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3818 > contraception, emergency contraception and medical abortion > Flashcards

contraception, emergency contraception and medical abortion Flashcards

1
Q

In the menstrual phase, what 2 hormones increase as a result of an increase in estradiol in the last follicular phase?

A

Increase in FSH and LH

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2
Q

List some contraception options (6)

A
  • awareness
  • barrier methods for both fe/m
  • hormonal methods
  • implants
  • emergency contraception
  • permanent methods like sterilisation
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3
Q

4 hormonal contraceptive options

A
  • OCP (COCP, POP)
  • vaginal rings
  • depot inj (P only)
  • LARCs (long acting reversible contraception e.g. IUD)
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4
Q

When do people on the COCP get withdrawing bleeding, and why?

A

During the inactive placebo pill to mimic a normal period

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5
Q

What is the first line contraceptive medication

A

COCP

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6
Q

3 most common estrogens

A

ethinyloestradiol, mestranol, estradiol

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7
Q

metabolic estrogen side effects (3)

A

increase coagulation factors, increase HDL/VLDL/TG, decrease bone resorption

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8
Q

Similarities of P and E in the menstrual cycle

A
  • suppresses FSH
  • potentiates the actions of each other
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9
Q

Differences of P and E in the menstrual cycle

A
  • P suppresses LH and FSH, E only suppresses FSH
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10
Q

Action of P in the menstrual system (6)

A
  • suppresses mid-cycle peaks of LH and FSH to block ovulation
  • suppresses endometrial proliferation
  • produces secretory endometrium
  • slow down movement of ovum
  • thickens cervical mucous making it impermeable to sperm and making it a non-receptive environment
  • decrease sperm motility
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11
Q

Action of E in the menstrual system

A
  • suppresses development of ovarian follicles by FSH
  • stabilises endometrium to reduce breakthrough bleeding and irregular shedding
  • potentiates P by increase conc. at receptors
  • prevents development of dominant follicle in the follicular progression
  • stimulates endometrial proliferation
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12
Q

Which E ingredient has the most bioavailability

A

ethinyloestradiol

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13
Q

What is mestranol metabolised to?

A

ethinyloestradiol

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14
Q

Main action of COCP

A

inhibit ovulation

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15
Q

What is the physical change that P potentiates?

A

Thickens cervical mucous

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16
Q

Define monophasic

A

Fixed dose of E and P throughout the whole 21 days of the active pills

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17
Q

What word defines ‘delaying period by 3 months’

A

Tricyclic

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18
Q

What happens if you delay period for too long

A

breakthrough bleeding

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19
Q

True/False?
Vaginal rings are a combined contraceptive agent

A

True

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20
Q

Increasing what ingredient, will increase risk of VTE?

A

E

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21
Q

What is MEC1-4 in the UKMEC risk criteria for hormonal contraceptives

A

MEC1/2 - safe
MEC3 - require clinical judgement
MEC4 - contraindicated

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22
Q

What 3 main precautions would put someone under the UKMEC3 (needs clinical judgment)?

A
  • BMI > 35
  • diabetes with a secondary impact like retinopathy
  • history of migraine with aura over 5 years ago
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23
Q

Why would someone with a history of migraines, with auras up to or over 5 years ago, be flagged when prescribing COCP?

A

It increases risk of VTE

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24
Q

When, after pregnancy can you start taking COCP

A

after 6 week postpartum

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25
What 6 precautions would put someone under the UKMEC4 (contraindicated)?
- current breast cancer - first 6 weeks postpartum - migraine with aura within the last 5 years - >35yrs - smoker - current or past VTE
26
What type of COCP is used for women with menstruation related problem
tricyclic with monophasic pill
27
3 strategies when managing breakthrough bleeding side effects in COCPs
- Increasing ethinyloestradiol from 20mcg to 30-35mcg - Change P dose - Change to vaginal ring to skip pill free breaks
28
How many active pills need to be taken in a row for woman to be covered?
7 days
29
Difference between POP and COCP
POP is taken continuously where there is no pill-free week (always has active pills)
30
3 progestogen ingredients
levonogestrel, norethisterone, drospirenone
31
What does POP do to the body (4)
- thickens cervical mucous, hindering sperm motility - makes endometrium inhospitable to fertilise eggs - slows ovum transport through fallopian tube - suppress ovulation
32
Why would someone need to use POP over COCP
Because they can't take E, one reason being E dries up breast milk, so breastfeeding mothers can't take E
33
How many days/weeks postpartum can you start using POP
21 days postpartum
33
How many days/weeks postpartum can you start using POP
21 days postpartum
34
Difference between drospirenone (Slinda) and older formulations of POPs
- Drospirenone has 4 inactive pills, whilst the others have continuous active pills
35
Whats the formal way to say the rod
long-acting reversible contraceptive (LARC)
36
Which CYP interacts with E and P
CYP450 and 3A4
37
Which is the only antibiotic that interacts with E and P
Liver inducing antibiotics like rifamycin and grisofulvin
38
Why does rifamycin interact with E and P
Its a liver-inducing antibiotic
39
How many weeks/days postpartum can you insert an IUD/implant
6 weeks
40
Chances of cervical cancer with a contraceptive?
Small increased risk with COCP but decreased risk with IUD
41
Chances of breast cancer with a contraceptive?
Minor increased risk in early use
42
2 emergency contraceptive pill ingredients
levonorgestrel and ulipristal
43
How long can someone return to hormonal contraceptives after taking levonorgestrel?
Can resume the next day
44
How long can someone return to hormonal contraceptives after taking ulipristal?
After 5 days
45
MOA of ulipristal
Suppresses the LH surge to inhibit/delay ovulation
46
MOA of copper IUD
inhibits fertilisation by releasing copper particles to disrupt sperm and ovum function
47
What is a non-hormonal emergency contraceptive
Copper IUD
48
2 medications for a medical abortion
Oral mifepristone and buccal misoprostol
49
3 ways a medical abortion induces a miscarriage
- prevent P from supporting preg - soften and dilates cervix - increases uterine contractility
50
When should woman test their human chorionic gonadotropic (HCG) levels when doing a medical abortion?
Test on the day of mifepristone, repeat after 7 days
51
Mifepristone class
P receptor antagonist
52
Mifepristone MOA (4)
- blocks P which is needed for continuation of preg - soften/dilates cervix - increases uterine activity - anti-glucocorticoid effects
53
Which medical abortion drug is taken first and which is taken second?
1. mifepristone 2. misoprostol
54
Misoprostol class
synthetic PG E1 analogue
55
Misoprostol MOA
- increases uterine contractility - soften cervix via smooth muscle actions - effects enhanced in combination with mifepristone
56
List some adv of medical abortion (5)
- less costly - privacy, autonomy - avoids invasive surgery - can get meds through telehealth - more natural process
57
List some adv of surgical abortion (6)
- no requirement to evacuate retained products like in medical abortion - performed under sedation - less pain - quicker - less risk of severe bleeding - avoid possible distress of seeing gestational sac
58
If heavy bleeding occurs after taking misoprostol (2nd med), why do pxs still have to get an ultrasound?
Heavy bleeding doesn't mean the fetus is expelled, px still needs to get checked
59
Some non-pharm practice points (4)
- have a support person - rest - heat packs - massage lower abdomen

3818 (8 decks)

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