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Competency > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

In the menstrual cycle, when to start COC?

A

Wtihin 7 days of first period, but protection only starts day 5 onwards

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2
Q

How does COC works in contraception?

A

Prevent ovulation from ovaries

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3
Q

What is the side effect to be expected in the first few months of taking COC?

A

Bleeding at unexpected times

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4
Q

In general, what are the side effects of COC?

A
  1. Cardio (e.g. HTN)
  2. Clotting (e.g. increased risk of VTE)
  3. Cancer (breast cancer)
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5
Q

Counselling for missed pill

A

< 12 hours: take asap, then the rest at usual timing

> 12 hours: take asap even if it means to take 2 at once, then take the rest at usual timing, but use backup for next 7 days

If missed pill during 3rd week: start next pack immediately once the current pack finishes

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6
Q

Place in therapy for progesterone-only-piills?

A

When estrogen is C/I: lactation, current DVT, migraines

  • Recommended for post-partum and breastfeeding (estrogen affects quantity and quality of milk hence progesterone can help here)
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7
Q

Contraindication of progesterone-only-pills

A

Ongoing breast cancer

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8
Q

When can women restart COC containing estrogen postpartum?

A

At least 6 months postpartum

(Note meanwhile, POP or implants can be used)

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9
Q

Dosing regimen for postinor-2 (levonogestrel) for emergency contraception

A

2 tabs STAT, then another 2 after 12 hours
- Take within 72h after unprotected sex

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10
Q

Dosing regimen for Ella (Ulipristal acetate) for emergency contraception

A

1 tab STAT within 120h (5d) of unprotected sex

(MoA: selective prosterone receptor modulator, prevents implantation of fertilised ovary, or delay ovulation)

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11
Q

In emergency contraception, what to do if patient vomits after taking the pills?

A
  • If within 2h, take another dose
    (less prominent with levonorgestrel)
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12
Q

Side effects of emergency contraceptions?

A
  • Irregular bleeding: Menses occur within 1 week before or after expected time
  • Breast tenderness, abdominal pain, fatigue, dizzy, etc.
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13
Q

How long to withhold breastfeeding after taking the following:
- Ella (Uripristal acetate)
- Levonorgestrel

A
  • Ella: withhold 1 week
  • Levonorgestrel: withhold 3 days
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14
Q

How to resume contraception after taking EC?

A
  • Levonorgestrel: Resume right away, use barrier method for next 7 days
  • Ulipristal: Wait until 5 days after UPA. Meanwhile use barrier method until next menstrual cycle or 14 days, whichever first
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15
Q

Dosing regimen for contraceptive patch

A

Once weekly for 3 weeks, then patch free for 1 week

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16
Q

Weight cutoff before contraceptive patch becomes less useful?

A

> 90kg –> not recommended

17
Q

Application sites of contraceptive patch

A

Lower abdomen, buttock, upper arm, upper thigh

18
Q

Can depo-provera (methoxyprogesterone injection) be used in patients taking AEDs?

A

Yes, efficacy not affected by AEDs

19
Q

Advantages of methoxyprogesterone injection?

A
  1. No estrogenic side effects
  2. Reduces menstrual bleeding after long-term usage
20
Q

Disadvantages of methoxyprogestone injection?

A
  • Hypoestrogenic state: may ppt menopause sx
  • Irregular bleeding for 6-9 months
  • Progestogenic side effects: weight gain, acne, nausea
  • Requires visit to doctor every 12 weeks for subsequent dosing
21
Q

When to inject methoxyprogestone injection?

A
  • By day 5 of menses
  • Immediately post-abortion
  • Immediately postpartum, non-breastfeeding
  • 6 week postpartum (exclusively breastfeeding)
21
Q

When to initiate backup contraception for methoxyprogestone injection, and how long should the backup contraception be for?

A
  • If injected outside of window, or 1 week late for next injection
  • Backup for at least 3 days (3-5 days)
22
Q

Significant adverse effect of methoxyprogestone injection?

A

Reduction in bone density

(Hence don’t use in young adults)

23
Q

Concerns of copper IUD?

A
  1. Perforation
  2. Embedement: pain and difficult to remove
  3. Expulsion: verify position with x-ray/ultrasound
24
Q

When can you insert copper IUD for contraception?

A

Anytime, as long as:
- No preg
- No dysmenorrhea

25
Q

How long can minera (levonorgestral 52 mg) IUD last?

A

5 years

26
Q

Implannon mechanism of action

A
  • Suppress FSH and LH hence suppressing ovulution
  • Thickening of cervical mucus
  • Thinning of endometrum lining
27
Q

When to insert implanon (etonogestrel)? What is its onset of contraception effects?

A

Day 1-5 of menstrau cycle, or after 1st trimester abortion
Onset is IMMEDIATE (similar to copper IUD)

28
Q

Main concerns of implanon?

A
  • Unpredictable, irregular bleeding patterns, which usually leads to early removal
  • Insertion and removal issues (since it can be implanted under arm) (similar to IUDs)

Competency (28 decks)

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