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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
Q

What 6 precautions would put someone under the UKMEC4 (contraindicated)?

A
  • current breast cancer
  • first 6 weeks postpartum
  • migraine with aura within the last 5 years
  • > 35yrs
  • smoker
  • current or past VTE
26
Q

What type of COCP is used for women with menstruation related problem

A

tricyclic with monophasic pill

27
Q

3 strategies when managing breakthrough bleeding side effects in COCPs

A
  • Increasing ethinyloestradiol from 20mcg to 30-35mcg
  • Change P dose
  • Change to vaginal ring to skip pill free breaks
28
Q

How many active pills need to be taken in a row for woman to be covered?

29
Q

Difference between POP and COCP

A

POP is taken continuously where there is no pill-free week (always has active pills)

30
Q

3 progestogen ingredients

A

levonogestrel, norethisterone, drospirenone

31
Q

What does POP do to the body (4)

A
  • thickens cervical mucous, hindering sperm motility
  • makes endometrium inhospitable to fertilise eggs
  • slows ovum transport through fallopian tube
  • suppress ovulation
32
Q

Why would someone need to use POP over COCP

A

Because they can’t take E, one reason being E dries up breast milk, so breastfeeding mothers can’t take E

33
Q

How many days/weeks postpartum can you start using POP

A

21 days postpartum

33
Q

How many days/weeks postpartum can you start using POP

A

21 days postpartum

34
Q

Difference between drospirenone (Slinda) and older formulations of POPs

A
  • Drospirenone has 4 inactive pills, whilst the others have continuous active pills
35
Q

Whats the formal way to say the rod

A

long-acting reversible contraceptive (LARC)

36
Q

Which CYP interacts with E and P

A

CYP450 and 3A4

37
Q

Which is the only antibiotic that interacts with E and P

A

Liver inducing antibiotics like rifamycin and grisofulvin

38
Q

Why does rifamycin interact with E and P

A

Its a liver-inducing antibiotic

39
Q

How many weeks/days postpartum can you insert an IUD/implant

40
Q

Chances of cervical cancer with a contraceptive?

A

Small increased risk with COCP but decreased risk with IUD

41
Q

Chances of breast cancer with a contraceptive?

A

Minor increased risk in early use

42
Q

2 emergency contraceptive pill ingredients

A

levonorgestrel and ulipristal

43
Q

How long can someone return to hormonal contraceptives after taking levonorgestrel?

A

Can resume the next day

44
Q

How long can someone return to hormonal contraceptives after taking ulipristal?

A

After 5 days

45
Q

MOA of ulipristal

A

Suppresses the LH surge to inhibit/delay ovulation

46
Q

MOA of copper IUD

A

inhibits fertilisation by releasing copper particles to disrupt sperm and ovum function

47
Q

What is a non-hormonal emergency contraceptive

A

Copper IUD

48
Q

2 medications for a medical abortion

A

Oral mifepristone and buccal misoprostol

49
Q

3 ways a medical abortion induces a miscarriage

A
  • prevent P from supporting preg
  • soften and dilates cervix
  • increases uterine contractility
50
Q

When should woman test their human chorionic gonadotropic (HCG) levels when doing a medical abortion?

A

Test on the day of mifepristone, repeat after 7 days

51
Q

Mifepristone class

A

P receptor antagonist

52
Q

Mifepristone MOA (4)

A
  • blocks P which is needed for continuation of preg
  • soften/dilates cervix
  • increases uterine activity
  • anti-glucocorticoid effects
53
Q

Which medical abortion drug is taken first and which is taken second?

A
  1. mifepristone
  2. misoprostol
54
Q

Misoprostol class

A

synthetic PG E1 analogue

55
Q

Misoprostol MOA

A
  • increases uterine contractility
  • soften cervix via smooth muscle actions
  • effects enhanced in combination with mifepristone
56
Q

List some adv of medical abortion (5)

A
  • less costly
  • privacy, autonomy
  • avoids invasive surgery
  • can get meds through telehealth
  • more natural process
57
Q

List some adv of surgical abortion (6)

A
  • 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
Q

If heavy bleeding occurs after taking misoprostol (2nd med), why do pxs still have to get an ultrasound?

A

Heavy bleeding doesn’t mean the fetus is expelled, px still needs to get checked

59
Q

Some non-pharm practice points (4)

A
  • have a support person
  • rest
  • heat packs
  • massage lower abdomen

3818 (8 decks)

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