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BNF Genito-urinary system > Contraception > Flashcards

Contraception Flashcards

1
Q

What are considered to be ‘highly effective’ contraception methods that should be recommeneded to patients on teratogenic drugs?

A

CU IUD
sterilisation
long acting reversible contraceptives
progesterone only implant

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2
Q

What formulations are COC availble as?

A

tablet, patches, vaginal rings

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3
Q

Health benefits associated with COC

A
  1. reduced risk of ovarian, endrometrial and colorectal cancer
  2. predictable bleeding
  3. reduced dysmenorrhea/menorrhagia
  4. management of PCOS, endometrosis
  5. improved acne
  6. reduced menopausal symptoms
  7. maintaining bone mineral density in peri-menpausa; females <50 yrs
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4
Q

What are monophasic COC pils?

A

Contain a fixed amount of oestrogen / progestrogen

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5
Q

What is normally the oestrogen component of COC?

A

Ethinylestradiol

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6
Q

What is generally contained in the first line option of a COC

A

ethinylestradiol + either levonorgestrol or norethisterone

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7
Q

If a patient is >90kg and wants a patch COC - what is the issue?

A

Absorption may be ineffective - needs additional precautions

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8
Q

Brand name for COC containing ethinylestradiol 20mch + desogestrol 150mcg

A

Gedarel

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9
Q

How long prior to surgery should COC be stopped?

A

4 weeks

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10
Q

What oral contraceptive has the MOA of altering cervical mucus and consistently inhibiting ovulation

A

Progesterone only contraceptives

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11
Q

What factors would influence a prescriber to choose POC over COC?

A

If the patient smokes, history of DVT, HTN (>160/95), valvular heart disease, diabetes with complications, migraine with aura

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12
Q

What hormone is contained in medroxyprogesterone acetate (Depo - provera)

A

Progesterone

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13
Q

What do patients need to be counselled on when starting a Progesterone depo injection?

A

Risk of fertility return being delayed

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14
Q

Norethisterone enantate (Noristerat) is an oily injection - how long does it last for?

A

8 weeks

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15
Q

What drug does Nexplanon contain?

A

Etonogestrel

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16
Q

how long does a nexplanon implant last for?

A

3 years

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17
Q

mirena, Jaydesd and Levosert are all types of what?

A

IUD containing progesterone

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18
Q

What is a benefit of hormone containing IUD over CU IUD?

A

They can help with heavy bleeding an period pain

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19
Q

examples of barrier methods

A

Condoms,diaphragms, cervical caps

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20
Q

How long after UPSI can a cu IUD be inserted?

A

5 days (120 hours)

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21
Q

How long after UPSI is levonorgestrol effective?

A

72 hours ( 3 days)

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22
Q

How lng after UPSI is ulipristal effective?

A

5 days (120hours)

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23
Q

If a patient has high body weight (>26, or >70kg) what emergency contraceptive should be used?

A

Uilpristal acetate or double dose of levonorgestrol

24
Q

How many days after having emergency ulipristal can a patient start regular contraception?

A

5 days

25
Q

What is the general advice for contraception use in women who are on enzyme inducing drugs

A

should start alternative contraception e.g. PO depo injection, IUD for duration of treatment and for 4 weeks on stopping

26
Q

If a women is to start an enzyme inducer for < 2 months, whast advice should be given regarding her contraception

A

can continue on COC + another barrier methd

27
Q

If a women is to start an enzyme inducer for > 2 months (except rifampicin or rifabutin), whast advice should be given regarding her contraception

A

Use monphasic COC at a dose of >50mcg of ethinylestraidiol and use an extended/tricycling regime. If breakthrough bleeding occurs, increase dose of ethinylestradiol by increments of 10mcg (max 70mcg)

28
Q

If a women is to start an enzyme inducer for > 2 months (including rifampicin or rifabutin), whast advice should be given regarding her contraception

A

alternative methods e.g. IUD must be used

29
Q

If a patient is using medication that increases gastric pH, what emergency contracpetion should e given?

A

Levonorgestrol or IUD as use of ulipristal has not yet been studied

30
Q

Can ulipristal be used more than once in the same cycle?

A

No - only to be used once per cycle. Levonorgestrol can be given > 1 per cycle

31
Q

Can levonorgestrol be used more than once in the same cycle?

A

Yes but EllaOne cannot

32
Q

A patient has severe asthma treated with corticosteroids can she has ulipristal?

A

No - antiglucocorticoid effect of ulipristal

33
Q

What are some risks associated wiht COC

A
  1. VTE + arterial thrombus
  2. increased risk of breast cancer
  3. Migraine - need to stop and refer
  4. cervical cancer
34
Q

If a patient starts her COC on day 6 of her cycle what needs to be advised?

A

additional precautions required for first 7 days

35
Q

What are Every Day (ED) tablets?

A

21 days of active + 7 days of placebo

36
Q

Additional precautions for Qlairia pils (ED) are needed for howmany days?

A

9 days

37
Q

If a patient vomits within 3 hours of taking her pill or has diarrhoea for >24 hours what should be advised?

A

Following instrctions for a missed pill - if persists >24 hours consider additional non oral contraception

38
Q

What happens if a women forgets to take a pill?

A
  1. take as soon as remember and take next pill at normal time
  2. no additional precautions required
39
Q

When is a pill classed as being ‘missed’?

A

> 24 hours

40
Q

If a patient has 2 or more missed pills what should she do?

A

extra contraception or abstain for 7 days, continue with normal regime. If the missed days run at the end of the packet, move onto new packet and skip the pill free intervalWha

41
Q

If a vaginal ring is expelled for < 3 hours what should the user be advised?

A

Rinse with cool water, reinsert no additional contraceptvie measures needed

42
Q

If a vaginal ring is expelled > 3 hours duringg week 1 or 2 of cycle what should the user be advised?

A

rinse with cool water, reinsert, use barrier methods for 7 days

43
Q

If a vaginal ring is expelled > 3 hours during week 3 of cycle what should the user be advised?

A

Insert a new ring or allow for withdrawl bleed and insert new ring after no more than 7 days

44
Q

How should a contraceptive patch e.g. Evra be applied?

A

Apply on day 1 of cycle, remove on day 8 and 15 to apply a new patch. Remove on day 22 for HFI

45
Q

If ap atinet forgets to reapply their new patch for > 48 hours what should be done?

A

apply a new patch (chaginging the new day 1) + additional measures for 7 days

46
Q

What contraception has the MHRA warning associated with uterine perforation

A

copper IUD

47
Q

If a IUD is removed after day 3 of menstrual cycle, what should be advised?

A

Additional contraception for at least 7 days

48
Q

If a patient has a IUD inserted but has a pre-exisiting STI what is a risk?

A

Development of pelvic inflammatory disease

49
Q

What is the MHRA warning associated with Esmya ( form of ulipristal) ?

A

Severe liver impairment - suspended of license

50
Q

What is the issue is a POC pil is delayed by 12 hours

A

contraceptive effect is lost

51
Q

If a POC pil is started on day 5 of cycle are additional measures requried?

A

No but if >5 days, needs 2 days of additional measures

52
Q

If vomiting or diarhorea occurs within 2 hours of taking a POC what advice should be given?

A

Take next pill asap, if this is > 3 hours then the additonal precautions needed for 2 days

53
Q

What age range is nexplanon licensed for use in?

A

18 - 40 year olds

54
Q

What is the MHRA warning associated with Nexplanon?

A

Risk of migration and neurovascualr injury

55
Q

What cancer risks are associated with HRT?

A
  1. endometrial cancer risk

2. ovarian cancer

56
Q

What are some of the cautions associated wiht HRT?

A

endometrial + ovarian cancer risk increased
increased stroke + CHD risk
VTE risk

BNF Genito-urinary system (3 decks)

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