contraception - drugs and devices and important safety info Flashcards
MHRA - IUD uterine perforation (for any IUD or IUS)
uterine perforation most often occurs during insertion, but it might not be detected until sometime later
risk of perforation increased when device is inserted up to 36 weeks PP or in pt who are BF
before inserted an IUD e.g copper IUD, or LVNGRL IUS inform patients of the signs and symptoms to look out for which may indicate uterine perforation
severe pelvic pain after insertion (worse than period cramps);
pain or increased bleeding after insertion which continues for more than a few weeks;
sudden changes in periods;
pain during intercourse;
unable to feel the threads.
when does uterine perforation occur more often (for IUD)
risk increased when device inserted up to 36 weeks PP or in pt who are BF
patient cant feel their threads. they should arrange a check up if the threads cant be felt, esp if …
significant pain also
Threads of IUD can be felt but the patient is in severe pain. Can this still indicate perforation of uterus?
Partial perforation may occur even if the threads can be seen; consider this if there is severe pain following insertion and perform an ultrasound.
when is IUD CI
genital malignancy
PID
recent STI if not fully investigated and treated
severe anaemia
unexplained uterine bleeding
if someone has menorrhagia (excess bleeding) which device may be preferable
progestogen IUD
if CU IUD is schedules for removal after day 7 of menstrual cycle (day 1-5 is period, 14 is ovulation) then what should you do
intercourse should be avoided or another method of contraception used for at least 7 days before removal of intra-uterine device.
CU IUD
the main excess risk of pelvic infection occurs when ? and what is it believed to be related to ?
occurs in the first 3 weeks after insertion and is believed to be related to existing carriage of a sexually transmitted infection.
Patient is on IUD but it has failed and they are pregnant. But they decide they want to continue with pregnancy to full term. So what should you do.
If an intra-uterine device fails and the woman wishes to continue to full-term the device should be removed in the first trimester if possible.
Remove device; if pregnancy occurs, increased likelihood that it may be ectopic.
what is the dose of ulipristal for EHC
30 mg for 1 dose, to be taken as soon as possible after coitus, but no later than after 120 hours.
what else is ulipristal indicated for
Uterine fibroids (under expert supervision)
MHRA safety info for ulipristal re liver issues
risk of serious liver injury has been reported for the brand used for symptoms of uterine fibroids
however this is NOT the case with EllaOne (used for EHC)
when ulipristal is used for EHC, when can you restart BF
Avoid for 1 week after administration—present in milk.
what to do if patient vomits after taking ulipristal for EHC
if vomiting occurs within 3 hours of taking a dose, a replacement dose should be taken;
patient has lower abdominal pain after taking ulipristal for EHC
seek medical attention promptly if any lower abdominal pain occurs because this could signify an ectopic pregnancy.
patient took ulipristal for EHC. they are worried because their period hasnt come yet. what do you advice
that their next period may be early or late;
that a pregnancy test should be performed if the next menstrual period is delayed by more than 7 days, is lighter than usual, or is associated with abdominal pain that is not typical of the woman’s usual dysmenorrhoea
when is double dose of levonorgestrel needed
BMI >26
weight >70kg
unlicensed
how often should you do gynaecoloigcal exam when you are inserting IUD
Gynaecological examination before insertion, 4–6 weeks after insertion, then annually.
what to do if vomiting after taking levonorgestrel for CONTRACEPTION - NOT EHC
If vomiting occurs within 2 hours of taking an oral progestogen-only contraceptive, another pill should be taken as soon as possible. If a replacement pill is not taken within 3 hours of the normal time for taking the progestogen-only pill, or in cases of persistent vomiting or very severe diarrhoea, additional precautions should be used during illness and for 2 days after recovery.
what can interere with absorption of oral POC including EHC
Vomiting and persistent, severe diarrhoea
what to do if patient vomits after taking levornorgestrel for EHC
if vomiting occurs within 3 hours, a replacement dose should be taken;
missed doses for progestogen contraceptive pill
When used as an oral contraceptive, the following advice is recommended ‘If you forget a pill, take it as soon as you remember and carry on with the next pill at the right time (this may mean taking 2 pills at the same time). If the pill was more than 3 hours overdue you are not protected. Continue normal pill-taking but you must also use another method, such as the condom, for the next 2 days’.
Lenoelle One Step can be sold to what age
Levonelle® One Step can be sold to women over 16 years; when supplying emergency contraception to the public, pharmacists should refer to guidance issued by the Royal Pharmaceutical Society.
oral POC can be started 21 days PP. do you need additionall contraceptive precautions?
Oral progestogen-only contraceptives can be started before 21 days postpartum without the need for additional contraceptive precautions. If started 21 days or more postpartum, additional contraceptive precautions are required for 2 days.
which progestogen contraceptive was linked to a higher tumour risk (meningioma, brain tumour mostly non cancerous)
MDP aka Depo provera
how often is MDP given (by deep IM and SC) for long term contraception
deep IM = every 12 weeks
SC injection = every 13 weeks
how long can Nexplanon (etonorgestrel) be left in place for
3 years
nexplanon - when you insert it when do you need extra precautions
if no hormonal contraceptive use in previous month
when inserted during the first 5 days of cycle, no additional contraceptive precautions are needed, when inserted at any other time, additional precautions (e.g. barrier methods) advised for next 7 days.
nexplanon - when you insert it when do you need extra precautions
when its used postpartum
when inserted within 20 days after delivery (or up to 6 months postpartum if fully breast-feeding and amenorrhoeic), no additional contraceptive precautions are needed, when inserted at any other time, additional precautions (e.g. barrier methods) advised for next 7 days.
MHRA safety info - nexplanon, new insertion site to reduce rare risk of neurovascular injury and implant migration
Correct subdermal insertion by an appropriately trained and accredited healthcare professional is recommended to reduce the risk of these events.
Patients should be advised on how to locate the implant, informed to check this occasionally and report any concerns. An implant that cannot be palpated at its insertion site should be located and removed as soon as possible; if unable to locate implant within the arm, the MHRA recommends using chest imaging. Implants inserted at a previous site that can be palpated should not pose a risk and should only be replaced if there are issues with its location or if a routine replacement is due.
what cancer does P contracetpions increase risk of
breast cancer
small increased risk
