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Competency > Contraception & pregnancy > Flashcards

Contraception & pregnancy Flashcards

1
Q

MOA of progestins in CHC

A
  • Reduce LH
  • Prevent ovulation
  • Thickens cervical mucus
  • Reduce endometrial receptivity and sperm survival
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2
Q

MOA of oestrogen in CHC

A
  • Reduce FSH
  • Prevent follicular development
  • Reduce irregular bleed
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3
Q

When is higher doses of ethinylestradiol recommended?

A
  • 30-35 mcg/pill
  • For those >70.5 kg
  • Breakthrough bleeding esp in 1st half of cycle
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4
Q

Favourable progestins without significant androgenic effects

A
  • Drospirenone (but with hyperkalemia)
  • Cyproterone (not for contraception alone; VTE)
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5
Q

Androgenic side effects of CHC

A

Acne
Oily skin
Hirsutism
Depression
Increased appetite

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6
Q

Estrogenic side effects of CHC

A

N/V, bloating
Decreased libido
Weight gain
breast tenderness
Irritability
Increased TG levels

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7
Q

Progestogenic side effects of CHC

A

Headache
Breast tenderness
HTN
Depression
Decreased libido
Increased appetite
Increased LDL & TC

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8
Q

CHC contraindications

A
  • Breastfeeding and <6 weeks postpartum
  • > 35 y.o. and smokes >15 sticks a day
  • SBP >160 or DBP >100 with end organ vascular disease of smoking
  • Uncontrolled dyslopidemia with additional CV risk factors
  • Diabetes with end organ vascular disease
  • Current or h/o DVT
  • Current or h/o IHD
  • Current or h/o stroke
  • Migrane with aura
  • Migraine without aura + >35 y.o.
  • Current breast cancer
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9
Q

Concerns for CHC

A
  • VTE
  • Breast and cervical cancer
  • Stroke
  • MI
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10
Q

DDIs with CHC

A
  • Antiretrovirals (NNRTIs, PIs)
  • ASMs (phenytoin, CPZ, barbiturates, topiramate, lamotrigine)
  • Rifampicin
  • Lamotrigine (increased risk of seizures when used as ASM monotherapy; less concerns if combined with VPA)
  • Abx (backup for treatment duration and 7 days after)
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11
Q

Managing missed doses for CHC

A

<12 hours late: not affected

> 12 hours late:
- 1st week: back up for 7 days
- 2nd week: back up generally not needed
- 3rd week: start hormone free period immediately or skip the hormone free period and start new pack after this pack is finished

If >1 dose missed:
- Generally same strategy but consider emergency contraception if sexual intercourse in the past 5 days

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12
Q

Managing missed doses for POP

A

Norgestrel (Opill): >3 hours, backup for 2 days
Desogestrel (Cerazette): >12 hours, backup for 7 days
Drospirenone (Slinda): >24 hours, backup for 7 days

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13
Q

Emergency contraception

A
  • Levonorgestrel (72 hours)
  • Ullipristal (120 hours)
  • Copper IUD (120 hours)
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14
Q

When to start CHC after emergency contraception?

A
  • Levonorgestrel (right away; 7 days backup)
  • Ullipristal (5 days later; 14 days backup or until next menstrual cycle)
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15
Q

When to inject Depo-Provera?

A
  • By day 5 of menses initiation
  • Immediately post-abortion
  • Immediately postpartum (if no plans for breastfeeding)
  • 6 weeks postpartum (if breastfeeding)
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16
Q

Concerns with Depo-Provera

A
  • Reduced BMD in patients <18 y.o. and >45 y.o.
  • Long-term use >2 years (menopausal symptoms)
  • Slow return to fertility
  • Irregular bleeding patterns
17
Q

Drug metabolism affected during pregnancy

A
  • Lamotrigine (increased UGT1A4 activity)
  • Fluoxetine (increased 2D6&2C9 activity)
  • Propranolol, olanzapine (reduced 1A2 activity)
18
Q

Which embryonic period is the most crucial for organ development?

A

3-10 weeks. Before that all or none effect

19
Q

NOEL of vitamin A

A

5000 IU or below considered safe. >10000 IU may increase risk of malformation

20
Q

Antihypertensives safe in lactation

A
  • Labetalol
  • Nifedipine LA
  • Methyldopa (postnatal depression with prolonged used)
  • Hydralazine
  • Enalapril/captopril
21
Q

Choice of therapy for DM in pregnancy

A
  • Insulins
  • Metformin
  • Linagliptin/SU (3rd line)
22
Q

Choice of therapy for hypertension in pregnancy

A
  • Nifedipine LA
  • Labetalol
  • Hydralazine (mimics severe preeclampsia)
  • Methyldopa (postpartum depression)
23
Q

BP goals in pregnancy

A
  • Initiation when 140/90 and above
  • Target for 135/85 and below
  • If gestational HTN: stop if BP < 130/80 after delivery
  • If chronic HTN: aim for <140/90 after delivery
24
Q

Choice of therapy for migraine in breastfeeding

A

Cafergot should be avoided
Others (Topiramate, amitriptyline, celecoxib, sumatriptan) compatible

25
Q

Glucose target during pregnancy

A

Fasting: <5.3
1h post meal: <7.8
2h post meal: <6.7

26
Q

Antibiotics to be avoided in pregnancy

A

Nitrofurantoin (38-42 weeks)
FQ
Tetracyclines
Bactrim (1st trimester and after 32 weeks)

Competency (6 decks)

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