levonorgestrel (Lenovelle)?

A

o 1.5mg single dose (3mg if BMI>26 or weight>70kg)

o Vomit w/in 3hrs -> repeat dose

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22
Q

Which emergency contraceptive pill is best if the pt is asthmatic?

A

levonorgestrel (Levonelle)

caution w/ Ulipristal (EllaOne)

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23
Q

How does the IUS work?

A

o Prevents endometrial proliferation

o Also cervical mucous thickening

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24
Q

How soon after having the IUS are you protected?

A

7d

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25
Q

Give 3 disadvantages of the copper coil

A

o Heavier, longer, more painful bleeds
o Uterine perforation (0.2%, higher if breastfeeding)
o 1/20 expulsion (most common in first 3m)
o If you get pregnant, more likely to be ectopic
o Small increased risk of PID in first 20d

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26
Q

If someone is already on hormonal contraception, which pill is best to take for emergency contraception if needed and why?

A

levonorgestrel (Levonelle)

Ulipristal (EllaOne) you have to also use barrier contraception for 5d after taking bc it might decrease the effectiveness of the hormonal contraception

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27
Q

When can the coils be inserted post-partum?

A

Both the IUS and IUD can be inserted w/in 48hrs of childbirth or after 4w

28
Q

What are the doses of levonorgestrel for emergency and routine contraception respectively?

A

Routine = 30mcg

Emergency = 1.5mg

29
Q

Which contraceptives inhibit implantation?

A

Levonorgestrel (Levonelle)

30
Q

Which emergency contraceptive pill is best if the pt is breastfeeding?

A

levonorgestrel (Levonelle)

delay breastfeeding for 1w after taking Ulipristal (EllaOne)

31
Q

Prescribe a POP / what do you look up in the BNF?

A

Look up norethisterone (350mcg), levonorgestrel (30mcg) or desogestrel (75mcg)

32
Q

Give 3 disadvantages of the IUS

A

o Barrier use for 7d
o Initial frequent bleeding and spotting
o Uterine perforation (0.2%, higher if breastfeeding)
o 1/20 expulsion (most common in first 3m)
o If you get pregnant, more likely to be ectopic
o Small increased risk of PID in first 20d

33
Q

How do you prescribe (or look up the prescription in the BNF) a COCP?

A

Search for “Ethinylestradiol” in the BNF
o You just prescribe ethinylestradiol w/ x, where x is e.g. levonorgestrel, norethisterone etc.
o Prescribed as one tablet od po

34
Q

The COCP increases and decreases the risks of which cancers?

A

Lower risk of ovarian, endometrial, colorectal

Higher risk of breast, cervical

35
Q

What are the UKMEC criteria?

A

1: no restriction on use
2. advantages > disadvantages
3. disadvantages > advantages
4. contraindicated

36
Q

What hormone is in the IUS?

A

Levonorgestrel

37
Q

How often is the injected depo provera given and by what route?

A

IM injection every 12w (Can be given up to 14w after last dose)

38
Q

Which contraceptives thicken cervical mucus?

A

Implant (nexlpanon)
Injectable (Depo Provera)
IUS
POPs

39
Q

What is in EllaOne?

A

Ulipristal (a SPRM)

40
Q

Which contraceptives make periods better and which make them worse?

A

Better:

  • COCP
  • IUS

Worse:

  • Implant
  • Injection
  • Copper coil
  • POP
41
Q

Do you need contraception post-partum?

A

Not for the first 6w

Then breastfeeding has a 98% contraceptive protection up to 6m

42
Q

Which contraceptive can be inserted immediately following TOP?

43
Q

What side effect is common from the POP?

A

Irregular bleeding

44
Q

How does the implant nexplanon work?

A

Inhibits ovulation and thickens cervical mucus

45
Q

Give 3 advantages of the IUS

A

o Intermittent, light, less painful bleeds (or amenorrhoea)
o LARC (Mirena/Kyleena lasts 5yrs, Jaydess lasts 3yrs, or Mirena 4yrs if using as endometrial protection for oestrogen only HRT)
o Can be given for contraception AND endometrial protection w/ HRT
o Can be given w/in 48hrs after childbirth
o UKMEC 1 for anticonvulsants

46
Q

Give 3 advantages of the implant nexplanon

A 
o	Most effective form of contraception
o	LARC (3 yrs)
o	No oestrogen
o	Can be inserted immediately following TOP
o	UKMEC 2 for anticonvulsants
47
Q

What’s the dose of EllaOne (Ulipristal)?

48
Q

Give 3 disadvantages of the COCP

A

o Forget to take
o Might not work if vomit w/in 2hrs of taking
o No protection against STIs
o Increased risk of VTE, breast Ca, cervical Ca, stroke, IHD
o Temporary side effects of headache, nausea, breast tenderness
o Interaction w/ enzyme-inducing drugs like rifampicin
o Not recommended >50yo, BMI>35, VTE risk, HTN, immobility, smoking, BC risk e.g. BRCA, gallbladder disease, DM, migraine, stroke, IHD, <6w post-partum and breastfeeding

49
Q

What are 2 alternative IUS devices to the Mirena? Describe how they’re different

A
  • Kyleena is smaller, lower levonorgestrel, lasts 5yrs, less chance of amenorrhoea
  • Jaydess has a smaller frame, narrower inserter tube, even lower levonorgestrel, lasts 3yrs
50
Q

What are 3 UKMEC stage 3 criteria for the COCP?

A
  • > 35yo AND <15cig/day
  • BMI > 35
  • VTE in 1st degree relative <45yo
  • Controlled HTN
  • Immobility e.g. wheel chair
  • Carrier of mutation ass.w. BC e.g. BRCA
  • Current gallbladder disease
  • Less severe DM diagnosed >20yo
51
Q

How does the COCP work?

A

Inhibits ovulation

52
Q

How soon after getting the implant nexplanon are you protected?

A

Barrier needed for first 7d unless inserted on day 1-5 of cycle

53
Q

Give an example of a combined contraceptive patch

54
Q

Which contraceptive doesn’t given immediate return to fertility after stopping?

A

Injectable depo provera

May take up to 12m to return to fertility

55
Q

When are you protected are starting COCP?

A

Immediately if w/in first 5d of cycle or if you start on day 21 post-partum

After 7d otherwise so use barrier

56
Q

What are the 3 forms of emergency contraception?

A

Levonorgestrel (Levonelle)
Uliprisal (EllaOne)
Copper IUD

57
Q

What’s the brand name of the injectable contraceptive?

A

Depo Provera

58
Q

How often and what time do you take the POP?

A

Od

w/in the same 3hrs each day (same 12hrs for Cerazette (desogestrel)

59
Q

When can the copper coil be inserted for emergency contraception?

A

o Insert w/in 5d of UPSI or up to 5d after likely ovulation date

60
Q

Which of the emergency contraceptive pills can be given multiple times per cycle?

A

Both of them! (levonorgestrel (Levonelle) and ulipristal (EllaOne)

61
Q

What is in the implant nexplanon?

A

etonogestrel (progesterone)

62
Q

What happens if you forget to change your combined contraceptive patch (Evra)?

A

End of week 1 or 2:
 <48 hrs -> change immediately
 >48hrs -> change immediately, barrier for 7d, emergency contraception if unprotected sex in last 5d or during the patch-free interval

End of week 3:
 Remove patch immediately, start new patch at start of next week 1 cycle

End of week 4 (patch free week):
 Barrier for 7d after delay of starting new patch cycle

63
Q

How do each of the emergency contraceptives work?

A

Levonorgestrel (Levonelle) inhibits ovulation and implantation

Uliprisal (EllaOne) inhibits ovulation

Copper IUD decreases sperm motility and survival -> prevents fertilisation and implantation

64
Q

Which contraceptives inhibit ovulation?

A 
COCP
Levonorgestrel (Levonelle)
Ulipristal (EllaOne)
Progesterone implant (Nexplanon)
Depo Provera (injected)
Cerazette POP (desogestrel)
65
Q

What happens if you miss 2 COCP pills?

A

 Take the last missed pill, even if means taking 2 pills at once
 Use barrier until taken pills for 7d in a row

In week 1?
• If unprotected sex in pill-free period or week 1 -> emergency contraception

In week 3?
• Omit the pill free interval

66
Q

How soon after mirena insertion are you protected?

A

Immediate protection if first 7d of cycle

Otherwise use barrier for 7d

67
Q

How soon after starting COCP and POP are you protected?

A

Immediately if first 5d of cycle

Otherwise use barrier for 2d

Prescribing PSA / Management (8 decks)

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