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Obstetrics & Gynae RIA > contraception > Flashcards

contraception Flashcards

1
Q

what nerves supply the external genitalia & pelvic floor muscles?

A

S2, S3, S4

pudendal nerve

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2
Q

average daily fluid intake

A

1500-2000 mls

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3
Q

medication for nocturia

A

desmopressin

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4
Q

treatment for urinary retention?

A

bladder catheterisation

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5
Q

1st & 2nd line treatment for overactive bladder?

A

1st line = bladder retraining for minimum of 6 weeks

2nd line = oxybutynin, tolterodine, darifenacin

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6
Q

what group is oxybutynin in?

A

antimuscarinic

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7
Q

type of incontinence overactive bladder causes?

A

urge incontinence

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8
Q

mechanism of oxybutynin

A

inhibition of muscarinic action of acetylcholine on smooth muscles therefore relaxing bladder

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9
Q

invasive therapies for overactive bladder (2)

A
  • Botulinum toxin A for detrusor overactivity

- percutaneous sacral nerve stimulation

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10
Q

involuntary leakage of urine during increased intra abdominal pressure e.g. coughing & strauining

A

stress incontinence

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11
Q

3 poss causes fo stress incintinecnce?

A
  • childbirth weakening pelvic floor muscles
  • denervation of pelvic floor muscles through pregnancy
  • oestrogen deficient states
  • pelvic surgery
  • prolapse
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12
Q

conservative measures for stress incontinence

A
  • lifestyle measures: stop smoking & weight loss
  • 3 months pelvixc floor muscles: kegel muscles
  • topical oestrogen
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13
Q

how does topical oestrogen help incontinence?

A

topical oestrogen helps improve stress incontinence by helping to tone muscles around the urethra to keep it closed

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14
Q

causes of urge incontinence

A

overactive bladder

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15
Q

symptoms of urge incontinence

A

overactive bladder: urgent desire to void, frequency, nocturia, overactivity of detrusor muscle

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16
Q

who can teach you about pelvic floor muscles?

A

referral to community physiotherapist or community continence team for pelvic floor muscle trainng

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17
Q

medication group that can cause incontinence through helping to relax urethral sphincter

A

alpha blockers

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18
Q

investigation to evaluate bladder function

A

urodynamic studies

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19
Q

red flags for incontinence (3)

A
  • visible haematuria: bladder cancer
  • pain associated with bladder filling: bladder cancer
  • abdominal pain: pelvic mass
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20
Q

what is urogenital prolapse>

A

when there is descent of one of the pelvic organs resulting in protrusion of the vaginal walls, affecting 40% postmenopausal women

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21
Q

Rectocele & enterocele are examples of?

A

posterior vaginal wall prolapses

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22
Q

5 risk factors for prolapses?

A
  • increasing age
  • multiparity
  • vaginal deliveries
  • obesity
  • spina bifida
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23
Q

treatment if prolapse is ulcerated

A

topical oestrogen

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24
Q

Guidelines used to assess if a patient under 16 is competent for consent for contraception?

A

fraser criteria

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25
Q

6 criteria for Fraser guidelines?

A

1) Have capacity - able to understand the contraception
2) Cannot be persuaded to tell their parents or let you tell them
3) Young person is likely to have sex with or without treatment
4) Best interests of young person to receive advice
5) consideration been given to the effect on physical/mental health of the young person if advice or treatment is witheld

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26
Q

where is emergency contraception available?

A
  • GPs
  • walk in centres
  • out of hours service
  • sexual health clinic
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27
Q

what causes overflow urinary incontinence

A

chronic urinary retention due to an obstruction to the outflow of urine

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28
Q

3 neurological conditions that can cause overflow urinary incontinence?

A
  • MS
  • spinal cord injuries
  • diabetic neuropathy
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29
Q

how is urodynamic test carried out?

A

thin catheter inserted into bladder and another into rectum. 2 catheters are used to measure the pressures in the bladder & rectum for comparison. bladder is filled with a liquid & measurements are taken;

  • cystometry
  • uroflowmetry
  • ;etc
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30
Q

2nd line medication for stress incontinence

A

Duloxetine

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31
Q

mechanism of duloxetine

A

SNRI antidepressant

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32
Q

side effects of anticholinergic medication e.g. amitriptyline

A
  • dry mouth
  • dry eyes
  • urinary retention
  • memory problems
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33
Q

contraception of choice if patient has breast cancer

A
  • copper coil

- barrier methods

34
Q

contraception to avoid if patient has cervical or endometrial cancer

A

avoid intrauterine system ( mirena coil)

35
Q

9 ABSOLUTE (UKMEC4) contraindications for combined contraceptive pill

A

1) uncontrolled HTN (>160/100)
2) migraine with aura
3) hx of VTE
4) aged over 35 smoking more than 15 cigs a day
5) major surgery with prolonged immbolity
6) vascular disease/stroke
7) IHD/cardiomyopathy/AF
8) liver cirrhosis
9) Lupus & antiphospholipid syndrome

36
Q

afetr last period how long is contraception required for

A

2 years in women under 50 and 1 year in women over 50

37
Q

which contraception should be stopped in over 50s due to risk of osteoporosis

A

depo provera projesterone injection

38
Q

what is lactactional amenorrhoea?

A

effective contraception
women must
- fully breastfeeding
- no periods

for up to 6 months

39
Q

when can combined pill be started after pregnancy?

A

6 weeks post partum

40
Q

3 ways in which the COCP prevents pregnancy

A

1) Prevents ovulation
2) thickening of cervical mucus
3) Inhibits proliferation of the endometrium - reducing the chance of successful implantation

41
Q

2 types of COCP

A

1) Monophasic pills - contain the same amount of hormone in each pill
2) Multiphasic pills: contain varying amounts of hromone to match the normal cyclical hormonal changes more closely

42
Q

side effects of COCP

A
  • breast pain & tenderness
  • mood changes & depression
  • headaches
  • HTN
  • VTE
  • Breast & cervical ca increased risk slightly - this returns to normal 10 years after stopping
43
Q

benefits of COCP

A
  • effective contraception
  • rapid return of fertility when stopping
  • improvement of menorrhagia, dysmenorrhea
  • reduced risk of endometrial, ovarian & colon cancer
44
Q

COCP effect on risk of different cancers?

A

increases risk of

  • breast cancer
  • cervical

reduces risk of

  • endometrial
  • ovarian
  • colon ca
45
Q

BMI UKMEC 3 for COCP

A

> 35

46
Q

when to start the combined pill

A

start on the first day of the cycle (first day of period) up to 5th day then works striaght away

if starting past day 5 then additional contraception required for first 7 days of consistent pill use

47
Q

what is missing one pill of COCP quantified as?

A

more than 24 hours late (ie 48 hours since last pill was taken)

48
Q

management if missed more than 1 pill & in day 1-7 of packet

A

emergency contraception

49
Q

management if missed more than 1 pill & in day 8-14

A

no emergency contraception required

50
Q

management if missed more than 1 pill & in day 15-21

A

no emergency contraception required

51
Q

2 types of POP

A
  • traditional POP e.g. norgeston

- Desogestrel only pill (cerazette)

52
Q

3 effects of progesterone only pill

A

1) thickens cervical mucus
2) altering endometrium making less accepting of implantation
3) reducing ciliary action in fallopian tubes

53
Q

how long till POP works

A

if taken in day 1-7 then effective straight away

if taken at other day in cycle then takes 48 hours to be effective as it takes 48 hours for cervical mucus to thicken enough to prevent sperm entering the uterus

54
Q

side effects of POP

A
  • breast tenderness
  • headaches
  • acne
55
Q

when is emergency contraception required re missing POP pills

A

if they have had sex since missing the pill or within 48 hours of restarting the regular pills

56
Q

what are the 2 forms of long acting progesterone contraceptives?

A

Implant

injection

57
Q

mechanisn of progesterone injection

A
  • inhibits ovulation

- thickens cervical mucus

58
Q

frequency of progesterone injection

A

12 week intervals

59
Q

side effects of progesterone injection

A
  • weight gain
  • acne
  • mood changes
60
Q

important side effect of depot injection

A

osteoporosis (reduced bone mineral density)

61
Q

2 unique side effects of progesterone injection

A
  • weight gain

- osteoporosis

62
Q

what is the progesteroen implant?

A

small flexible tube placed in upper arm - releases progesterone into the systemic circulation for 3 years

63
Q

what are the 2 types of intrauterine coils

A
  • Copper coil

- Levonorgestrel intrauterine system

64
Q

what is the intrauterine coil - device?

A

copper coil

65
Q

contraindications for intrauterine coils?

A
  • PID
  • immunosuppresion
  • pregnancy
  • unexplained bleeding
  • pelvic ca
  • uterine cavity distortion ie. fibroids
66
Q

side effects after insertion of coils

A

crampy abdominal pain

bleeding & pain on insertion

vasovagal reactions

PID

67
Q

when is expulsion rate high after insertion of coil

A

in first 3 months

68
Q

3 things that need to be excluded for non visible threads?

A
  • expulsion
  • pregnancy
  • uterine perforation
69
Q

follow up after coil insertion?

A

3-6 weeks later to check the threads

70
Q

duration of effective contracteption for copper coil

A

5-10 years

71
Q

mechanism of copper coil?

A

copper is toxic to the ovum & sperm. also alters endometrium making it less accepting of implantation

72
Q

drawbacks of copper coil

A

may cause heavy or intermenstrual bleeding

pelvic pain

increased risk of ectopic pregnancies

73
Q

what is the mirena levonorgestrel coil licensed for?

A
  • contraception
  • HRT
  • menorrhagia
74
Q

benefits of levonorgestrol coil system?

A
  • can make periods lighter
  • can improve pelvic pain in endometriosis
  • no increase in VTE risk
75
Q

3 options for emergency contraception

A

Copper coil

Levonorgestrel

ulipristal

76
Q

time frame to take levonorgestrel for emergency contraception

A

72 hours

77
Q

time frame to take ulipristal for emergency contraception

A

120 hours

78
Q

side effects of Levonorgestrel

A
  • nausea & vomiting
  • spotting/changes to next period
  • diarrhoea
  • breast tenderness
  • dizziness
79
Q

2 significant restrictint to taking Ulipristal?

A
  • breastfeeding avoided for 1 week

- avoided in patients with severe asthma

80
Q

when can regular contraception be started after taking emergency contraception

A

for Levonorgestrel: COCP or POP can be started immediately (effective 7 & 2 days respectively later)

Ulipristal: wait 5 days before starting COCP or POP (effective 7 & 2 days respectively later)

Obstetrics & Gynae RIA (9 decks)

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