Contraception II Flashcards by sophie hayton

when starting COC when is it effective immediately?

day 1 of natural cycle

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if you start COC on day 1-5 do you need additional precautions?

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when is starting COC classed as quick starting

> day 6

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if quick starting COC (6th day and after of cycle) for how long must you use additional precaution?

7 days

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how many days into period can you start POP without needing additional precautions

1-5

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if quick starting POP (6th day or later) how long must you use additional precaution for?

2 days

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POP pill examples?

noriday
cerazette
mironor

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Kylie would like to start taking Cerazette for the first time. It is day 12 of her 30-day menstrual cycle and shell have her first pill today. Does she need to take additional precautions?

yes for 2 days as its a POP

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Kendall has been taking Microgynon 30 ED. She started the pill on day 8 of her cycle. Does she need to take additional precautions?

yes as not within first 5 days

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examples of COC

zoely
qlaira
logynon
microgynon

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for zoely COC what day can you start it, if after this how long must you add additional precautions?

1-2

7 days

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for qlaira COC what day can you start it, if after this how long must you add additional precautions?

1-2

9 days

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for combined TDS and vaginal ring what day can you start it, if after this how long must you add additional precautions?

1-5

7 days

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for POP traditional/ desogestrel what day can you start it, if after this how long must you add additional precautions?

1-5

2 days

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for POP injectable and implant what day can you start it, if after this how long must you add additional precautions?

1-5

7 days

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for levonorgestrel intrauterine system what day can you start it, if after this how long must you add additional precautions?

1-7

7 days

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for Cu IUD what day can you start it, if after this how long must you add additional precautions?

any start day

0 days

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changing from COC to POC:

what advice do you give for it to be effective immediately ?

tell them to not have HFI

on start day of HFI start the POP and it will be effective immediately

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changing from COC to POC:

if the person has already started their HFI what advice do you give?

(finish the white pills if ED or HFI)

then start the POP but use additional precautions for 2 days

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POP to COC:

advice?

need additional precautions for 7 days

POP to COC:

exceptions to 7 day precautions

if POP to Qlaira COC:
additional precautions for 9 days as its triphasic

POP to Zoely: additional precautions for 7 days

why do you need 9 days precautions when POP to Qlaira?

as its triphasic

when changing to any non-monophasic pills what must you advise

go straight to day 1 as there’s different concentrations each pill

if you’ve missed COC can you take two within one hour- to stop it being a missed pill?

yes this isn’t a problem and keeps it within the 24 hours

when is EHC indicated for COCs?

if 2 or more missed within 24 hours

exceptions to when EHC is needed in COCs?

Zoely (monophonic) Qlaira (triphasic) EHC is indicated if 1 or more is missed in 12 hours

when is a POP classed as a missed pill?

micronor and noriday: >3 hours late Cerazette and Cerrelle: >12 hours late

what to do if you miss your POP?

continue pills with 2 days precautions

when is EHC indicated in POP?

If 1 or more pills are missed within >3/ 12 hours)

non hormonal EHC?

Cu-IUD

hormone EHC?

Levonelle 1.5mg or EllaOne 30mg

Kourtney takes Logynon ED. She missed her pills only on day 1, 14 and 24 and had sexual intercourse on day 25. Does she need EHC?

NO Missing day 1 elongates pill free period. However built cover as didn’t stop for 7 days. Missing 1 on day 14 but to be compromised she needs to have missed 2. So not compromised 24- this is a placebo pill so should be fine as doesn’t make any difference

Kourtney takes Logynon ED. She missed her pills only on day 1, 14 and 24 and had sexual intercourse on day 19. Does she need EHC?

YES | Sexual intercourse on 19, not waited 7 days so she could get pregnant

Kourtney takes Logynon ED. She missed her pills only on day 13, 14 and 24 and had sexual intercourse on day 25. Does she need EHC?

NO- cover rebuilt

Khloe takes Noriday (POP) she missed 1 pill on day 6 and had sex on day 9. Does she need EHC?

NO Missing 1 pill makes her compromised But has taken 2 days so she has brought her cover back up to normal

Kris takes Logynon ED. She missed her pills on day 14, 15 and 22 and has sex on day 17. Does she need EHC?

YES- cover not rebuilt | 22 is placebo so doesn't effect

what types of drugs makes contraception ineffective?

anti epileptics antiretro virals antibiotics- only if enzyme inducing st Johns wort and griseofulvin

why do anti-epileptics make contraception ineffective?

enzyme inducers

TF: once the enzyme inducing drug has been stopped contraception will be effective immediately

FALSE | 28 days after taking enzyme inducing medicine it won't work as effectively

what can be recommended if a patient is on enzyme inducing drugs?

Parenteral POCs | IUS

TF: antibacterials with no enzyme inducing activity won't have an effect on contraceptive cover?

true- UNLESS vomiting and diarrhoea occur

can women be reassured that the contraception efficacy of both IUDs and injectables aren't affected by drug interactions?

yes

will the implant be effected by enzyme inducing drugs?

yes- efficacy may be reduced

Kendall, 24 had a baby 3 months ago and requires regular long term contraception. Her PMR shows she takes Carbemazepine MR 400mg for epilepsy. Is the Mirena IUS suitable for her or not?

Mirena- LARCs- slowly releases Levongesterol. Yes as it doesn’t get effected by Carbemazepine. Hormone isn’t systemic- acts locally

Khloe uses Depo- Provera (POC) and presents a Rx for Rifamipicin 300mg capsules BD 6/12. Will taking this antibiotic compromise her contraceptive cover?

DMPA | This is fine with enzyme inducers. Cant recommend orals, patches or implant but the DMPA is fine

kylie uses Nexplanon implant (POC) she presents a Rx for Rifampicin. Will taking this compromise her contraceptive cover.

YES as its known to be effected by enzyme inducing medication

Kim has never used contraception before. She takes Ventolin for asthma and has a family history of uterine cancer. She takes Sumatriptan for migraines which occur 1-2 times monthly. Her migraine symptoms include headache, ringing in the ears and zig-zagging lights in her field of vision. Dr Johnson is asking if Logynon ED is suitable for use.

Migraine with aura!! She fits category 4. This means Logynon is unsuitable as it is a COC which means has oestrogen Cant give this

what can taking valproate in pregnancy cause?

congenital malformation and neurodevelopment disorders

what type of contraceptive is needed if on this medication?

LARC or any with a failure rate of <1% all female patients of child bearing age regardless of sexual activity